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The impacts of public hospital autonomization : evidence from a quasi-natural experiment

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  • Wagstaff, Adam
  • Bales, Sarah

Abstract

This paper exploits the staggered rollout of Vietnam’s hospital autonomization policy to estimate its impacts on several key health sector outcomes including hospital efficiency, use of hospital care, and out-of-pocket spending. The authors use six years of panel data covering all Vietnam’s public hospitals, and three stacked cross-sections of household data. Autonomization probably led to more hospital admissions and outpatient department visits, although the effects are not large. It did not, however, affect bed stocks or bed-occupancy rates. Nor did it increase hospital efficiency. Oddly, despite the volume effects and the unchanged cost structure, the analysis does not find any evidence of autonomization leading to higher total costs. It does, however, find some evidence that autonomization led to higher out-of-pocket spending on hospital care, and higher spending per treatment episode; the effects vary in size depending on the data source and hospital type, but some are quite large -- around 20 percent. Autonomy did not apparently affect in-hospital death rates or complications, but in lower-level hospitals it did lead to more intensive style of care, with more lab tests and imaging per case.

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Bibliographic Info

Paper provided by The World Bank in its series Policy Research Working Paper Series with number 6137.

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Date of creation: 01 Jul 2012
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Handle: RePEc:wbk:wbrwps:6137

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Related research

Keywords: Health Systems Development&Reform; Population Policies; Health Law; Health Monitoring&Evaluation; Disease Control&Prevention;

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References

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  1. Guillem López & David McDaid & Joan Costa-Font, 2006. "Health care management autonomy: Evidence from the Catalonian hospital sector in a decentralised Spain," Working Papers, Research Center on Health and Economics 993, Department of Economics and Business, Universitat Pompeu Fabra.
  2. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-66, November.
  3. Grannemann, Thomas W. & Brown, Randall S. & Pauly, Mark V., 1986. "Estimating hospital costs : A multiple-output analysis," Journal of Health Economics, Elsevier, vol. 5(2), pages 107-127, June.
  4. Carol Propper, 2013. "Competition, Incentives and the English NHS," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, vol. 11(1), pages 16-20, 04.
  5. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991-9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, 01.
  6. Weaver, Marcia & Deolalikar, Anil, 2004. "Economies of scale and scope in Vietnamese hospitals," Social Science & Medicine, Elsevier, vol. 59(1), pages 199-208, July.
  7. Hodgkin, Dominic & McGuire, Thomas G., 1994. "Payment levels and hospital response to prospective payment," Journal of Health Economics, Elsevier, vol. 13(1), pages 1-29, March.
  8. Hanson, Kara & Atuyambe, Lynn & Kamwanga, Jolly & McPake, Barbara & Mungule, Oswald & Ssengooba, Freddie, 2002. "Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy," Health Policy, Elsevier, vol. 61(1), pages 73-94, July.
  9. Propper, Carol, 1996. "Market structure and prices: The responses of hospitals in the UK National Health Service to competition," Journal of Public Economics, Elsevier, vol. 61(3), pages 307-335, September.
  10. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
  11. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-in-Differences Estimates?," The Quarterly Journal of Economics, MIT Press, vol. 119(1), pages 249-275, February.
  12. Feldstein, Martin S, 1971. "Hospital Cost Inflation: A Study of Nonprofit Price Dynamics," American Economic Review, American Economic Association, vol. 61(5), pages 853-72, December.
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Cited by:
  1. London, Jonathan D., 2013. "The promises and perils of hospital autonomy," Social Science & Medicine, Elsevier, vol. 96(C), pages 232-240.

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