Getting incentives right : an impact evaluation of district hospital capitation payment in Vietnam
AbstractWith the movement toward universal health coverage gaining momentum, the global health research community has made significant efforts to advance knowledge about the impact of various schemes to expand population coverage. The impacts on efficiency, quality, and gaps in service utilization of reforms to provider payment methods are less well studied and understood. The current paper contributes to this limited knowledge by evaluating the impact of a shift by Vietnam's social health insurance agency from reimbursing hospitals on a fee-for-service basis to making a capitation payment to the district hospital where the enrollee lives. The analysis uses panel data on hospitals over the period 2005-2011 and multiple cross-section data sets from the Vietnam Household Living Standards Surveys to estimate impacts on efficiency, quality, and equity. The paper finds that capitation increases hospitals'efficiency, as measured by recurrent expenditure and drug expenditure per case, but has no effect on surgery complication rates or in-hospital deaths. In response to the shift to capitation, hospitals scaled down service provision to the insured and increased provision to the uninsured (who continue to pay out-of-pocket on a fee-for-service basis). The study points to the need to anticipate the intended and unintended effects of any payment reform and the trade-offs among policy objectives.
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Bibliographic InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 6709.
Date of creation: 01 Nov 2013
Date of revision:
Health Monitoring&Evaluation; Health Systems Development&Reform; Health Law; Population Policies; Disease Control&Prevention;
This paper has been announced in the following NEP Reports:
- NEP-ALL-2013-11-29 (All new papers)
- NEP-DEV-2013-11-29 (Development)
- NEP-SEA-2013-11-29 (South East Asia)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010.
"System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia,"
Journal of Health Economics,
Elsevier, vol. 29(4), pages 585-602, July.
- Moreno-Serra, Rodrigo & Wagstaff, Adam, 2009. "System-wide impacts of hospital payment reforms : evidence from central and eastern Europe and central Asia," Policy Research Working Paper Series 4987, The World Bank.
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