Penalizing patients and rewarding providers: user charges and health care utilization in Vietnam
Penalizing patients and rewarding providers: user charges and health care utilization in Vietnam
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DOI：
10.1093/heapol/czi011
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发表时间：
2005-03-01
影响因子：
3.2
通讯作者：
Akram-Lodhi, H
中科院分区：
文献类型：
--
作者：
Sepehri, A;Chernomas, R;Akram-Lodhi, H
1995年实行的全面的用户收费制度为越南的公共卫生机构，特别是医院提供了不断增长的收入来源。到1998年，用户收费收入占公立医院收入的30%。提供者的收入越来越依赖于费用收入和基于供应的奖金，其结果是监管不力的按服务收费制度取代了基于集中确定的全球预算的薪资制度。本文探讨了提供者对使用公共提供的卫生服务的潜在影响。使用 1996-98 年期间基于设施的数据，对医院从患者获得收入的两种来源（即用户收费系统和基于服务收费的第三方支付系统）下治疗强度的相对贡献进行了比较和对比。比较的主要重点是所有医院接触者的治疗强度、住院情况和住院时间、通常由医疗服务提供者做出的决定，而患者对此影响很小或没有影响。结果表明，患者收入的增长与强度的大幅增加相关。在住院患者接触的情况下，强度的增长更为明显。此外，富裕人士的入院率和住院时间均远高于穷人，参保者的入院率和住院时间也远高于未参保者。医疗保险参保者和未参保者的医院护理强度的增加可以被视为医疗服务提供者在面对分配给医院的公共资源份额不断缩小以及工资和薪金较低的情况下增加医疗保险保费和使用费收入的尝试。
The introduction of a comprehensive system of user charges in 1995 provided public health facilities in Vietnam, especially hospitals, with a growing source of revenue. By 1998 revenues from user charges accounted for 30% of public hospital revenues. Increasingly, provider incomes have relied on fee revenues and provision-based bonuses, the effect of which is that a poorly regulated fee-for-service system has replaced a salary system based upon a centrally determined global budget. This paper examines the potential influence of providers' on the use of publicly provided health services. Using facility-based data over the period 1996-98, the relative contribution of treatment intensity is compared and contrasted under the two sources of hospital revenues from patients, namely a user charge system and a third party payment system based on fee-for-services. The primary focus of the comparison is on the treatment intensity for all hospital contacts, hospital admissions and the length of hospital stays, decisions normally taken by the providers and over which patients have little or no influence. The results indicate that growth in patient revenues was associated with large increases in intensity. The growth in intensity was more pronounced in the case of inpatient contacts. Moreover, both the admission rate and the length of hospital stay were far higher for better off individuals than for the poor, and greater for the insured than the uninsured. The increase in the intensity of hospital care for both health insurance enrollees and the uninsured can be seen as, among other things, an attempt on the part of providers to increase revenue from health insurance premiums and user charges in the face of a shrinking share of public resources allocated to hospitals, and low wages and salaries.