The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
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...
| Main Authors: | , |
|---|---|
| Format: | Policy Research Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2012
|
| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2012/07/16511544/impacts-public-hospital-autonomization-evidence-quasi-natural-experiment http://hdl.handle.net/10986/11942 |
| Summary: | 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. |
|---|