This paper explores the fiscal autonomy of Vietnam's public hospitals through analysing the formal autonomy rules and the actual autonomy practices among selected hospitals. We argue that Vietnam's autonomisation of public hospitals underpins the increasing switch of healthcare costs from the state onto society alongside the transition from the universal and free healthcare services to a mix of state subsidy and fees-for-services. Utilised as a strategic instrument, hospital autonomy is reinforced in service provision, capital mobilisation, and allocation of net revenues, leaving autonomy in other dimensions increase incrementally. Consequently, Vietnam's hospital autonomisation has occasioned various revenue-maximising practices including the provision of "patient-requested" services, provider-induced supply of unnecessary services, excessive use of high-tech diagnostic equipment, inappropriate prescription of drugs, increase in patients' length of stay, and receipt of informal payments. While discerning healthcare reform in a country context, this paper expects to offer lessons to policy-makers in developing countries, which reform their healthcare services along the market principle.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
<p>Intrigued by the burgeoning commercialisation of public services in Vietnam, this research seeks to understand the nature of autonomy that public service delivery units have been given as part of the greater effort of the Government of Vietnam to separate business and service provision from state management. In addressing this objective, the research bases its analysis on historical institutionalism and sociological institutionalism that illuminate insights into institutional factors shaping the autonomy policies and the implementation of the policies in practice. The main data sources the research draws on are legal documents, government reports and in-depth interviews with managers and staff of public service delivery units. The research findings illustrate that autonomy is very limited in many aspects of management because the autonomy reforms are largely influenced by the socialist-oriented market path dependence. Amidst the exhaustion of resources and legitimacy due to the regime’s flawed economic structure and inherent problems of cronyism and corruption, autonomy is utilized primarily as a strategic instrument to mobilize resources indispensable for the socialist survival. This policy direction creates incentives for the various forms of rent-seeking and corrupt behaviour among public service delivery units, occasioning the rapid and aggressive commercialization of public services. While the root of these problems lies in the intent of the policies, these problems are further nurtured by historical and cultural factors, and seriously compounded by the absence of an effective regulatory and accountability system and the lack of political commitment to fight corruption from the top leaders. The research addresses the gap in the academic literature by offering an illuminating insight into the nature of autonomy of a country context and demonstrating the merit of converging historical institutionalism and sociological institutionalism for the study of public policies. The research’s significant contribution to policy-making is that it highlights the need to build institutions to fit in well with the reform ideas, especially when such ideas are borrowed or transferred from advanced countries with well-developed institutional foundations.</p>
<p>Intrigued by the burgeoning commercialisation of public services in Vietnam, this research seeks to understand the nature of autonomy that public service delivery units have been given as part of the greater effort of the Government of Vietnam to separate business and service provision from state management. In addressing this objective, the research bases its analysis on historical institutionalism and sociological institutionalism that illuminate insights into institutional factors shaping the autonomy policies and the implementation of the policies in practice. The main data sources the research draws on are legal documents, government reports and in-depth interviews with managers and staff of public service delivery units. The research findings illustrate that autonomy is very limited in many aspects of management because the autonomy reforms are largely influenced by the socialist-oriented market path dependence. Amidst the exhaustion of resources and legitimacy due to the regime’s flawed economic structure and inherent problems of cronyism and corruption, autonomy is utilized primarily as a strategic instrument to mobilize resources indispensable for the socialist survival. This policy direction creates incentives for the various forms of rent-seeking and corrupt behaviour among public service delivery units, occasioning the rapid and aggressive commercialization of public services. While the root of these problems lies in the intent of the policies, these problems are further nurtured by historical and cultural factors, and seriously compounded by the absence of an effective regulatory and accountability system and the lack of political commitment to fight corruption from the top leaders. The research addresses the gap in the academic literature by offering an illuminating insight into the nature of autonomy of a country context and demonstrating the merit of converging historical institutionalism and sociological institutionalism for the study of public policies. The research’s significant contribution to policy-making is that it highlights the need to build institutions to fit in well with the reform ideas, especially when such ideas are borrowed or transferred from advanced countries with well-developed institutional foundations.</p>
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