PUBLIC-PRIVATE PARTNERSHIP: POTENTIAL COLLABORATION WITH PRIVATE PROVIDERS FOR THE PROVISION OF AMBULATORY CARE IN THE

MEKONG REGION, VIETNAM

Pham Le Tuan, PhD

Toronto, July 12 2011  

Outline

Introduction Methods Results Discussions and policy implications

Introduction Private providers have become an important part of many

health systems The Doi Moi process launched in Vietnam in 1986 paved the

ways for many substantive health reforms. The private sector was legalized in same time with the

introduction of health insurance two decades ago Currently, the State owned Social Health Insurance covers

some 60% of total Vietnamese population. A relatively broad benefit package is entitled to the insured but

only available in public facilities and a few accredited private hospitals.

The study aims to explore the possibility for collaborating with private providers for the provision of ambulatory care at the primary level in the Mekong region, Vietnam

Methods Study site: In Mekong Region. Focus group discussion with government officials: exploring

knowledge, views, assessment and attitude towards private providers.

Facility survey: assessing the professional competency of private providers, their qualification, availability of equipment…

Private provider in-depth interview: focusing on potential for and challenges regarding public-private partnerships.

Exist survey of private providers clients: aiming to understand health seeking behaviors, fees, and perceived quality of care.

Data analysis: data entry using SPSS 10, and data analysis using STATA 10. Qualitative data were coded for key themes.

Results Results of FGDs with health officials

Private providers were recognized for its role in assisting the public sector to reduce crowding within the public hospitals

Overuse of antibiotics and induced-demand interest Good quality as evidenced by the courtesy of personnel and

short waiting time Strong consensus in favor of public-private collaboration to

improve competition between service providers The collaboration should be piloted in qualified policlinics Challenges: wide variation of fees for services, “low quality

medicines”, low awareness of the population; and lack of human resources for regulating, M&E and quality assurance.

FGDs with health officials A strong consensus in favor of collaborating with private providers to

provide ambulatory health services for insured individuals.

Public-private partnership could improve competition between service providers and be an impetus for both public and private health providers to improve their quality of care.

Such collaboration should be first piloted in qualified policlinics and specialized clinics. The pilot should be rigorously monitored and evaluated before being scaled up.

Challenges to such collaboration: the wide variation between fees for

services actually charged by private providers and those regulated by the SIA; limited list of medicines; additional administrative burdens for SIA; low awareness of the health insurance benefit package and co-payment rules; and lack of personnel and relatively weak capacity for regulation, monitoring, and quality assurance.

Results of health facility survey

Province Specialized clinic

Policlinic General hospital

Total

Ben Tre 5 3 0 8

Can Tho 5 2 1 8

Kien Giang 7 1 1 9

Tien Giang 3 3 1 7

Tra Vinh 6 2 0 8

Total 26 11 3 40

Characteristics of participantsFrequency Percent

Age

15-40 103 51.8

41-60 60 30.2

>61 36 18.1

Gender Male 64 32.0

Female 136 68.0

Education level

Did not go to school 10 5.0

Primary school 59 29.5

Secondary school 74 37.0

High school 36 18.0

College/university 21 10.5

Characteristics of participants

Occupation

Unemployed 2 1.0

Farmers 59 29.5

Students 3 1.5

House workers 42 21.0

Retired 6 3.0

Civil servants 13 6.5

Employees 21 10.5

Venders 43 21.5

Fishermen, gardeners 3 1.5

Others 8 4.0

Average income (VND)*

<500,000 15 10.9

500,000-1,000,000 61 44.2

1,000,000-1,500,000 31 22.5

1,500,000-2,000,000 12 8.7

> 2,000,000 19 13.8Defined as poor according to local criteria

Yes 6 3.0

No 193 96.5

Possession of a 139 cardYes 4 66.7

No 2 33.3

Possession of a health insurance card**

Yes 78 39.0

No 83 41.5

Health seeking behaviorCharacteristic  Decision Frequency Percent N

First provider soughtYes 160 80.0 200

No 40 20.0

Closest providerYes 34 17.0 200

No 166 83.0

The nearest provider to home

Public owned 129 64.5 166

Another private facility 34 17.0Traditional health facility 2 1.2

Reason for choosing facility

Proximity 33 16.5 200

Familiarity of provider 30 15.0Good attitude of provider 29 14.5

Reasonable price 11 5.5Convenient opening-hours 27 13.5

Good quality service 148 74.0Recommended by someone 32 16.0  

Healthcare expenditures

Clients’ satisfaction Private providers Neither satisfied nor

dissatified Satisfied Very satisfied

Cleanliness of the facility 5(2.5%) 113(56.5%) 82(41%)

Wait time for services 7(3.5%) 107(53.5%) 86(43%)

Explaination given by the provider 0(0%) 106(53%) 94(47%)

Cost of services 5(2.5%) 145(72.5%) 50(25%)

Overall perceived quality of care 1(0.5%) 104(52%) 95(47.5%)

Public providers Very dissatisfied Dissatisfied Neither satisfied nor dissatified Satisfied

Cleanliness of the facility -  2(6.1%) 20(60.6%) 11(33%)

Wait time for services 1(3%) 18(54.5%) 8(24.%)) 6(18.2%)

Explaination given by the provider 1(3%) 13(39.4%) 9(27.3%) 10(30.3%)

Cost of services - 1(3%) 18(54.6%) 14(42.4%)

Overal perceived quality of care  - 8(24.2%) 19(57.6% 6(18.2%)

Discussion Key findings

Government officials have relatively positive attitudes towards private providers.

Almost all surveyed private providers serve insured patients, although they are not paid by the insurance agency.

The vast majority of providers expressed their willingness to collaborate with the public sector to provide health services for insured people.

Clients who sought care at both public and private sector were much more satisfied with the private providers.

Collaborating with private providers to offer ambulatory care at the primary level to health insurance beneficiaries seems feasible and promising from both health officials’ and private providers’ viewpoints.

The collaboration should be piloted and evaluated before being scaled up.

Policy implications Provides practical evidence on the possibility collaboration

between public and private for ambulatory care at primary level.

Both public and private sectors have gradually been driven towards each other.

The Mekong regions seems ready for a major next step in public-private partnership, with a controlled experiment extending insured primary care benefits through accredited private providers.

The partnership is operationally and administratively feasible as ambulatory services are technically simple and could be monitored at a low cost.

THANK YOU!