Örgütsel Davranış Araştırmaları Dergisi
Journal Of Organizational Behavior Research
Cilt / Vol.: 9, Sayı / Is.: 2, Yıl/Year: 2024, Sayfa/Pages: 95-104
https://doi.org/10.51847/M1JcunFDqY2528-9705

THE EFFECT OF FINANCIAL AUTONOMY ON MEDICAL TREATMENT IN CENTRALPUBLIC HOSPITALS IN VIETNAM
Nga Phuong NGUYEN1, Thao Huong PHAM2*, Nam Hoai NGUYEN3
1State Audit Office of Vietnam, Hanoi, Vietnam.
2Department of Research Management, National Economics University, Hanoi, Vietnam.
3Office of the People’s Committee of Thanh Hoa Province, Thanh Hoa City, Vietnam.

*Corresponding Author
E-mail: Phamhuongthao@neu.edu.vn

ABSTRACT
Although autonomy provides a better opportunity for Vietnamese public agencies to operate more efficiently, many
obstacles related to autonomy need to be addressed for the better operation of these agencies. This study analyzes the impactof financial autonomy on medical treatment among central public hospitals of Vietnam. In addition to reviewing autonomy
regulations, the research looked at patient care in key public hospitals. The data collected served as an example for theassessments of patients and non-patients on their care and any changes in their health. The result implicates that, theprofessional level of doctors participating in treatment at central public hospitals is very good; therefore, even thoughpatients have to share a bed with other, the positive change in the patient’s health is very positive. However, central public
hospitals are facing barriers from current policies; consequently, the ultimate goals of financial autonomy in healthcare
sector could not be reached. Discussions and recommendations will be pointed out for the better prospective landscape ofcentral public hospitals.
Keywords: Autonomy, Hospital, Patient, Policy.

INTRODUCTION
Medical care is a special activity related to the lives of people in all regions of the country. Like
most countries around the world, public hospitals play a key role in medical examination andtreatment for people in Vietnam. In the system of public hospitals, central public hospitals arehaving a team of leading experts in the medical field. They are general and specialized hospitals
with the best quality in the country. Central public hospitals are hospitals affiliated-with the
Ministry of Health or other central ministries. These hospitals received the best investment fromthe State in terms of facilities as well as medical equipment to serve medical examination andtreatment. Possessing a team of leading medical experts and the best medical equipment are thefoundation for these public hospitals to play a leading role in scientific research and developmentof the medical industry, as well as take on roles and responsibilities on implementing direct-line
guidance for lower quality hospitals. However, in the context of socialization and financial
autonomy are being promoted in many areas of socio-economic aspects, healthcare field in
Vietnam cannot stand out from this trend (Cheng, 2014; Nguyen et al., 2020). The promotionGeliş tarihi/Recieved: 14.05.2024 – Kabul tarihi/Accepted: 05.09.2024 – Yayın tarihi/Published: 15.09.2024© 2024 Journal of Organizational Behavior Research. Open Access - This article is under the CC BY NC SA license(https://creativecommons.org/licenses/by-nc-sa/4.0/)

96 Örgütsel Davranış Araştırmaları Dergisi

Journal of Organizational Behavior Research
Cilt / Vol.: 9, Sayı / Is.: 2, Yıl/Year: 2024, Sayfa/Pages: 95-104
of financial autonomy, on the one hand is being seen as having a positive impact on increasing
financial resources for public hospitals. On the other hand, it affects the chance of patients toaccess healthcare because of high costs for medical examination and treatment. Fees frommedical examination and treatment becomes the main source of revenues for these public
hospitals. Therefore, it is necessary to research and evaluate the evaluation of views of patients,
who come for examination at central public hospitals. Patients’ assessments on accessing to the
medical equipment system and their health’s changes are useful information about the results ofimplementing the financial autonomy policy in Vietnam, especially are in central public
hospitals.
MATERIALS AND METHODSThe hospital’s job as a component of the healthcare system is to make sure that patients receive
complete medical treatment, including preventative and curative care. In community healthcare, the hospital serves a broad role that is harmoniously connected to both society and the
medical sector; it is neither distinct nor isolated (Cole, 2020). Public health care, however,remains a vital hospital function (Davis et al., 2004; McCarthy, 2010). In order to examine andtreat patients, hospitals are frequently furnished with a large number of beds and medical
equipment. A group of extremely skilled medical professionals is also available at the hospital tohandle both inpatient and outpatient duties. When a doctor schedules an inpatient treatment
visit or receives a referral from another medical facility, inpatient therapy is administered. The
patient has to be admitted to the hospital in order to get inpatient care (Anguelovski et al., 2020).
As opposed to this, outpatient therapy occurs when a patient follows a doctor’s order without
the necessity for hospitalization (Zhang et al., 2018).
Since the early 1980s, public sector hospitals around the world have been subject to close
scrutiny from the public agencies. The public sector’s financial obligations have led to
expectations for efficiency and effectiveness under centralized government supervision, in
addition to the public sector’s complicated bureaucracy. Giving public hospitals more authority
to manage the operations of public health facilities is one policy choice that governments arevery fond of. Because of this, “hospital autonomy” efforts have been put forth as a crucialcomponent of the health sector reform process in several affluent nations (like Denmark, France,
Singapore) and numerous developing nations (like Ghana, Indonesia, Kenya). Research was donein India and Indonesia outside of Africa, as well as in Ghana, Kenya, and Zimbabwe in subSaharan Africa. The main goals of the studies were to: a) describe and analyze the experiencesof public sector hospitals with hospital autonomy in each of these countries; and b) draw wider
lessons on hospital autonomy maintenance from the experiences of these countries. Hospitals
are categorized as budget units, autonomous units, cooperative units, and private units based on
their financial autonomy; each type of hospital has varying degrees of autonomy, which are
expressed in the following aspects: the right to decide; market access; ultimate beneficiary; social
responsibility and function. This classification was made by Nhung Thach Phuong et al. (2023)
in I study Improving Hospital’s Quality of Service in Vietnam: The Patient Satisfaction Evaluationin Multiple Health Facilities. The study Autonomy and Responsibility in Japanese hospitals byKodera and Yoneda (2019) analyzed the process of deep and extensive reform of Japan’s public
hospital financial system in recent times. The goal of the reform is to increase the autonomy and

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responsibility of public hospitals. Through analysis, the author has pointed out the factors that
determine the success of public health system reform and drawn lessons for lower middleincome countries in implementing this activity. The author’s research has practical significancenot only for Japan but also for countries that are reforming their public hospital financing
systems. Numerous cutting-edge medical gadgets are created as technology develops. Faster andmore accurate patient examinations and treatments are made possible by it.
Medical examination and treatment are directly impacted by medical equipment, a specificcommodity. Because it helps doctors diagnose and treat patients precisely, promptly, safely, andefficiently, it is one of the key elements influencing the efficacy and quality of medical practice.
For this reason, hospitals always value having access to a system of specialized and contemporary
medical supplies, equipment, and instruments.
System is a concept used to refer to whole entities, that is, things and phenomena with a unified
and complete structure, arranged according to certain principles and relationships, andgoverned by some general rules. The system consists of components that interact with each otherto perform necessary functions. Changes in this part will impact more or less, directly or
indirectly, on other parts in the system. The health system, therefore, is a complex of people,
organizations and resources arranged and linked together to promote, restore and maintainhealth for the community (Pham Tien et al., 2023). The healthcare system contains people who“buy” medical services and people who “sell” medical services, and there are rules that control
that “buying” and “selling” process. The basic difference between this “buying” and “selling”
and other service market systems is that the “buyer” is not completely knowledgeable about the“goods” he or she intends to buy (it is difficult for the patient to know that he or she has thedise”se). What to do, how to treat it and how much it will cost), and the “seller” does not havethe right to maximize profit on the “goods” they sell. There is an ethical bond between medical
service providers and medical service users.
The medical facility system is a component of the medical system. The medical facility system isclassified by economic sector, by medical level and by fields of activity. Operating mostly on
public or nonprofit donations for funding, public medical institutions are facilities that the state
has invested in both facilities and finances. In order to provide public health care units withcomplete autonomy and responsibility to grow and develop their operations and enhance theirperformance, the operational and financial mechanisms of the units are being reinvented. Highquality medical examination and treatment. Central level hospitals are hospitals at the highest
level in the health sector organization system. Hospitals at the central health level and a part of
the hospitals at the local health level (province and city health lines directly under the central
government) form specialized medical areas with the task of using high technology, spearhead,focusing on scientific research activities, scientific and technical direction and support for local
medical services.
In order to gather information for evaluating the state of medical equipment at several central
public hospitals, the study looked at 162 individuals receiving care at seven different central
hospitals: Bach Mai, Viet Duc, K Tan Trieu, E. Thai Nguyen, Lung Central, and Central
Endocrinology. There were both inpatient and outpatient patient groups among the interviewees.
Certain patients will possess health insurance cards, while others will not, as a result of therandom survey method’s selection. In order for these individuals to evaluate “the current levelof medical equipment serving the treatment/treatment process at the hospital,” questions based98 Örgütsel Davranış Araştırmaları Dergisi

Journal of Organizational Behavior Research
Cilt / Vol.: 9, Sayı / Is.: 2, Yıl/Year: 2024, Sayfa/Pages: 95-104
on the Likert scale will be posed to them (C12). The patient’s instinctive appraisal of hospitals’
cutting-edge medical technology is persuasive, despite the fact that their evaluation lacks
professional credibility. The details on the condition of medical examination and treatment
equipment in hospitals are quite helpful.
The Likert scale was employed in the study to enable the patients under investigation to rate theirown level of health improvement following hospital treatment. The study compared theevaluation of the change in the patient’s health following treatment between the chosen
institutions using the estimation with categorical variables approach. Compare the assessmentof the quality of medical equipment at these institutions with the variation in the course of thedisease. The investigation was also carried out to see whether improvements in the illness status
were dependent on social factors such as: choice of a voluntary treatment room (bedroom fortreatment with high cost), choice of doctor…

Reviews Polices on Financial Autonomy for Public Hospitals
The Department of Medical Examination and Treatment Management is assigned by the Ministryof Health to be the focal point to establish councils to build a list of technical services andtechnical processes. The Department is responsible for coordinating with the Department of
Financial Planning and experts to develop technical and economic norms as a basis forestablishing medical service prices. Up to now, the results have not been achieved, areincomplete and still have many shortcomings because the construction of the technical list is still
independent of the construction of medical service prices. Medical service prices are also
determined by the opinions of leading doctors from many hospitals across the country.
Therefore, out of a total of more than 18,239 technical service categories, only about 947
services are built based on technical and economic norms (Chen, 2013; Nam et al., 2020). Morethan 4,000 technical service categories have not yet been priced and over 11,000 services haveno technical process. At the same time, the service list has not been updated; lack of connectivity;
The group list is not reasonable, the price is higher or lower than the actual cost, the same pricebut different drugs, supplies, chemicals, human resources, time and payment conditions shouldbe implemented at hospitals. There are still many problems and errors so social insurance refuses
to pay. A comparison of hospitals in the same class, including Hue Central Hospital, Bach Mai
Hospital, and Cho Ray Hospital, reveals that their standards for the use of medications, supplies,
and chemicals in the overall expenses of medical examination and treatment varied (Pham et al.,2019).
The price of medical examination and treatment services based on health insurance payments
has not been fully calculated according to the current price, and has not kept up with the pricecalculation roadmap in Decree No. 85/2012/ND-CP and Decree No. 16/2015. /ND-CP;
Up to now, bidding for equipment procurement is still carried out on the basis of general legal
documents on capital investment issued by the Government and functional ministries andbranches, in other words, there is no document yet. There is no specific document on the
procurement of medical equipment for public hospitals that are assigned autonomy. Units thatare assigned autonomy, when investing in building facilities using the Public Service
Development Fund or loans, not state budget capital, must still fully carry out investment
procedures and submit them to competent authorities approval rights. Joint venture activities toinstall machinery and equipment in hospitals also apply the same process as for public service

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units according to the Law on Management and Use of Public Assets No. 15/2017/QH14 dated
December 21. June 2017 and the Ministry of Health have drafted a Circular to provide specificguidance, but it has not been agreed upon by ministries and branches.
RESULTS AND DISCUSSION
Of the 162 patients who responded to the questionnaire, there were 34 inpatients and 138
outpatients; Of which only 24 patients answered the number of days of inpatient treatment up
to the time they were investigated; 20 people provided information about the estimated numberof days remaining in inpatient treatment until discharge. Data processing results show that
inpatients had an average number of days in the hospital until the time of interview was nearly
3 weeks; and they are about 2 weeks away from being discharged from the hospital. Outpatient
treatment time is generally less, as they only need about 3 weeks to return to their normal healthstate after seeing a doctor (Table 1).
Table 1. Responses of interviewees about their treatment times
N

Minimum Maximum Mean

Std.
Deviation

Inpatients
The number of days of inpatient treatment up to thetime they were investigated

24

3

90

19.75

17.316

The number of days remaining in inpatient
treatment until discharge

20

0

90

14.15

20.459

1

250

13.28

28.540

0

40

7.44

6.240

Outpatients
The number of days of treatment up to the time they127
were investigatedEstimated number of days of treatment until
recovery108

Source: Data from investigated 162 patients being treated at 7 central hospitals

When comparing the duration of inpatient stays in central hospitals between the patient
population with insurance cards and the patient population without insurance cards, according
to statistical findings, just 7 patients out of the 155 patients who are still alive do not utilize theirhealth insurance cards. While patients receiving inpatient treatment without a health insurance
card sometimes only need to be treated for less than a week before being released from thehospital, patients with cards typically stay for at least three weeks throughout their stay. Thosewith insurance cards are able to predict how long they will need to stay in the hospital fortreatment; however, those without insurance cards are rarely certain of the precise number ofdays they will need to stay. Until patients are released from the hospital, they might keep
receiving treatment (Table 2).

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Journal of Organizational Behavior Research
Cilt / Vol.: 9, Sayı / Is.: 2, Yıl/Year: 2024, Sayfa/Pages: 95-104
Table 2. Patient’s treatment time based on insurance card ownership status
N

Minimum Maximum Mean

Std.
Deviation

Having insurance card
The number of days of inpatient treatment up to thetime they were investigated

149

1

250

14.43

27.288The number of days remaining in inpatient treatment
128
until discharge

0

90

8.49

10.070

4

7

5.50

2.121

Unhaving insurance card
The number of days of inpatient treatment up to thetime they were investigated2

The number of days remaining in inpatient treatment
until discharge0

Source: Data from investigated 162 patients being treated at 7 central hospitals

Based on the outcomes of data processing, the evaluation and impression of the state-of-the-art
medical equipment supporting the hospital’s examination and treatment procedure for inpatientand outpatient groups differ somewhat. Information from 162 patients, including inpatient andoutpatient. Just around 50% of inpatients agree with the evaluation if approximately 65% ofthem believe that the hospital’s medical equipment that supports the examination and treatment
procedure is ranked at a good level. This. From lowest to highest, if we compare each pair of
inpatient and outpatient evaluations with the degree of modernity of medical equipment
supporting the hospital’s examination and treatment procedure, the patient Compared to
inpatients, outpatients frequently have a more relaxed attitude (Table 3).
Table 3. Perceived level of modernity of medical equipment serving the examination/treatment
process at the hospital for inpatient and outpatient groups

Inpateint
Outpateint

Code BNNT-NT

Assessmentss of interviewees

Total

1

2

3

4

5

Count

1

1

14

9

9

34

% within Ma BNNT-NT

2.9%

2.9%

41.2%

26.5%

26.5%

100.0%% within c12

100.0%

10.0%

28.6%

14.3%

23.1%

21.0%

% of Total

.6%

.6%

8.6%

5.6%

5.6%

21.0%

Count

0

9

35

54

30

128

% within Ma BNNT-NT

.0%

7.0%

27.3%

42.2%

23.4%

100.0%% within c12

.0%

90.0%

71.4%

85.7%

76.9%

79.0%

% of Total

.0%

5.6%

21.6%

33.3%

18.5%

79.0%

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NGUYEN et al.

Total

Count

1

10

49

63

39

162

% within Ma BNNT-NT

.6%

6.2%

30.2%

38.9%

24.1%

100.0%% within c12

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%% of Total

.6%

6.2%

30.2%

38.9%

24.1%

100.0%

Source: Data from investigated 162 patients being treated at 7 central hospitals

When considering the evaluation of patients with insurance cards compared to the remaining
patients, the data processing results show that people with health insurance cards have a morelenient view of the modernity of medical equipment. Used to examine and treat their diseases;
On the contrary, the group that does not use health insurance cards expressed a more strictfeeling (Table 4).
Table 4. Perceived level of modernity of medical equipment serving the examination/treatment
process at the hospital among patients with health insurance cards

unhaving
Havinginsurance card insurance card

Ma SHTBH

Assessmentss of interviewees (c12)

Total

Total

1

2

3

4

5

Count

1

9

45

63

37

155

% within Ma SHTBH

.6%

5.8%

29.0%

40.6%

23.9%

100.0%% within c12

100.0%

90.0%

91.8%

100.0%

94.9%

95.7%

% of Total

.6%

5.6%

27.8%

38.9%

22.8%

95.7%

Count

0

1

4

0

2

7

% within Ma SHTBH

.0%

14.3%

57.1%

.0%

28.6%

100.0%% within c12

.0%

10.0%

8.2%

.0%

5.1%

4.3%

% of Total

.0%

.6%

2.5%

.0%

1.2%

4.3%

Count

1

10

49

63

39

162

% within Ma SHTBH

.6%

6.2%

30.2%

38.9%

24.1%

100.0%

100.0% 100.0% 100.0%

100.0%

100.0%

100.0%

38.9%

24.1%

100.0%% within c12% of Total

.6%

6.2%

30.2%

Source: Data from investigated 162 patients being treated at 7 central hospitals

Evaluation of the investigated patient group about health changes after treatment, regression
estimation results show whether or not the family personally thanks the treating team of doctors.
The condition has no bearing on the course of treatment (Pvalue > 5%); the circumstances are
the same regardless of whether the patient selects their physician or the head of the treatment
unit prescribes the course of action. In contrast, patients who meet the requirements for medical
treatment in volunteer rooms recover more quickly from their illnesses than those who do not
utilize voluntary rooms (Pvalue < 5%). Put another way, the regression results demonstrate that:patients do not need to worry about not receiving quality care from a doctor; even sharing a bed
with other patients does not prevent the top medical team’s treatment from improving their102 Örgütsel Davranış Araştırmaları Dergisi

Journal of Organizational Behavior Research
Cilt / Vol.: 9, Sayı / Is.: 2, Yıl/Year: 2024, Sayfa/Pages: 95-104
health; and doctors’ conditions are generally very good at central public hospitals. Treatment
outcomes will improve when a voluntary chamber is used because it fosters a sense of comfort
and individual autonomy (Table 5).
Table 5. Assessments of the patient team on health status changes
Source

SS

df

MS

Model

5.53994399

41.384986

Residual

122.9045

157.782831213

Total

128.44444

161.79799158

C14

Code having good relationship with doctor
Unhaving good relationship with doctor

Code choosing doctor for curing
unchoosing doctor for curing

Code sharing bed with other patients
Unsnharing bed with other patients

Number of obs = 162
F (4,157)= 1.77
Prob >F.
= 0.1377
R-squared= 0.0431
Adj R-squared. = 0.0188
Root MSE.
= .88478
P >!t!

[95% Conf.
Interval]-.1413963 .1603246-0.88 0.379-.4580676.175275.0041026

0.03

0.978

-.2863228.2945279-0.43 0.670-.4018108.2588562

Coef

Std. Err.1460367-.0714773 .1672415

t

Code using bedroom for treatment with high cost-.6948877-.3600138 .16952415 -2.12 0.035
Unusing bedroom for treatment with high cost-.0251399_cons

8.197287.210376

19.95 0.000

3.781755
4.61282

Source: Data from investigated 162 patients being treated at 7 central hospitals

CONCLUSION
Examination and treatment fees would be seen as the main revenues of hospital, in the context
of financial autonomy is being deployed in Vietnam. Patients in difficult economic circumstanceare facing barriers to adequate medical care system. In contrast, socialized medical equipment
being deployed in public hospital, consequently, brings chances for patients to access better
conditions of medical examination and treatment. The entire cost of the patient's care is less thanwhat a patient would have to spend in industrialized nations like the US, Japan, etc. for theidentical procedure and protocol. Leading the way in this socialization process are central
hospitals. However, there is still work to be done on the financial autonomy mechanism andpolicy for public non-business groups. It is imperative to finalize the legal documentation system,
particularly with regard to joint venture implementation, in order to bolster hospital trust in
their ability to foster autonomy, enhance the caliber of medical equipment, and deliver patientcare. As a result, Vietnam’s health system will perform better in its capacity, enhancing
community service energy and people’s standard of living.

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ACKNOWLEDGMENTS: The authors are grateful to the permanent staff of the seven central
public hospitals in Vietnam for their response to our questionnaire.
CONFLICT OF INTEREST: None
FINANCIAL SUPPORT: None
ETHICS STATEMENT: This study adhered to ethical guidelines and principles in research. Allprocedures involving human participants were conducted by the ethical standards of the 1964
Helsinki Declaration and its later amendments or comparable ethical standards. Informed
consent was obtained from all individual participants included in the study. Confidentiality andanonymity were strictly maintained throughout the research process.
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