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...

Full description

Bibliographic Details
Main Authors:	Wagstaff, Adam, Bales, Sarah
Format:	Policy Research Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2012
Subjects:	BEDS BIOCHEMISTRY C-SECTION C-SECTIONS CLINICAL GUIDELINES CLINICAL MANAGEMENT COMPLICATIONS DEATH RATES DEATHS DEVELOPING COUNTRIES DEVELOPMENT POLICY DIAGNOSIS DIAGNOSTIC TESTS DISSEMINATION DRUGS ENROLLEES EXPENDITURES EXPOSURE FEE SCHEDULE FINANCIAL MANAGEMENT FINANCIAL RISK HEALTH CARE HEALTH CARE MANAGEMENT HEALTH CENTERS HEALTH ECONOMICS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH ORGANIZATION HEALTH POLICY HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEM REFORM HEMATOLOGY HOSPITAL HOSPITAL ADMISSIONS HOSPITAL AUTONOMY HOSPITAL CARE HOSPITAL COST HOSPITAL COSTS HOSPITAL MANAGEMENT HOSPITAL MANAGERS HOSPITAL OUTPATIENT SERVICES HOSPITAL STAFF HUMAN DEVELOPMENT HUMAN RESOURCES ILLNESS INCENTIVE PAYMENTS INCOME INPATIENT ADMISSION INPATIENT ADMISSIONS INPATIENT CARE LAB TESTS LEPROSY LIVING STANDARDS LOCAL AUTHORITIES LOCAL GOVERNMENTS MEDICAL EXAMINATION MEDICAL EXAMINATIONS MEDICAL SERVICES MENTAL ILLNESS MINISTRY OF HEALTH OUTPATIENT CARE PATHOLOGY PATIENT PATIENTS PEDIATRICS POLICY CHANGE POLICY DISCUSSIONS POLICY RESEARCH POLICY RESEARCH WORKING PAPER PROVIDER INCENTIVES PROVINCIAL HOSPITAL PROVINCIAL HOSPITALS PUBLIC ADMINISTRATION PUBLIC HOSPITALS PUBLIC POLICY PUBLIC SERVICES QUALITY ASSURANCE QUALITY OF CARE REHABILITATION RESPECT RURAL DISTRICT SOCIAL HEALTH INSURANCE STD SURGERY TRADITIONAL MEDICINE TREATMENT TUBERCULOSIS UNIONS USE OF RESOURCES USER FEES VISITS WORKERS WORLD HEALTH ORGANIZATION
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

id	okr-10986-11942
recordtype	oai_dc
spelling	okr-10986-119422021-04-23T14:02:58Z The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment Wagstaff, Adam Bales, Sarah BEDS BIOCHEMISTRY C-SECTION C-SECTIONS CLINICAL GUIDELINES CLINICAL MANAGEMENT COMPLICATIONS DEATH RATES DEATHS DEVELOPING COUNTRIES DEVELOPMENT POLICY DIAGNOSIS DIAGNOSTIC TESTS DISSEMINATION DRUGS ENROLLEES EXPENDITURES EXPOSURE FEE SCHEDULE FINANCIAL MANAGEMENT FINANCIAL RISK HEALTH CARE HEALTH CARE MANAGEMENT HEALTH CENTERS HEALTH ECONOMICS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH ORGANIZATION HEALTH POLICY HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEM REFORM HEMATOLOGY HOSPITAL HOSPITAL ADMISSIONS HOSPITAL AUTONOMY HOSPITAL CARE HOSPITAL COST HOSPITAL COSTS HOSPITAL MANAGEMENT HOSPITAL MANAGERS HOSPITAL OUTPATIENT SERVICES HOSPITAL STAFF HUMAN DEVELOPMENT HUMAN RESOURCES ILLNESS INCENTIVE PAYMENTS INCOME INPATIENT ADMISSION INPATIENT ADMISSIONS INPATIENT CARE LAB TESTS LEPROSY LIVING STANDARDS LOCAL AUTHORITIES LOCAL GOVERNMENTS MEDICAL EXAMINATION MEDICAL EXAMINATIONS MEDICAL SERVICES MENTAL ILLNESS MINISTRY OF HEALTH OUTPATIENT CARE PATHOLOGY PATIENT PATIENTS PEDIATRICS POLICY CHANGE POLICY DISCUSSIONS POLICY RESEARCH POLICY RESEARCH WORKING PAPER PROVIDER INCENTIVES PROVINCIAL HOSPITAL PROVINCIAL HOSPITALS PUBLIC ADMINISTRATION PUBLIC HOSPITALS PUBLIC POLICY PUBLIC SERVICES QUALITY ASSURANCE QUALITY OF CARE REHABILITATION RESPECT RURAL DISTRICT SOCIAL HEALTH INSURANCE STD SURGERY TRADITIONAL MEDICINE TREATMENT TUBERCULOSIS UNIONS USE OF RESOURCES USER FEES VISITS WORKERS WORLD HEALTH ORGANIZATION 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. 2012-12-07T22:16:11Z 2012-12-07T22:16:11Z 2012-07 http://documents.worldbank.org/curated/en/2012/07/16511544/impacts-public-hospital-autonomization-evidence-quasi-natural-experiment http://hdl.handle.net/10986/11942 English en_US Policy Research Working Paper; No. 6137 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research :: Policy Research Working Paper Publications & Research East Asia and Pacific Vietnam
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	BEDS BIOCHEMISTRY C-SECTION C-SECTIONS CLINICAL GUIDELINES CLINICAL MANAGEMENT COMPLICATIONS DEATH RATES DEATHS DEVELOPING COUNTRIES DEVELOPMENT POLICY DIAGNOSIS DIAGNOSTIC TESTS DISSEMINATION DRUGS ENROLLEES EXPENDITURES EXPOSURE FEE SCHEDULE FINANCIAL MANAGEMENT FINANCIAL RISK HEALTH CARE HEALTH CARE MANAGEMENT HEALTH CENTERS HEALTH ECONOMICS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH ORGANIZATION HEALTH POLICY HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEM REFORM HEMATOLOGY HOSPITAL HOSPITAL ADMISSIONS HOSPITAL AUTONOMY HOSPITAL CARE HOSPITAL COST HOSPITAL COSTS HOSPITAL MANAGEMENT HOSPITAL MANAGERS HOSPITAL OUTPATIENT SERVICES HOSPITAL STAFF HUMAN DEVELOPMENT HUMAN RESOURCES ILLNESS INCENTIVE PAYMENTS INCOME INPATIENT ADMISSION INPATIENT ADMISSIONS INPATIENT CARE LAB TESTS LEPROSY LIVING STANDARDS LOCAL AUTHORITIES LOCAL GOVERNMENTS MEDICAL EXAMINATION MEDICAL EXAMINATIONS MEDICAL SERVICES MENTAL ILLNESS MINISTRY OF HEALTH OUTPATIENT CARE PATHOLOGY PATIENT PATIENTS PEDIATRICS POLICY CHANGE POLICY DISCUSSIONS POLICY RESEARCH POLICY RESEARCH WORKING PAPER PROVIDER INCENTIVES PROVINCIAL HOSPITAL PROVINCIAL HOSPITALS PUBLIC ADMINISTRATION PUBLIC HOSPITALS PUBLIC POLICY PUBLIC SERVICES QUALITY ASSURANCE QUALITY OF CARE REHABILITATION RESPECT RURAL DISTRICT SOCIAL HEALTH INSURANCE STD SURGERY TRADITIONAL MEDICINE TREATMENT TUBERCULOSIS UNIONS USE OF RESOURCES USER FEES VISITS WORKERS WORLD HEALTH ORGANIZATION
spellingShingle	BEDS BIOCHEMISTRY C-SECTION C-SECTIONS CLINICAL GUIDELINES CLINICAL MANAGEMENT COMPLICATIONS DEATH RATES DEATHS DEVELOPING COUNTRIES DEVELOPMENT POLICY DIAGNOSIS DIAGNOSTIC TESTS DISSEMINATION DRUGS ENROLLEES EXPENDITURES EXPOSURE FEE SCHEDULE FINANCIAL MANAGEMENT FINANCIAL RISK HEALTH CARE HEALTH CARE MANAGEMENT HEALTH CENTERS HEALTH ECONOMICS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH ORGANIZATION HEALTH POLICY HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEM REFORM HEMATOLOGY HOSPITAL HOSPITAL ADMISSIONS HOSPITAL AUTONOMY HOSPITAL CARE HOSPITAL COST HOSPITAL COSTS HOSPITAL MANAGEMENT HOSPITAL MANAGERS HOSPITAL OUTPATIENT SERVICES HOSPITAL STAFF HUMAN DEVELOPMENT HUMAN RESOURCES ILLNESS INCENTIVE PAYMENTS INCOME INPATIENT ADMISSION INPATIENT ADMISSIONS INPATIENT CARE LAB TESTS LEPROSY LIVING STANDARDS LOCAL AUTHORITIES LOCAL GOVERNMENTS MEDICAL EXAMINATION MEDICAL EXAMINATIONS MEDICAL SERVICES MENTAL ILLNESS MINISTRY OF HEALTH OUTPATIENT CARE PATHOLOGY PATIENT PATIENTS PEDIATRICS POLICY CHANGE POLICY DISCUSSIONS POLICY RESEARCH POLICY RESEARCH WORKING PAPER PROVIDER INCENTIVES PROVINCIAL HOSPITAL PROVINCIAL HOSPITALS PUBLIC ADMINISTRATION PUBLIC HOSPITALS PUBLIC POLICY PUBLIC SERVICES QUALITY ASSURANCE QUALITY OF CARE REHABILITATION RESPECT RURAL DISTRICT SOCIAL HEALTH INSURANCE STD SURGERY TRADITIONAL MEDICINE TREATMENT TUBERCULOSIS UNIONS USE OF RESOURCES USER FEES VISITS WORKERS WORLD HEALTH ORGANIZATION Wagstaff, Adam Bales, Sarah The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
geographic_facet	East Asia and Pacific Vietnam
relation	Policy Research Working Paper; No. 6137
description	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.
format	Publications & Research :: Policy Research Working Paper
author	Wagstaff, Adam Bales, Sarah
author_facet	Wagstaff, Adam Bales, Sarah
author_sort	Wagstaff, Adam
title	The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
title_short	The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
title_full	The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
title_fullStr	The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
title_full_unstemmed	The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment
title_sort	impacts of public hospital autonomization : evidence from a quasi-natural experiment
publisher	World Bank, Washington, DC
publishDate	2012
url	http://documents.worldbank.org/curated/en/2012/07/16511544/impacts-public-hospital-autonomization-evidence-quasi-natural-experiment http://hdl.handle.net/10986/11942
_version_	1764418590603214848

The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment

Similar Items