COSTING OF CLINICAL SERVICES AND COST DETERMINANTS AT PUBLIC DISTRICT HEALTH FACILITIES IN FOUR PROVINCES OF VIETNAM

Abstract

This study aims first to calculate the unit cost of all outpatient services and inpatient services at 33 public district health facilities that pilot two different capitation models in Vietnam. It then seeks to explore the determinants of the calculated unit costs. Costing was conducted by using secondary data from the calendar year 2014 which was collected by the Health Strategy and Policy Institute. A “top-down” approach with step-down allocation method was applied to calculate the unit costs in the selected health facilities from the providers’ perspective. For exploring the determinants of unit costs, an ordinary least squares regression analysis was employed. On average, the unit cost per outpatient visit, inpatient bed-day and discharge in four provinces ranged from 73,000 VND (US$3.45) to 133,000 VND (US$ 6.29), 233,000 VND (US$ 11.04) to 282,000 VND (US$ 13.34), and 1,097,000 VND (US$ 51.90) to 1,487,105 VND (US$ 70.21), respectively. On average, the labour: material: capital costs ratio of four provinces is 41 : 46 : 13. The unit cost of outpatient visit and inpatient days at each province was found to be higher than the latest fee schedule which took effect in June 2017. The OLS regression showed that for hospital discharges, an increase in the occupancy rate results in a reduction in the unit cost whereas an additional day of hospital stay results in an increase in the unit cost. For hospital days, the increase in the occupancy rate was associated with the reduction in the unit cost per inpatient day. The capitation dummy is not significant, in other words, there is no difference in unit cost of inpatient services in facilities that pilot the capitation for outpatient services relative to those that pilot capitation for inpatient and outpatient services. This study not only supports efforts of reforming provider payment system but also provides useful information in financial management. The results on unit costs are useful for policy-makers in setting and revising the payment rates from health insurance scheme. Moreover, understanding the cost structure also helps hospital managers to run their facilities more efficient.