Costing of services of Vietnamese hospitals: identifying costs in one central, two provincial and two district hospitals using a standard methodology

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Abstract
Background The People's Republic of Vietnam is currently in a period of transition from a purely socialistic country towards a so‐called socialist market economy. Since the introduction of the Doi Moi policy in 1987, health care services have been liberalized, medical practitioners have received the right to open private hospitals and private pharmacies are booming. However, the majority of inhabitants strongly depends on governmental hospital services. These services are currently going through a financial crisis. This demands the quest for efficiency and the wise allocation of public funds. Research question The efficient allocation of funds depends on the quotient between costs and health outcomes, but the costs of health services in Vietnamese hospitals are unknown. Therefore the study analysed five hospitals in Vietnam and determined the average costs as well as the main cost drivers. Methodology The full costs of five hospitals were analysed, including depreciation and the value of donations. The costs were allocated to cost centres and cost units by a stepping‐stone method. Major findings As expected, the average costs per inpatient day at a central hospital are about 300% of the costs of provincial hospitals and about 600% of the costs of district hospitals. However, the costs of some laboratory procedures and operations done at district hospitals are higher than those of provincial or even central hospitals. The main reason for the high costs of some procedures at district hospitals was the low quantity of these procedures at that level. This is a strong indicator that some procedures, in particular major operations, should not be performed in Vietnamese district hospitals. Copyright © 2004 John Wiley & Sons, Ltd.