Dual practice of public hospital physicians in Vietnam

Abstract

Promoting public private partnership is one of the major health system reforms of the Vietnamese government to achieve universal health coverage. It has encouraged the development of the private sector and created a mixture of public and private health service delivery within the public hospitals. As a result, the phenomenon of physician dual practice has become very popular in recent years. Nevertheless, it has been poorly regulated as well as studied systematically. Therefore, this study aims at providing a comprehensive understanding of the phenomenon in Vietnam by examining three aspects: 1) the motivation of dual practice participation, 2) the effects of dual practice on physicians performance, and 3) the view of service users and providers on public hospital physicians dual practice. A survey with 510 physicians and 292 patients was conducted at 10 public hospitals of all three levels (central, provincial, and district) in the Northern and Southern parts of Vietnam in January 2015. Results show that extra private income is the main motivation to take-up dual practice and basic salary increase is the most preferable option to give-up private practice. Higher-position physicians are more likely to participate in dual practice. Dual practitioners spend less time for public practice and refer more public patients to private practice compared to non-dual practitioners. Physician dual practice is a common practice although both patients and physicians perceive that it increases out-of-pocket payment. They both have high consensus on imposing regulations to regulate dual practice but not on banning it as well as terminating the public-private mix of public hospitals. This study suggests reforming provider payment mechanism at both institutional and individual levels to discourage dual practice. The public and private practice within public hospitals should be separated. Further studies to examine the impacts of dual practice on the quality of care are recommended. Cross-country comparison would provide important policy perspectives for countries with similar health system architecture, which are reforming the health sector to achieve universal health coverage.