Table 5 provides an overview of the international and Vietnamese practice related to implementation of FFS payments. Table 5. Fee-For-Service Key features International practice Vietnamese practice Calculation of fees -Fees calculated based on -Fees calculated with costs, negotiation and policy incomplete cost basis priorities -Lack of consistent and -National fee schedule concrete guidelines for adapted and approved at local adapting national fee level schedule on a regular basis Services Fee schedules should reflect -Fees based on bundling of some bundling of services services (not too many items and not (Circular 43/2013/TT-BYT too few) 17216 services, Circular 37/2015/TTLT-BYT-BTC 1887 fees) Cost items Payment system does not Fees include the following exclude key cost items cost items: (1) Drug, blood, (capital investment and infusion, consumables; (2) training are exceptions) Utilities (electricity, water, waste, etc.); (3) Maintenance of medical equipment; and (4) Full amount of salary costs Fund holding If there is fund holding, the Fund holding is applied for rules of payment to providers hospitals with primary health should be transparent, and care services registration of providers should not be at HI card holders to cover costs greater financial risk than of referrals at higher levels they are able to manage (referrals and self-referrals) -Providers are at greater financial risk than they are able to manage, since they do not have control over referral expenditures -Payment rules are not fully transparent Payment Caps, Deficits and -There is a hard budget cap -Cap is applied based on Surpluses and overruns are carefully revenues from registered HI managed and controlled or cap for referral payment -Providers are allowed to -Deficit still can be keep a portion of surpluses, reimbursed by VSS
Table 5 provides an overview of the international and Vietnamese practice related to implementation of FFS payments. Table 5. Fee-For-Service Key features International practice Vietnamese practice Calculation of fees -Fees calculated based on costs, negotiation and policy priorities -National fee schedule adapted and approved at local level -Fees calculated with incomplete cost basis -Lack of consistent and concrete guidelines for adapting national fee schedule on a regular basis Services Fee schedules should reflect some bundling of services (not too many items and not too few) -Fees based on bundling of services (Circular 43/2013/TT-BYT 17216 services, Circular 37/2015/TTLT-BYT-BTC 1887 fees) Cost items Payment system does not exclude key cost items (capital investment and training are exceptions) Fees include the following cost items: (1) Drug, blood, infusion, consumables; (2) Utilities (electricity, water, waste, etc.); (3) Maintenance of medical equipment; and (4) Full amount of salary costs Fund holding If there is fund holding, the rules of payment to providers should be transparent, and providers should not be at greater financial risk than they are able to manage Fund holding is applied for hospitals with primary health care services registration of HI card holders to cover costs of referrals at higher levels (referrals and self-referrals) -Providers are at greater financial risk than they are able to manage, since they do not have control over referral expenditures -Payment rules are not fully transparent Payment Caps, Deficits and Surpluses -There is a hard budget cap and overruns are carefully managed and controlled -Providers are allowed to keep a portion of surpluses, -Cap is applied based on revenues from registered HI or cap for referral payment -Deficit still can be reimbursed by VSS