EVIDENCE IN DEVELOPING AND REFINING CAPITATION PAYMENT FOR HEALTH CARE: THE CASE OF VIETNAM

SARAH BALES

Publication

EVIDENCE IN DEVELOPING AND REFINING CAPITATION PAYMENT FOR HEALTH CARE: THE CASE OF VIETNAM

SARAH BALES

Abstract

Capitation payment for health services is a prospective payment mechanism theoretically expected to incentivize provider efficiency-enhancing behavior. “Does this policy work to achieve intended objectives?” “What design and contextual features influence results achieved by the policy?” A global systematic literature review finds diverse and complex policy design, but research design challenges inhibit unbiased evaluation of this policy. Using a rigorous controlled before-after research design, this thesis reveals failure of capitation payments to achieve Vietnam’s intended policy objectives. Explanations for policy ineffectiveness are exposed through application of the Institutional Analysis and Development framework, which dissects the complex and conflicting incentives in five action areas within the Vietnam health system context. Vietnam’s experience illustrates failure to achieve a coherent policy design and implementation due to lack of policymaker understanding of the complex interactive policy components, divergent stakeholder interests, weak political influence of the policy target and inconsistent policy image. This research contributes to provider payment policy revision in Vietnam, while presenting a mixed methods approach to analyzing the complexity of health financing reform and generating important empirical based insights into policy failure.