Vietnamese Delegate: Healthcare Autonomy Drives Doctors from Rural Hospitals

Nguyen Lan Hieu, a delegate to the National Assembly and Director of Hanoi Medical University Hospital, has raised concerns about the impact of financial autonomy on healthcare services at the district level in Vietnam. He argues that the current system places a significant burden on medical staff, leading experienced doctors to seek opportunities in urban centers or establish private clinics.

Hieu observed that while policies like increased subsidies and continuous training have boosted the healthcare sector, the autonomy model for rural and mountainous hospitals is problematic. These hospitals serve primarily low-income populations, with nearly 99% of their revenue coming from health insurance. The pressure of self-financing often leads to delayed salary payments and hinders income growth for staff.

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The autonomy in regular expenses always creates a burden for medical staff here, and the phenomenon of quitting is largely due to this reason. Salaries are often not even received on time, let alone additional income.

"The autonomy in regular expenses always creates a burden for medical staff here, and the phenomenon of quitting is largely due to this reason," Hieu stated. He believes this situation drives "skilled and experienced doctors to find ways to move to the city or open private clinics." Therefore, he proposed that rural and mountainous district-level hospitals should be exempted from financial autonomy to alleviate the pressure and prevent them from deviating from their core mission.

To address this, Hieu suggested supplementing the national target program with financial resources to provide stable base salaries for medical staff in rural and remote areas. He also recommended categorizing health check-ups based on patient groups: those with chronic conditions or registered with local hospitals, workers and civil servants requiring regular check-ups, and vulnerable groups like the elderly, children, and those with financial difficulties. This structured approach, he believes, would improve efficiency and ensure better support for essential healthcare services.

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skilled and experienced doctors to find ways to move to the city or open private clinics.