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Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).Quan hệ lợi ích trong thực hiện tự chủ tài chính ở các Bệnh viện Quân y (Qua thực tế Bệnh viện Quân y 103).
HO CHI MINH NATIONAL ACADEMY OF POLITICS NGUYEN DUC HUNG THE RELATIONSHIP OF INTEREST IN THE IMPLEMENTATION OF FINANCIAL AUTONOMY IN MILITARY HOSPITALS (THROUGH REALITY 103 MILITARY HOSPITALS) SUMMARY OF THE DOCTORAL THESIS MAJOR: POLITICAL ECONOMY Code: 931 01 02 HA NOI - 2022 INTRODUCTION The necessity of the thesis Over the years, Vietnam's public health system has always been supported by the Party, Government, the government pays attention to comprehensive investment and has well ensured the health care mission for the people of the country However, now for public hospitals to develop and stand firmly in the market economy if only relying on the state budget is not enough From that fact, in recent years the Government and the Ministry of Health have issued many decrees, documents, and regulations, guiding the implementation of financial autonomy mechanisms for public non-business units in general and public hospitals in particular Financial autonomy is now a necessary condition for the implementation of advanced health management methods to improve the quality of health care for the people Military hospitals are a part of the country's healthcare system Based on the traditional, over the years, military hospitals have focused on building a team of qualified, experienced doctors, actively cooperating with leading experts in the country and some countries with advanced medicine in the world; investing in equipment and machinery, advanced and modern methods of diagnosis and treatment to improve the quality of examination, treatment for the patient Strictly implementing regulations on management and use of the State budget, dated February 13, 2018, the Minister of National Defense has issued Directive No 85/CT-BQP on financial autonomy for hospitals and medical examination facilities, medical treatment in the Army However, financial autonomy is a completely new mechanism for military hospitals, so when it comes to implementation, many complicated problems have arisen, especially interests and resolving the relationship of interests between the subjects This is a very important issue, if the relationship between interests is not well resolved, conflicts will arise Disagreement occurred within the hospital, and the efficiency of task performance decreased… all measures to promote the positivity, dynamism, and creativity of people and other resources in the construction of a military hospital will not bring the desired effect Conflict of interest is the main obstacle and negative impact on the long-term development of military medical hospitals in financial autonomy Stemming from the above reasons, the PhD candidate chooses the topic: “The relationship of interest in the implementation of financial autonomy in Military Hospitals (Through reality 103 Military Hospital)” to doctoral thesis research Research purpose and research task 2.1 Research purposes Clarifying the theory of the relationship of interests in the implementation of financial autonomy in military medical hospitals; on that basis, the thesis analyzes and assesses the reality of the relationship of interests in implementing financial autonomy in military hospitals through practice at Military Medical Hospital 103 and then proposes solutions to ensure a harmonious relationship of interests in the implementation of financial autonomy in military hospitals in general and 103 Military Hospital in particular 2.2 Research task To achieve the above research purpose, the thesis identifies the tasks that need to be performed: Firstly, an overview of the research situation, identify the content that other topics have studied and can inherit and confirm the thesis gaps that need further research Secondly, clarify some concepts related to the topic; interpret the concept, characteristics, content, and factors affecting the relationship of interests in implementing financial autonomy in military medical hospitals Thirdly, the analysis assesses the reality of the relationship of interest in the implementation of financial autonomy in military hospitals (through the practice of 103 Military Hospital) Point out the results and limitations on the relationship of interests in the implementation of financial autonomy, and find out the causes of those results, and limitations Fourthly, propose solutions to mainly contribute to ensuring a harmonious relationship of interests in the implementation of financial autonomy in Military Hospitals (According to the reality of 103 Military Medical Hospitals) the current Objects and limitations of the research scope of the thesis 3.1 Research subjects The research object of the thesis is the relationship of interests in the exercise of financial autonomy; basic interest relationships in the supply and use of medical examination and treatment services when military hospitals exercise financial autonomy 3.2 Limited scope of research About the content: The main research of the thesis is the relationship of interests in the implementation of financial autonomy in Military Hospitals (through the practice of 103 Military Hospital) However: Firstly, the thesis does not study all stages of the supply process and use services at military hospitals but only focuses on providing medical examination and treatment services; Secondly, the thesis does not study all subjects, but only four subjects and 03 relationships of interest that play the most important role in providing and using medical examination and treatment services, medical treatment when military hospitals exercise financial autonomy About time: The thesis studies the relationship of interest in implementing financial autonomy in Military Hospitals from early 2018 to December 2020 About space: Thesis of interest relationship research in implementing financial autonomy in Military Hospitals (Through the fact 103 Military Hospital) is mainly Theoretical basis and research methods 4.1 Theoretical basis The thesis is made based on the theoretical basis of Marxism - Leninism, Ho Chi Minh thought, opinions, the Party's guidelines and the State's policies on the relationship between interests and financial autonomy 4.2 Research Methods - The thesis uses the scientific abstraction method to research, at the same time combined with other methods such as the logical method combined with history, analysis and synthesis, using statistics and modeling for research - Specific research methods: Firstly, Collect data: For secondary data, the PhD candidate collects data from the annual summary report and an annual report summarizing party and political work of the Military Medical Department, Military Medical Hospital (concentrating on Military Medical Hospital 103), and figures published in Army journals For primary data, graduate students use the sociological investigation method through a survey by questionnaire Secondly, data processing: After collecting the data, the PhD candidate enters it into Excel software, and calculates absolute numbers and percentages to illustrate the analysis contents Thirdly, data analysis: From primary and secondary data collected by the Ph.D candidate using the synthesis method, compare, analyze and comment to clarify the relationship of benefits in implementing financial autonomy in military hospitals and 103 Military hospitals - In addition, PhD the candidate also conducts meetings, exchanges, and consults experts on the financial autonomy of military hospitals and the relationship of interests between the subjects The scientific and practical values of the thesis Firstly, the thesis provides a new approach to financial autonomy in military hospitals The approach of the thesis on the relationship of interests is done from the perspective of political economy to the field of financial autonomy Secondly, through research, and actual analysis, the thesis clarifies the reality of the relationship of interests in the implementation of financial autonomy in military hospitals There is a beneficial relationship between The subject of State management with military medical hospitals; the military hospitals with doctors in the hospital; medical doctors with patients From that point out the advantages, limitations, and causes advantages, the limitations in dealing with the relationship of interests when the military hospital exercises financial autonomy Thirdly, propose some comprehensive solutions and feasible to ensure a harmonious relationship of interests for the subjects participating in the process of implementing financial autonomy in military medical hospitals Structure of the thesis: In addition to the introduction, conclusion, list of references, and appendices, the thesis consists of chapters and 10 periods Chapter OVERVIEW OF RESEARCH WORKS RELATED TO THE THESIS 1.1 SCIENTIFIC RESEARCH WORKS RELATED TO THE THESIS TOPIC 1.1.1 Group of scientific works on the relationship of interest Works: “The Wealth of Nations" by Adam Smith; Principles of Political Economy and Taxation” by David Ricardo The book: “Relation of economic interests between workers, farmers, and intellectuals in Vietnam today” by Dang Quang Dinh; “Resolving the relationship of economic interests in the process of urbanization in our country today” (2013) by author Do Huy Ha Ngo Tuan Nghia with the project, “Relation of interests in the field of intellectual property in Vietnam's international economic integration” Nguyen Duy Phuc, “Creating and promoting healthy labor relations in small and medium-sized enterprises in Hanoi city” Dinh Thi Thanh Nga, “Contract for medical examination and treatment services under Vietnamese law” 1.1.2 Group of scientific works on financial autonomy and financial autonomy in public hospitals 1.1.2.1 Scientific research on financial autonomy - Scientific topic: “Scientific basis for perfecting the financial mechanism for private universities” by Dr Bui Van Hong; “Renovation of financial management to implement the financial autonomy mechanism to serve the requirements of a fundamental and comprehensive renovation of higher education of the Party and the State" by Dr Nguyen Hong Lien Tran Duc Can with the project “Improving the financial autonomy mechanism in Vietnamese public universities” Le Thi Thanh Tam, “Scientific basis for university management under the Ministry of Industry and Trade in the direction of autonomy and self-responsibility” Nguyen Tri Huong, “Financial autonomy at Ho Chi Minh National Academy of Politics” Cao Thanh Van, “Financial management mechanism at Can Tho University of Medicine and Pharmacy” 1.1.2.2 Scientific studies on financial autonomy in public hospitals - Article: “Autonomy and performance in the public sector: The experience of English NHS hospitals” by a group of authors including Verzulli, Jacobs, Goddard; “Autonomy Policy In Hospital Management” by a group of authors including Ana Rusmardiana, Mahyudin Ritonga, RiskaHediya Putri, Linda Puspita, NuryLuthfiyatil Fitri Report “Lessons for hospitals to exercise autonomy in Vietnam from international experience" by the Ministry of Health Tran The Cuong with the project, “Expanding financial autonomy for public hospitals in Vietnam" Do Duc Kien, “Study on the impact of financial autonomy on the quality of public hospitals in Vietnam” Seminar “Hospital autonomy: Improving the quality of medical examination and treatment” by the Ministry of Health 1.1.3 Group of scientific works on the relationship of interests in realizing financial autonomy Article: “Public hospital financial autonomy: Innovation from awareness to action” by Vietnam News Agency; “What does the director of Hospital K say about the implementation of hospital financial autonomy?” by Thai Binh author; “Autonomous hospital: Problems arise” by Duong Ngan 1.2 OVERVIEW OF RESULTS OF RESEARCH WORKS RELATED TO THE THESIS AND ISSUES WHICH THESIS RESEARCH CONCENTRATION 1.2.1 Overview of the results of scientific research works related to the thesis topic - Theoretical basis All works have research, quite systematic analysis to clarify the concept of benefits, financial autonomy in general in each field, and each specific relationship that the research work Studies show that interest is a political-economic category, where there are production and business activities, there is a relationship of interest and the subject of production and business is the subject of the relationship of interest The authors also argue that dealing with an interesting relationship is a complicated matter, if not handled correctly, inconsistency will affect the interests of the parties involved and their relationship in the process of production and business The authors have clarified and affirmed the role and importance of benefits for each individual, that is the motivation for each employee to strive for selfimprovement, thereby promoting the development of productive forces Studies have provided, clarify the rationale for benefits and the relationship of interests in the market economy in general and in financial autonomy in public hospitals in particular - Practical basis The studies on financial autonomy, although not directly analyzed, clarify the interests of stakeholders when participating in financial autonomy activities, but indirectly showed that when public non-business units exercise financial autonomy, all positive aspects bring certain benefits to the subjects Studies show that n fact, the relationship of interest plays an important role in maintaining, and strengthening relationships between subjects when participating in production and business activities or providing all kinds of services The reality of the beneficial relationships under many different research angles, including personal interests, collectively, the society has been clarified by the analytical works with specific proofs, giving the author an overview of the reality of the beneficial relationships among the stakeholders in society Thereby, the author has thoughts and determines the practical research direction of the topic, the source of data to be approached, the plan to collect data and survey the status of the relationship of interests in the implementation of financial autonomy in military medical diseases Proposing solutions to the above research work is also the basis for the author to continue to perfect solutions to harmonize the relationship of interests from the perspective of financial autonomy in military hospitals in the context of the current socialist-oriented market economy Thus, it can be said that the aforementioned studies have mentioned many contents about the benefits, and relationship of interests from different angles, in many different fields, but they all share the same view of interests, and harmony in the relationship of interests are the driving force behind organizations and individual action However, there has not been any comprehensive study on the beneficial relationship in financial autonomy, especially the benefits relationship in financial autonomy in military hospitals Therefore, many contents on this issue have not been studied, this is a gap that the researcher must continue to study 1.2.2 Issues the thesis focuses on in research Firstly, to further clarify the theory of the relationship of interest, financial autonomy, and building a theoretical framework on the relationship of interests in implementing financial autonomy in military medical hospitals The thesis needs to identify the basic interest subjects and the relationship of interests between the subjects in the implementation of financial autonomy in Military Hospitals Secondly, the thesis deeply analyzes the contents and factors affecting the relationship of benefits in implementing financial autonomy in military hospitals At the same time, the thesis studies the experience of several military hospitals in ensuring a harmonious relationship of interests in implementing financial autonomy and drawing some reference lessons for military hospitals in general and Military Hospital 103 in particular Thirdly, from the basic contents identified and clarified in the theoretical basis; the thesis examines the reality of the relationship of interests between the subjects to analyze and evaluate the relationship of interests in the implementation of financial autonomy in military hospitals (through the fact 103 Military Hospital), to see the results achieved and limited problems in the relationship of interests when implementing financial autonomy in military hospitals From there point out the causes of the results and limitations of the relationship of interests in implementing financial autonomy in military medical hospitals Fourthly, through recognizing the limitations, and the causes of the limitations from the actual situation, the thesis gives viewpoints and proposes solutions to ensure a harmonious relationship of interests in implementing financial autonomy in military hospitals in the following years Chapter THEORETICAL AND PRACTICAL BASIS FOR THE RELATIONSHIP OF INTERESTS IN THE IMPLEMENTATION OF FINANCIAL AUTHORITY IN MILITARY HOSPITALS 2.1 SOME BASIC ISSUES ON THE RELATIONSHIP OF INTERESTS AND FINANCIAL AUTHORITY IN PUBLIC HOSPITALS 2.1.1 Relationships of interest in public hospitals - Benefit Approach from the perspective of political economy: the main benefit is the satisfaction of needs More specifically, benefits stem from needs, are something to meet needs, and needs give rise to benefits - Relationship of interest According to the Advanced Curriculum, the main theory: “Interesting relations are links with beneficial goals that are consciously established in the process of interaction between members of society on a certain economic basis” - Relationships of interest in public hospitals According to the PhD candidate: Relationships of interest in public hospitals are the establishment of an interactive relationship to achieve legitimate interests between entities in the process of providing and using medical services 2.1.2 Financial autonomy in public hospitals According to the PhD candidate: Financial autonomy for public hospitals is hospitals that are empowered to make their own decisions, and selfresponsibility according to the degree of autonomy in revenues, expenses, and other resources of their units within the framework prescribed by law 2.1.3 The concept of the relationship of interests in the implementation of financial autonomy in Military Hospitals Inheriting scientific works that have studied the benefits, the relationship of interests and financial autonomy, drawing experience from practice, the PhD candidate said that: The relationship of interests in the implementation of financial autonomy in military hospitals is the establishment of conscious interactions of interests between the subjects involved in the process of providing and using medical services, medical treatment when military hospitals exercise financial autonomy to improve the quality of medical examination and treatment services, cure the sick 2.2 CHARACTERISTICS, CONTENTS AND FACTORS AFFECTING THE RELATIONSHIP OF INTERESTS IN FINANCIAL AUTHORITY IN MILITARY HOSPITAL 2.2.1 Features of the relationship of interests in realizing financial autonomy in Military Hospitals Firstly, the beneficial relationship between management agencies and military hospitals is not just a common interest but also the benefit of ensuring that the army's potential can well meet the ability to change the state of combat readiness when situations arise Secondly, the beneficial relationship between the military hospital and the doctors in the hospital is not merely the relationship of interest between the collective and the individual but also the beneficial relationship between a military unit and its soldiers Thirdly, the relationship of interest between doctors in a military hospital and patients is the relationship between the army and the people about benefits in the process of providing and using medical examination and treatment services Fourthly, military hospitals have just implemented financial autonomy in providing medical examination and treatment services medical treatment, while performing the mission of training soldiers' combat readiness and participating in international military medical missions, should deal with the relationship of interests that differ in each task 2.2.2 Content of the relationship of interests in the implementation of financial autonomy in Military Hospitals 2.2.2.1 The relationship of interests between the State subject and Military Hospitals in the exercise of financial autonomy The relationship of interests between the State subject and military hospitals is a condition for harmoniously settling the relationship of interests between subjects in the provision and use of medical examination and treatment services, medical treatment when military hospitals exercise financial autonomy This relationship, through directives, resolutions, regulations, etc., creates a legal mechanism for interest owners to base their interests on and supervise the realization of the interests of other actors Financial autonomy contributes to reducing the state budget for annual recurrent expenditures for military hospitals and facilitates the Army to invest in other units Military medical hospitals in the implementation of financial autonomy and self-balancing revenue-expenditure and must deduct from the budget a prescribed amount depending on the size and operations of each hospital When self-financed, military hospitals must make estimates and have specific plans, and not depend too much on the upper management agency Although military hospitals are financially self-sufficient, they are still part of the Army's payroll organization, when there is a situation or when there is a request from the superiors, the hospitals are ready to change the status from providing services to performing military-defense tasks according to regulations Operation principle: all activities of military medical hospitals are reflected through the annual plan and approved by the competent authority, uniformly managed from top to bottom Financial activities must ensure publicity and transparency to exercise the supervision and inspection rights of functional agencies, military personnel, and defense workers in the process of distributing, managing, and using capital and assets of the State, the Army, and hospital revenues, effectively implementing the Law on thrift practice, anti-waste, and anti-corruption law 11 2.3.1 Experience in ensuring a harmonious relationship of interests in implementing financial autonomy in some military hospitals 2.3.1.1 Experience of Eastern Military Hospital Firstly, there is always the close attention and direction of leaders and commanders at all levels; good ideological work, and create a high consensus in awareness and action Secondly, to build, promulgate and organize well the implementation of the regimes, policies, and regulations to ensure effective operation Thirdly, constantly improve the quality management of examination, treatment, and development of information technology in the activities of the Hospital Fourthly, focus on social work and communication activities Fifthly, along with financial autonomy, the hospital always pays attention to well implementing the tasks of military-defense work 2.3.1.2 Experience of 175 Military Hospital Firstly, the requirement is to make every cadre, hospital staff, especially the staff in charge, understand the roles, purposes, requirements, the content of dealing with the relationship of interests in the financial autonomy mechanism; hold the goal, guiding views and tasks and solutions determined by the Central Military Commission and the Ministry of National Defense Secondly, based on the thematic resolution of the Hospital Party Committee on “financial autonomy”, Party committees and commanders at all levels organize thoroughly and concretize into targets and measures in the resolutions of their respective leaders Thirdly, the hospital focuses on “Innovating service style and attitude towards patient satisfaction”; strictly implementing the Code of Conduct of medical staff; reforming the reception process, instructing the patient; deploying the reception room system, suggestion box, and hotline 2.3.2 Lessons learned for military hospitals in general and 103 Military Hospitals in particular on ensuring the harmonization of the relationship of interests in realizing financial autonomy Through empirical research on the settlement of interest relationships in last-line public hospitals, financial autonomy has been practiced for a long time, some lessons can be drawn for military hospitals in general and 103 military hospitals in particular regarding the settlement of the relationship of interests in the exercise of financial autonomy as follows: Firstly, there is an adjustment of the direct relationship between the management agency and military hospitals Secondly, minimize the risks related to personal benefits brought about by the financial autonomy mechanism Thirdly, improve patient satisfaction in medical examination and treatment Fourthly, strengthen inspection work, supervise the harmonization of the relationship of interests between the subjects of the hospital 12 Chapter THE CURRENT STATUS OF THE RELATIONSHIP OF INTEREST IN THE IMPLEMENTATION OF FINANCIAL AUTONOMY IN MILITARY HOSPITALS (THROUGH REALITY 103 MILITARY HOSPITALS) 3.1 OVERVIEW OF THE ACTUAL SITUATION OF IMPLEMENTING FINANCIAL AUTHORITY IN MILITARY HOSPITALS FROM 2018 - 2021 Implementing the Government's Decree No 16/2015/ND-CP dated February 14, 2015, on regulating the autonomy mechanism of public nonbusiness units; Directive No 85/CT-BQP dated February 13, 2018, of the Ministry of National Defense on financial autonomy for hospitals and medical examination and treatment facilities in the Army In 2018, there were 29 hospitals in the Army that started implementing the financial autonomy mechanism under the decision of the Minister of National Defense When implementing financial autonomy, the system of documents of the State and the Army meets the orientation of the autonomy roadmap, helping hospitals to implement autonomy is relatively convenient in terms of legislation, there is a basis to resolve the relationship of interests between the subjects Next, hospitals are allowed to actively expand various types of revenuegenerating activities to ensure financial resources, actively mobilize capital sources, and allocate and use financial resources reasonably Stable source of income, hospitals have invested in purchasing modern equipment, developing technical expertise, improving the quality of examination and treatment, improving patient satisfaction, building a brand, increase income for the team of doctors Currently, the number of people using health insurance cards in military hospitals tends to increase Currently, all hospitals have ensured enough salary and allowances according to ranks and grades for officials and employees working in the hospital Many hospitals pay extra income for staff, hospital staff in the following year was higher than in the previous year and higher than in the years when financial autonomy was not practiced In which, 8/29 hospitals have an additional income of from 36 to 128 million VND/person/year; 4/29 hospitals have an additional income of less than 12 million VND/person/year; 3/29 hospitals have not yet created a source to spend additional income According to statistics, only after the hospital implemented financial autonomy for a short time until September 2018 reduced defense budget spending for military hospitals by VND 1,350 billion However, this is the first time that military hospitals in general, Military Medical Hospital 103 in particular exercises financial autonomy, so there are still some limitations such as: The financial autonomy mechanism in military hospitals is a new issue involving many fields; Meanwhile, the legal documents of the Ministry of National Defense guiding incomplete, and synchronous, especially those that affect the interests of the subjects 13 During the initial period of self-financing, many hospitals are still confused in allocating funds to ensure the performance of their assigned tasks, between the hospital's revenue and the state budget Some doctors working at some hospitals have not been able to balance revenue and expenditure therefore, without additional income, I have unstable thoughts, and comparisons, and want to apply for a job change Some patients are not satisfied with some military hospitals with degraded infrastructure, and unmodern equipment, while the hospital still charges according to the general service tariff 3.2 THE CURRENT SITUATION OF THE RELATIONSHIP OF INTERESTS IN THE IMPLEMENTATION OF FINANCIAL AUTONOMY AT 103 MILITARY HOSPITALS IN THE PERIOD 2018 - 2020 Over 70 years of construction and growth, Military Hospital 103 is a unit with many important successes, continuously enrolling in the history of the country's medicine, in the region, and the world Doctors of Military Hospital 103 have successfully “conquered” many difficult organ transplants, such as the first kidney transplant in Vietnam (1992), the first liver transplant (2004), heart transplant (2010), multi-organ (pancreatic-kidney) transplant in 2014, lung transplant in 2017, bowel transplant (in 2020) With those achievements, the hospital has been awarded the title of Hero of the People's Armed Forces three times by the State and many other noble awards The reality of the relationship of interests in implementing financial autonomy at 103 military hospitals has advantages and many difficulties, specifically expressed as follows: 3.2.1 The relationship of interests between state agencies with 103 Military Hospital Under the close attention, leadership, and direction of the Central Military Party Committee, the Ministry of National Defense, the implementation of Directive 85/CT-BQP is an important milestone for Military Medical Hospital 103, represents the innovative thinking of the Decision for the hospital, is the process of bringing the Party's resolutions and the Government's decrees to life Directive 85/CT-BQP is also an important legal basis for ownership and distribution for hospitals to satisfactorily settle the relationship of interests between the subjects, timely response to the requirements of the market economy, creating a strong driving force to promote development and bring the best benefits, create a new relationship between subjects This is the period with the most open policy for subjects participating in the examination and treatment process at Military Medical Hospital 103 Resolutions and directives of the Central Military Party Committee, the Ministry of National Defense for hospitals, gradually institutionalized in all aspects, specific regimes and policies such as organizing payroll, hospital beds, regimes for doctors and patients, 14 Closely combining economic construction and development with defense consolidation will create a new position and force for the Army in general and the hospital in particular The Hospital has actively used state budget funds to perform its tasks effectively; at the same time actively use assets, and human resources to develop and improve the quantity and quality of activities providing medical examination and treatment services, medical treatment, thereby reducing the state budget allocation and increasing the payment to the state budget Table 3.3: Data provided and paid to the state budget annually of 103 Military Hospital (Unit: billion) Year Content State budget for hospitals The hospital pays the state budget 2016 2017 2018 2019 2020 244 251 253 141 125 1.9 2.5 10.8 15.2 19.5 Source: Author compiled from the report of 103 Military Hospital 3.2.2 Relationship of benefits between 103 Military Hospital with a team of doctors - Firstly, the spirit of solidarity in the hospital is enhanced Solidarity can only be achieved when the relationship of interests is harmoniously resolved Seeing this clearly, the hospital's regulations and regulations related to the interests of the subjects were built based on resolutions and directives of the Army and the Ministry of Health; promote democracy, encourage and respect creativity, and democratic discussion and debate to promote the wisdom of the entire hospital, of each cadre and party member in formulating and requesting approval of regulations and regulations The democratic dialogue regime is implemented in an orderly manner, twice a year From the democracy of the hospital, the collective wisdom of the team of doctors and staff is promoted Therefore, all activities of the hospital have unity, consensus, and high determination, the number of applications to transfer out is decreasing, the number of applications to the hospital for work is increasing, and the number of working hours is increasing Table 3.4 New employee data to be transferred and received Content Please move out New reception Extend working time 2016 10 23 2017 11 38 2018 41 Source: 103 Military Hospital 2019 14 34 2020 24 39 15 - Secondly, the relationship of interests in the economic field, and politics is gradually resolved harmoniously Economic: On May 15, 2018, the Hospital issued Decision No 460/QD HVQY103 on the establishment of the Salary Council; established internal spending regulations, in 2020, the hospital has put into use new central buildings; invest in more modern machines with a great cost The income survey of the medical staff at the hospital showed that 32% had an income increase of 11 - 20%, 56% of income increased from 21 - 30%, and 12% of income increased by over 31% compared to before financial autonomy; 76% think that this level of income is quite enough for living needs About politics: The hospital has rearranged personnel, scientifically arranged work, effectively use human resources, ensure the rights and interests of the subjects, focus on training, fostering, and improving the qualifications of the medical staff in the hospital, and building a team of medical staff who are increasingly capable of taking on more of the hospital's work The actual survey showed that: 87% of the respondents said that standards, regimes, policies, the income level is suitable for the task requirements, 8.3% think that it is quite suitable and only 4.7% think that it is not suitable In the years from 2016 to 2020, the hospital sent 137 comrades to graduate training and 215 comrades to improve professional qualifications Particular: Table 3.6 Data on sending staff for training and retraining Content 2016 2017 2018 2019 Postgraduate training 24 46 53 28 Professional training, 42 61 35 28 new techniques 2020 35 39 Source: 103 Military Hospital 3.2.3 The beneficial relationship between physician and patient When 103 Military Hospital implemented financial autonomy, the doctorpatient relationship was raised to a new level, this is both a requirement and also shows that the relationship of interests is effectively resolved Express: - Firstly, the quality of the medical team has been improved In the hospital's financial autonomy mechanism, to deserve the benefits they receive, stand firm in the new environment, meeting the requirements of satisfying more and more patients' needs, the doctors in the hospital are always proactive, and actively improve their professional qualifications The quality of the research projects that have been tested and accepted is high, in which the topic received high appreciation from the leaders of the State and the health sector From that research, there have been many new techniques successfully developed at various levels: 16 Table 3.10 Number of new techniques deployed 150 106 100 50 67 27 38 2016 2017 2018 2019 Source: Report on annual task performance of 103 Military Hospital - Secondly, the relationship between doctors and patients is getting better and better 100% of doctors self-identified that they often treat patients equally, and 91.4% self-identified as having a considerate attitude and being gentle with the patient This is also quite similar to the patient's comments to the doctor Up to 88.4% of patients said that the doctors had fully guided them when doing the examination and admission procedures; 90.2% of patients rated the doctors as attentive, welcoming, and ready to help patients; 92.8% had full instructions on how to take the drug, issues to monitor before and after taking the drug; the consultation and explanation before performing the techniques and procedures on the patients of the doctors are evaluated, full is 95.4%; the patient's sympathy for illness and pain was 86.5%.… The above results show that the attitude of the medical staff is rated relatively well by the patients and has changed a lot compared to the result of 82.4% having a good attitude surveyed in 2016 by the hospital - Thirdly, the needs of the patient when participating in the examination process and more and more satisfying treatment When patients are satisfied more than their needs, they will have confidence in the hospital's medical team and the hospital will attract more and more patients Reality has confirmed this more clearly since the hospital implemented financial autonomy Table 3.8 Number of patients examined and treated Content 2016 2017 2018 2019 2020 Medical examination Treat Surgery in the operating room Type surgery 355.126 47.557 394.521 51.000 500.536 51.993 565.695 54.545 504.303 46.998 13.027 13.888 15.928 16.835 14.726 8.874 9.121 9.970 9.689 8.934 Source: Summary report on annual task performance of 103 Military Hospital 17 3.3 THE GENERAL ASSESSMENT OF THE STATUS OF THE RELATIONSHIP OF INTERESTS IN IMPLEMENTING FINANCIAL AUTHORITY AT 103 MILITARY HOSPITAL 3.3.1 Achievements and causes 3.3.1.1 These achievements Firstly, ensuring a harmonious relationship of interests, so the hospital has successfully implemented the great policy of the Army, reducing annual hospital budget expenditures Secondly, ensure the harmony of interests between the Hospital and the team of doctors in the hospital Thirdly, the doctor-patient relationship is getting better and better Fourthly, harmonize interests, hospitals are growing, and patient satisfaction is increasing 3.3.1.2 The reason for the results achieved - Objective reasons Firstly, our Party and State always have a policy, the right way to deal with the relationship of interest Secondly, the hospital always receives the attention, leadership, and direction of the Central Military Party Committee, the Ministry of National Defense in the course of performing its tasks and the attention, guidance, and support of superior professional agencies Thirdly, the hospital has a tradition of more than 70 years of construction and development - Subjective reasons Firstly, the Party Committee and Board of Directors of 103 Military Hospital have many policies, and correct leadership measures to resolve the relationship of interests in realizing financial autonomy Secondly, the hospital's medical team has a strong political will with basic training, a high professional level, meeting the requirements of immediate and long-term tasks Thirdly, promote the strength, role, and responsibility of mass organizations in the hospitals 3.3.2 Limitations and reasons 3.3.2.1 Limitations The process of resolving the relationship of interests in the exercise of financial autonomy at Military Medical Hospital 103 has certain limitations Specifically: Firstly, the issuance of specific legal documents by the management agency as a basis for the hospital to harmoniously settle the relationship of interests in the implementation of financial autonomy is inadequate Secondly, deal with the relationship between individual interests and collective interests financial autonomy in the Hospital is sometimes not harmonized 18 Thirdly, sometimes there are still signs of inconsistency in benefits between doctors and patients Fourthly, in realizing the hospital's financial autonomy and the patient will sometimes have contradictions 3.3.2.2 The cause of the limitations - Objective reasons Firstly, the work of understanding, informing, and propaganda mainly to clarify the goals, requirements, and contents of financial autonomy, but the benefits of hospital self-financing have not been clarified Secondly, although financial autonomy is allowed in military hospitals, it is still necessary to ensure the implementation of the task of strengthening national defense and security in the new situation therefore, policies cannot only be for the sake of solving the interests of the subjects, but also must meet the task of building and defending the Fatherland of the Army Thirdly, the State's regulations on health service prices only account for 4/7 of direct costs and have not been adjusted in time according to reality, so conflicts of interest have arisen - Subjective reasons Firstly, there is still limited awareness of some medical staff on renovating the mechanism from centralizing subsidies to implementing financial autonomy Secondly, during the initial period of implementing financial autonomy, the Party committees and commanders of several faculties, the hospital's wards have not been deeply aware of the policy of implementing autonomy, and have not seen the rights, responsibilities, and interests, so they are still afraid Thirdly, the interests of the subjects in implementing financial autonomy in the departments and rooms in the hospital are not equal and have only been successful in certain departments Fourthly, at present, the hospital bed utilization rate is often above 100%, so it is always overloaded, thus leading to a shortage of specialized machinery, and doctors have to work too hard…, making patients not fully enjoy their legitimate rights Fifthly, the fact that the doctor is always in a state of stress, so it is difficult to avoid the consequences affecting the spirit, and the service attitude of the doctor, thereby easily causing conflicts between the doctor and the patient On the other hand, some patients when coming for examination and treatment also have an inappropriate attitude, they always set high demands, even beyond the ability of the physician 19 Chapter PERSPECTIVES AND SOLUTIONS TO ENSURE A HARMONIOUS RELATIONSHIP OF IN INTERESTS IN IMPLEMENTING FINANCIAL AUTHORITY IN MILITARY HOSPITALS IN GENERAL, MILITARY HOSPITAL 103 IN PARTICULAR 4.1 FORECASTING TRENDS AND PERSPECTIVES AND SOLUTIONS TO ENSURE A HARMONIOUS RELATIONSHIP OF IN INTERESTS IN IMPLEMENTING FINANCIAL AUTHORITY IN MILITARY HOSPITALS IN GENERAL, MILITARY HOSPITAL 103 IN PARTICULAR 4.1.1 Forecasting trends to ensure harmonization of the relationship of interests in implementing financial autonomy in Military Hospitals The current, interests between entities are intertwined based on both cooperation, and competition with each other in the market economy But the big trend is cooperation and development, but also contains instability, conflict takes many forms and is complex For the Army: In the following years, continue to implement the project: Renovating the financial mechanism according to the Law on State Budget The settlement and implementation of benefits are regularly added and renewed However, hostile and reactionary forces continued to promote anti-sabotage activities, denying the Army's economic construction function; the adjustment of force organization in economic units, also directly affects the thought and life of a part of officials, employees and employees For military hospitals: Financial autonomy is an inevitable trend in the development of military medical hospitals to match the general trend of public non-business units Next to the advantages, dealing with the benefits of financial autonomy in hospitals will also face difficulties and challenges For the medical team: Continue to maintain political bravery, have medical ethics, and be an ethically pure, clean, and healthy lifestyle When military medical hospitals implemented the financial autonomy mechanism came to completion, the belief, love of the industry, love of the profession, a long-term attachment to the military medical profession, etc of the medical staff are increasingly confirmed However, besides the positive side, the impact of the negative side of the market economy on the quality, and the capacity of military medical staff is also very complicated, and not easy to overcome immediately For patients: As the economic life of the people is growing, the demand for health care of the people also increases in both quantity and quality Along with that, Vietnam is currently at the stage of population aging with an increasing proportion and number of elderly people, this will further increase the health care needs of the people In the context of, that trend, ensuring the harmonization of the relationship of interests and financial autonomy in military hospitals should be based on specific perspectives and solutions 20 4.1.2 The basic point of view to ensure the harmonization of the relationship of interests in implementing financial autonomy in Military Hospitals Firstly, to ensure the harmony of interests among stakeholders based on strict compliance with the laws of the State and military regulations Secondly, solving the relationship of interests in the implementation of financial autonomy in military hospitals needs to ensure fairness between the subjects Thirdly, ensure the harmonization of the relationship of interests between the subjects in implementing financial autonomy based on improving the quality of medical examination and treatment services of the hospital Fourthly, harmonize the relationship of interests in the exercise of financial autonomy based on patient-oriented, patient-centered 4.2 SOLUTIONS TO ENSURE A HARMONIOUS RELATIONSHIP OF IN INTERESTS IN IMPLEMENTING FINANCIAL AUTHORITY IN MILITARY HOSPITALS IN GENERAL, MILITARY HOSPITAL 103 IN PARTICULAR 4.2.1 Strengthen propaganda work, raise awareness of stakeholders in resolving interest relationships in implementing financial autonomy in Military Hospitals 4.2.1.1 Strengthening propaganda work, educating stakeholders to clearly understand the need for a harmonious settlement of the relationship of interests in implementing financial autonomy in military hospitals To propagate and educate effectively, those who directly propaganda must firmly grasp the propaganda contents; characteristics of the target audience Propaganda content is short, profound, practical, and specific The form of propaganda is easy to understand and implement The purpose of propaganda and education is to help stakeholders be fully aware of the benefits they can gain when hospitals transition to financial autonomy, especially potential, long-term benefits At the same time, it is necessary to propagate and educate the subjects to determine the right position, their role in the relationship of interests between the subjects, and get benefits commensurate with the position, that role, thereby creating unity and consensus among the subjects in the relationship 4.2.1.2 Expanding and renewing forms and methods of propaganda - Enhance the quality and quantity of articles on specialized pages, categories, and topics of specialized journalism related to financial autonomy and the benefits of implementing financial autonomy in hospitals in the Army Timely conveying information through news columns, reportage, and quick recording in radio and television programs of the Army, especially defense and security television channels Conduct communication on the hospital's fan page and website about the hospital's successes and difficulties in implementing financial autonomy so that the subjects understand, strive, and share Through this communication channel, the hospital has provided accurate information to the subjects, avoiding unnecessary misunderstandings and doubts 21 - On the other hand, propaganda should be carried out regularly, continuously associated with forecasting the situation and focus propaganda on “hot spots” about conflicts of interest 4.2.2 Promoting the leadership and direction capacity of the Party Committees of the hospitals in resolving the relationship of interests when the hospitals exercise financial autonomy - Party committees at all levels need to strictly implement working regulations and leadership regulations on key aspects; keep holding on and strengthen the absolute, direct leadership in all aspects of the Party Committee over the activities of the Hospital Well implement the principles of democratic centralism, leadership, and direction, and deploy the formulation and implementation of democratic regulations at the grassroots to ensure efficiency - Party committees at all levels must show their real role in leading cadre work, and directly managing the contingent of cadres Strictly, openly and transparently implementing regulations on personnel management in all stages, without allowing any mistakes or negative effects - At the same time, Party committees at all levels actively carry out inspection, supervision, and enforcement of party discipline, and settle complaints and denunciations according to the Party's regulations to prevent and prevent major defects and violations of the party organization and its members Strengthening inspection and supervision to ensure public, transparent, and efficient use of finance 4.2.3 Institutionalize the rights and responsibilities of each subject to resolve the relationship of interest The rights and responsibilities of the subjects in the settlement of the interesting relationship are very important In the relationship of interests, the subjects need to know their rights and responsibilities to have a sense of implementation - For state management agencies of military medical hospitals in the Army Firstly, the fact that the Army assigns financial autonomy to military medical hospitals does not mean white-out for hospitals In carrying out the tasks that the hospitals are financially self-sufficient, they still have to strictly comply with the regimes prescribed by the Army Secondly, strengthening inspection work, supervising the operation of hospitals, and the quality of medical examination and treatment services provided Capture and record the feedback of patients and patients' families about the quality of examination services, and treatment, so that there are timely corrective solutions- For military hospitals It is necessary to be self-aware and well implement the provisions of the law in their interests about the interests of the other subjects It is necessary to develop a hospital development strategy in the short term and long-term in line with the development strategy of the Army and the health sector 22 Internal inspection and control is an objective requirement for military medical hospitals in financial autonomy Hospitals need to strictly publicize the price list of medical examination and treatment services after being approved by the competent authority Assign tasks, and properly and fully identify the rights and responsibilities of individuals according to the hierarchy and each job position Promote the roles and responsibilities of mass organizations such as military councils, trade unions, etc - For the team of military doctors It takes effort, striving to train and improve professional qualifications and experience in examination and treatment, changing attitudes towards patients and their family members; struggling with negative manifestations, violates the legitimate interests of themselves and other subjects Actively changing, proactively adapting, and ready to receive and complete the task under all conditions Build yourself a firm stance and ideology, and clearly define your responsibilities to yourself, the hospital, and society in the process of transforming the hospital's mechanism Training in moral qualities, regular lifestyle, culture, civility in communication and behavior, keeping a calm, friendly attitude, and proper manners in examining and treating patients - For the patient Firstly, patients need to be sure of their rights and obligations when going for medical examination and treatment The 2009 Law on Medical Examination and Treatment is the highest legal document that stipulates the right to and obligations of the patient, the main subject of medical examination and treatment activities Secondly, the patient needs to provide complete and accurate information to help the medical team make the best examination and treatment options The patient's attitude to the medical team needs respect from both sides In addition, patients need to strictly abide by the rules of the hospital Thirdly, people need to raise awareness and be proactive in buying health insurance 4.2.4 Harmonize the relationship of interests in realizing financial autonomy in Military Hospitals by the conditions of the socialist-oriented market economy in our country the current Firstly, to solve the problem of salary and allowances for the medical team and staff working in the hospital ensure appropriate, effective, and fair To implement a fair wage policy to be effective and efficient, military hospitals with financial autonomy need to amend and improve the salary policy, and internal spending regulations to suit the actual situation In the process of formulating the policy of salary and additional income, taking into account the performance of military-defense tasks 23 Secondly, harmonize the relationship of interests between the subjects in the joint venture and association Management agencies and military hospitals need to have specific regulations on joint ventures, linking with partners to ensure compliance with the regulations of the State and the Army but also does not cause difficulties for the joint venture process The joint venture information must be disclosed to the responsible parties before and after the transaction The hospital's supervisory boards and branches strengthen supervision and ensure the harmonization of interests Thirdly, to settle harmoniously when there are conflicts of interest Situations of “conflict of interest” may occur between subjects in the process of providing medical examination and treatment services at military medical hospitals in financial autonomy To control “conflict of interest”, it is necessary to: strengthen propaganda and education activities to raise the awareness of stakeholders about laws and regulations in the health sector, medical ethics, and hospital regulations Handle “conflict of interest” situations by the law and the agreement between the parties Fourthly, improving the quality and ethics of the medical team as well as the image of the revolutionary soldier in the market economy First of all, attach importance to the traditional ethical education of the health sector: The study, follows the Hippocratic oath, oath, and medical ethics of the great physician Hai Thuong Lan Ong, especially Uncle Ho's thought on medical ethics The hospital committees, leaders, and departments need to innovate in current medical ethics education, it is necessary to have an appropriate analysis of the relationship between the physician's sacrifice and dedication with the physician's “survival” concern At the same time, strictly handle violations of professional regulations and professional ethics, infringing upon the interests of other subjects A physician must always build and practice medical ethics by himself: Must have compassion, be willing to save the sick, and most importantly put the interests, of the patient's life above his interests 4.2.5 Taking patient satisfaction as the center in resolving the relationship of interest when Military Hospitals exercise financial autonomy For the patient to be delighted when entering the clinic, for medical treatment at military hospitals, hospitals need to the following things well: Dedicated and enthusiastic with patients Improve communication and behavioral skills Provide complete and necessary information Ensure fairness and transparency Ensure patient safety Reduce waiting time 24 CONCLUSION Solve and implement well the relationship of interests between the subjects in the implementation of financial autonomy in military hospitals in general and 103 Military Hospital, in particular, is one of the vast and complex issues of theoretical significance and practices are important to promote positivity, initiative, and creativity of the team of doctors and military hospitals to improve the quality of examination and treatment for patients, uphold the tradition and continue to build a good image of military hospitals in particular and the military in general as well as contribute to the development of the country's health sector The PhD candidate has developed the concept of the relationship of interests in the implementation of financial autonomy in military medical hospitals From that point of view, the main subjects, characteristics, and content of the beneficial relationship between the subjects in the provision and use of military medical examination and treatment services are clarified On that basis, the thesis points out several factors affecting the above beneficial relationships The thesis has studied in general the implementation of financial autonomy in military medical hospitals; in in-depth analysis, data are demonstrating the status of solving the relationship of interests in the exercise of financial autonomy at 103 military hospitals, which is specifically expressed through three basic interest relationships From there, draw the achieved results, and the remaining limitations and find out the causes of that situation To harmoniously settle the relationship of interests in implementing financial autonomy in military hospitals, the thesis proposes several solutions that are feasible in practice The solutions, which directly affect the will, the belief, and determination of the stakeholders; strongly promote positivity, initiative, and creativity of the team of doctors, and contribute to enhancing the prestige and strength of the Army The relationship of interests in implementing financial autonomy in military hospitals is a new topic, has a fairly large scale, and researches in a relatively sensitive field, so it requires systematic and basic research in many different fields Based on the initial research contents and results, the PhD candidate will continue to supplement, expand and develop further research issues, and contribute to clarifying the theoretical and practical bases surrounding the issue of interest relationships in the construction of military hospitals, military construction, strengthening national defense and firmly defend the Socialist Fatherland 25 LIST OF PUBLISHED WORKS OF THE AUTHOR RELATED TO THE THESIS Nguyen Duc Hung (2018), “The role of military medical examination and treatment services in the socialist-oriented market economy”, Asia-Pacific Economic Review, No 516, pp.51-53 Nguyen Duc Hung (2020), “Beneficial relationship in handling finance independently in military hospitals”, Review of finance, Vol.3, Issue 4, pp.42-44 Nguyen Duc Hung (2020), “Characteristics of the relationship of interests in the implementation of financial autonomy in military medical hospitals”, Asia-Pacific Economic Review, No 578, pp.67 -69 Nguyen Duc Hung (2021), “Basic factors affecting the relationship of interest in realizing financial autonomy in military medical hospitals”, AsiaPacific Economic Review, No 593, pp.72-74 ... illustrate the analysis contents Thirdly, data analysis: From primary and secondary data collected by the Ph.D candidate using the synthesis method, compare, analyze and comment to clarify the relationship... university management under the Ministry of Industry and Trade in the direction of autonomy and self-responsibility” Nguyen Tri Huong, “Financial autonomy at Ho Chi Minh National Academy of Politics”... autonomy in Military Hospitals (through the practice of 103 Military Hospital) However: Firstly, the thesis does not study all stages of the supply process and use services at military hospitals