Evaluation of allocation and use of health financing in Nam Dinh Province:  Luận văn ThS. Hành chính công (Chương trình đào tạo thí điểm)

UPPSALA UIN1VERSITĨT UPPSALA UNIVERSITÉT& IMU UNIVERSITY OF ECONOMICS & BUSINESS VNU-UEB 1ASTER THESỈS OF MPPM EViUATION OF ALLOCATION ANB SE OF HEALTH FINANCING 11 NAM DINH PROVINCE A u lh o r: Ninh Thi Hoai Thu Supervisor: Dr H ans Blom kvist l.ocul Supervisor: I)r N gu yên Phu Ha Cíass: MPPM INTAKE ỉ f u ■- Ị iv:-: - • V •: I i Hanoi, January - 2015 Acknovvledgements The thesis has been carried out by thc author NinhThiHoai Thu in the ìmevvork o f the M aster’s degree program o f Public M anagement -U p p sala Jẩversity It is certain that the thesis vvould not be fulfill well without the ỉnhusiastic help o f the Svvedish and Vietnamese instructors and a number o f eders and governmental officials o f institutions related to the research field I am m uch obliged to Dr Hans Blomkvist - Uppsala University, Svveden vb has offered very clearly oriented guides in the process o f my selecting oúcs and launching research, Dr Nguyen Phu Ha, leading me in the esarch process, giving me more knovvledge and helping me resolve liíìcultiesduring the whole process I sincerely thank the lectures who were enthusiastic to impart useful navledge ot' the public m anagem ent o f the entire course Thanks for the uport o f the Universitv o f Economics and Business, o f coordinators and Ttgram m anagers who have created tầvorable conditions for the course I am gratetul to the leaders and experts o f the Department o f Planning n Finance - Ministry o f Health, thc leaders o f Health Department o f Nam )ih province for their providing materials, answering in interviews and ratin g íầvorable conditions, which enables me to perlorm the subịect and c e ss to data sources It is also impossible íor me to tbrget the good feelings and thc support o f 11 c lassmates, friends, colleagues who contributed their ideas, provided 'Ìtirmation to me during my fulfilling the thesis work Y o u rs faithfully, Abstract Tite Evaluation o f the allocation and use o f health lìnancing in Nam Dinh province l£^e: Pinal assignm ent tor Mastcr Program in Public M anagement Auh >r: NinhThiHoai Thu Si|e.-visors: - Dr Hans Blomkvist - Uppsala University, Sweden - Dr Nguyen Phu Ha Dae when the thesis is presented: 2014 - 12 Ain: The study aimed to evaluate the allocation and use o f íinancial rsn rc e s o f Nam Dinh province, iđentiíy the strengths, weaknesses, 0)p)rlunities and threads o f Nam Dinh province’s health sector in allocation aid Lse addiíional ĩinancial resources, calculate the expected demand o f e;p:nses and income possibilities and then to propose solutions to increase rcvmues to meet spcnding needs and manage hcalth financing in effective lVehod: Analysis o f docum ents, in-dcpth interviews and SWOT RĩSilt & C o nclu sion s: Health sector o i'N a m Dinh province in recent years hismade rem arkable achievem ents in various íìelds o f healthcare for the ptO'le, Nam Dinh has íìnished most important output indicators on or ahead oltie expected plan Plans to develop health sector closely linked with the yta socio-economic developm ent plan from 2011 to 2015 and the p»rí)nnance indicators ot' the national health sector Hovvever, there is no liik between the plan and the annual budget vvith goals, outcome and output ncicators o f the sector, due to the current Capital expenditure and recurrent ooenditure is expected to comply with the norms stipulated in Decision [ 51/2006 / Ọ D -T T g o f the Prime Minister, an annual increase o f about 15% til íầils to ensure adequate ílnancial resources required to minimum pcnding demand o f Nam Dinh province’s health Ít inevitably leads to 'ulget deficits, required to cut down on some spending items, resulting in 01-guaranteed operating costs o f local health By necessity o f being vãlable with solutions to increase revenue sources, the author has applied V O T analysis for strengths, vveaknesses, opportunities and challenges o f Jan Dinh province in the m anagem ent o f health íìnancing, assessment o f lbcation situation, from which calculates the actual spending needs o f the eilth sector and propose measures to raise revenues tor the health sector eie Based on the calculated demand shorttầll, assess the current íinancial ĩs)urces and trend analysis o f tìnancial resources can be offset in time to ían Dinh province, the author makes a num ber o f recom mendations as )lows: Ó' expenditures for investment and development - For the local budget: The Province needs to increase investment Cipitals from the health hudget at least 20% over the previous year, and S)end 30% o f the total expenditures for invcstmcnt and development from tle local budget for health to implement The scheme o f upgrading the dstrict hospitals and the regional general hospital as dìned in Decision N) 47/2008/Ọ D -T T g o f the Prime Minister - The province should spend at least 40% o f lottery revenues (expected líttery source for investment, upgrade o f infrastructure, social welfare, sich as education, health, culture and sport is about 50 -70 billion \N D /y ear) for health, especially for investment and upgrade o f the povincial general hospital, district hospitals and inter-district regional g-neral hospitals, preventive health centers and etc - For Central budget: Although the province regulates the adjustment rate o f the Central budget, because o f the total provincial budget for investment and development in average level (estimated 800-1000 billion VND/year), it cannot spend m ore for health It requires the Central budget to c o n tin u e to support the province to upgrade provincial general hospital into regional medical center; upgrade the district health system, especially the district hospitals and district preventive health centers For recurrent expenditu re - Ensure that the level o f recurrent expenditure on health per capita prescribed by the Prime Minister, including expenditure increase by 0% because the province has adịustment rate o f t h e budget Annual increase in recurrent expenditure over the previous year is 20 % to reduce shortage in recurrent expenditure - Recurrent expenditure íor provincial hospital beds is around 35-45 million VN D/year, district hospital beds 30-35 million/year, provincial preventive health centers: 31-35 million VND/staff/year, district preventive Health centers: 28-32 million VND/staff'/year to ensure regular operation o f the unit, so that these units can purchase, repair and maintain assets, equipment and have íìnancial resources for the etTective implementation o f autonomy, selt-responsibility under Decree No 43/2006/ND-CP For the íinancial m anagem en t * Enhance the role o f the Department o f Health in Consulting the People's Committe e to allocation o f local health budget, both regular and investments; the Department o f Health is allowed to m an age the general budget; the Department o f ỉỉealth is responsible for: - Guiding the business units under Department o f Construction to estimate budget to report to the Department o f Finance, Department o f Planning and Investment and the People's Com mittee, People's Council for consideration and decision - Preparing a plan for allocation o f the budget for health services in local units, including provincial, district and commune health íầcilities Consult the Department o f Finance, Department o f Planning and Investment to the People's Committee for approval - Delivering estimates, adịusted estimates íor the health units in the province, the preventive medicine centers and district hospitals - With regard to the communal level, based on the annual budget allocation for each district health department, the Department o f Finance implements supplementation to the district budget to assign estimates o f recurrent expenditure, expenditures for medical staffs in communes, allovvances for medical staffs in villages in the CHS The allocation for each commune is decided by the district People's Committee * Promote the implementation o f socialization o f iocal health activities such as: Encourage the đeveloprnent o f non-public health facilities; the province needs to take land and allocate land without collection o f land use fees for private hospitals; when planning residential areas and new urban areas and industrial zones, thc province nccds to regulate land arcas for hospital construction Encourage the public medical tầcility to borrovv capitals, implement joint ventures and associate to install machinery and equipment to serve medical examination * Recommend the Provincial People's Committee to base on the actual situation in the locality, the People's Council to issue fee levels o f some basic health services at commune to raise revenues for the operation o f commune health centers such as hcalth Insurance, health care fund for the poor in order to improve the quality and performance o f CHS Suggestions for íuture research: The limitations o f the thesis wi 11 be discussed and what can be suggested to study turther in future research proịects C on tribu tion o f the thesis: This study providcs directions for changes in the m anagem ent and use o f íinancial resources o f Nam Dinh province Ít also provides useful recom mendations in attracting sources o f revenue to assure tasks for medical expenses o f Nam Dinh province This is a rerence to the offìcers involved in the reasonable and ìlcient planning and allocation o f íỉnancial resources Table of Contents ACCRONYMS LIST OF T A B L E S 10 lntroduction 1 1.1 General introduction 11 1.2 Obịectives of the study 14 1.3 Study questions 15 1.4 Study methods 15 Reference framework 16 2.1 Strengths 17 2.2 Weaknesses 17 2.3 Opportunities 18 2.4 Threats 19 Study method 19 Data source 20 Secondary data source 20 4.1.1 Data from reports settlements of revenue and expenditure 20 4.1.2 Data from nevvspapers and internet 21 4.2 Primary data source .21 Researching results 22 5.1 Assessment of implementation oí the State Budget Law and its implementing g u id elin es 22 5.1.1 Mechanisms and tbrms of budget management 22 5.1.2 Implementation of expenditure norms/ hudget allocation norms 25 5.1.3 Evaluation ofthe implementation of the Govemment's Decree No 43 32 5.2 Construction of cost estimates and expenditure needs of the health sector in Nam D i n h .34 5.2.1 Priorities, strategies and activities of local sectors: 34 5.2.2 Pinancial demand ot Mcdical Service in Nam Dinh province 40 5.3 Financial resources of the medical Service in Nam Dinh 48 Conclusion, recommendation and contribution of the thesis 50 6.1 Conclusion and recomendation 50 6.2 Contribution of the thesis 52 Reíerence 53 Appendix 55 ACCRONYMS BKHĐT Ministry o f Planning and Investment BTC Ministry o f Pinance BYT Ministry o f Health BNV Ministry o f Interior BHYT Health Insurance CT M TỌG National Target Program UBND People's Committees HĐND People's Council KCB Healthcare KHHGĐ Pamily planning NS Budget NSNN State budget XD CB Capital construction SYT Health department QĐ Decision NĐ Decree TTLT Joint Circular tr.đ Million Vietnam dong gb Medical bed bc Payroll 10 LIST OF T A B L E S Table 1: SW O T m o d e l 15 Table 2: Comparisons betvveen the norms o f Decision 151 and Decision 139 25 l able 3: Budget allocation norms o f Nam Dinh Province 27 Table 4: Synthesis o f tìnancial sources in 2011-2013 27 Table 5: Group structures oí'budget expenditure on disease prevention 30 Table : Structures o f expenditure on health care in 2 31 Table 7: Structures o f expenditures on health care in 31 Table : Factors atTecting the needs and priorities o f the Health Sector D e v e l o p m e n t 34 Table 9: Synthesis o f priorities, objectives and strategies 37 Table 10: The inain criteria to prepare a tìnaneial p l a n 40 Table 11: Expected íìnancial de mand o f t h e medical Service in Nam Dinh 46 Table 12: Expected tìnancial capacity and shortage o f revenues o f the health sector in Nam D i n h 47 Table 13: Current status and tendency tor financial c h a n g e s 49 41 10 11 Rate of villages with health stalT Number of doctors/10 thousand people Nuinher of medical exam inat ion/ pcrson/y ear Number of public hospital beds/10 thousand people (excluding hospital beds of Communal Healthy Stations) 12 13 81.9 5.1 16.7 >5 100 >8 3.0 3.5 18.0 20.0 100 Source: Nam Dinh Department o f Health Second: Criteria, basic contents reílect the medical scale o f the province, including: - Population by economic - social regions - Hospital beds o f levels, units, demand tor increase in hospital beds to ensure the number o f b e d s/ 10,000 people (currently 17.08 beds /10 thousand people, and in 2010, 21.5 beds/10 thousand people), the overload o f beds by levels - Staffs, employees oi' levels, each unit, demand for an increase in employees - Students (numbers o f existing and new students, the average number o f students) - Nuinbers o f people entitled to mcdical care under Decision No 139/2002/QD-TTg dated 10/15/2002 oỉ the Prime Minister - Numbers o f children under six - Main activities, protessional criteria to be a ch iev ed in the year T hird: Based on the macroeconomic assumptions provided hy Department o f State Budget - Ministry o f Pinance for the prọịcct o f Public íìnancial reform to calculate the Medium-term expenditure draít such as: - Annual medical inílation 7% - Annual increase in salaries 15% Fourth: Dem and for Capital cxpcnditures to develop medicai íacilities: According to the overall development plan o f medical sector to 2010 and to 2020 o f the province: 43 (1) Expemỉiture fo r Disease Control and Prevention: Includes expenditures oí'regular operations o f the preventive medical íầcilities and for disease control and prevention: - Expenditures o f the preventive medical tầcilities such as: Preventive medical centers, centers for HIV/AIDS prevention; centers for reproductive health care; and etc Minimum demand for expenditures o f these units include: expenditures for people, proíèssional activities, procureinent and overhaul and etc - Expenditure íor Disease Control and Prevention: ensure íunds for the initiative in the control and prevention o f disea ses in both Central and local levels, including funds to buy drugs, chemicals, and materials for disease control and prevention, funds for training, allovvances íor the disease control in extraordinary cases (2) Expenditures fo r medical care: - Regular expenditures o f hospitals, health centers in district level: Minimum dcmand for expenditures oí' these units include: expenditures tbr people, protessional activities, procurement and overhaul and etc - Expenditures for medical care tor the poor: + Subịects for estimates include: - Poor households as dclìned in Decision No 170/2005/QD- ITg dated Julv 08, 2005 o f the Prime Minister On the basis o f the province's poor household rate, poverty reduction rate is expected poor household rate is 10,6% in 2010; in ,6 % in 2008; % per year, expected ,6 % in 2009 and 4,6% 2010 - Ethnic households (except for households vvith high income) in communes, wards and towns in Region II and III are classiíìed by level o f development and recognized under the current decisions o f the Minister, the Head o f the Committee o f Ethnic Minorities and Mountainous areas (now the Committee o f Ethnic Minorities); + Expenditures: Implementation o f the health insurance policy tor the p oor, the rights o f p e o p le w ith health Insurance, in w h ic h the p oor are paid 43 (Ị) Expenditure fo r Disease Con troI and Preventỉon: Includes expenditures o f regular operations o f the preventive mcdical íầcilities and for disease control and prevcntion: - Expenditures o f the preventive medical íầcilities such as: Preventive medical centers, centers for HIV/AIDS prevention; centers tor reproductive health care; and etc Minimum demand for expenditures o f these units include: expenditures tor people, professional activities, procurement and overhaul and etc - Expenditure f'or Disease Control and Prevention: ensure funds for the initiative in the control and prevention o f d isea ses in both Central and local levels, including funds to huy drugs, chemicals, and materials for disease control and prevention, funds íor training, allowances ior the disease control in extraorđinary cases (2) Expendiíures fo r medical care: - Regular expenditures o f hospitals, Health centers in district level: Minimum demand lbr expenditures o f these units include: expenditures for people, proíessional activities, procurement and overhaul and etc - Expenditures for medical care 1'or the poor: + Subịects for estimates include: - Poor households as deíined in Decision No 170/2005/ỌD-TTg dated July 08, 2005 o f the Prime Minister ()n the basis o f the province's poor household rate, poverty reduction rate is expected poor Household ratc is 10,6% in 2010; in ,6 % in 2008; % per year, expected ,6 % in 2009 and 4,6% 2010 - Ethnic households (excep t for households with high income) in communes, wards and towns in Region II and 11! are classitìed by level o f development and recognized under the current decisions o f the Minister, the Head o f the Committee o f Ethnic Minorities and Mountainous areas (now the Committee o f Ethnic Minorities); + Expenditures: Implementation o f the health Insurance policy for the poor, the rights o f people with health insurance, in which the poor are paid 44 high technology services On the other hand, in the future, district hospitals, provincial hospitals and commune Health stations will be upgraded to increase the ability to provide medical services to the poor and the poor will enịoy more medicaỉ services with better quality Costs for these services are increasing so that it is necessary to adịust spending levels to purchase health Insurance accordingly 2010 estimated spending levels under the Prime Minister's decision is 80,000 VND/person which demands tor a spending level o f 220,000 VND/person With this plan, the health insurance fund for the poor is 15,592 million V N D in 2014, 26,019 million VND in 2015, 27,121 million VND in 2016, 28,137 million VND in 2017 - Support fo r low-income peopỉe to purchase health Insurance: The scheme o f socialization o f Health activities has been approved hy the Prime Minister and the Decree No 63/2005/ND-CP stipulates support for low-income people to purchase Health Insurance The State supports 30% o f the level o f support for the poor every year With this plan, support for the iow income people to purchase the health Insurance is 1,760 million VND in 2014, 5,499 million VND in 2015, 9,238 million VND in 2016, 14,517 million VNI) in 2017 (3) Expenditures fo r other Health activities, including: + Activities o f the Council o f Medical Examination + Activities o f Provincial Board o f Health Protection + Healthy Cultural Villages + Prevention o f Injuries and accidents + Health activities at schools + Plan for the National Nutrition + Reciprocal Capital o f the loan and aid in rccurrcnt expcnditures 45 + Expenditures 1'or prọịects o f national target programs beyond additional Central budget to secure íunding for the implementation o f the objectives o flocal health care + Safety in blood transfusion + Prevention o f non-communicable diseases (cardiovascular, neurological diseases, diabetes ) + Implementation o f reproductive health strategy + Implementation o f the project o f Controlling microbial contamination and chemical residues in food (4) Expenditures fo r heaỉth care in communes and viỉỉages: - Expenditures for health care in communes include expenditures for medical staffs in communes, allovvances tor medical staffs in villages and recurrent expenditures for communal health care + Expenditures for salaries and contributions are based on the nu mber o f commưnal medical staff and: * Salary regime for communal medical staiT, * Contributions, * Preíerential allovvances o f the sector (Circular No 02/TTLT-BTCBYT-BNV) * Allowanccs prescribed in Circular No 09/2003/TT-B YT-BTC-BNV dated September 29, 2003 on guiding the implementation o f Decision No 55/2003/ỌD-TTg dated July 30, 2003 o f the Prime Minister + Regular expenditures for communal health care: Base on actual activities, the demands and capabilities o f thc local budget to estimate under the provisions o f Circular No 119/2002/TTLT-BTC-BYT dated December 27, 2002 on guiding revenues and expenditures and recurrent expenditures o f CHSs Minimum expenditures should be 10 million VND/station/year (excluding salaries, allovvances and contributions o f the communal health staffs, tunding for health carc for the poor in the communes) for payment o f electricity, water, telephone, stationery, maintenance o f assets and etc 46 + Allowanees tor medical staffs in villages: Based on the number o f staíTs and the provincial People's Committee regulations, minimum expenditure is 40,000 VND/person/month under Notiíication No 176/'TBV P C P dated October 14, 1998 o f the Government OHìce b) On the basis o f the health targets to be achieved, the íinancial dem and o f the medical Service in Nam Dinh is expccted as follows: Table 11: Expected íinancial dem and o f the medical Service in Nam Dinh Unit: Million VND Total amount 2014 2015 2016 2017 I Expenditures for investment and development 136,030 188,860 166,657 140,023 631,570 II Regular expenditures: In which: 253,949 300,184 340,378 387,767 1,282,278 No Expenditures Regular expenditurcs oíthe S t a t e budget ibr medical íầcilities 108.318 120,497 132,847 147.33 508.993 Expenditures for National Target Program 4.847 5.574 6,410 7.372 24.203 Expenditures tbr medical examination tor the people under the social policies 30.312 47.070 55.021 65,049 197,452 Expenditures from other revenues 110.472 127.043 146.100 168.015 551.630 389,979 489,044 507,035 527,790 1,913,848 Total amount Source: The author calculation and evaluation 47 Based on these assumptions, the íìnancial revenues for the Health sector in Nam Dinh are summarized in the following table: Table 12: Expected íìnancial capacity and shortage o f revenues of the health sector in Nam Dinh Expectation Revenues 2014 2015 2016 2017 Total amount State budget for expenditure for investment Total amount 84,150 110,770 102,160 96.750 393.830 - Local budget 44,350 52,570 62,160 71.750 230.830 - Central budget 16,000 55,000 40,000 25,000 136,000 - ODA 23,800 3,200 27,000 State budget for regular expenditure Total amount - Local budget - Central budget 134,064 161,632 182,446 206,131 684,283 129,21 156,058 176,036 198,759 660,070 4,847 5,574 6,410 7,372 24,203 110,472 127,043 146,100 168,015 551,630 328,686 399,445 430,706 470,896 1,629,733 84,150 110,770 102,160 96,750 393,830 244,536 288,675 328,546 374,146 1,235,903 From the non-husincss revenues Total amount - ỉospital charges - Health Insurance - Other charges Tota! am ount - Investment - Regular 48 Shortagc o f íinancial resources for 61,293 89,599 76,329 56,894 284,115 9,413 1,509 11,832 13,621 46,375 51,880 78,090 64,497 43,273 237,740 - Regular - Investment Source: The author calculation and evaluation 5.3 Financỉal resources o f the medical Service in Nam Dinh - Local budget: 2011 is considered the íìrst year o f the budget stabilization for the 201 1-2013 period Based on the budget allocation norms stipulated in Decision No 151/2006/ỌD-TTg o f the Prime Minister and based on the ability to tìnancial balance and s o c io -e c o n o m ic d evelop m en t strategy o f the province, the annual increase in expenditures from the local budget íbr the Health Sector o f Nam Dinh is 15% - The Central budget is supplemented for the local budget: Forecast on the basis oí'programs and schemes o f the Ministry o f Health - The rcvenues beyond the State b u d g e t include hospital charges, hcalth Insurance and other sources such as fees and charges vvill increase because in the íuture the implementation of Circular No 03 wi 11 be more co m p reh en sive, correct and the p o licie s o f hospital charges and health Insurance w ill bc changcd, and increase in living standards lead to the highcr ability for m edical Service paym ent The increase in annual revenue is assumed to be 15% The Government tends to implement overall health Insurance by 20 ; as a result there is a tendency o f increase in revenues from health Insurance and decrease in direct hospital fees Pinancial resources, current status and tendency summarized in the following table: for changes are 49 Table 13: Current status and tendency for íìnancial changes Pinancỉal resources Tendency C u r r c n t status Current tlnancial resources State budget investment for Shortage, no complete Increase, supplementation upgrade o f inírastructure trom sources of government and equipment at district bonds and commune levels in supporting State budget ior Shortage, no increase in Changes rccurrent expenditure expenditures due to people to purchase health Insurance, health íầcilities o f the health care inílation increase the level o f the íacilities hospital fees to offset and ensure operational costs State budget for Shortage, no preventive Increase, the State continues for unexpected to ensure support preventive Health fund activities disease Hospital fees, direct Partial hospital fees Service tees Gradual increase, allovvintì the health tầcilities to implement íìnancial autonomy, ensure dcmand íor 1'unds when the State hudụct reduces Revenue from health Revenue from the Increase the level o f fee and Insurance framework of partial changes, implcmentation of the hospital fees overall health insurance New financial resources Government bonds Government allow to issue From 2008 to 2010 health for investment in bonds for investment in sector has lìnancial soưrces to invest in districts and health Service health Service communes Encourage investment Not yet, only support Increase, allovving private machines in a few health participation with greater socialization for Capital support to upgrade care facilities health care Service Health care facilities o f the State Source: The author syrtthesis and evaluation 50 Conclusion, rccomm endation and contribution o f the thesis 6.1 Conclusion and recomendation Given the current expenditures and expected recurrent expenditures in accorđance with the norms stipulated in Decision No 15 1/2006/ỌD-TTg o f the Prime Ministcr, an annual increasc o f about 15% have not ensured adequate tìnancial resources tor minimum expenditure demands o f t h e Health Service in Nam Dinh It will lead to budget detìcits and have to cut down some expenditure items, resulting in no guarantee o f expenditures o f local health Based on the calculated demand shortíầll, assess the current ílnancial resources and trend analysis o f tìnancial resources can be offset in time to Nam Dinh province, the author makes a number o f recommendations as follows: For expenditures for investment and development - For the local budget: The Province needs to increase investment capitals írom the health budget at least 20 % over the previous year, and spend 30% o f the total expenditures tor investment and development trom the local budget for health to implement The scheme o f upgrading the district hospitals and the regional general hospital as detìned in Decision No 47/2008/Ọ D-TTg o f the Prime Minister - The p r o v in c e should spend at least 40% oi' lottery revenues (expected lottery source for investment, upgrade o f infrastructure, social welfare, such as education, health, culture and sport is about 50 -70 billion VND/year) for health, especially for investment and upgrade of' the provinciaỉ general hospital, district hospitals and inter-district regional general hospitals, preventive health centers and etc - For Central budget: Although the province regulates the adjustment rate oí' the Central budget, because o f the total provincial budget for investment and development in average level (estimated 800-1000 billion VND/year), it cannot spend more for health Ít requires the Central budget to continue to support the province to upgrade provincial general hospital into regional 51 m edical center; upgrade the district health system , esp ec ia lly thc district hospitals and district preventive Health centers For recurrent expenditure - Ensure that the level o f recurrent expenditure on health per capita prescribed by the Prime Minister, including expenditure increase by 20% because the province has adịustment rate o f the budget Annual increase in recurrent expenditure over the previous year is 20 % to ređuce shortage in recurrent expenditure - Recurrent expenditure íor provincial hospital beds is around 35-45 million VND/year, district hospital beds 30-35 million/year, provincial preventive health centers: 31-35 million VND/staff/year, district preventive health centers: 28-32 million VND/staff/year to ensure regular operation o f the unit, so that these units can purchase, repair and maintain assets, equipment and have íìnancial resources tor the eíìective implementation o f autonomy, selt-responsibility under Decree No 43/2006/ND-CP For the ílnancial managcmcnt * Enhance the role o f the Department o f I lealth in Consulting the People's Committee to allocation o f local health budget, both regular and investments; the Department o f Health is allowed to manage the gcneral hudget; the Department o f Health is responsible tor: - Guiding the business units under Department o f Construction to estimate budget to report to the Department o f Finance, Department o f Planning and Investment and the People's Committee, People's Council for consideration and decision - Preparing a plan for allocation o f the budget íor health services in local units, including provincial, district and commune health facilities Consult the Department o f Finance, Department o f Planning and Investment to the People's Committee for approval - Delivering estimates, adịusted estimates for the health units in the province, the preventive medicine centers and district hospitals - With regard to the communal lcvel, bascd on the annual budget allocation for each district Health department, the Department o f Finance implements supplementation to the district budget to assign estimates o f recurrent expenditure, expenditures for medical statTs in communes, allowances for medical staffs in villages in the CHS The allocation íor each c o m m un e is decided by the district People's Committee * Promote the implementation o f sociali/.ation o f local health activities such as: Encourage the development o f non-public heulth íầcilities; the province needs to take land and allocate land without collection o f land use tees tor private hospitals; when planning residential areas and new urban areas and industrial zones, the province needs to regulate land areas tbr hospital construction Encourage the public medical tầcility to borrow capitals, implement joint ventures and associate to install machinery and equipment to serve medical examination * Recommend the Provincial People's Committee to base on the actual situation in the localitv, the People's Council to issue íee levels o f some basic health services at commune to raise revenues tbr the operation o f coimnune health centers such as health Insurance, health care lund for the poor in order to improve the quality and períorinance o f Cl 1S 6.2 Contribution o f thc thcsis This study provides direction tor changes in the management and use o f íìnancial resources o f Nam Dinh province The study also providcs useíul recommendations in attracting revenue to ensure expenditures for the m edical Service o f Nam Dinh province This is a reference to the officers involved in reasonably and efficiently planning and allocatin g iìnancial resources 53 Rerence Books 11J ADB (1999), Managing Government ExpencHture (Asian Development Bank, Manila) [2] Dunn, William N (2008), Public Policv Analysis: An introduction (New Jersey: Pearson) [3] Jody Zall Kusek, Ray c Rist (2004), Ten Steps to a Results-Based Monitoring and Evaluation System (The World Bank, Washington, D.C) [4] Owen E Hughes (2003), Public Management & Administration: An ỉntroduction Thirđ Edition.(Palgrave macmillan, New York) [5] Peter, Guy B (1996), American Public Poỉicy: Promise and Per/ormance Pourth Edition (Chatham, Nevv Jersey: Chatham house publishers, Inc.) |6| World Bank (1998), Public Expenditurc Management Reviews Ị7Ị Ministry o f Health, Health coordination group 2011 Strengthening the management capabiỉitv and rẹ/orm o f heaỉthcare ỷìnancing for implementation o f the 5-vear Plan ọf Health sector /rom 20 ì Ị-2015 Joint Annual Health Revievv (JA11R) Ị8 ] Ministry of Health, Health coordination group 2013 Towards universa! heaỉth Insurance Joint Annua! I lcalth Review (JAHR) [9] DFỈD 2010 Solving corruption in the health sector [10] People's Council o f Nam Dinh province 2013 On the task o f socio- economic development Nam Dinh province in 2014 Resolution No / 13/NỌ-HDND dated December 12, 2013 [11] People's Council o f Nam Dinh province 2013 On ratiỷìcation o f esíimates o f revenues and expenditures and the aỉỉocation o f investment and development Capital belonging to budget of Nam Dinh province in 2014 Resolution No 26/2013 / N Q -H D N D dated December 12, 2013 54 I 121 Health Department o f Nam Dinh province l i nal report o f the medical work in years 201 / 2012, 2013 [13] Health Department o f Nam Dinh province Settlement report o f years 2011, 2012 , 2013 [14] People’s committee o f Nam Dinh province Decỉsions on alỉocating targets o f the State budget in 2009-2013 Appendix List o f interviewees w • 'íi " p R ii& * x & £ f >**Ti^ịrỊffl! J M : aip- ’ B ui Thi M in h T h u T n T h u I ỉu o n g O ffice D irc cto r Unit H ealth D e p a rtm e n t o i 'N a m D in h p ro v in c e 1iead o f Hinance H ealth D e p a rtm e n t o í N a m D e p a rtm e n t D inh p ro v in c e D ep u ty o f F in a n ce H ealth D e p a rtm e n t o f N a m D e p a rtm e n t D inh p ro v in c e H ead o f P la n n in g H ealth D e p a rtm e n t o í 'N a m D e p a rtm e n t D in h p ro v in c e N g u y e n T hị B in h Do Ngoe Dung N guyen Van H oa D ire cto r P rovin cial G e n e l Hospital Do Van Đuoc C h ie ta c c o u n ta n t P rovin cial G e n e l H ospital H o a n g M a n h V iet D ire cto r T n Thi T h u I lon g C hieí' a c c o u n ta n t N g u von V an U o n g D irector 10 V u Thi D u o n g C’h i e f a c c o u n ta n t 11 P h a m T ie n D u n g D ire cto r 1lealth c e n te r o f Y Yen district 12 Pham H ung C uong A c c o u n ta n t 1iealth c e n te r o f Y Y en district 13 N g u y e n V a n T in h H ead o f c o m m u n e H ealth c e n te r o f Y en T h an g health c e n te r c o m m u n e , Y Y en district N guyen T rong 1ỉead o f c o m m u n e 1lealth c e n te r o f Y en T ru n g Thuy health c e n te r c o m m n e , Y Y en district 14 G e n eral llo s p ita l o f Hai lla u district G en eral H osp ital o l'H a i lla u district G en eral H osp ital o f 1ruc Ninh district G e n eral H ospital o f'T ru c N inh district