IMPACT OF COST STRUCTURE AND MACROECONOMIC POLICIES ON THE FINANCIAL AUTONOMY OF PUBLIC HOSPITALS: THE CASE OF CHILDREN’S HOSPITAL 1 (2022–2025)
Main Article Content
Abstract
Objective: To examine the effects of cost structure and macroeconomic policies, particularly health insurance (HI) reimbursement mechanisms, on the financial autonomy of public hospitals in Vietnam.
Methods: A case study was conducted at Children’s Hospital 1 during 2022–2025 using a sequential explanatory mixed-methods design. Quantitative data consisted of monthly financial reports (n = 48), while qualitative data were obtained through seven in-depth interviews with representatives from the Department of Health, hospital executive leadership, and heads of functional departments. Interrupted Time Series (ITS) regression was applied to assess the impact of policy changes on hospital financial performance.
Results: Between 2022 and 2025, total hospital revenue increased by 54.6%, whereas total expenditure rose by 98.0%, mainly due to higher personnel costs, medical consumables, and investments in advanced technologies. Revenue from medical examination, treatment, and service activities accounted for more than 93.0% of total revenue in 2025. However, the revenue-to-expenditure ratio declined from 130.5% to 101.9%, indicating increasing operational cost pressures. ITS analysis demonstrated significant effects of policy changes on hospital financial performance. Depreciation expenses increased substantially following infrastructure modernization and expansion. The findings also indicated that the current HI reimbursement mechanism does not fully cover management costs, depreciation, and operational expenses associated with high-technology services at tertiary hospitals.
Conclusion: Financial autonomy has contributed to improving operational capacity and governance efficiency in public hospitals. However, ensuring long-term financial sustainability requires further refinement of medical service pricing toward full-cost recovery and the development of financial policies better aligned with the characteristics of the public healthcare system.
Keywords
hospital financial autonomy, cost structure, macroeconomic policy, health economics, Children’s Hospital 1
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References
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