PDF(Pubmed)
Abstract：
BACKGROUND: In Vietnam and many developing countries, private healthcare is increasingly being leveraged by governments to complement public services and increase health service access and utilisation. Extensive understanding of patterns of utilisation of private over public health services, and the rationale for such consumer decisions, is important to ensure and promote safe, affordable and patient-centred care in the two sectors. Few studies within the Southeast Asian Region have explored how private and public providers interact (via social networks, marketing, and direct contact) with consumers to affect their service choices. This study investigates providers\' views on social factors associated with the use of private over public health services in Vietnam.
METHODS: A thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics.
RESULTS: Multiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients\' needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients\' demands rather than medical needs, as well as the significant technical requirements for quality and safety.
CONCLUSIONS: This study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector.
METHODS: A thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics.
RESULTS: Multiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients\' needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients\' demands rather than medical needs, as well as the significant technical requirements for quality and safety.
CONCLUSIONS: This study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector.
摘要：
背景：在越南和许多发展中国家，政府越来越多地利用私人医疗保健来补充公共服务，并增加医疗服务的获取和利用。广泛了解私人医疗服务的利用模式，以及这种消费者决策的理由，对于确保和促进安全很重要，这两个部门的负担得起和以患者为中心的护理。东南亚地区很少有研究探索私人和公共提供者如何互动(通过社交网络，市场营销，和直接接触)，影响消费者的服务选择。这项研究调查了提供者对与越南使用私人公共卫生服务相关的社会因素的看法。
方法：对越南国民议会有经验的卫生系统利益相关者进行了30次半结构化访谈，政府部门,私人健康协会，健康经济协会，以及公立和私立医院和诊所。
结果：发现多种社会因素影响私人选择而不是公共服务，包括口碑,医患关系和医疗保健提供者之间的关系，医护人员的态度和行为，和营销。虽然私人提供者最大限度地利用这些社会因素，大多数公共提供者似乎忽视或只表现出有限的兴趣在使用营销和其他形式的社会互动来改善服务，以满足患者的需求，尤其是那些需要严格医疗干预的人。然而,私人提供商面临着与过度广告相关的特殊挑战，过度服务，过度关注患者的需求而不是医疗需求，以及质量和安全的重大技术要求。
结论：这项研究对越南的政策和实践具有重要意义。首先,公共提供者必须将与消费者的社交互动作为提高其服务质量的有效策略。第二,需要私人提供者的适当法规来保护患者免受不必要的治疗，成本和潜在危害。最后,这项研究的见解与许多面临适当管理私营卫生部门增长的类似挑战的发展中国家直接相关。
方法：对越南国民议会有经验的卫生系统利益相关者进行了30次半结构化访谈，政府部门,私人健康协会，健康经济协会，以及公立和私立医院和诊所。
结果：发现多种社会因素影响私人选择而不是公共服务，包括口碑,医患关系和医疗保健提供者之间的关系，医护人员的态度和行为，和营销。虽然私人提供者最大限度地利用这些社会因素，大多数公共提供者似乎忽视或只表现出有限的兴趣在使用营销和其他形式的社会互动来改善服务，以满足患者的需求，尤其是那些需要严格医疗干预的人。然而,私人提供商面临着与过度广告相关的特殊挑战，过度服务，过度关注患者的需求而不是医疗需求，以及质量和安全的重大技术要求。
结论：这项研究对越南的政策和实践具有重要意义。首先,公共提供者必须将与消费者的社交互动作为提高其服务质量的有效策略。第二,需要私人提供者的适当法规来保护患者免受不必要的治疗，成本和潜在危害。最后,这项研究的见解与许多面临适当管理私营卫生部门增长的类似挑战的发展中国家直接相关。
