Hiệu quả tự chủ tài chính bệnh viện công lập tại Việt Nam: Nghiên cứu tổng quan hệ thống và phân tích gộp

The global healthcare landscape faces persistent challenges related to financial sustainability and operational efficiency. In this context, financial autonomy for public hospitals has emerged as a critical healthcare reform trend, widely adopted to enhance service quality, optimize resource utilization, and alleviate the burden on state budgets. In Vietnam, the policy of financial autonomy for public hospitals, initiated in 2005, has undergone several adjustments. However, existing research on its impact remains fragmented and sometimes contradictory, lacking a comprehensive overview. This systematic review and meta-analysis aims to address this gap by rigorously evaluating the actual effectiveness of financial autonomy on public hospital performance indicators in Vietnam, providing robust scientific evidence for future policymaking and strategic adjustments.

Policymakers in healthcare, public health researchers, hospital administrators, and academics interested in healthcare finance and public sector reforms in Vietnam and developing countries.

This study presents a systematic review and meta-analysis to evaluate the effectiveness of financial autonomy policies on performance indicators in Vietnamese public hospitals. The research systematically screened studies conducted in Vietnamese public hospitals and published between 2015 and 2024, focusing on those with quantitative outcome measures of financial performance. Through a rigorous screening process, seven studies were identified for meta-analysis, comprising three on full autonomy and four on partial autonomy. The findings demonstrate that financial autonomy generally leads to significant improvements, with an overall increase in total revenue by 59.0%, staff income by 68.3%, and a notable reduction in dependence on the state budget by 12.8%. A comparative analysis revealed distinct advantages between the two models: full autonomy proved more effective in enhancing staff income (110.3% increase) and reducing budget dependence (19.8% reduction), while partial autonomy showed superior effectiveness in boosting total revenue (40.6% increase). These results underscore that financial autonomy can substantially improve hospital performance indicators in Vietnam. The study concludes by recommending a model of controlled autonomy combined with comprehensive payment system reform to optimize both financial gains and service quality, ensuring the long-term effectiveness of this critical policy.