Dual Practice of Public Hospital Physicians: Implications for Universal Health Coverage in Vietnam

Vietnam has adopted a public-private mixed health service delivery system for 30 years to mobilize more resources for the health sector. Public hospital physicians are allowed to practice for the private sector outside official working hours; therefore, physician dual practice is very common. This paper investigates the characteristics and dynamics of the phenomenon, focusing on the choices of physicians about whether to engage in dual practice, as well as their performance in their public practice. The analysis is based on a survey at 10 public hospitals in Vietnam with 510 physicians. Half of public hospital physicians reported participating in at least one type of private practice. Personal characteristics (gender, age, position), private practice income, and clinical autonomy are the reasons for dual practice involvement. Dual practitioners spend more time overall in clinical practice than their non-dual-practice counterparts, but reduce the time for public practice to have more time for private practice. They are also more likely to refer public patients to private practice. Nevertheless physicians appear to still be committed to the public sector to enlarge their professional networking, participate in training opportunities, and fulfill their sense of public responsibility.

Ngan Do is currently a postdoctoral fellow at the Walter H. Shorenstein Asia-Pacific Research Center, Stanford University. Prior to that, she worked as a Health Leadership Development Initiative fellow at the World Health Organization Western Pacific Regional Office. Her research focuses on comparative healthcare systems and health reforms in Asia; payment incentives; physicians’ behaviors, human resources for health, and the public-private partnership in the health sector. She experienced field-work in Cambodia, Lao PDR, Philippines, Korea, and Vietnam. Ngan achieved her Ph.D. degree in health policy and management at Seoul National University College of Medicine. She earned her master degree on public policy at the KDI School of Public Policy and Management, and her bachelor degree on international relations at the Diplomacy Academy of Vietnam.