Objective: To assess the changes in the delivery of hospital services in relation with LOS and cost of care after 18 month implementation of the pilot of case-based payment. Method: In this evaluation, the quantitative part involves analysis of secondary data which allows comparison of means of key variables (Ieng of stay, cost per case, drug cost per case, average lab-test cost per case) between the two groups of cases having and not having enrolled in the pilot of case-based payment model. Clinical and cost data were extracted from 5,511 records of inpatients of the selected conditions, at two hospitals of Thanh Nhan and Ba Vi, in the period from December 2009 to June 2011. Main findings: The pilot of case-based payment method had positive impact on cost containment and quality of care. The average Length of Stay and mean costs were found lower with groups of cases enrolled in the pilot although the positive findings are not always consistent. The enrolled group of acute appendicitis showed lower means in tenns of both LOS and cost per case (4.26 vs 5.52; P = 0.03 and VND 2,779,624 versus 3,417,472; p 0.001). The cases in the group of spontaneous delivery were found with lower average LOS (2.49 versus 2.85; p 0.01) but higher cost per case (VND 918,012 versus 742,157; p 0.001). Lower costs of drugs and lab-test were found for every sub-groups of cases having enrolled in the pilot. Conclusion: Case-based payment with the application of care pathways could be considered an effective way for cost containment and improvement of quality of care with consdierable potential advantages, including more efficient use of resources with significant reductions in average length of stay, average cost percase and average drug cost per case. However, better capacity and effective technical solutions should be taken for the implementation of the payment method in a desirable scale.
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