Learning from international experience to improve appropriateness of hospital admissions in Vietnam’s health system - Policy note

Jul 19, 2026

The policy note analyzes how international experience can inform Vietnam’s development of hospital admissions criteria, aiming to reduce avoidable and inappropriate inpatient use under pressure from rising admissions to the social health insurance fund. It reviews international approaches to assessing admission appropriateness, including definitions, classifications for payment, use of admission criteria, and auditing methods. It then compares proposed Vietnamese emergency and traditional medicine admission criteria with external protocols such as AEP, and provides recommendations to strengthen consistency, quality, and patient safety in claims review.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages22

Reading Time55 min

Introduction

International use of hospital admission appropriateness assessment

Defining admission and various classifications of admission for payment purposes

Use of admission criteria

Auditing inappropriate admissions

Vietnam’s development of admission criteria

Institutional interest in admission criteria

Assessing the proposed Vietnamese emergency admission criteria through comparison with the AEP

Vietnamese Traditional medicine admissions criteria

Recommendations for Vietnam

Additional references

Annexes

Annex A: Day of care criteria from AEP in EU and the US

Annex B: Specialist admission criteria from the international literature

Annex C: Claims review data analysis of admission characteristics

Public Disclosure Authorized Public Disclosure Authorized Sarah Bales, PhD 28/06/2021 Policy note: Learning from international experience to improve appropriateness of hospital admissions in Vietnam’s health system Table of contents Introduction ............................................................................................................................................ 2 International use of hospital admission appropriateness assessment................................................... 2 Defining admission and various classifications of admission for payment purposes ........................ 3 Use of admission criteria .................................................................................................................... 5 Auditing inappropriate admissions..................................................................................................... 8 Vietnam’s development of admission criteria ........................................................................................ 9 Institutional interest in admission criteria ......................................................................................... 9 Assessing the proposed Vietnamese emergency admission criteria through comparison with the AEP .................................................................................................................................................... 12 Vietnamese Traditional medicine admissions criteria ..................................................................... 14 Recommendations for Vietnam ............................................................................................................ 15 Additional references............................................................................................................................ 16 Annex A: Day of care criteria from AEP in EU and the US .................................................................... 17 Annex B: Specialist admission criteria from the international literature ............................................. 18 Annex C: Claims review data analysis of admission characteristics ..................................................... 20 Abbreviations AEP Appropriateness Evaluation Protocol DRG Diagnosis-related groups ECG Electrocardiogram EU European Union GP General practitioner MOH Ministry of Health NEWS National Early Warning Score OECD Organization for Economic Cooperation and Development TM Traditional medicine US United States VSS Vietnam Social Security Acknowledgements This report benefitted from the helpful and detailed comments and feedback from Leopold Aminde, Ngo Thi Dieu Thuy, Christophe Lemiere and Dao Lan Huong. Introduction Hospital overcrowding and pressure on Vietnam’s social health insurance fund from a growing rate of admissions (rising from 6.5 to 8.0 per 100 people between 2008 and 2018) has recently been exacerbated by a policy that allows patients to access inpatient services at provincial and lower level hospitals without any referral or additional copayments (implementation of Article 22 of the amended Law on Health Insurance 2014) . In response, the Ministry of Health (MOH) is developing policies on hospital admissions criteria in emergency cases and in traditional medicine hospitals as part of a strategy to reduce avoidable admissions. Collaboration between the MOH and Vietnam Social Security (VSS) in developing these criteria and designing ways to use them as part of claims review has potential for both enhancing quality and appropriateness of healthcare services, improving patient safety and convenience by avoiding unnecessary hospital stays and enhancing efficiency and cost-savings that would enhance sustainability and effectiveness of health insurance fund use. Claims review is defined in the Health Insurance Law as “the specialized activity implemented by the health insurance organization aimed at

FAQs

Why is Vietnam developing admission criteria for emergency and traditional medicine hospitals?

To reduce avoidable admissions and ease pressure on the social health insurance fund caused by a growing rate of hospital admissions, especially when patients can access inpatient services without referral or extra copayments.

What does the note cover regarding international admission appropriateness assessment?

It reviews how other health systems define admissions for payment, apply admission criteria, audit inappropriate admissions, and evaluate approaches for consistency across providers and health outcomes for patients.

How does the note evaluate Vietnam’s proposed emergency admission criteria?

It compares the proposed Vietnamese criteria with the Appropriateness Evaluation Protocol (AEP) and uses that comparison to inform recommended improvements for the Vietnamese policy development process.

Jul 19, 2026

Upload by Olivia Brown