Tap chi Khoa hpc Nghen cuu Sic khde vd Phdt triin (Tpp 04, So 01-2020 Joumal ofHealth and Development Studies (Vol.04, No.01-2020) BAI BAO NGHIEN C t U GOC Thirc hifn quyen an sinh xa hdi ve kham chiia benh cho ngu^ dan thong qua hoat dong cong tac xa hgi 6t A^et Nam hien Nguydn Thi Kim Hoa'*, Nguyen Thi Lien^ Myc tieu: Mo ta thuc tr^ng thuc hifn quyen an sinh xa hpi ve kham chira bfnh ciia nguoi dSn thong qua hogit dong c6ng tie xa hpt (CTXH) Phmrag phap nghien clhi: Thiet ke cat ngang mo t i Nghien curu dupc thvre hifn tai tmh Ha Npi, Quang Ninh, Hoa Binh, Da NEng, Bin Tre, Ddk Ldk va p h i H6 Chi Minh, tii thing 6/2018 d i n thing nam 2019 Kit qua: Kit qua nghien cijru cho thiy v€ quyen dupc h6 trp dieu dudng, cham soc sue khoe hoEit dpng cong tac xa hfi ndi bat nhit la tuyen tniyen chinh sich va bifn hf chinh sich la boat dpng dupc sur dung vcri ty le thip nhdt Ve quyen dupc ho trp tiem chimg nguta bfnh, ho9.t dong dupc chii trpng nhieu nhdt cCing la tuyen (ruyen chinh sach va thap nhat la hoat dpng ho trg chuin bj ho sa chinh sach Ve quyen dupc ho trp chi phi di€u tri, kham chiia benh, hoat dpng chii dao l i tuy€n truySn va tu vin chinh sach, ho^t dong it dupc thuc hien nhit la k^t n6i ngu6n lyx; ho tro Ve quySn dupc c4p the b i o hiem y t£ (BHYT) mien phi, ho^t dpng dupc thuc hifn voi ty If cao nhat van la hoat dpng tuyen tniyen chinh sach va t h ^ nhat la ket n6i nguon lye h5 trp Ket lu^n: Tijr cac can thiep va su trp giiip ciia CTXH, nguin dan co the tiep c|ui va thuc hien quyfin khim chiia bfnh ciia minh Nha nu6c cin co r i sodt va b6 sung c i c van ban luat, chinh sich, chuang trinh, djch vy ve y te de mpi ngucri dan dupc tiep csin va thy huong dich vu Trong thai gian toi can day manh han nua sir tham gia cila CTXH vifc thiic dSy thuc hifn quyin an sinh xa hpi (ASXH) ciia nguai dan cf ng dfing n6i chung va c i c ca scr y te n6i riSng Tu- khoa: quy^n an sinh xa h6i, khim chua bfnh, thuc hifn, CTXH chuySn nghifp DAT VAN DE Cong tac bao vf va cham s6c sdc khoe eda ngudi dan l^ mOtttongnhiing nhifm vu quan trong, uutienhang dku eua Dang, Chinh phu, cae eSp chinh quyen va can s\r tham gia cua moi ngudi dan, d^c biet l^ nhung ngudi tham giationglinh vuc y te va nhung ngirdi dam nhiem cong tae cong tac cham soc va bao vf sdc khoe nhan dan Nghj quySt s6 15/NQ-TW 1/6/2012 cua Ban Chdp hanh Trung uong khda XI * Bia chi Hin hf: Nguyin Thj Kim Hoa Email: kimhoaxhh®.vahoa com ' Tnrang DH Khoa hpc Xd hpi vd Nhdn van • Truang DH Lao dpng Xa hpi m6t s6 v^n d^ v6 chinh sach xa hoi giai do^n 2012-2020 dh muc tieu din nam 2020, CO ban bao dam an sinh xa hgi toan dan, bao dam mdc tdi thieu ve y tl cho ngudi dan Tuy nhien, vi nhiiu Iy khac ma mpt b6 ph^n ngudi dan vln chua duoc tiep can va thi^ hudng cae chinh saeh, chuong trinh, dich vu y tl, dd eo quyen kham chua benh Do hp ikt ein dugc sir trg giup thdng qua boat dong CTXH noi rieng va cae hogt dong ciia cae nganh ngh6 khae noi chung Trudc b6i canh dd Dang va Nha Ngay nhgn bdi 14/01/2020 Ngdy phdn bi^n: 09/3/2020 Ngdy ddng bdi 24/312020 Nguyin Thi Kim Hoa vd cgng s|r Tgp eh ' -wisa f.Mc -.sr iv i-_^ ^_-L ,>,-•' >„ ,, "_ '"•_ - j, Joumal of Health and Development Studies (ybl04 rto"' " nude ta da ban hanh de an 32 ve phat triSn ngbl CTXH giai doan 2010-2020, nh4m tao nln tang co ban cho viec cho tiien khai cac hoat dgng CTXH bfnh vien Bo y te da ban hanh Quylt dinh s6 2154/QDBYT ng^y 15/7/2011 phe duyet "Dl an phat triln ngbl CTXH nganh y tl giai doan 2011-2020" hudng din muc tieu hinh va phat triln nghi CTXH nganh y tl, gop phan tang cudng chat lucmg, hieu qua eua su nghiep bao ve, cham soc va nang cao sdc khoe nhan dan Din nam 2015, Bo Y te tilp tuc ban hanh Thong ta s6 43/2015/TTBYT quy dinh vl nhiem vu v^ hinh thuc to chuc thuc hifn nhiem vu CTXH cua bf tta vifn, tiong quy dinh ro nhifm vy hd trg, tu vdn giai quylt cac van de ve cong tac xa h^i cho ngudi benh va ngudi nha ngudi bfnh tiong qua trinh kham bfnh, chua benh vv Cac van ban tien da dugc cac co quan ehdc nang trien khai rgng cac ea sd y te v^ ngoai cgng dong Thong qua bai viet nay, itaom nghien cdu mo ta thuc ttang ta\rc hifn quyen an sinh xa hgi ve kham chua benh cua ngudi dantadngqua boat dOng cong tac xa hoi Tu cac boat dgng cua CTXH nhu ta van chinh saeh, bien hg chinh saeh, h6 tig chuan bj ho so va ket noi cde nguon lire w ngudi dan c6 the tiep can va thuc hifn quyen kham chua bfnh ciia minh mgt each hifu qua cdufrudngDgi hgc Khoa hgc Xa hgi va Nhan van (DHKHXH&NV) va mgt s6 tiirdng, ca quan khac ph6i hgp taye hifn Thiet ke nghi§n cuu: Thilt kl c^t ngang m6 ta Dia dilm, thdi gian: Dl tai dugc thuc hien tai tinh/thanh ph6, la Ha Ngi, Quang Ninh, Hoa Bind, Da Ning, Bin Tre, Dak Ldk va taanh phd Hd Chi Minh,tiit4/ 2018 din 5/2019 Doi taong nghien cdu: Ngudi dan dang sinh song tai 07 tirta da duge chgn vao nghien cdu taugc Ha Ngi, Quang Ninh, Hoa Binh, Ben Tre, Da Ning, Dak Lak va Ho Chi Minh Ngudi dan duge lira chpn tham gia frong nghien cdu la nhiing ngudi yeutae,bao gdm: Ngudi ngheo, can ngheo, ngudi khuylt tgt, ngudi mac bfnh hiem ngheo, ngudi c6 cong vdi each mang Nghien cdu logi tid nhung ngudi dan la ngudi giau c6 v^ nhihig ngudi ed van de ve sdc khoe tam thdn Dfii tagng nghien cdu dugc thdng bao tiirdc vl muc dich cua nghien euu, cac boat dgng se tham gia (tra Idi phieu hoi, phong vdn sau) va tu nguyen tham gia nghien cdu Co mlu, each chgn mSu: Tai moi tinh/ thanh, dl tai lira chgn 02 quan/huyfn va m6i quan/huyen lira chgn 01 xa/phudng dl tiln hanh khao sat Cd mlu khao sat cua dl tai la 2.100 ngudi dan Vifc lua ehpn tinh/ ph6 ya quan/huyen eo tinh din eac dja ban da triln khai nhiiu hogt dgng nhu tSp PHLTONG PHAPNGHlfeN ClTU huan, hgi thao va tuyen tiuyln vl CTXH Bai vilt d\ra tien ket qua khao sat xa hgi hgc Xa/phudng dugc ly:a chgn la co can bg tit cua de tai cap Nha nude, Ma sd KX.Ol 36/16- nghifp chuyen nganh CTXH Iam can bg van 20 ve "Thuc hiin quyen an sinh xd hgi ciia boa xa hgi, hp nam chde cac van ban, chinh ngu&i ddn thdng qua hogt dgng CTXH chuyinsach va thudng xuyen ho frg cac d6i'taong nghiep & Viit Nam hiin nay" nh6m nghien cua CTXH Tgp chi Khoa hpc Nghien cuu Sic khde vd Phdt tnin (Tgp 04, S6 01-2020) Joumal ofHealth and Development Studies (Vol.04, No.OI-2020) Bdng Co c^u mau khao sat tai tinh/thanh ph6 STT Huyfn, xa Tinh D5k U k Quang Ninh Hoa Binh Ha Noi TP H6 Chi Minh Da Ning Ben Tre Xa Yang Tao, Huy^n Lak Phuang Tan Lap, Tp.Buon ma Thuot Phucmg cam Binh, Tp.Cam Pha Phuang Hong Gai, Tp.Ha Long Xa Du Sang, huyen Kim B6i Xa Yen Lap, huyen Cao Phong Thi tran Van Dinh, huyen U"ng Hoa Phuang Lien Mac, Quan Bac Tir Liem Phuong Phii Trung, QuSn Tan Phu Phuang 6, Quan Phuang Thanh Khe Tay, Quan Thanh Khe Phuang Nam Duang, Qu|in Hai Chau Phuong Ph6 Khuang, TP BSn tre Phucmg 6, TP Ben Tre So lurnig ngiroi dSn 150 150 150 150 150 150 150 150 150 150 150 150 150 150 2100 Tong Chung D^o due nghiSn cuu Trude thue hien khao sat ngudi dan hay nhan vien CTXH, dilu tra vien diu giai thich day du, ro rang y nghTa cua hoat dpng khao sdt, cam ket gift kin thong tin ca nhan cua ngudi dugc h6i, td d6 huy dOng su tham gia ti; nguyfn cua cdc b8n Ky thuat, cong cu vk quy trinh thu thap so lifu: Bg c6ng eu bao gdm bang hoi da dugc sd dung dg thu thap s6 lieu d 07 tinh/thanh Tgi moi tinh/thdnh p h i da to chuc toa dam vdi Sd lao dgng thuang binh xa hgi, tiong c6 npi dung vl hoat dpng CTXH thuc hien quyen an sinh ve cham soc sue khoe Doi vdi ngudi dan tgi moi xa/ phudng lap danh sach theo to khu va taon xom, chpn 150 ngudi dan theo bude nhdy K Dieu tia vien la to trudng ddn pho/tnrdng thon hogc can bg hpi phu nft dieu tia 10 ngudi to/thon cua minh fren ca sd da dugc tgp huan dilu tra vien Thong tin thu dugc dam bao khach quan va du tin cgy Phmmg phap thu thap so lifu: phong van true tiep ngudi dan taeo bg cau hoi duge taiet ke san vl mgt so yeu to lien quan den ta^c trang thirc hifn quyin khdm chua bfnh cua ngudi dan (nhan khdu hgc, tadi, gidi tinh, ngbl nghiep ) Xd Iy va phan tich so lieu: Cac s6 lifu dupe kilm ti^ ma boa, nhap hfu bang phdn mem Epidata phi6n ban 3.1, dupc lam sgch tiirde nhap hfu vaxdly taeo chuong trinh SPSS 16.0 KET QUA NGHIEN CUtJ Quyin ASXH vl kham chua benh thuc sy la mot nhung quyin quan trgng va la bifn p h ^ cdu canh dii vdi ngudi dan, nhdt la doi vdi cdc nhom ngudi khuylt tdt, ngudi cao tiioi, ngudi ngheo/can ngheo, w cac trucmg hpp doi mat vdi riii ro Im dau, benh tat cho ngiKri dan; dongtiidiciing tao tdm ly yen tam hon eho ngudi dan qua trinh dilu trj bfnh tat Chinh vi thi, cac iJian vien CTXH chuyen nghifp, ban chuyen nghifp vd khong Nguyen Thi Kim Hoa vi c§ng stf Joumal ofHealth and Development Studies (Vol 04 No.O' chuyentiehcue thirc hifn, tiong tj^ tmng nhiiu vao eong tac h6 frp edp the BHYT miln phi va bd tep ngudi dan tiem chung ngua bfnh Cae hogt dgng h6 frg ngudi dan tauc hifn quyen ASXH vl kham chua bfnh taong qua hogt dgng CTXH dugc tai hifn ro net qua cdc bang dudi ddy Bang Quyin duoc ho trg- dieu dudng, cham soc sue khoe Quang Ninh N=300 III Ha Ngi N=300 Hoat d$ng CTXH S4 TP Ben Ball Tong Ning HCM Tre Lii< N=2100 N=300 N=300 N=300 N=300 Tuy6n truyen chinh sach 3,3 14,7 28,7 14,0 9,7 28,0 17,3 16,5 Tu van chinh sach 11,0 17,3 11,7 8,7 5,3 7,3 10,0 10,2 Bien ho chinh sach 5,0 5,0 2,3 1,3 3,0 1,7 6,0 3,5 4,3 3,3 4,7 4,3 1,0 3,7 6,7 4,0 5,3 3,7 5,7 2,3 0,7 1,0 7,3 3,7 0,7 1,0 0,0 0,0 1,0 0,9 Ho trg chuan bi ho sa chinh sach Ket noi ngudn l\rc h6 tro Khac 0,0 3,3 Trong s6 2100 nguoi dan duoc khao sat, ket qua tai bang cho thay phan Ion hoat dong tuyen truyen chinh s4ch ducfc thuc hi$n kha t6t (16,5%) tiep dSn la hoat dong tu v§n chinh sAch ciing co ty le kha cao (10,2%), thap nhat a kSt qua chung ciia 07 tinh la hoat dong bien ho chinh s4ch va hoat dpng khac (3,5 % va 0,9%) V6i hoat dong tuyen truyen chinh sach dia phucmg CO ty 1^ cao nhat la Hoa Binh (28,7%) va thip nhit la TP H6 Chi Minh (9,7%), hojt dong ket noi nguon l\rc cung c6 ty le thdp (3,7%), a boat dpng TP H6 Chi Minh la ph6 co ty le thap nhjt (0,7%) va cao nhit laD5kLSk7,3% Bang Quyen dirprc ho t r g tiem chiJng ngira b^nh Hoat dpng CTXH Tuyen truyen chinh sach Tu van chinh sach Bi$n hO chinh sach Ho tn? chuan bi ho sa chinh sach Kit nii nguon luc ho tri? „ , j ^ Qnang Hoa Di ° ' " Ninh Binh Ning N=300 N=300 N=300 22,3 24,3 64,7 27,7 29,0 18,7 22,3 17,0 14,0 9,7 4,0 3,3 7,0 2,0 4,0 3,7 4,7 1,0 TP HCM N=300 6,3 Ben Tre N=300 Djk Laii N=300 ^^"^ ^"'^^^ 37,7 33,7 31,0 7,0 21,3 17,0 7,7 5,9 8,7 4,0 1,0 0,7 0,0 7,3 ,.^ _, Tgp chi Khoa hpc Nghiin ciu Sic khde vd Phdt trien (Tpp 04 S6 01-2020) Joumal ofHealth and Development Studies (Vol.04, No.01-2020) Bang vl quyin dupetiemchung ngda bfnh cho thdy hogt dgng hfi frg chudn bi hd so chinh sdch va kit ndi nguin lire h6 tig ehilm ty le thdp (4,0% vd 4,4%) Hogt dgng tayfin truyin chinh sach vdn la boat dgng chilm ty le cao nhdt (31%) Bdng 4.Quyln &tr^c ho trijr chi phi dilu tri, kham chira benh Hoftd$ngCTXH Quang H6a Da TP Bin Dik Hii NOi Ting Ninh Binh Ning HCM Tre Lik N=300 N=2100 N=300 N=300 N=300 N=300 N=300 N"300 TuySn truyin chinh sdch 10,3 Tu van chinh sdch Bien hp chinh sach 21,0 58,3 29,7 18,0 23,0 17,0 9,3 5,7 Ho trp chuin bi h i sa chinh sach 9,0 2,0 10,7 Ket noi nguon luc h5 trp 11,7 3,7 Khac 1,3 5,7 29,3 9,7 28,7 11,0 6,3 8,0 13,7 15,7 2,3 2,3 1,0 5,3 6,1 4,0 2,3 1,7 11,0 5,8 10,0 4,7 0,3 1,7 7,7 5,7 1,7 2,3 0,0 0,0 0,7 1,7 22,7 25,7 Quyin dupe ho frg chi phi dilu tii, kham Chi Minh Hogt dpng ket noi ngudn luc ho chua bfnh bang cho thdy vdi boat dgng frg, chudn bi ho sa chinh sdch cd ty If taang tayen trayin ehinh sachtinhcd ty le cao nhdt duong (5,7% va 5,8%) la Hoa Bmh (58,3%) va thdp nhdt la TP H6 Bang Quyen duwc c^p the BHYT miln phi Hoat dOng CTXH H i NOi N=300 Quang H6a Da TP Ben Dik Ninh Binh Nang HCM Tre Lik N=300 N=300 N=300 N=300 N=300 N=300 Ting N=2100 Tuy^n truyen chinh sach 8,3 20,3 70,0 26,0 12,0 36,7 30,7 29,1 Tu van chinh sach 25,3 16,7 26,3 16,0 5,7 11,0 15,3 16,6 Bien hp chinh sach 15,3 8,3 7,0 2,0 1.7 1,7 7,3 6,2 2,7 9,7 17,7 7,3 3,0 7,0 12,7 8,6 10,0 1,0 12,7 5,7 Ho trp chuan bj ho sa chinh sach Ket noi nguon l\rc ho trp 5,0 5,8 0,0 0,7 Nguyin Thi Kim Hoa vd cgng sp Tgp chlr Joumal ofHealth and Development Studies (VoL04 N0.