Bảo hiểm y tế cho hộ gia đình di cư nghiên cứu trường hợp hà nội

Bao hiem y te cho ho gia dinh di cir: Nghien cihi trirdng hop Ha Noi Nguyen Nhir T r a n g ' ' Vi?n xa hpi hoc, Vi$n Hta ISm Khoa hoc Xa hpi Vift Nam Email: nhutrang6@gmail.com Nli|n ngdy 18 thang nam 2019 Chap nhan dang ngdy 15 thang 10 nam 2019 Tom tat: Trong bii canh hdi nhap va toan ciu hda cang sSu rpng, lao dgng di cu 1^ m^t phin khong thi tach rdi gifta cac nin kinh ti Ngudi lao dgng di cu da gop phin dang ke vao s\r t5ng trudng kinh ti va phat triin ciia dat nudc Nhan thuc dugc vai trd ciia di cu, ttong nhung nam gin dSy, Dang va Nha nudc ta ludn quan tam den vi?c bao v? quyin lgi va lgi ich hgp phap, quyen iugc lam vi?c va an sinh xa hgi ddi vdi ban thSn ngudi di cu va gia dinh ciia hg Trong do, bao liiem y tl (BHYT) toan dan la muc tieu ldn ciia nganh y ti Vi?t Nam M0t ttong nhung kho khan cuavi?c thyc hien muc tieu la ty le tham gia BHYT cua ngudi di cu cdn thip Diiu da lam anh hudng din viec tiip can va sir dung dich vy y t8 (DVYT) co chat lugng cua ngudi di cu tgi thj hi?n nay, ttong dd cd Ha Ngi Tir khoa: Bao hiim y ti, di cir, hp gia dinh, Ha Ngi PhSn loai aganh: Xa hgi hpc Abstract: hi the context of increasingly broad and profound integration and globalisation, migrant workers are an integral part among economies They have made significant conttibutions to the economic growth and development ofthe country Aware ofthe role of migration, in recent years, the Vietnamese Party and State have always paid attention to the protection of legitimate rights and interests, the rights to work and to social security, of the migrants themselves as well as their families, hi that, universal health insurance is a major target of Vietnam's health sector One of the difficulties in realising the target is that the rate of migrants who join health insurance remains low That has made impact on the access to and use of healthcare services of proper quality by migrants in cities nowadays Keywords: Heahh insurance, migration, household, Hanoi Subject classification: Sociology 103 Khoahpcxahoi VietNam, s6 11 -2019 Dgt van de Trong nhiing nam gan d^y, qua trinh day manh cdng nghiep hda, Men dai hda va thi hda d Viet Nam da thu hut mgt luc lugng ldn lao di cu den tim kiim ca hdi viec lam va sinh sdng Tai cac dd thi ldn cua Viet Nam nhu Ha Ndi, Thanh phd Hd Chi Minh, dan sd ca hgc tang nhanh ngudi di cu tu cac tinh, cac vung ndng thdn din tun kiem ca hgi viec lam va xay dung cude sdng mdi Theo Tdng cue Thdng ke, ty Ie di dan tir ndng thdn den thi tren tdng sd dan thi tang tir 8,9% nam 2009 Ien 11% nam 2019 Trong ty le di cu til thi tdi thi tren tdng sd dan thi giam tir 7,6% nam 2009 xudng 6,7% nam 2019 iTdc tinh vao nam 2019, dan sd di cutir ndng thdn thi se dat triSu ngudi, cao han dan sd di cu tii thi den nong thon 1,4 trieu ngudi Ket qua dieu tra Di cu ndi dia qudc gia 2015 cho thay, 79,1% ngudi di cu cd ngudn gdc xuat than tCr ndng thdn, cdn lai 20,9% la tu thi Xet theo ludng di cu (ndng thdn - thi, thi ndng thdn, ndng thdn - ndng didn va thi - thi) thi ludng di cu ndng thdn - thi chigm ty trgng ldn nhat cac ddng di cu Dd la chua ke den nhiing cu dan den phd lam viec theo thdi vu va di cu ngan han Ddng ngudi di cu ndng thdn - dd thi tun kiim viec Iam ludn tiem an nhimg nil ro d noi den, dd cac van de ve y te cham sdc sue khoe dugc cho la quan trgng Trong bdi canh do, cung vdi bao hiem xa hdi, BHYT la van de toan cau nham bao dam quyen ngudi, thuc hien cdng bang xa hdi tiip can cac DVYT va cham sdc sdc khde ddi vdi nhihig ngudi di cu Nghien cuu d Viet Nam va ragt sd nudc khu vuc nhung thap ky g ^ day cho thdy, cac yiu td kinh ti, xay dung va thiet ki chinh sach la nhiing rao can chu y^u tac dgng true tiep den tiip c$n cac dich vu xa hdi ca ban cua ngudi, dac biet ddi vdi nhdm dan sd dac thu la ngudi di cu Dira vao ngudn sd liSu cua Ngan hang The gidi tu eudc khao sat ve Tinh hinh cu tni d Viet Nam (HRS 2015/2016), bai viit phan tich thuc trang su dung BHYT cua ngudi di cu tvr ndng thdn vao phd; nhiing nguyen nhan khach quan va chu quan can trd ngudi di cu tham gia bao hiem y te Tu dd de xuat mdt sd khuyen nghi chinh sach nham khac phuc cac rao can giup ngudi di cu tham gia BHYT sau rdng han Thirc trang bao hiem y ti hd gia dinh hifn BHYT la hinh thdc bao hiim Nha nudc td chuc thuc hien vi muc tieu cham sdc sue khde nhan nhan, khdng vi muc dich loi nhuan BHYT la mdt nhung tieu cht danh gia tiip can DVYT ciia ngudi dan cham sdc sue khde Hudng din muc tieu BHYT toan dan nam 2020, hien ty le bao phu BHYT d cac nhdm dan cu da tang len rd ret: dien bao phu BHYT toan qudc dat 86,9% [8], dien bao phu BHYT d nhdm di cu toan quic la 67,6 % [5], va bao phu BHYT d nhdm di cu tai khu wuc thi nhu Ha Ndi la 77% [3], BHYT hd gia dinh dugc thuc hien bit dSu td 1/1/2015 theo qui dinh cua Luat BHYT mdi Thirc hien BHYT hd gia dinh d6i vdi cac gia dinh di cu gap nhiiu kho khan han dac diem ddi sdng dich chuyin cua chinh cac hd gia dinh di cu Nguyen Nhu Trang 2.1 Mgt sd ddc trung cua hd gia dinh di cu Dac tnmg hg gia dinh la mdt nhiing tiSu chi dS p h ^ biet cac loai hg gia dinh khac nhau: vi du nhu hg gia dinh ndng thdn vcri hg gia dinh dd thi; hg gia dinh theo tdn giao va hp gia dinh khdng theo tdn giao; hg gia ffinh di cu va hp gia dinh khdng di cu Nghien cuu sau dac diem cua hp gia dinh di cu chiing tdi phat hien mdt vai diem dang chu y: so vdi hp gia dinh khdng di cu thi qui mo hp gia dinh cua ngudi di cu thudng nho hem Nghien curu tren 5.000 hp gia dinh tir khao sat ve tinh hinh cu tni d Viet Nam Ngan hang The gidi tai tra cho thay: qui mo hg gia dinh cua nhiing ngudi di cu thap hem nhieu so vdi qui md hg gia dinh cua nhflng ngudi khdng di cu Ket qua khao sat CO 18% hg gia dinh ngudi di cu cd ngudi, chi % hg gia dinh cua ngudi khong di cu cd mdt ngudi Ty Ie hd gia dinh CO tre em d cac gia dinh khdng di cu la 60%, ty le d cac gia dinh di cu nhd hon va chi 33% Tudi trung binh ciia cac chu hd gia dmh di cu la 34 tudi, tre han rat nhieu so vdi tu6i trung binh cua cac gia dinh khong di cu la 47 tudi Ty le kit hdn d chu ho cac gia dinh khdng di cu la % ty le d chu hd cac gia dinh di cu la 75% (cd hgp ddng lao ddng) va khu vuc phi chinh thuc (khdng cd hgp ddng lao ddng) Ket qua nghien cuu cho thiy, ty le cd BHYT nhdm nhiJng ngudi Iam viec cd hgp ddng lao dgng la rat cao so vdi nhdm nhirng ngudi lam viec khdng cd hgp ddng: 82,8% ngudi di cu lam viec cd hgp ddng lao ddng cd BHYT, chi cd 55,3% ngudi lao ddng khong cd hgp ddng cd BHYT Nhu vay, tinh trang hgp ddng lao ddng la yeu to true tiep anh hudng den viec cd hay khdng cd BHYT ciia ngudi lao dpng di cu Mgt mat, BHYT hd gia dinh gop phan dam bao an sinh siic khde cho ca hg gia dinh ngudi tham gia; mat khac, quy dinh dang gay nhiing khd khan nhat dinh cho ngucri dan, mSc du miic phi mua the BHYT dugc giam dkn theo sd lugng vien hp Vi du, niu hd gia finh cd ngudi thi phi BHYT mdi nam se la 2.246.400 ddng, da tinh theo muc giam dan Sd tiin phai ddng phi mot lin v§n la khd khan ddi vdi nhiing gia dmh di cu cd mdc thu nhap thip va chua dn dinh Trong trudng hgp gia dinh cd ngudi cd sue khde kem, mudn danh tiin bac d i mua the BHYT cho ngudi dd cung khdng mua dugc Ddi vdi nhiing hd gia dinh dl cu d&n sdng tai thi, mdc sing thip va chi phi kham chiia benh cao, BHYT cang ddng vai 2.2 Do bao phu BHYT trd quan trgng cham sdc sdc khde cua Mac du dp bao phu BHYT cua ngudi di cu nhdm lao ddng BHYT cdn cd y nghia tai Ha Ndi cao han bao phu BHYT cua dac biet han ddi vdi hd gia dinh ngudi di cu ngudi di cu tren toan qudc, nhung nghien cuu phai ddi mat vdi nh&ng thiet thdi dinh tinh cho th4y ngudi di cu cdn gap trd viec tiip can vdi nhung dich vu cham sdc ngai mua the BHYT qui dinh tham gja siic khde bi han che bdi cac mdi quan BHYT theo hd gia dinh hien Cd su khac he xa hgi cdn long leo tai noi d mdi Han biet tham gia BHYT giiia hg gia dinh di nOa, diiu kien tai chinh eo hep nen cu CO ngudi lam viec d khu vuc chinh thiic khdng phai hg gia dinh di cu nao cung cd 105 Khoa hpc xahgi VietNam, so 11 - 2019 nhdm cd ty Ie BHYT trai tuyin cao la nhdm dudi 18 tudi chiim 54,1% Viec di chuySn den cac tinh/thanh phd khac nai cu tni d i kham chira benh theo dang ky BHYT 2.3 BHYT trdi tuyin dii vdi nhdm dudi 18 tudi la mOt khd khan BHYT trai tuyin khdng ho trg chi tra hoac Idn Khd khan khdng chi viec di chuyen xa chi chi tra mgt phan ngudi di cu su anh hudng den siic khde cac em ma ban dung tai ncri cu tni mdi BHYT trai tuyin la than c^c em phai nghi hgc hoSc cha me hay rao can ldn nhat cac hd gia dinh di cu ngudi than phai nghi lam viec de dua cac tiep can cac DVYT nhim cham sdc sue em di kham chira benh N i u chap nhgn khde Phan tich sd lieu cho thay ty le ngudi KCB tai nai cu tni thi hd gia dinh di cu se di cu cd BHYT tai cac tinh/thanh phd khac phai chip nhSn tu chi tra bang tien tui ca noi cu tni cao nhat la d nhdm tren 40 tudi nhan hoac chi dugc BHYT chi tra mgt phin chiem 57,2% Day la nhdm trung nien, la nhd tdng chi cho cac DVYT Trong nhdm ma sdc khde bat dau cd dau hieu do, ty ie BHYT trai tuySn d hg gia dinh giam Slit, chac chin hg se gap khd khan khdng di cu la rit thip, chi 0,6% R5 rang tiip can cac DVYT phai di chuyen den so sanh vdi nhiing hg gia dinh di cu thi tinh/thanh phd khac nai cu tni de kham chiia BHYT tai noi cu tni la mgt lgi the cua hg benh (KCB) dugc chi tra tCr BHYT Xip thii gia dinh khdng di cu (Bang 1) the mua BHYT hg gia dinh d i giam bdt chi phi kham chua benh cho minh Bang I: Tinh trang BHYT theo tudi, gidi tinh cua ngudi di cu va khong di cu (%) [3] Gioi tinh Nam Nii Tuoi Chung