Một số khó khăn trong tiếp cận dịch vụ y tế của người cao tuổi ở nông thôn hiện nay

Mot so kho khan tiep can dich vu y tS cua nguoi cao tuoi 6^ nong thon hien Nguyen Thi Thiiy Linh*** Tom tat: Chdm sdc sue khde (CSSK) Id mdt nhung quyin ca bdn ciia ngudi Ciing vdi suphdt triin kinh ti - xd hoi chdt luong cugc sdng dugc cdi thien keo theo tudi thg binh qudn ngdy cdng gia tdng khien sd ngudi cao tuoi (NCT) tgi Viet Nam dang co xu hudng tdng nhanh Tuy nhien, cdc nghien cim gdn day chi rdng NCT Viit Nam, dgc biet Id d khu vuc ndng thdn, dang gap nhieu vdn di liin quan din sue khde (binh tat), nhdt Id bdi cdnh nai day cdn thiiu co sd vat chdt vd chdt lugng khdm chica binh eon chua cao Dua vdo ngudn tdi lieu thii cdp vd sd lieu tinh todn cua tdc gid tir bd so lieu Khdo sdt Mice sdng ddn cu Viet Nam (Vietnam Household Living Standard Survey VHLSS) ndm 2016^ cua Tdng cue Thdng ke bdi viet md td tinh hinh sue khde the chdt, tinh thdn vd phdn tich mdt sd khd khdn tiip can dich vu y ti ciia NCT a ndng thdn, qua ggi md hdm y chinh sdch nhdm ndng cao co hdi tiep can dich vu y te cua NCT ndng thdn boi cdnh hien Tu khoa: Ngudi cao tudi, Ndng thdn, Siic khde the chat, Sire khde tirih than, Tiep can dich vu y te Abstract: Health care is one of the most common rights of human As a consequence of social and economic development, living standards have been improved, contributing to the gradual increase of life expectancy and yet the number of elderly in Vietnam Recent studies, however, have shown that the elderly in Vietnam, especially those in rural areas are facing health problems due to inadequate health facilities and health care quality A preliminary literature review and data analysis based on the 2016 Vietnam Household Living Standard Survey (HLSS) by Vietnam General Statistics Office, the article aims at providing a description of physical and mental health status of the elderly in Vietnam, an analysis of the disadvantages of health care systems for the elderly in rural areas, as well as policy suggestions for improvement of the current situation Keywords: The old, Rural Areas, Physical Health, Mental Health, Access to Health Services '*'ThS„ Vien Xa hgi hgc, Vien Han lam Khoa hgc xa hdi Viet Nam; Email: thuylinh.ajc 298@gmail.eom ^VHLSS la cuge Khao sat Miic sing dan eu dinh ky nam mgt lin Tdng cue Thdng ke thue hien VHLSS nam 2016 dugc tiSn hanh tren 9.399 hg gia dlnh, khao sat eae ngi dung nhu: viec lam, thu nhap, y te, giao due, tieu dimg Trong dd, s6 NCT dugc khao sat la 4.462 ngudi, NCT d khu vuc ndng thon chiem gin 66,4% tdng s6 NCT NCT duge chia nhdm: nhdm NCT tir 60-69 tudi (chiem 54,5%), nhom NCT tir 70-79 tuoi (chiSm 25,1 %) va nhdm NCT tir 80 tudi trd len (chi^m 20,3%) 48 Dat van de Sau hon 30 nam ddi mdi, ndng thdn Viet Nam dang cd nhieu thay ddi v l kinh te, xa hdi Cimg vdi qua tiinh phat triln kinh te - xa hgi, tudi thg binh quan cua ngudi dan gia tang, miic sinh giam xuong da thiic day gia hda dan sd d Viet Nam Theo sd lieu cua Tdng cue Dan sd - Ke hoach hda gia dinh (Bd Y tl), Viet Nam chinh thiic budc vao giai doan gia hda dan sd tir nam 2011 va hien ed khoang 10,1 trieu NCT', chilm 11% dan sd; tiong 65,7% NCT sdng d ndng thdn, la ndng dan va lam ndng nghiep, thu nhap thip (Dan theo: Bd Lao dgng - Thuong binh va Xa hdi, 2019) Sd lugng NCT Viet Nam ndi chung va NCT d nong thdn Viet Nam ndi rieng hien dang cd xu hudng tang nhanh, hg phai ddi mat vdi nhieu khd khan cugc song, dac biet la vin d l CSSK Phin Idn NCT ndng thdn khdng eo luong huu, sdng phu thugc hoac van phai ty muu sinh kiem song Trong dd, cac hinh thiic tuong trg giiip theo md hinh truyen thdng cho ngudi gia dang suy yeu, md hmh an sinh nha nude chua dam bao tdt tiong viec hd tig cho cugc sdng ciia NCT, dieu dat nhilu cau hdi nghien ciiu lien quan den thyc tiang sue khde the chat, tinh than va nhung khd khan chi phdi viec tiep can dich vu y te cua NCT d ndng thdn Bai viet tim bieu tinh tiang siic khde the chat, tinh than va phan tich mdt so khd khan tiep can cac dich vu y te ciia NCT d ndng thdn thdng qua cac chi bao nhu: nhan thiic cua ban than NCT ve CSSK, sy quan tam hd tig eua gia dinh va dieu kien kinh te; tir dd ggi md ham y chinh sach nham tang cudng CSSK cho NCT d ndng thdn tiong bdi canh hien ' Dieu Luat Ngudi cao tudi nam 2009 quy dmh, NCT la cong dan Viet Nam tir du 60 tuoi trd len Thong tin Khoa hoc xa h6i sd 12.2019 Vai net ve thuc trang sue khde ciia ngudi cao tudi d nong thdn Sue khde the chdt Hien nay, mac du tudi thg trung binh ciia NCT Viet Nam kha cao (73 tudi) song tudi thg khde manh cua NCT lai kha thap (Le Xuan Cii, Pham Hai Hung, 2018) Nhin chung, NCT \^et Nam ndi chung va d khu vuc ndng thdn ndi rieng van chua thyc su khde manh nhu mong mudn Theo bao cao ciia Bd Y t l , ed khoang 95% NCT mac benh, trung binh moi NCT mac 2,69 benh, chu yeu la benh man tinh va khdng lay truyen Ty le NCT cd siic khde tdt chi chiem khoang 5-7%; siic khde kem la 23%; cdn lai la siic khde trung binh (Le Nggc Lan, 2010) Nhu vay, da so NCT diu mic cac benh man tinh va ty le la rit cao Cac benh man tinh va benh thdng thudng nhu tang huyet ap, tieu dudng, ung thu va benh phdi tac man tinh (von co nguyen nhan tir cac benh v l dudng hd hip keo dai) la cac benh khdng lay nhiem chinh ma NCT d ca khu vyc ndng thdn va thi hien dang mac phai Ty le mac benh ung thu d NCT da tang len va chilm 20% miic tan tat sd nhiing ngudi tir 60-64 tiili (UNFPA, 2019) Do tiidi cang cao, ty le mac benh ung thu cua NCT cang Idn anh hudng tir nhieu benh khac Ngoai ra, nhiing benh ly nhu tim mach, xuong khdp, thinh/thi giac, cung gay anh hudng Idn den sue khde va chat lugng cugc sdng cua NCT (Pham Thing, 2007) Tudi tac dugc coi la mgt ylu td cd moi lien quan chat che vdi tinh trang siic khoe cua ngudi Sd lieu phan tich tir VHLSS nam 2016 cho thiy, cd 17,4% NCT d nong thdn bi benh/cbin thuong nang phai nam mgt cho va can ngudi cham soc 12 thang trudc thdi dilm khao sat Trong nhdm tudi NCT, nhdm NCT tix 80 tiidi trd len mic benh chilm ty le cao nhit 49 (26,2%) va cd sd lan mac benh nang ciing nhieu nhit (trung binh 2,05 lin/nam, tiong nhdm 60-69 la 1,93 lin/nam va nhdm 70-79 la 1,83 lin/nam) Da sd NCT thudc nhom tudi 60-69 d ndng thdn van lam ndng nghiep (mgt sd di xay dung, phu hd ), it cd thdi gian va co hdi tiep can vdi cae dich vu y te nen de bi benh/chan thuong nang hon so vdi nhdm NCT tir 70-79 tudi tudi nhit dinh, NCT thudng it nhilu bi rdi loan ve tam ly, di chuyen it hon hoac cd nhung uu tu, phien mudn cugc sdng thay dii, viec giao tilp ciing tid nen khd khan hon Nhung tid ngai v l tinh thin d NCT thudng bieu hien qua su mac cam ve ban than hoac phai nhd tdi su giiip cua ngudi khac Cd the thay, chia se niem vui tiong cugc sdng dac biet quan tigng ddi vdi Nhin chung, NCT d khu vuc ndng thdn NCT Tuy nhien, sy khac biet ve tam ly giua dang gap van de ve siic khde the chat Dii NCT va ngudi tre tuoi lai la rao can ddi vdi la benh thdng thudng hay benh man tinh thi sy chia se giiia hai the he khac Trong cugc song ve gia eua NCT deu bi anh NCT sdng thien ve qua khii, thi nhiing hudng nghiem tigng neu khdng dugc chua ngudi tie tudi lai hudng nhieu den tuong lai tri kip thdi Cd the thay, nhung chi sd ve Dd la ly ma ca cac vien tiong sire khde, thong tin ve ty le benh tat ndi tren gia dinh ddi ciing cd nhung bieu lam gay cho thay nhu cau cao ve CSSK cua NCT d tianh cai, xung dot Dieu tia ve Bao lye gia dinh d Viet Nam (nam 2012) cho thay, dien nong thdn hien hinh nhat la hanh vi bao lye ve siic khde tinh Sue khde tinh thdn CJ ndng thdn Viet Nam, NCT ve than nhu si nhuc, cai Ion (38%) va sir dung gia chu yeu sdng ciing gia dinh Tuy nhien, ngdn ngii thd tuc (23%) NCT deu da trai qua NCT ciing dang chiu tac ddng ciia sy thay (Hdi Lien hiep Phu nii Viet Nam, 2012) ddi cau tiuc gia dmh ty le hg gia dinh Nhu vay, quy md gia dinh va quan CO cha me sdng chung vdi cac da giam he ling xir gia dinh thay ddi, NCT d ro ret Xu the gia dinh hat nhan trd nen phd ndng thdn dang gap phai cac van de ve tam bien khien ty le cd don va cd lap d nhirng ly, tinh cam Neu khdng dugc dap iing ve NCT cang gia tang (UNFPA, 2019) mat tinh cam mdt thai gian dai, NCT Ty le cac gia dinh cd quy md nhd dang gia se bi anh hudng true tiep ve mat siic khoe, tang va chiem 74% nam 2017 (Tdng tam ly cua ban than va gian tiep anh hudng cue Thdng ke, 2017) Trong sd nhirng NCT tdi ca cac vien gia dinh Ngoai song mgt minh, cd tdi 80% la phu nii va CSSK thi chit, sire khde tinh thin cua NCT 80% song d ndng thdn (Pham Thang, Dd Cling can dugc dac biet quan tam de NCT Thi Khanh Hy, 2009) Nghien ciiu ciia sdng vui, sdng khde, sdng cd ich ve gia Nguyen Diic Chien, Nguyen Thi Huyen Mgt so khd khan tiep can dich vu Giang (2018) cho thay, NCT d ndng thdn y te cua ngirdi cao tudi d nong thon gap nhieu khd khan ve siic khde tinh than Theo A.L Ann va A Ronald (1973), cai thoat ly lam viec va sdng xa que dich vu y tl bao gdm tat ca cac dich vu Hen Su thay ddi ve md hinh chung sdng cd quan tdi cac chan doan va dieu tri benh the khien cho cugc sdng cua NCT d ndng hoac chuong trinh nang cao, cai thien va thdn cang them khd khan, ca ve mat CSSK phuc hdi sue khde Tiep can dich vu y te the chat lan siic khde tinh than dugc hilu la sy tilp can cac dich vu y te san Ty le CO don cua NCT d khu vyc ndng cd tdt nhit kha nang ciia ngudi benh, thon dang cd xu hudng tang theo tudi O mdt cho phep mgi ngudi cd dugc cac dich vu 50 hg cd nhu cau kham/ chira benh Theo do, chiing tdi lam rd mdt sd khd khan tiep can dich vu y te cua NCT ndng thdn dang gap phai hien Thii nhdt, hiiu biet vd nhdn thiic ve sue khde binh tdt ciia bdn thdn ngudi cao tudi Theo ket qua danh gia nam thyc hien Luat NCT cua Bd Lao ddng - Thuong binh v a X a h d i vaUNFPA(2016), vl chi bao hiem y te, cd den 90%j NCT co the bao hiem y te (trong dd hon 30% la tu mua, 59% la dugc cap) (Dan theo: Nguyen Qudc Anh, 2018) Nhu vay, phan Idn NCT da cd nhan thiic tot ban tiong viec bao ve va CSSK ciia minh ve gia Dang luu y la, cd 10,3% NCT chua cd bao hiem y te, dd ty le d khu vuc ndng thdn chiem cao gap hon lan so vdi khu vyc thi (tuong ling la 12,5% so vdi 5,5%)) (Bd Lao ddng - Thuong bmh va Xa hgi, UNFPA, 2016), dieu cd the NCT Viet Nam chu yeu sdng d ndng thdn (gap hon lan khu vyc thi) ( B d Y t l , 2018) Da sd NCT d khu vuc nong thdn chua cd thdi quen kiem tia siic khde dinh ky nen phat hien benh thudng d giai doan mudn khien viec chiia tri gap nhieu khd khan Mdt sd nghien cuu cho thay, nhin chung NCT d ndng thdn van cdn gap nhieu khd khan tiong van de tu CSSK eho ban than bdi hg chua nhan thiic dugc rd tam quan tigng cua viee dieu tri sdm cac loai benh thdng thudng va benh man tinh d tudi gia Budc sang tudi 60, NCT can dugc kham siic khoe dinh ky tai cac co sd y te de kip thdi xac dinh cac yeu td nguy co, phdng tranh va phat hien sdm benh tat de chira tri kip thdi Tuy nhien, viec kham chua benh kip thdi ddi vdi NCT d nong thon van cdn han ehl nhieu nguyen nlian khac nhau, tir y thiic ve bao ve siic khde den nhiing lo ling phat sinh biet ve benh tat, khd khan tiep can co sd y te, chi phi kham Th6ng Hn Khoa hoc xa h^i so 12.2019 chiia benh, (Le Van Kham, 2014) Ngay ca vdi nhiing ngudi thudng xuyen dau dm, benh tat thi viec kham chiia benh eua hg Cling cd nhiing trd ngai nhat dinh Trinh hgc v i n ciia NCT ndi chung cdn thip, dac biet la NCT d ndng thdn Hon 59% sd NCT khdng cd dilu kien hgc hanh day du, chi cd 0,21% cd tiinh trung hgc tid len, do nhiing hieu biet ve y hoc co ban, cac phuong phap tap luyen, phdng benh, tiep can dich vu y te cua NCT cdn ban che (Le Van Kham, 2014) Nhan thiic kem khien cho viec tiep can va sit dung cac dich vu y te cua NCT d khu vyc ndng thdn trd nen khd khan Thu hai, thieu su hd trg tic phia ngudi thdn gia dinh Cach sap xep md hinh ehung sdng dugc xem la mdt nhiing yeu td tac ddng tdi tam ly va nhan thiic cua NCT viec lua chgn loai hinh dich vu y te de sir dung Theo md hinh truyen thdng, hau het NCT d nong thdn sdng chung vdi chau gia dinh da the be Trong quan niem cua da sd NCT, viec sdng vdi la duong nhien va hg khdng cd lua chgn nao khac (Bui The Cudng, 2005) Dieu the hien rd hon doi vdi NCT d ndng thdn va vdi nhung NCT cd miic song thap Ngudi d nhdm tudi cang cao CO ty le mong mudn dugc sdng vdi chau cang nhieu Tuy nhien, dudi tac dgng ciia qua tiinh dd thi hda, bien dai boa, ciing vdi qua trinh di cu da khiln cho gia dinh Viet Nam dang cd xu hudng hat nhan hda va thu hep quy md, ty le NCT song chung vdi cai cd xu hudng giam di (Nguyen ThiNggcHa,2016) Qua trinh cdng nghiep hda, dd thj hda dien manh me d cac phd Idn da thu hut khdng it Iao ddng nhap cu tir cac khu vuc nong thdn Ngay cang cd nhilu ngudi tre mdi rdi ndng thdn de tim kilm cdng viec cd thu nhap cao bon d cac thi, NCT d lai nipl s o Rnu nneui nong th6n tiong nhiing hd gia dinh khuyet thi he va hg rat de tdn thuang thieu su cham soc, hd tig thudng xuyen eua cai NCT cd don la mdt tiong nhiing nhdm ddi tugng gap nhieu khd khan nhieu ngudi s6 hg sdng thieu thdn ca ve vat chat lin tinh than Vdi ngudn thu han che va miic thu nhap it di nhu vay, NCT cd don chi tieu rit eo hep, chu yeu cho nhiing rihu cau thiet yeu, cugc sdng cua hg da phan rat khd khan (Nguyin Thi Nggc Ha, 2016) Dilu anh hudng trye tiep tdi y thiic tu CSSK ciia NCT d ndng thdn ndi rieng va ca nude noi chung Cham sdc truyen thdng ciia gia dinh doi vdi NCT dang giam di thu nhap ciia phan Idn hd gia dinh cd NCT thap khien cho NCT khdng du dieu kien chi tia cho cac dich vu CSSK va tdi cac co sd y te cdng de dieu tri benh Ddng thdi, khd khan sap xep cugc sdng da khien cho nhan thuc cua NCT ve viec tim hieu cac kien thiic ve CSSK gap nhieu ban che Thay vi tdi cac co sd y te, ty cham sdc dugc coi la hinh thiic phd bien ddi vdi NCT d nong thdn hien Phan Idn NCT d nong thon thieu kien thirc ve CSSK va phdng benh, dac biet la nhdm NCT sdng cd don khong CO chau ben canh 51 Khd khan ve kinh te la mdt nhiing yeu td tac ddng din md hinh lua chgn sir dung dich vu y te cua NCT d nong thdn Nam 2016, ty le NCT sdng d muc ngheo ddi nghiem trgng (dudi mdt nira thu nhap chuan ngheo) va miic ngheo ddi tang dan theo tudi Tuy nhien, ty le ngheo d nhdm tudi tir 80 trd len la thap ban so vdi nhdm tudi 70-79, dieu cd the ty le nhdm NCT 80 tudi trd len dugc nhan trg cap xa hdi cao bon NCT la nhdm ddi tugng dac thu cua xa hdi, khdng phai NCT nao ciing cd luang va trg cap xa hgi de ty chi tra cho cac boat ddng tham kham, chiia benh cua minh, dac biet la NCT d ndng thdn Vi vay, md hinh sit dung dich vu y te d cac tuyen khac hien van bi anh hudng bdi kha nang chi tia va kha nang tiep can dich vu (Nguyen Quoc Anh, 2018) Ddi vdi cac benh thong thudng, NCT d nong thdn thudng cd xu hudng khdng di kham chiia benh d benh vien ma se ty mua thudc dieu tri hoac tdi tram y te xa Tuy nhien, ddi vdi cac benh lay nhiem hoac benh man tinh, NCT ndng thdn van phai tdi cac co sd y te tuyen huyen, phd hoac benh vien/phong kham tu nhan de tham kham vdi miic chi phi kha cao, nhit la ddi vdi trudng hgp NCT khdng cd bao hilm y te Dieu thyc sy gay Thu ba, khd khdn ve ngudn luc kinh te khd khan Idn vdi nhiing NCT ngheo, NCT Theo sd lieu cua Bd Lao ddng nong thdn sdng d khu vyc kho khan, vung Thuong binh va Xa hdi, van cdn 1/3 sd sau, viing xa NCT thudc dien ngheo va can ngheo, ddi Sd lieu phan tich tir VHLSS nam 2016 song gap nhieu khd khan, nhat la d cac viing nong thdn va mien nui Khoang 2/3 sd cho thiy, cd sy chenh lech Idn viec NCT khong co ngudn trg cap xa hgi thudng lua chgn va sii dung cac dich vu y te ciia xuyen va khdng ed bao hiem y te Chi cd NCT ndng thdn giiia cac nhdm co miic 35,6% (d thi) va 21,9% (d ndng thdn) sdng khac loai hinh benh vien CO luong huu hoac trg cap tir Nha nude Da tuyIn trung uong, neu nhu cd 8,9% NCT so NCT cd siic khde kem nhung phan Idn thugc nhdm miic sdng ngheo lua chgn sir la khdng dugc cham sdc y te day du dung thi cd tdi 10,5% NCT thudc nhom thieu tien va thieu co hgi tiep can dich vu y miic sdng giau sir dung loai hinh y te te cd chit lugng (Trin Thi Minh Thi, 2014) Tuong ty, d loai hinh benh vien tinh, NCT Thdng tin Khoa hoc xa hoi sd 12.201S 52 nhdm ngheo la 19,7% va 24,7% d NCT thudc nhdm giau Ngugc lai, vdi loai hinh tiam y te xa, neu cd tdi 28,3% NCT thudc nhdm ngheo sii dung thi chi cd 12,2% NCT thudc nhdm giau va 14,2% NCT thudc nhdm miic sdng kha tiep can loai hinh co sd y te (Xem: Bang 1) Ben canh dd, sy khac biet ve sir dung loai hinh co sd y te tu nhan ciing dugc the hien ro timg nhdm miic sdng ciia NCT d khu vuc ndng thdn, NCT thudc nhom mice sdng cang cao Ve sice khde tinh thdn, NCT ndng tiidn dang chiu tac ddng cua sy thay ddi cau triic gia dinh ty le hd gia dinh cd cha me sdng chung vdi cac da giam ro ret Sy thay ddi ve md hinh sdng chung cd the lam cho cugc sdng cua NCT cang them khd khan, ca vl mat CSSK tbi chit lan siic khde tinh than NCT dang gap cac van de ve tinh than nhu cd don, mac cam ty ti phai nhd den su giiip cua ngudi khac T^ le ed don cua NCT dang cd xu hudng tang Bang 1: Sir dung djch vu y te ciia NCT nong thon chia theo nhom thu nh^p C^c loai hinh co* sd" y te Nh6in thu nhap N Benh vien tinh Benh vien Trung uong Yte tunhan Co s6 y te khac Nhom ngheo 28,3 Benh vien tuyen huyen/TP 47 19,7 8,9 23,7 4.8 575 Nh6m can ngheo 23,9 45,2 24,2 23,3 2,6 569 Nhom trung binh 19,3 49,2 22,5 1,9 579 Nhom 14,2 42,5 24 7,1 32,9 39,7 1,9 552 Nh6m gi^u 12,2 43,6 24,7 10,5 31,5 2,4 404 Chung 23,6 51 22,2 7,2 26,7 2,5 2.679 Tram y te xa/phtrong Nguon: Tinh toan tiJ sd lieu VHLSS (2016) thi cang cd kha nang lua chgn sir dung dich vu y te tu nhan va cac loai hinh dich vu y te tuyen tren nhieu hon Nhu vay, rd rang khd khan ve kinh te da can trd rat nhieu tdi viec tiep can cac dich vu y te ciia NCT d ndng thdn thdi diem hien Ban luan va ket luan Cac phan tich d tren da de cap tdi tinh hinh siic khoe va nhiing kho khan tiep can dich vu y te cua NCT d nong thon hien Ve sice khde thi chdt, hien nay, NCT chii yeu mac ca cac benh mantinhva benh thdng thudng Chu yeu la cac benh vl xuong khdp, huyet ap, tim mach, thinh giac, thi giac Trung binh mgt NCT d Viet Nam dang mac tdi ba loai benh Ddng thdi, tuoi cang cao, ty le mac benh cua NCT cang gia tang theo tudi Sdng cd don lam gia tang nhung van de nii ro cugc sdng ciia NCT, gay bat Igi tdi siic khde tinh than va siic khde noi chung cua NCT NCT van cdn gap nhieu khd khan tiong van de tu CSSK cho ban than thieu hilu biet ve tinh hinh benh tat va chua nhan thiic day du dugc tam quan tigng ciia viec dieu tri sdm cac loai benh thdng thudng va benh man tinh d tudi gia Phin Idn NCT d nong thdn van phai lam viec dl kilm them thu nhap, trinh hgc van cua NCT ndi chung cdn thap nen nhiing hieu biet vl sire khde, cac phuong phap tap luyen, phong benh, tiep can dich vu y te cdn ban che Nhan thiic kem di kem vdi tam ly ngai tdi cac benh vien chi phi dat dd va thii tuc phiic tap da khien cho viec tiep can va sir dung 53 cac dich vu y te eiia NCT d khu vyc ndng ttion tid nen khd khan hon Viec thay ddi md hinh chung sdng da khiln cho mdt bg phan NCT d ndng thdn hien thieu di sy hd trg tir phia ngudi than tiong gia dinh v l vin dl CSSK NCT CO don la mdt tiong nhung nhdm ddi tugng gap rat nhieu khd khan cugc sdng thieu thon ca ve vat chat Ian tinh than Ngudn thu ban che, miic thu nhap it di va thieu hut sy quan tam cham soc ca ve vat chat lan tinh than tir phia ngudi than gia dinh khien NCT sdng cd don (hoac NCT sdng vdi chau) tid thaiih nhdm ddi tugng yeu the ciia xa hdi, khdng the ty lo lieu dugc cugc song ciia minh, nhat la roi vao tinh tiang 6m dau benh tat giam ngheo, vay vdn san xuit, cac hoat dgng quyen gdp tai chinh va vat chit tir cdng ddng, can tiep tuc dugc day manh hon niia de cd the cham sdc va bao dam an sinh xa hdi tdt hon cho NCT ndng thdn bdi canh gia hda dan sd d Viet Nam hien • Tai lieu tham khao Nguyin Quoc Anh (2018), "Gia hda dan sd va chat lugng cugc sdng ngudi cao tudi d Viet Nam", Tap chi Xa hgi /)pc,sd 4(144), thang 12 Ann, A L., & Ronald, A (1973), A Framework for the Study of Access to Medical Care, Health Services Research Bd Lao ddng - Thuong binh va Xa hgi, UNFPA (2016), Bdo cdo ddnh gid Vi ngudn luc kinh ti, md hinh sir dung nam thuc hien Ludt ngudi cao tudi, dich vu y te d cac tuyen khac hien Ha Ngi van bi anh hudng bdi kha nang chi tra cua NCT NCT d nong thdn van cdn phai Iao Bg Lao ddng Thuong binh va dgng de kiem them thu nhap va cd miic Xa hdi (2019), Cugc sdng cho sdng thap Hien nay, ngudn thu nhap chu ngudi cao tudi, http://www.molisa yeu cua NCT d ndng thdn van la ndng gov.vn/Pages/tintuc/chitiet.aspx?Tin nghiep hoac dugc ho trg tir chau, dieu TucID=29546&page=20 anh hudng tryc tiep tdi y thiic ty CSSK BgYtl(2018), Viet Nam cdnnhiiuthdch ciia NCT d ndng thdn ndi rieng va ca nude thiic chdm sdc sice khde ngudi ndi chung NCT thudc nhdm miic sdng cao tudi, https://www.moh.gov.vn/ cang cao thi cang cd kha nang lua chgn sir chuong-trinh-muc-tieu-quoc-gia/-/asset dung djch vu y te tu nhan va cac loai hinh j u b l i s h e r / n g l IfEWgASC/content/ dich vu y te tuyen tren nhieu hon nhdm viet-nam-con-nhieu-thach-thuc-trong NCT cd mice sdng thap d ndng thdn -cong-tac-cbam-soc-suc-khoe-nguoi -cao-tuoi?inheritRedirect^faIse Nhu vay, tinh hinh siic khde va khd khan tiep can cac dich vu y te cua Nguyen Diic Chien, Nguyen Thj Huyin Giang (2018), "Thach thiic dat ddi NCT d ndng thdn cho thay, cdng tac vdi thyc hien quyen cham sdc sire truyen thong, hudng din CSSK ddi vdi khde cua Ngudi cao tuoi d ndng thon NCT can tiep tuc dugc quan tam Mang Trung du miln niii phia Bic", trong: Vii ludi y te co sd can dugc phat trien hon Cdng Giao (chu bien, 2018), Quyen cua vdi md hinh td chiic phii hgp de NCT tiep Ngudi cao tudi, Nxb Chinh tri qudc can dich vu thuan tien Nha nude can chu gia- Sy that Ha Ngi tigng md rgng cac loai hinh va quy md bao phu ve bao hiem xa hgi va bao hiem y te Cac boat dgng trg giiip NCT nhu xda ddi (xem tiip trang 32) 32 www.chinajusticeobserver.com/msights/ chma-estabUshes-tiTree-intemet-courts-totiy-intemet-related-cases-onhne.html Klaus Schwab (2016), The Fourth Industrial Revolution, World Economic Forum How to litigate before the internet courts in China, https://www.chinajusticeobserver com/insights/how-to-litigate-before-theintemet-coiirts-in-china.html Trin D i e Hiln (chil bien, 2008), Khoa hgc vd cdng nghe thi gidi: Nhiing xu hudng mdi, Nxb Khoa hgc va ky thuat Ha Ndi Trin Thj Van Hoa (chu bien, 2017), Cdch mang Cdng nghiep 4.0: Vdn di (tiip theo trang 53) Le Xuan Cu, Pham Hai Hung (2018), Xu the gid hda ddn so a nude ta hien vd yeu cdu ndng cao chdt lugng sdng cua ngudi cao tudi http://www tapchicongsan org vn/Home/PrintStory aspx?distiibution=5 223 9&print^me Bill Thi Cuong (2005), Trong miin an sinh xd hdi nghiin cim ve tudi gid Viet Nam, Nxb Dal hgc Quoc gia Ha Ndi, Ha Ngi Nguyen Thi Nggc Ha (2016), "Thuc tiang sap xep cugc sdng ciia ngudi cao tudi hien nay" Tap chi Xd hdi hoc, sd 4(136) 10 Hoi Lien hiep Phu nir Viet Nam (2012), Dieu tra qudc gia ve ngudi cao tudi Viet Nam VNAS 2011 - cdc kit qud chu yiu, Nxb Phu nii, Ha Ngi 11 Le Van Kham (2014), " Vin dl vl ngudi cao tudi d Viet Nam hien nay", Tgp chi Khoa hoc xd hdi Viet Nam, sd (80) 12 Le Nggc Lan (2010), Mdt sd vdn di ca ban vi ngudi cao tudi Viet Nam giai dat cho phdt triin kinh ti'- xd hdi vd hdi nhap qudc ti cua Viet Nam, Nxb Chinh tri qudc gia Ha Ndi Nguyin Khanh (2018), Dinh danh img dung goi xe: Cdng nghe hay vdn tdi?, https ://dantri.com.vn/kinh-doanh/dinhdanh-ung-dung-goi-xe-cong-nghe-hayvan-tai-20181129085542203.htin Hoang Phe (chu bien, 2003), Tic dien tieng Viet, Vien Ngdn ngu hgc, Nxb Da Nang va Trung tam Tu diln hgc, Da Nang Trin Thiiy (2019), ifng dung tri tue nhdn tgo: 50% vdn cdn thdo, https://vietnamnet vn/vn/kinh-doanh/dau-tu/tbe-gioi-bung-no -tri-me-nhan-tao-dn-viet-cham-chan-502 604.html doan 2011-2020, Vien Nghien ciiu Gia dinh va Gidi 13 Pham Thing (2007), "Dilu tra dich tl hgc ve tmh hinh benh tat, nhu cau cham sdc y te va xa hdi cua ngudi cao tudi Viet Nam", Tap chi Ddn sd vdphdt trien, so 14 Pham Thing, Do Thi Khanh Hy (2009), Bdo cdo tdng quan ve chinh sdch cham sdc nguoi gid thich ung vdi thay ddi co cdu tudi tgi Viet Nam, Ha Ndi 15 Trin Thi Minh Thi (2014), Nghien cim tdng quan ve vai trd gia dinh vd Nha nude cham sdc ngudi cao tudi: Nhiing vdn de thuc tiin vd chinh sdch, De tai nghien ciiu khoa hgc cip co sd, Vien Xa hdi hgc 16 Tdng cue Thdng ke (2015), Kit qud khdo sdt Muc sdng ddn cu Viet Nam ndm 2014, m m i 17 Tdng cue Thdng ke (2017), Kit qud khdo sdt Muc sdng ddn cu Viet Nam ndm 2016, Ha Ngi 18 UNFPA (2019), Huang tdi chinh sdch qudc gia todn dien thich img vdi gia hda ddn sd a Viet Nam, Ha Ndi  ... rieng van chua thyc su khde manh nhu mong mudn Theo bao cao ciia Bd Y t l , ed khoang 95% NCT mac benh, trung binh moi NCT mac 2,69 benh, chu yeu la benh man tinh va khdng lay truyen Ty le NCT cd... Hy, 2009) Nghien ciiu ciia sdng vui, sdng khde, sdng cd ich ve gia Nguyen Diic Chien, Nguyen Thi Huyen Mgt so khd khan tiep can dich vu Giang (2018) cho thay, NCT d ndng thdn y te cua ngirdi cao. .. Chien, Nguyen Thj Huyin Giang (2018), "Thach thiic dat ddi NCT d ndng thdn cho thay, cdng tac vdi thyc hien quyen cham sdc sire truyen thong, hudng din CSSK ddi vdi khde cua Ngudi cao tuoi d