THÔNG TIN TÀI LIỆU
Nghi§n ciiu Gia dinh vk Gi6i sg - Mgt sd ldo can irong tidp cdn djch vu khdm chiifa benh cua ngUol ddn hien D|ng Thanh Nhan Vien Nghign cOxi Gia dinh va Gidi Tdm tat: Kha nkng tiep can cac dich via kham chSa bfinh Id vdn di quan trong cham s6c sflc khoe cua ngUdi dan Trong nhflng nam qua, Vifit Nam da c6 nhilu thay d^i tich cUc he thong chSm s6c sflc khoe, Tuy nhien, vSn c6n t6n t^i khong it nhiing thach thflc vi$c hUdng tdi muc tieu tiSp cdn cdng bdng -vi sflc khoe todn dan Tren cO sd tdng quan tai liSu nghign cflu CO lien quan, bai vigt phan tich mpt so" rdo can tiSp cdn djch vu kham chflla benh cua ngu6i dan hi^n va di xudt mot so giai phap gdp phdn nang cao kha ndng tiffp cac dich vi^ khdm chiia benh noi chung va tig'p cdn cac dich vu khdm chiia b§nh co chdt lUdng noi rieng cua ngu6i dan Vifit Nam'" Tuf khoa: Tilp cdn dich vy y te; Rao can dich vu khdm chCa bgnh; Ch&m soc siic khoe D$t van de Kha ndng tifip cdn cdc dich vu khdm chQa bfinh Id mOt pham uCl cua cdng bdng siic Idioe ndi rifing va cdng bdng xa hdi ndi chung Hifin nay, kha n3ng tifi^p cdn cdc dich vu kham chQa bfinh ciing Id mfS quan tdm todn cdu bcri tlnh trang thifi^u su cdng b ^ g tig'p cdn chdm sdc siic kh6e b cdp qudc gia vd todn cdu (WHO, 2013) Tai mfit s6 qudc gia, todn b6 70 Nghien cihi Gia dinh vk Gidi Quyin 27, so 4, tr 69-78 nhihig ngu^ thu6c nhom 20% gidu nhdt dugc tig'p cdn dich vu y tfi dd m6t nfta s6 tii em lhu6c nhdm 20% nghfio nhdt khOng dugc tigp cdn dich vu y tg Chinh phu mfli nudc d^u phai c6 trach nhifim dSm bao cho ngucfi ddn tigp cdn dugc cdc dich vu y tfi^ ca ban va bdo vfi ngucd ddn udnh khoi doi ngheo cac chi phi y tg l(5n hay nhfing thifit hai vi siic khoe khdng dugc sii dung dich vu y lg cdn M6i qu6c gia c6 nhi^u su lua chgn chinh sdch y tg khde phu thuflc vao cdc quygt dinh v^ chuih tri, btfi canh Ijch sit vd gia tri xa hfli (World Bank, 2007; Apamaa Somanathan va cac tdc gia khac, 2013) Cflng bdng Id mflt Uong nhihig muc tifiu Imng ddu cua hfi thtfng cham soc siic khoe cua Vifit Nam Mfl'i quan tdm khflng chi dugc th^ hifin Uong cac chuih sach, ludt phdp md dugc tri^n khai rflng rai bdi mflt hfi th6ng cham sdc sdc khoe ban ddu vuon dfin tdn tuygn co sc» (PAHE, 2011) Tuy nhifin, cdc nghifin ciiu v^ khd ndng tigp cdn dich vu khdm chBa bfinh cua gia dinh Vifit Nam rdt han chg Trong hfi thfldng chi stf y tfi Vifit Nam, cac chi s6 vi cflng bang stfc khoe chua dugc th^ hifin ro rdng Diiu cung phdn nao han chfi su hi^u bifit cua nhdn vifin y tg, nghifin cihi vifin ciing nhu cdc nha Idp sdch vific xdy dung nhiing can thiftp ttft hon nhdm dat dugc muc tifiu cflng bdng siic khoe cho mgi ngu6i ddn Tigp cdn dich vu y tg khflng chi don gian Id co hfli sur dung dich vu chdm soc sdc kho^, ddy Id khai nifim da chi^u dua trfin su tuong tac giiia hfi thtfng y tg vdi cdc cd nhdn, hfl gia dmh va cflng ddng Trdi ngugc vdi nhflng gia thigt ph6 bign trudc ddy cho rdng tinh trang sdc khoe Id cdc vSh di cd nhdn, cdc ygu tfl' xd hfli dugc nhin nhdn rflng rai la cd tdc dflng dfin siic khoe Cac hdnh vi nguy ca d6i vdi stic khoe phai dugc ddnh gia ddi chigu vdi cdc khuynh hudng vd chinh sdch xa hdi rdng Idn hon (WHO, 2011) Trfin co sd tdng quan, phdn tich cdc nghifin ciiu, tdi lifiu cd lifin quan, bdi vigt phdn tich mflt sd rao can tigp cdn dich vu khdm chfla bfinh ciia nguM ddn hifin vd dg xudt mflt sd giai phdp gdp phdn ndng cao kha ndng tigp cdc dich vu kham chi^ bfinh ciia ngudi ddn M^t so rao can trongtiepcan djch vg kham chQa benh Rdo can ve khoang each dia 1^ Di^n kifin dia ly cd anh hudng tdi tifip cdn dich vu y tfi'va vific tifip cdn v^ mat dia 1^ dfin cdc co sd y tg dugc bdi khoang cdch vd thdi gian Nhui chung, ngudi ddn d khu vuc mi^n nui (khflng tinh dgn di^u kifin kinh tg) tigp cdn dich vu y tfi ft hon vihig ddng bdng Tai khu vuc mign ndi, ngudi nghfio chu ygu dgn tram y tgxa nhi^u hon rd rfit so vdt khu vuc ddng bdng; ngucd gidu tigp cdn dich vu y tg tuygn trfin cao gdp Idn ngudi nghfio Nguin nghfio khu vuc mign nui, tigp cdn cdc dich vu y tgthdp hon Dang Thanh Nhan 71 Idn so vdi ngucd gidu tai khu vuc ddng bdng cdc viing cao nguyfin cfia Viet Nam, ngudi ddn cho bifit, khflng cd phuong tifin giao thdng nfin d^ dgn dugc Uung tdm y tg, uam y tfi ho phdi di qud niia ngdy hodc nhigu hon (Rheinlander vd cdc tdc gia Wide, 2011) Mdc dii, ngucd ngheo dugc cdp the bao higm y tg nhung da sd sdng d khu vuc heo ldnh nfin khflng thg tigp cdn cdc CO sd y tfido khd khan phuong tifin di lai Vific thigu phuong tifin di lai co th^ ldm cho bfinh nhdn lua chgn siir dung dich vu y t€dl tig'p cdn hon cho dtl chdt lugng kem hon (Ti-dn "Htdn, 2005; Trdn Thi Mai Oanh va cac tac gia khde, 2012a) Rd rdng, khoang each dia 1^ thuc su Id rao can dnh hudng Idn den vific suf dung dich vu y tgcfia nhdm ngudi nghfio va ddn tflc thi^u sd Rao can ve kinh te - van hoa - xd hoi Yfiu td tai chinh, bao gdm chi tra mic tifip tign tdi dugc xem Id khd khdn chinh tigp cdn dich vu y tg cua ngudi nghfio Mflt sd nghifin ciiu tign hdnh tai khu vuc nflng thfln cflng cho tfidy xu hudng ngudi ngheo tri hoan di kham chfla bfinh khflng cd kha ndng chi tra Cd thg ndi, d mgi mdc thu nhdp mfli mflt qudc gia, sdc khde vd bfinh tdt thudng tudn theo mdt quy ludt xa hfli la dia vj kinh tg xa hfli cdng thdp thi tlnh trang siic khoe cdng tfi (UNICEF, 2004; Trdn Thi Minh Nggc, 2012) Khoang cdch xa hfli vd su khde bifit ngdn ngfl gifla bfinh nhdn vd nhdn vifin y tfi cung dugc coi Id mflt nhflng trd ngai tigp cdn dich vu khdm chfla bfinh Phdn Idn cdn bfl y tg Id ngudi Kmh, h-ong nhihig ngudi ddn tflc thigu sd lai hifi'm noi dugc tigng phd thdng (Vd Vdn va cdc tac gia khde, 2004) Di Udnh bi higu nhdm, ngudi bfinh thuflc nhdm ddn tdc thigu sd thudng it chia se J tudng vdi nhdn vifin y tg vg nguyfin nhdn gdy bfinh hay ddt cdc cdu hdi dg ldm rd v^ cdc don thudc, each thlic di^u tri cu th^ Digu gdy khd khdn cho vific chdn dodn bfinh cua bdc sy (Rheinlander vd cac tdc gia khde, 2011) Vific ddng bdo ddn tflc thi^u sd thudng dp dung mdt sd hu tuc lac hdu phong tuc tdp qudn ddn tdc vao vific chiia bfitih trudc di khdm chiia bfinh tai cdc co sd y tdcd thg ddn dfi'n su chdm irS sit dung dich vu y id cung nhu nhiing tai bign cd thg xay dfli vdi bfinh nhdn (Bd Y tfi', 2006) Cd su khde bifit gifta ddn tflc Kinh vd cdc ddn tflc thi^u s6 vific tigp cdn chdm sdc vg mdt y tddac bifit vigc sinh vd cham sdc nhd Nghign cliu cua Knowles vd cdng su ndm 2009 cho thdy, phu nfl ngudi Kinh cd ty lfi sinh tai cdc co sd y tg cao hon cdc ddn tdc khde (gdp gdn bdn Idn); Va ty Ifi td vong me d cdc ddn tdc thi^u sd cao gdp Idn so vdi ty Ifi tii vong d ngudi Kinh Cac bd me ngudi Kinh cd xu hudng tun kigm chdm sdc siic khoe gdp hai Idn so vdi cdc bd me ddn tflc thigu sd (Knowles vd cdc tdc gia khde, 2009) 7S Nghidn cdU Gia dinh va Gidi Quyin 27, so 4, tr 69-78 Cd th^ thdy cdc nhdm ddn cu khde cung cd nhfltig cdch ling xit khflng gidng gdp phai vdn d^ vg sflc khde Vifit Nam, tu mua thudc chiia ui la hdnh vi/flng xix chdm sdc sflc khoe phd bifin dau dm da dugc chi cdc nghifin cflu vg dich vu y tg d Vifit Nam (Hoan XL vd cac tdc gia khde, 2011; Lfi Bao Chdu vd cdc tdc gia khac, 2012) Vific khdng chfla tri gi hodc tu chfla tri thudng gap nhigu hon d nhdm cd thu nhdp thdp (Trdn Thi Mai Oanh vd cdc tdc gia khde, 2012b) Ngu£ri bfinh thudng tu mua thudc theo Idi khuyfin cda nhd cung cdp thudc hodc theo don thudc trudc, mdt sd tu tdng hodc gidm ligu digu tri hodc bd dd thudc sau mdt thdi gian digu hi ngdn ki ca cac loai thufl'c lifin quan dfin khdng smh hay khdng sinh phd rflng dugc dhng di diiu tri cho tte em (Rheinlander vd cac tdc gia khde, 2011) Gia dinh va cflng ddng dugc cho thdy cd th^ anh hudng tdi vific tigp cdn vdi chdm sdc sflc khoe Trong xa hdi Vifit Nam, ngu£ri cao tudi nhu flng/ba thudng cd anh hudng Idn ddn cdc lua chgn dd ed lua chgn dg tigp cdn djch vu kham chfla bfinh (Duong va cdc tdc gia khde, 2004; Rheinlander va cdc tdc gia khde, 2011) Rao can tii phfa ngudi sur dung dich vu Cdc ygu td dac digm nhdn khdu, xa hdi cua cd nhdn vd gia dinh nhu: gidi ti'nh, trinh dfl hgc vdh, nhdn thtic vg bfinh tdt cfia ngudi bfinh, mflc sdng cfia hfl gia dinh cung cd anh hudng dfin vific sii dung eac dich vu y te Nghifin cflu cua Trdn Thi Mai Oanh vd cdng su (2012b) da chi rdng ddi vdi ngudi cao tudi, nam gidi diiu tti tai bfinh vifin nhigu hem nfl Nhflng ngudi cd trinh dfl hgc vdn cao hon ed xu hudng tigp cdn dich vu nhigu hon nhung ngucd khflng dugc dgn t n i ^ g , ddc bifit ddi vdi dich vu chdm sdc sflc khde tre em Nhiing bd me ed trinh dd lua chgn ca sd digu tri cho nhanh hon cac ba me cd trinh dd thdp Higu bifit vg bfinh tdt ho^c mflc dd nghifim cfia bfinh tdt cung Id yfiu id tdc ddng dgn h^ih vi tim kidm hinh thflc cham sdc sflc khde cfia ngufn ddn Ngudi nghfio va ddn tdc thi^u sd Ihudng cd nhdn bidt chdm vg nhflng ddu hifiu cfia bfinh tdt vd digu dd ddn dfin vific chdm irS quygt dinh tim kigm dich vu chdm sdc sflc khde (Knowles vd cdc tdc gid khac, 2009; Trdn Thi Mai Oanh vd cdc tac gia khac, 2012b) So vdi nhdm ngudi giau, ngufri ngheo ihudng ft quan tdm dgn thih trang sflc khde cua minh cho dgn khdng th^ tti hoan vigc khdm, chfla bfinh Ngu^ ngheo cung ed xu hudng ft sfi dung cac co sd y ^ h o n ngudi giau vd chi khdm, chfla bgnh bfinh da d mflc nghifim ttgng Khi dm dau, ngudi ngheo phai phu thudc nhigu vao cac co sd y lg tuygn dudi khflng tigp cdn dugc cdc phuong lifin vdn chuygn nhanh chdng vd ddng lin cdy dl dfi'n bfinh vifin tuygn ttfin (Trdn Thj Minh Nggc, 2012; Nguygn Thanh D^ng T h a n h Nhkn 73 Lifim vd cdc tdc gia khde, 2013) Khi gdp trgng bfinh, hg thudng phm cdt giam chi hfiu, bdn Ign gd, ndng san hodc vay mugn, cdm cd dg chay chua bfinh tdt Day la digu phd bign d cdc nudc cd thu nhdp trung binh thdp ttong dd cd Vifit Nam (David H Peters vd cac tdc gia khde, 2008; WHO, 2011; Bart Jacob vd cdc tdc gia khac 2012) Ngodi ra, cdc nhdm thu nhdp thdp hon thudng hay sfi dung cdc trung tdm y tg cfia nhd nudc, chu ygu Id trung tdm y id xd cd chdt lugng kem Cdc nhdm ddn tflc thigu sd cd kha ndng tifip cdn cdc dich vu y id kem hon nhi^u yfiu td nhu: thu nhdp thdp hon, chi dua vdo tign tdi, hfi thdng y tfi quan hfiu, va cdc ydu Id ndi lai cua cae nhdm ddn tflc thigu sd, nhu chg dfl phu he, tfln giao vd thg gidi quan (PAHE, 2016) Nghign cdu cfia Vu Manh Lgi va Trdn Thi Minh Thi (2012) cho thdy, cdc tdng Idp khac ed digu kifin tigp cdn vd sfi dung dich vu y tg khde Ngudi d tdng ldp cao cd ty lfi tham gia bao hi^m y id cao hon vd sfi dung dich vu y tg tuydn trfin cao hon ngudi d tdng ldp thdp; ngudi d tdng Idp thdp ft tim ddn co sd y id vd cdn thi hg chon sfi dung dich vu y tg tuyen CO sd nhigu hem Nghifin cuu cho rdng chfnh sdch hfl trg ngucn ngheo tham gia bao hi^m y tdtd cd hifiu qua tdt, cai thifin kha nang tigp cdn dich vu y tg cfia tdng I ^ thdp nhdt (nhi^u ngudi ngheo nhdt), va cdn dugc tigp tuc Phan u'ch vd tidp can va sfi dung dich vu y tg til nghifin cflu cung gm rdng nha nudc cdn ddu tu nhigu ban vdo cdc ca sd y td tuyfi'n CO sd, noi ngudi ngheo cd thg dg dang hem ttong vific tigp cdn vd sfi dung cdc dich vu khdm chiia bgnh Ngodi cac ydu td kg trfin thi cac ygu td Ufin quan ddn ddc diem nhdn khdu, xa hfli Idide nhu: tudi, ngh^ nghigp, thu nhdp, nm cu mi, nhdn thflc, thdi quen, tinh tt^ng sflc khoe cfia nguM ddn, vific cd the BHYT hay khdng, kha ndng chi tta djch vu y id cung cd anh hudng ddng kd ddn kha ndng tidp cdn dich vu khdm chua bfinh (WHO, 2011; PAHE, 2013, 2016) Rao can tCr phia co sd cung flng dich vu Nhung rao can ttong tifip cdn dich vu y tdbao gdm rdt nhigu ygu td cd mffi lifin hfi vdi nhu kha nang cung dng dich vu y td, chdt lugng dich vu y tg, thudc men vd cac thfi tuc y tg; cdc tucmg tdc cd nhdn gifla nhdn vien y tg vd ngudi su dung dich vu y td; thdi dfl vd truygn thflng; va nhdn thiic cfia ngudi sfi dung dich vu y tg v^ chdt lugng chdm sdc Kha ndng cung flng dich vu y tg ciing Id mflt nhihig ydu td anh hudng true tidp tdi kha ndng tidp cdn dich vu khdm chiia bfinh cfia ngudi ddn bao gdm: su sdn cd cfia ngudn luc (nhdn luc, ca sd vat chdt, ttang thidt bi, thudc men, vdt tu y tg ), cdc loai hinh dich vu vd kmh phi hoat dflng cfia ca sd y td; cdc phucmg thflc chi tta theo quy dinh (phf dich vu, chi phf ngodi bao hi^m, chi phf gidn tifip ) (Syed et al., 2008; PAHE", 2013) Hifin d 74 Nghien cdu Gia dinh vk Gidi Quyin 27, so 4, tr 69-78 Viet Nam tmh trang qud tai b cdc bfinh vifin cflng mydn eu^i la mflt can ttd rdt Idn ttong kha nang cung ling ^ch vu y tdvd cung flng dich vu y tg cd chdt lugng Tinh trgng qud tdi d benh viin cdng Vg cung cdp dich vu cham sdc sflc khde, mflt ttong nhiing khd khdn chfnh Vifit Nam dang phai ddi mdt la tlnh ttang qud tdi tai cac bfinh vifin tuygn tinh va ttung uong Tmh trang ndy phdn Idn Id do: chdt lugng dich vu chdm sdc sflc khde d tuydn ca sd cdn han chd, ngudi ddn ky vgng dugc sfi dung dich vu chdm sdc sflc khde chdt lugng c:ao, thudn tign di lai, su chfinh ifich thdp vd vitn phf gifla cdc tuydn khdm chite bfinh, v.v Mfit sd IS din ddn tinh ttang qud tai cd lign quan ddn co chd quan IJ tdi chirji, kha ndng cung cdp cdc dich vu chdm sdc sflc khde, chdt lugng chdm sdc vd hoat dflng cfia cdc ttam y td xa, ddc bigt la d vflng sdu, vflng xa cdn nhigu ban chg va cdn dugc cai thifin (BO Y tg, 2014; PAHE, 2013) Chi tiiu cdng cho y te Chi tigu vg y tgda tdng ddng kg ttong 10 ndm qua, nhung chi tifiu cflng danh cho y td bao gdm ca chi tifiu bao hidm y td chi tra vd cae nhd tdi ttg ho ttg hifin chidm gdn 50% tdng chi tigu y td Hem 50% cdn Iai chu ygu Id cdc khoan chi tta phi sfi dung dich vu vd lidn thudc true tidp tfi tign ngudi ddn Chi phi cao chdm sdc sflc khde tfi tidn cfia bgnh nhdn da gdy cdc vdn dd bdt binh dAng khde nhu hfl gia dinh phai giam chi tigu cfia hg cho cdc nhu cdu thidt ydu khde vd gdy nghfio ddi (PAHE, 2013; Vifin Chidn luge va Chinh sdch Y td, 2011) Cdc nhdm thifit thdi chiu cdc gdnh ndng bdt binh ddng qua hfi thdng chi cho y te' Tdng ngdn sdch theo kg hoach cho y tg d Vifit Nam tdng gdn gdp dfli vg gid tti tidn tfi 64.000 t^ VND (hiong duong 3,21^ USD) ndm 2011 Ifin 117.000 ty VND (tuang duong 5,8 ty USD) ndm 2015 Tdng chi cho y td theo phdn ttdm GDP tang tfl 4,9% ndm 1998 Ifin 6,7% nam 2012; ngdn sach y td theo ty le phdn ttdm cfia ldng ngdn sdch nha nudc tdng tfl 8,8% nam 2011 Ifin 9,4% ndm 2015 (Hoang Van Minh, 2016) 'I\iy nhifin, tdi 90% ngdn sach y tfi dugc ddnh eho chi thudng xuygn, nhu luong vd chi phf van hdnh ca sd vdl chdt Trong dd, dich vu cflng cd rdt ft tidn ttidn vg ndng cao hifiu qud, vd g i ^ chi phf dich vu (Oxfam, 2017) Tai chfnh y id d Viet Nam phu thuflc vdo ngudn chi cua tu nhan, nhdt Id chi tra tu tfic cfia hfl gia dinh Gid tti chi tta tu tflc tang tfl 43,5% ndm 2012 Ifin 48% tdng chi cho y tgndm 2013 (ty Ifi cao nhdt ttong tdng chi cho y tg) (PEPFAR, USAID, 2016), khifin nhigu hfl ddn, ddc bigt hfl cd chfi hfl Id nfl hfl nghfio nflng thfln vd hfl ddn tflc thidu s6) cd nhi^u nguy ca bi ngheo T^ lg ndy cao hon nhilu so vdi mflc dudi 30% WHO dg xudt WHO nhdn thdy chi tra tu tdc cao thudng ddn tdi vSn di chi phi "tham hga" cho y tg (tfic D$ng Thanh Nhan 75 chi phi y td chidm bdng hoac titn 40% kha nang chi tra) d nhidu qudc gia trfin thg gidi Vigt Nam, ty lfi chi phf "tham hga" vd nghfio hda chi phf y tg khd cao (dfi dang giam) ttong giai doan 1992 - 2012, ddc bigt d cdc nhdm dan thigt thdi nhu ngudi nghfio, ngudi cd kha ndng tidp cdn gido due thdp vd ngudi ddn ndng thdn Theo nghign cflu cfia Hodng Van Minh va Nguyen Thi Phuong (2015), cd hSi 583.724 hfl gia duih Vifit Nam bi rdt xudng hay lun sdu vdo canh ngheo chi tifiu y td d Vifit Nam vao nam 2012 (Hodng Van Minh, Nguyfin Thi Phuang, 2015) Nghifin cflu cfia PAHE (2016) da chi rdng ty lfi nghfio hda chi phf "tham hga" cao hon ttong nhdm cdc hfl nghfio vd cdc hfl nflng thdn Cac chfnh sdch giam ngheo cung nhu vific phdn bd ngdn sach vd chi cho y tfi cdng chua dat hifiu qua cao qud ttinh xdy dung phdt tridn chfnh sdch chua dua ttfin bdng chflng sdt thuc, quan tri y Id chua hifiu qua, thidu hoat ddng theo doi thudng xuyfin va cd ca chd kidm sodt chdt lugng dang tin cay ciing nhu thidu tidng ndi cfia xa hfli ddn su Chdt lugng dich vu y te Ddi vdi rao cdn tfl phia ca sd cung iing, su sdn cd vd chdt lugng dich vu, ddc biet la chdt lugng dich vu cua ede eo sd y tdd cdc tuydn id nhiing ydu tfl' quan ttgng anh hudng ddn vific sfi dung dich vu y td gifla cdc nhdm dfli tugng dd bi tdn thuong Cac dich vu chdm sdc sflc khde sdn cd ddm bao ngudi ddn cd thg tidp cdn bdt cfl dich vu nao vd bdt cfl nao hg cdn Chdt lugng chdm sdc phu thuflc chu ydu vko kha ndng chuydn mfln vd thai chdm sdc cung nhu su sdn cd cua thudc va trang thidt bi Khd khdn Idn nhdt cfia cdc ea sd cung ling dich vu d tuydn co sd Id su thidu hut nhdn vifin y td, ttang thidt bi va thudc digu tri va thflng tin chuydn mdn hfl ttg hoat dflng didu tri Ty le can bfl y id tuydn xa cd kidn thflc vd ky ndng dfing ttong so cdp cdu, chdn dodn vd didu hi mflt sd bgnh, cung nhu kidn thfic vg xfi IJ bgnh dich rdt han chd(17,3% sd bdc sT vd y sT ed kidn thflc vd ky ndng dfing ttong xfi tri so cdp cflu, 17% sd bdc si vd y sT dugc hdi bidt dugc ede ddu hifiu nguy hidm thdi ky phu nfl mang thai, 50,5% cdn bd dugc hdi bidt cdch chdn dodn tdng huydt dp, 15,6% bidt cdch xfi tri mdt vu dich ) (Vifin Chidn luge vd Omih sdch Y tfi, 2011; PAHE, 2016) Chdt lugng dich vu y td kfim va thigu ttang thigt bi vd nhdn vign y id ttdm ttgng d cdp huydn vd xa d vfing sdu, vflng xa, cung nhu ehi phf bao hidm y tg ldng tfi ddu ndm 2016 da cfing cd thfim su bdt binh dang vg y td Bdt blnh dang vd kha nang t i ^ cdn cdc dich vu cd chdt lugng va bdt binh ding vg mflc dfl dugc hudng lgi tfl cae djch vu ed chdt lugng vdn Id vdh dg quan ttgng cfia hfi thdng y id (Oxfam, 2017) Nhdn li^ y te Tlnh ttang thidu nhdn luc y tdndi chung vd nhdn luc cd ttinh dfl Id bdc 74 NghiSn cihJ Gia dinh v^ Gidi Quyin 27, so 4, tr 69-78 sT d tuydn y id ca sd, cung nhu nhdn luc y td du phdng vdn cdn Id vin di ddng lo ngai Cang ngdy cang thdy ro su dich chuygn cfia nhdn vifin y td tfl tuydn duffl Ifin tuydn ttfin, tfi dia phuang Ifin ttung uong vd tfi khdi nhd nudc sang khdi tu nhdn Nhilu bfinh vifin huyfin, ttung ldm y td huyfin nhigu nam khdng luy^n dugc bdc si ndo sd lugng cdn bfl dich chuygn tdi noi khac vdn tidp dign (Vidn Chidn luge vd Chuih sdch Y tg, 2011; Bfl Y td 2015) vfing sdu, vfing xa, vfing cd hoan canh khd khan tuih ttang thidu hut nhdn vifin y id cdn nghifim trgng hon Sd lugng nhdn vifin y id du phdng, dugc si cd bang dai hgc, ky thudt vifin y td, vd y td van It han so vdi nhu cdu Vific ddu tu vdo dao tao vd phat ttidn ngudn nhdn luc vd chfnh sdch dai ngd nhdn vifin y td cdn nhigu bdt cdp (Vifin Chidn luge vd Chinh sdch Y te, 2011; PAHE, 2013) Thidu gdn kgt gifla ddo tao vd sfi dung da tdn tai lfi nhilu ndm ddn dgn nghich 1? vfia "lam phdt ddo tao" vita "thidu nhdn luc", dac bifit d mflt s6 dia ban khd khan vg digu kifin kinh td-xa hfli va d mflt sd Imh vuc cflng tdc, mflt sd chuydn ngdnh khd tuy^n Vi du, thidu nhan vifin y tg d cdp huyfin vd xa d vfing sdu, vfing xa, ngudn nhdn luc y lg du phdng hifin cdn thidu vg sd lugng, chdt lugng chua cao, thifi'u nhung ngudi dugc ddo tao chinh quy, dfing chuyfin ngdnh vi y tgdu phdng (PAHE, 2016; Oxfam, 2017) Ket luan Nhu vay, cdng bang ttong tigp cdn dich vu y id Id kdt qua cfia su tutmg tdc giua cung vd cdu d cdc cdp dfl khac Dd Id mdt qud ttinh bao gdm nhifiu giai doan khac ma theo cdc cd nhdn cd nhu edu vg chdm sdc sflc khoe, tim kidm cac dich vu cd sdn vd chdp nhdn dugc di ed dugc mflt can thiep thfch hgp vi mdt y td Kha ndng tidp cdn dich vu y td chiu ldc dflng cfia nhigu ydu id khac nhau, dd khdng ehi Id vdh dd xudt phdt tfl cd nhdn ngudi sfi dung dich vu y tg ma cfia ca co sd cung fing dich vu vd cdc thd chd, he thdng chfnh sdch c6 lien quan Dd ndng cao kha ndng tifip cdn cdc dich vu khdm chfia bfinh ddc bifit Id cdc dich vu khdm chiia bfinh co chdt lugng cho ngudi ddn ddi hoi phai xdy dung va hoan thien mflt hfi thdng chinh sdch vd y td dam bao tfnh hgp IJ an todn, thudn lidn vd hifiu qua cfia cdc dich vu y td Mflt he thdng y tdhoat dflng tdt va ed chdt lucmg ddi hdi phai dugc xdy dung ttfin ngn ldng nhflng gl ngudi sfi dung djch vu cdn, Nhd nudc phai tidp tuc tdng ddu tu, ddng thdi ddy manh xa hfli hda phdi tti^n nhanh hfi thdng y tg cflng Idp vd ngodi cdng Idp; hodn chinh mfl hinh td chflc vd cfing cd mang lu^ y td co sd; phat mdn nhanh y id du phdng Bgn canh dd, cdn ndng cao vi thd kinh tg xa hfli cfia ngudi ddn va tdng cudng truyin thdng vl chdm sdc sflc khde ndi chung vd chdm soc sflc khde ban ddu ddn timg dia phuong Ddng thd, chfl ttgng khdu ddo tao nhdn vign y lg vd mat chuyfin mfln cung nhu giao tifip vdi bfinh nhdn Dang Thanh Nhan 77 Dd danh gia mflt each todn difin \^ ddy dfi vg ehSt lugng dich vu khdm chfla bfinh d Viet Nam cdn thidt phai cd nhflng nghien ciiu qui mfl vd chi tidt v l tidp cdn cdc dich vu khdm chua bfinh cd chdt lugng cfia ngudi ddn Viet Nam hien di ddnh gid dugc thuc ttang, quan didm, thai dfl va cdc ydu td tac ddng ddn kha nang Udp cdn dich vu y td cd chdt lugng cfia ngudi ddn Qua dd xdc djnh dugc muc tigu, phuong hudng vd d l xudt cdc giai phdp ndng cao hieu qua tidp cdn cac dich vu kham chfla bgnh va khdm chfla benh cd chdt lugng ngucd dan ttong thdi gian tdi.B Chu thich '" Bai vifit dugc thuc hien ttong khudn khd Di tai cdp B6: "Nghien cHu khd ndng tiep can cdc dich vu khdm chSa benh cd dial lugng cua gia dinh Viii Nam hien nay" (Ma sd KH XH-GD/16-19/11) Di tai diufic Chuang trmh NCKH cdp Bo "Nghien cflu danh gia t6ng the vfi gia dinh thcri kJ cong nghifip hoa, hifin dai hoa da't nudc, h6i nhap qudc te" cua Vien Han ISm Khoa hoc xa hfli Vifit Nam Tdi lifiu trich ddn Apamaa Somanathan, Ajay Tandon, Ddo Lan Huung, Kari L Hurt, va Heman L Fuenzalida - Puelma 2013 Tiin tdi bao phu Bdo hiim y titodn ddn dViit Nam Ddnh gid vd Gidi phdp Bart Jacob et al 2012 Addressing access barriers to health service: an analytical framework for selecting appropriate interventions in low-income Asian countries Bd Y le 2015 Bdo cdo chung Tdng quan ngdnh y tindm 2015 Bd Y te 2014- Bdo cdo tdm tdt cdng tdc y tindm 2013 vd nhiim vu trgng tdm ndm 2014 Bfi Y tg' 2006 Phdn tick thifi: trgng siic khde tre em vd cdc can thiep d Viet Nam Ha Nfli David H Peters et al 2008 Poverty and access to health care in developing countries Ana New York Academy of Science 1136:161-171, 2008 Duong, D.V., CW Bums, A.H Lee 2004 "Utilization of deUvery services at the primary health care level in mral Viemam" Social Science & Medicine, 59(12), 2585-2595 Hoan, T.L., E Ottosson, T.K.C Nguyen et al 2011 "Drug use and self-medication among children with respuatory ilhiess or diarrhea ui a rural district m Vietnam: a qualitadve sUidy" Journal ofMuttidisciptinary Healtticare, 4: 329 Hodng Van Minh 2016 Phdn tick ngdn sdch vd chi y tid Viit Nam Hodng Van Minh, Nguyfin Thi Phuang 2015 Chi tiiu cho ylitCc tien idi cua hd gia dinh Viet Nam 1992-2014 Knowles, J.C, S Bales, L.Q Chong et al 2009 "Healdi equity m Vietnam: a situational analysis focused on maternal and child moraUty" Background paper for "•'Equity in access to quality healthcare for women and Children" Hanoi: UNICEF 78 Nghien cflu Gia dinh va Gidi Quyen 27, so 4, tr 69-78 Lfi Bao Chau, Trdn Hflu Bich, Hfii Ngoc Linh, H o ^ g Thi K^, Nguyfin HiUdng Thuy 2012 "Sfi dung dich vu khdm chiia benh cua ngudi dan tai CHILILAB nam 2011: Thuc ttang vd mdt sd dfi xudt" tgp chi Y ticdng cdng, Sd 24 Ministry of Health 2005 Hospital system of Viet Nam - an overview Medical Publishing House Nguyfin Thanh Liem, Hd Anh Dflc, Peter Miller 2013 Thuc trgng s&c kJioe vd si dung dick vu y ticua ngudi ngheo, dong bdo ddn tdc thieu sdvd pku nStgi Thdi Nguyen Nxb Van hoa Thdng tin Oxfam 2017 Thu hep khodng cdch: CUng gidm bdt binh ddng d Viit Nem PAHE 2011 "Cong bdng sflc khde d Vifit Nam: Goc nhm Xa hdi Dan su" Nxb Lao dflng PAHE 2013 He thdng y ti'Viel Nam: Hudng tdi muc tiiu vd cdng bdng Nxb Lao dong PAHE 2016 Cdng bdng y ted Viet Nam - Gdc nhin cua xd kdi ddn su PEPFAR USAID 2016 Dudn chinh sdch y te20I6 Tdi chinh y ted Viit Nam Rheinlander X, H Samuelsen A Dalsgaard, Flemmmg Komadsen 2011 "Perspectives on child dianhoea management and health service use among ethnic minority caregivers in Vietnam" BMC Public Health, 11:690 Syed, U., Khadka, A Khan et al 2008 "Care-seeking practices m South Asia: using formative research to design program interventions to save newborn lives" Journal of perinatology, 28; S9-S13 Trdn Thi Mai Oanh, Nguyfin Thi Thang, Nguyen Hoang Giang, Hoang Thu Thuy 20i2a "Cic yfiu td anh hucnig d£n nang thu hdt vd tti cdn bfi y tfituy^n CO sd mfit sd tinh mien ndi" Tap chi Chinh sdch Y ti, Sd 10.2012 Tr&i Thi Mai Oanh Nguyfin Thi Thdng, Duang Huy Luang, Hoang Thu Thuy, Nguyin Hoang Giang 2012b "Kfit qua thuc hifin chflc nang, nhiem vu cua mfit sd tram y tfi'xa khu vuc mi^n niii" Tgp chi Chinh sdch Y te', Sd 10.2012 Trdn Thi Minh Ngoc 2012 "PhSn tdng xa hfii chSm sdc sflc khoe" Ky yfi'u Hfli nghi khoa hoc kinh tfi y lfi' Idn thfl hai - Tdi chinh y ti hudng tdi chdm sdc siic khde toan ddn Ha Noi, thang n / I T r ^ Tudn 2005 Viii Nam - quyet tdm chinh tri manh me cho cdng bdng ve siic kkoe nhung khdng dgt dugc muc tiiu di ra: nku cdu cua viic ndng cao ndng luc nghiin c«K cdc chinh sack y ti' Trung tSm nghien cflu vd dao tao Phat tri^n C6ng ddng UNICEF 2004 Cdng bdng vi sdc khoe Viet Nam: Ddnh gid tinh kinh chii trgng vd tuoi thg bd me vd Ire sd sinh Vifin Chifin luge va Chinh sach Y tfi' 2011 Ddnh gid viic thuc kiin chdc ndng nkiim VM cua Tram Y ti xd tgi cdc vung mien Ha Nfli Vo Van, T, L.N Hoat, T Jan van Schie 2004 Situation ofthe Kink poor and minority women and their use ofthe maternal care and family planning service in Nam Dong VO Manh L d , Trdn Thj Minh Thi 2012 Nkdng vdn died bdn vi cdc ^ai tdng xd hdi cua Viit Nam giai dogn 20II-2020 Vifin Han ISm Khoa hpc Xa hdi Vifit Nam World Bank 2007 Vietnam Development Report: Aiming higk Joint Donor Report to Ike Vietnam Consultative Group Meeting In Hanoi WHO 2011 Tuyen tap ve cdc nkdn to quyit dink sib: khde mang tinh xd hdi: Bdo cdo long kit Xda bo khodng cdch mot theke WHO 2013 Researckfor universal health coverage: World health report ... cdc nghifin ciiu v^ khd ndng tigp cdn dich vu khdm chBa bfinh cua gia dinh Vifit Nam rdt han chg Trong hfi thfldng chi stf y tfi Vifit Nam, cac chi s6 vi cflng bang stfc khoe chua dugc th^ hifin... phdp gdp phdn ndng cao kha ndng tigp cdc dich vu kham chi^ bfinh ciia ngudi ddn M^t so rao can trongtiepcan djch vg kham chQa benh Rdo can ve khoang each dia 1^ Di^n kifin dia ly cd anh hudng... Gia dinh va cflng ddng dugc cho thdy cd th^ anh hudng tdi vific tigp cdn vdi chdm sdc sflc khoe Trong xa hdi Vifit Nam, ngu£ri cao tudi nhu flng/ba thudng cd anh hudng Idn ddn cdc lua chgn dd
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