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Tgp chi Khoa hgc - Cong nghe Thuy sdn So 1/2014 KET QUA NGHIEN CQU D A O TAO SAU DAI HOC MOT SO GUI PHAP NHAM DAY NHANH LO TRINH THy^C HIEN BAO HIEM Y TE TOAN DAN TAI TINH KHANH HOA SOME SOLUTIONS TO ACCELERATE IMPLEMENTATION ROUTE OF POPULA TION HEALTH INSURANCE IN KHANH HOA PRO VINCE Dqng Thi Kim Loan', Pham Xudn Thuy', Thdi Ninh' Ngay nhfln bai: 23/7/2013; Ngiy phan bi^n thdng qua; 21/8/2013; Ng^y duyet dang 10/3/2014 TOIM TAT Nghien cuu ndy nghien ciru thuc trgng th^c hien Bdo hiem y te todn ddn tgi tinh Khdnh Hoa bdng cdc phirang phdp tdng hop, phdn tich, so sdnh Nghien cdu da dua cdc nhgn djnh ve nhirng mgt dgt dug'c nhirng mgt hgn che va di xuat gidi phdp nhdm ddy nhanh Ip trinh thuc hien bdo hiem y te todn ddn tai tinh Khdnh Hda: (i) Cdi tien vd thay doi mgidi me tu qudn ly dieu hdnh ciia ca quan Bdo hiem xd hpi; (li) Ndng cao ehdt lupng vd ddp dng nhu cdu khdm chda benh BHYT; (id) Tdng cudng cong tdc tuyen truyen vdn dpng tham gia BHYT vd Idem tra Tir khda: bdo kiem yte, bdo hiem xd hpi, tinh Khdnh Hoa ABSTRACT This study research of the status of population health insurance in Khanh Hoa province in the synthesis, analysis comparison, The study has made comments about the gain result, the restrictions and proposed solutions to accelerate impementation route of population health insurance in Khanh Hoa province: (i) Improvement and powerful method to change management mindset of social insurance agencies: (li) Improve quality and meet the needs of health care insurance; (iii) Enhance the propagation insured motor and testing Keywords: health insurance, society murance Khanh Hoa province I OAT V A N D £ Sau gan 20 nam thye hipn chi'nh sdeh, phdp lugt v l Bao hilm y t l (BHYT) vd 03 nam Lu|t BHYT cd hieu lye, BHYT da bao phd 63.7% dan so d nude [1] vd tai tinh Khdnh Hda Id 58% dan s6, dd ngydi ngh^o vd d c d i i tygng ehinh s d d xa hOi da dirge Nha nydc ho trg hodn todn mde ddng BHYT [2] Mge du tinh Khdnh H6a da ban hanh nhieu van bdn hydng din, d c djnh hydng chinh sdch tdi chinh y te dygc xdc djnh nhat quan va ro rang, eong tac tuygn truyln da dygc d l y mgnh vd tang cydng, song ndm 2010 t j l§ tang tham gia BHYT ehi thdm 1,17% so vdi nam 2009; ndm 2011 t? I§ tham gia BHYT chf th6m 1.04% so vdi nam 2010, vdn cdn nhieu kho khdn thdeh thire li^n quan d i n vi^c tham gia BHYT cda d e d l i tygng theo quy djnh, eung nhy ngydi ty nguypn tham gia BHYT [2] O l dgt dygc myc tieu BHYT todn ddn vdo ndm 2014 thi cdn rlt nhilu thdeh thuv, dd id vipe bao phd BHYT cho khu vye lao d0ng ty do, ngydi lao d$ng Uong cdc h$ gia dinh, ndng nghipp, ngy nghi|p, Idm nghidp edn rlt thap Cung vdi do, khd ndng tdi ehlnh ciia qu? BHYT d i i vdi nhu d u ehi phi y t l cdng Id vin d l Idn Do vdy, viec nghidn cii'u: "IVl$t s i gidi phdp nham d l y nhanh Ip trinh thyc hipn Bdo hilm y tl todn ddn tgi tinh Khdnh HIa" Id d n thilt d l ddm bdo cdc quy djnh cda Ludt Bao hilm y t l , gdp phln giO virng an ninh chinh trj, dam bdo tr|t ty an todn vi I n d|nh an smh xa hpi trdn dja bdn tinh Khdnh H6a Hi#n d mpt so d n g trinh nghifin cdu v l Bdo hilm yte tai Viet Nam Diln hinh s i d d Id nghi§n cdu d a d e tdc gia d Vipn chiln iyge ehinh sdeh y te (2006) [5) Nhin chung nghiln cdu d i tiln hdnh phdn t i d , ddnh gid kit qua thyc hi#n chinh sdch BHYT, ' D§ng Thj Kim Loan: Cao hoc Qudn trj kinh doanh 2009 - Trydng Ogi hpc Nha Trang ^ TS Phgm Xudn ThOy, ^ ThS Thdi Ninh' Khoa Kmh t l - Tafdng Ogi hpc Nha Trang 148 • TRLfdNG OAI HOC NHA TRANG Tgp chi Khoa hgc - Cong ngh? Thuy s So 1/2014 nhirng khd khdn, virdng mde qua trinh thyc hi|n diinh sdch BHYT, khd ndng ddp dng eua d i n h sdch BHYT d l i vdi anh hydng phdt triln mlt nIn y te d n g bing, hipu qua vd phdt triln, nhung bat d p v l mdt chinh sdch BHYTdn sira doi, 1)1 sung Nghign ciru d a Phgm Dinh Thdnh (2004) [3] dya cdc gidi phdp de tyng byde md r|ng phgm vi ^am gia bdo hilm y t l theo dilu kien vd kha ndng d a timg nhdm doi tygng tiln tdi bao phd tdi mpi ting Idp ddn ey, vd d l xult d c (Keu kipn c^n thilt vd ding bp v l vdt chit ky thu$t, ve ludt phdp Tuy nhign vai trd chd d$ng eua BHXH cdn lu md, tac gia cung da chya dya mpt giai phap cy t h i cho doi tygng la nong ddn chiem 70% ddn so Vipt Nam NghiSn d u cua Nguyin Thj Ty (2006) [4] Idm ro sy d n thilt, ban chat, vai tro d a BHYT, tim hilu kinh nghipm eua d c nydc tren t h i gidi tir dd xdy dyng t i t hon chinh sdch BHYT tgi Vi§t Nam, ddnh gid thyc trang thye hi^n BHYT tgi Viet Nam thdi gian qua vd cull cdng Id mt nhyng giai phdp nhdm hodn thipn chinh sdch BHYT Nghidn cdu ndy eh[ ddng igi d mde d$: kiln nghj, de xult xdy dyng ehinh sach bao hilm y te tai Vipt Nam Nd chi gidi hgn hodn flii§n chinh sdeh n6n thilu tinh chit thyc t l vd khd cd the tien tdl bao hilm y t l todn ddn Hipn chya d tde gia ndo nghien cdu thyc trgng vd ede gidi phdp d l y nhanh 1$ trinh thye hipn Bdo hilm y t l todn dan tgi tinh Khdnh Hoa IIL K^T QUA NGHIEN CLPU VA T H A O L U A N II D | TITONG VA PHUaNG P H A P NGHIEN CLTU Doi ti/pmg va phgm vi nghien eChi Doi tirgng eua nghien ciru: Cong tde thye hipn bao hilm y t l todn dan tgi tinh Khdnh Hda Phgm vi: Cdng tdc bao hilm y t l todn ddn tgi b'nh Khanh Hda tir ndm 2009 - 2011 tgi Bao hilm xa hOi tinh Khdnh Hoa Dir Ij^u va phipcng phdp nghiSn ciru Nghien cdu ndy sir dgng dong thdi so li^u thy d p Dy li^u thy d p dygc thu thap thdng qua bdo d o d a Bdo hilm xa hgi tinh Khanh Hda, d e thing tin qua mang Internet PhiFong phdp nghien edu: Sd dgng phyong phdp so sdnh, phdn t i d , ting hgp dya tren d e sd lipu thu th^p dygc lay ty ede bao cdo thydng nien d a Bao hilm xa h^i tinh Khdnh HIa d l phdn tfch thyc trgng cdng tdc ^ y c hipn bdo hiem y te todn ddn tinh Khdnh Hda Ben cgnh dd, phyong phap ph6ng vin ehuy§n gia dyge thyc hipn nhdm ddnh gid nhu'ng mgt dgt dygc, ehi nguyen nhdn ciia k i t qud ndy, cung nhy phan t i n tai thye hi|n bao hilm y t l todn ddn tai Bao hiem xa h|i tinh Khdnh Hda Cdc ehuydn gia dyge mdi pi^ong vin bao gIm ehuydn gia n$i b^: Ban Gidm doc, Tardng, Phd phdng thulc Bdo hilm xa hpi tinh Khanh H6a, ehuydn gia ngodi: nguydn lanh dao Bdo hiem xd hpi Khdnh Hda Thyc trgng thyv hi$n Bao h i l m y t l tgi tinh Khdnh Hda 1.1 Thi/ctr$ng -Tmh hinh thu, ehi BHYT Bdng So thu, chi va can d l i quy BHYT tgi tinh Khdnh Hda (Bon VT tlnti: tn$u dSng) NAm SA thu BHYT 2009 169.124 2010 2011 S& quy BHYT air d^ng KCB (90% s6 thu) S6 chi BHYT S6lt6tdir 152.211 190.047 - 37.836 299.405 269.464 218 020 + 51.444 356.562 320.906 266.412 + 64.494 (Ngu6n: [21) Ty nam 2009 trd v l tnrde, nhd nydc thye hi^n chi tra 100% ehi phi khdm ehCra benh BHYT theo danh mye cua BO Y t l quy djnh, n§n quy BHYT ludn bj vd quy vd mat can d l i nhieu ndm iiln, nam 2009 quy BHYT tgi tinh Khdnh Hda bj dm 37.836 tn$u ding, cd nghTa Id BHXH Vi^t Nam phai dilu tilt vd bd Nam 2010 thyc hi§n quy ^ n h eda Lu^t BHYT ngydi tham gia BHYT ciing ehi trd d i phf khdm chira b|nh BHYT theo d c mde khdc nhau, tdng nhdm dli tygng d d c mde d n g chi t r i khdc nhy: hyu tri 5%; ngydi ngheo 5%; d " nghdo 20%, ngydi lao dpng 20%; hpc sinh - smh vien 20%; ngydi cd edng, tham gia khdng chiln, tre em dirdi tuli khong edng ehi trd V\^c quy ^nh edng chi tra da han c h i Igm dyng quy BHYT nen quy BHYT d k i t dy la 51.444 tripu dong D i n ndm 2011, dp dgng quy djnh toan ehi phf khdm chda bpnh BHYT eho ede ea sd khdm chira benh theo khodn dinh suit ngn cdc b$nh vien eung nhy dpi ngu y, bac sy dd hgn c h i rlt nhieu d c khdu ky thu§t khdng d n thilt ho$e TRUONG OAI HOC NHA TRANG • 149 Tgp chi Khoa hgc - Cong nghe Thuy sdn So 1/2 tinh trgng d p thuoc, chi djnh chin dodn trdn Ian nIn quy BHYT ed k i t dy la 64.494 tripu dong, co sd y t l thi chd d§ng viec sy dgng nguon quy, b|nh nhan thi dam bao dygc quyln Igi kham chya bpnh Mdt khdc, theo quy djnh cda Lugt BHYT so k i t dy quy BHYT trln mOt d|a bdn d p tfnh sS dygc trich Igi de d i u ty co sd vgt chit eho ngdnh y t l tinh d l phye vg Igi cho d e d l i tygng tham gia - Tinh hinh thu vd phdt hdnh t h i BHYT Bang Tmh hinh thu va phat the bao h i l m y t l tai tinh Khdnh Hda nSm 2009 - 2011 Nam 2Q09 Ooi t i r i n g So the BHYT /Tong so doi t i w n g Nam 2010 TjIfH So the BHYT ning sd ddi t i r ^ g Nim 2011 Tilft St> t h i BHYT /Ting s6 ail tut^g '*m 94.176/103.467 91 113.869/124.667 91 119.040/133.812 69 15.585/15.585 100 15.907/15907 100 16.853/16.853 100 - Ngi^crj CO cong, CCB 7.019/7.019 100 6.992/6.992 100 6.566/6.566 - Dai bleu quoc tioi, HDND 1.511/1.511 100 1.449/1.449 100 1.615/1.615 100 - Bao trg xa tloi, ngtfcri cao tuoi 5.667/6.514 87 6.629/6.976 95 16.248/17.196 94,5 - Ngwai ngh^o, dan toe thieu s6 163 077/163.077 96,5 NgifoiLDvaNSDLOdong Hi^u tri, t r a cap BHXH NSNN ho trg 100% m 104.826/106.299 96,8 28.262/28.262 100 100 145 259/147.456 Than nhan quSn dOi, c6ng an 072/6.072 100 4,071/4.071 - Tre em dugi tuoi, Ithac 91.372/92.767 98,5 106.937/109.016 98,1 103.740n 07.484 100 9e,a N S N N h t r g m p t phan - C | n ngh6o - Hoc sinh-sinh vien Nliom t^F nguydn Hiam gia BHYT v4 tv dOng (Ngudn: 30 339/85 343 35,6 40.801/114877 35,5 57.779/124/430 46,4 160.531/208.670 76,9 176 267/214.824 82,1 185.202/209.653 88,3 58.728/447.247 13,1 72.918/419.045 17,4 80.642/446.123 18 [2]) B d n g c h o t h i y viec t o c h i r c t h y c hien t h u v d phdt h d n h t h B H Y T n h i n c h u n g la t h u d n Igi cae n h m doi t y g n g d y g e n g a n s d e h n h a n y d c d o n g 0 % kinh p h i N h o m d l i t y g n g d y g c hS t r g m o t p h l n h o d c m u a t y n g u y p n co ty le t h a m gia B H Y T t h a p n h a L N h d m doi t y g n g bdt b u d e c d ty le t h a m gia B H Y T tren % q u a d e n a m , n h y n g t h y d n g c h | m trS v i | c phdt h d n h t h i B H Y T c h o n g y d i lao d p n g , d a c biet Id n g y d i lao d p n g d c d c d o a n h n g h i d p n g d p n g B H X H , BHYT 1.2 NhOng kit qud da d^t du^ - Ndm 2009 tong so thu bao h i l m y t l todn tinh K h d n h H d a dgt trieu d o n g ; n a m t o n g s o t h u b d o h i l m y t l t o a n tinh K h a n h H d a d g t 9 b i p u d o n g , t a n g h o n trieu d o n g so vdi ndm 2010, ttrang d y o n g tang 77,03%; nam 1 t o n g s o thu b d o h i l m y t l t o d n tinh K h d n h H d a dgt tai^u d o n g , t a n g tripu d o n g s o vdi nam 2010, t y a n g d y a n g tang 19,09% - N h d m doi t y g n g t i l t bupe e d t y le t h a m gia B H Y T t r e n % q u a d e n a m ; hpe sinh sinh viSn d g t tren 8 % 1.3 NhOng mdt han dii - Ngdnh BHXH chya ddp yng kjp thdi vdi yeu d u nhipm vg Ngdnh BHXH dam nhgn khoi lygng eong vile Idn d l i tirgng tang nhanh Viec phan d p cong tdc 150 • TRLTONG €»AI HOC NHA TRANG gidm djnh y t l v l huy^n chya dygc kjp thdi, miS'i phdn d p hodn todn cho t i t d cdc huy§n td' ndm 2009 Dpi ngu gidm djnh vidn y t l edn thilu vd yli|t chya CO co c h i kilm sodt chi KCB BHYT d tuy^n xa, chya kilm sodt dygc gid thule, gid v§t ty ti6u hao Uieo quy djnh, nen chya ddp dng dygc nhl^A vg kiem sodt chi phi KCB BHYT Bidn ehi, co clu l i ehye cdn bp thu hi#n cdn thilu, chya phd hpp vdi ySu d u nhi|m vy - He thong y t l vd nhdn lye chya ddp dng y&u d u khdm chira b$nh H^ thing ca sd khdm chira b$nh chya ddp i>ng ygu d u khdm chOa b$nh, chit lygng d a djch vy KCB thap, chya ddp dng ySu d u eda ngydi b^nh vi v^y tinh hip d i n cda vipc tham gia BHYT Uilp, ngydi dan khong muln tiiam gia BHYT Vdi \ri§c m* rdng dilu ki§n tham gia BHYT ty nguy§n, nen da si Id d l i tirgng cd nguy ca hogc dang mie b|nh mdi tham gia BHYT, nhdn ddn chya d y thyc tham gH vi ^ nghTa chia se mi ro d n g ding Co s6 KCB qud tai d t i t d d e tijyIn ndn hgn ehi dih d I t lirgng khdm chu>a b|nh, Idm gidm tinh thu hOl cda ehinh s d d - Cdng tdc tuydn truyln v l BHYT vd d n g tdc d i cath hdnh d f n h hgn c h i Cdng tdc Uidng tin, tuydn tmyln chya ddp i>ng dirge y l u d u nhi^m vy, ddc bi$t Id d t i m vT mO Tgp chi Khoa hgc - Cong nghe Thiiy sdn Cdi cddrx Uid tgc hdnh ehinh chya th|t sy hi|u qud, chya gidm philn hd cho ngydi b$nh, viec dp dgng phln mim thing ke, ting hgp chi phi KCB BHYT cln vydng mIe chya triln khai dyge, khdng t$p trung dyge nhdn lye d o viec gidm sdt t d n ehi phi KCB - Khd Uiu hdt d l i tygng tham gia Mde ho trg ddng BHYT d l i vdi d e doi tygng c$n nghio, hpc sinh, ngydi thupc h | ning Idm ngy nghipp Id thap so vdi dilu kipn hoan d n h song cda hp n#n chn tang them ty Ip ho trg Tuy nhiln vdi trxiic ho trg hi^n hdnh thi d c dja phyang da gap khan vipc can doi ngdn sdeh 1.4 Nguydn nhdn - Nguyen nhdn chd quan + B | may dilu hdnh thye hi§n ehi dO BHYT Bp mdy hogt d$ng, ca d u to chdc hipn cda CO quan BHXH da rlt Idn, nhan sy khdng phdi It nhyng d l triln khai hipu qua sdu sat d i n nhdn ddn thi chya dd Ca quan BHXH cdc d p Igi edng Ide trien khai nhilu cdng tae nhipm vy tir che d$ BHXH din BHYT, dd vdi nhilu nhdm d l i tygng, 10 trinh, cdch thd'c t l chtpc triln khai thyc hi$n khdc nhau, ty nguypn d , bat bupe ed, eung dnh hydng rlt nhieu d i n hi#u qud hogt d|ng cda CO quan BHXH, ding nghTa vdi dnh hydng d i n s i lygng tham gia BHYT cda nhdn dan Co ehi tuyln dgng, sy dgng nhdn tdi, co ehi lyang thydng, khuyin khich d|ng viln d l i vdi d|i ngij thye hipn nhi^m vy, cong tdc qudn tn dilu hdnh chya ddp Crng dygc vdi yeu d u , chya that sy dygc quan tdm, thay d l i , d n qud ngng v l co che bao d p , kdm linh d|ng vd hipu qud Chya xdy dyng dyge cdc chien Iyge, k l hogeh nhdn sy, quan tn dilu hdnh, d n phy thu^c vd dp dyng mOt each cdng nhic cae quy djnh d s i n ciia nhd nydc Cdc nguyen tie Idm vipe chya dygc d$i ngu nhdn vien thyc hi$n mOt edeh nghiem tde, tuan thd, d n d ty tydng •^ Igi, thg dOng, dn lyang nhd nydc, tinh to chdc ky lu§t chya dygc de cao vd dyge thye hipn m|t cdch nghifim minh + Cdng tdc BHYT vd tuyfin truyln chya dap yng yeu d u Hipn mdi d i dirng Igi d mye gdi van bdn, ban hdnh vdn ban, td chdc so kit, tdng kit nhy Id mOt hinh thdc Trong thye t l viec triln khai BHYT gin nhy Id nhi|m vy ehlnh, trpng tdm vd nhat d a ngdnh BHXH, ty tuydn truyln, phd biln, triln khai thye hi0n, ty thdn vgn d$ng, thdo gd vydng mIe, nlu cd cda cac co quan chdc ndng ed tham quyln thi hogc chya kjp Uidi ho$e d n ehung d u n g chya sdu sdt vd eg thi Vipc phdn b l kinh phi cho d n g tdc tuyen truyln hipn chya dyge quy djnh rd rdng vd chya dd UBND tinh thye hipn chire nang So 1/2014 quan lif' nha nydc v l BHYT tgi dja phyang nhyng vipc t)6 tn' kinh phi eho edng tae tuyen truyen ehinh sach BHYT tgi dja phirang d n gap nhieu khd khdn - Nguyen nhan khach quan + Chinh sdch d l i vdi ngydi d " ngheo chya thuc d l y vipc tham gia bdo hilm y t l : Dieu ki|n kinh t l d a nhdm doi tirgng egn nghIo thye sy khong khde bi$t nhilu so vdi nhdm d l i tygng ngh6o nhyng d c chinh sdeh yu dai eho nhdm doi tirgng d n ngheo Igi hgn ehi han nhieu so vdi d l i tirgng ngheo Mac du da dygc h i trg den 85% nhyng s i tham gia van d n thip, dieu ndy d t h i d n lien quan d i n nhdn thdc ve Igi ich eda viee tham gta BHYT chya day du, eung vdi d c h t l chdc khdm chira bpnh BHYT chya thudn Igi cho ngudi tham gia Mgt y l u to d n phdi xem xet den dd id mde eung chi trd eao tdi 20% nhy quy djnh hi$n vd khdng cd trln gidi han mde eung chi trd mOt nam eung dyge xem Id mpt rdo d n hgn che sy tiep cdn cda ngirdi d n ngheo d l i vdi d e djeh vy y t l , ddc bi^t id d e dieh vy ky thu|it eao, ehi phf Idn + Nh$n thdc cda ngydi tham gia bao hiem Dii voi nguoi lao ddng cdc doanh nghi$p: Cdc doanh nghipp khdng ddng, trdn ddng hodc ddng khdng day dd BHYT eho ngirdi lao dpng nh|in thde eda ehd sd dung lao d|ng ve ehinh sdch BHYT chya dly dd, trdch nhi|m thye Uii phap lu§t chya nghiem Ngydi lao dong d n thilu hilu bilt v l quyen Igi BHYT hogc bj han che vipc doi hli quyln Igi ndy kjf hgp ding lao dpng Trong dd, cdng tdc tra, kilm tra vd dp dyng eac ehi tdi XLF ly' vi phgm d n hgn ehi, d y a dd mgnh DSI vcn hQC sinh, smh vidn: Chya cd sy phdi hgp ch^t che giira ngdnh gido dye - ddo tgo vdi ca quan BHXH ndn d n g tde ehi dao, hydng din triln khai Lu|t BHYT d e nhd trydng chya kip thdi vd chya hipu qua; Hpc sinh, sinh vien eOng dang tham gia nhieu loai hinh bao hilm thyang mgi khde ndn dnh hirdng den viec tham gia BHYT Doi vOi trd em duifi tu6i: Cdng tdc Igp danh sdch, bdn giao danh sdeh trd em dydi tuli giCra UBND d p xa, phydng, ea quan Lao dpng TBXH vd CO quan BHXH d n eh§m Chya thdng nhat quy trinh d p tiie BHYT tgi dja phyang, nhilu trydng hgp till BHYT da dygc ca quan BHXH phdt hdnh, chuyen eho dia phyang nhyng Igi khdng d i n dyge tay d e doi tygng thieu quy trinh dly dd d p phdt the BHYT Oil vai nguoi tw nguy$n tham gia BHYT: S i ngydi ty nguydn tham gia BHYT cdn thip, da s i ngirdi tham gia Id ngydi mde bdnh man tfnh, benh d chi phi a i u tri cao Van de ndy cd lien quan d i n vipc td ehye, vdn dpng tuyen tnjyIn cho ngydi ddn hilu rd chinh sdch BHYT, tich eye tham gia BHYT TRUONG OAI HQC NHA TRANG • 151 Tgp chi Khoa hgc - Cong nghe Thiiy sdn •*• Khd ndng dap irng va tilp d n djeh vy y t l Chya d sy d i u ty Uifeh dang eho d e ca sd y te tyong t h f d vdi so lirgng ngydi tham gia BHYT, yeu kem, hgn ehi ve d eon ngydi, co sd vat chit, phyong tidn V.^ UiugL Ca che Uid tgc hdnh chfnh d n rydm rd phde tgp, gay khd khan, phde tgp Quy trinh chuyin tuyen edn nhilu philn hogc the BHYT chi d gid tii tgi d c co sd y te d ky hgp ddng KCB BHYT da Idm gidm di phan ndo y nghTa vd gid tq tham gia BHYT Tinh ti-gng Igm dyng quy BHYT tai co sd y te v i n diln khd phuc tap nhy; ehi djnh thye hien djeh vg ky thudt, sir dgng may mde thiet bi dygc b^ng bj ti> nguIn xa hpi hda rdng rai, qua md-e d n thilt vdi tinh tigng bpnh ly, Igp h i sa bpnh an khong d l todn BHYT; thing ke nhdng chi phi khdng thudc phgm vj Uianh todn d a BHYT; thdng ke so lygng thudc vdt ty y t l tieu hao nhieu han sd lygng tiiyc t l d l djnh ho so bdnh an hogc khdng ed ehi djnh sir dyng U^ng ho sa bpnh dn dp gid thude, djeh vy ky thugt, vat ty yte tidu hao d l nghj ea quan BHXH t d n cao hon mde gid da dirge d p d thIm quyen phd duypt, hogc dp theo mire gid dygc phd duydt sai quy dinh M^t s6 gidi phdp gdp p h l n hoan thipn cdng tdc BHYT tgi tinh Khanh Hda 2.1 Cdi tiin vd thay dii m^nh me phuong thuv vd tw qudn /j^ diiu hdnh cua co quan BHXH • Xdy dung ki ho$ch ddo t^o phu hop va hieu qua Cd k l hogeh dao tgo td mdi dyge tuyen dgng, d l nlm bat dyge mot sd edng vide ehlnh, ting Uil d a eo quan dan vj tnj'de vdo Idm d c cdng vide ey thi Tgo ca hdi dygc ddo tao vdi t i t d nhdn vidn, di nhidn ia tgp bung dao tgo ede nOi dung lidn quan den nghe nghidp chuyen mdn, b i n cgnh vipe td d d e ddo tgo d c ITnh vye theo quy djnh cda nhd nirdc - Xdy dgng mdi tnfdng ldm vi^c l^di tnrdng Idm vipe d i md, kieh thich sy nang d$ng phdt huy dirge hidu qua hogt ddng cda nhan vidn, ehu trgng d n g tae giao viec, trao quyen ddng ngydi dung vide Cdc van d l lyang, thydng, hirdng d c c h i dd dge thu d a nganh nen xay dyng mpt ea c h i thich hgp, ti'dnh chu nghTa binh qudn, cdo bang, kh&ng dya tren mire lyang md dya vdo hidu qud d n g tde, tren ca sd danh gia hipu qua d n g tae Tgo eg h^i thang tien vd phat tnen vdi tat ca mpi nhdn vidn Ca ehi bo nhipm vd d t nhle vdo d c vi tri qudn 1;^ trdn ea sd ddnh gia ddng hipu qud, nang lye Idm vide, khd ndng quan ly, lanh dgo eda nhan vidn, tgo eho nhdn vidn sy tin tydng vd d m nhdn dyge thdnh qud lao ddng d a minh ludn dygc ghi nhgn vd ed gid trj vdi ban thdn hp vide thdng tiln 152 • TRUONG DAI HOC NHA TRANG So 1/2014 ve sau hdi dd d c dieu kipn, tranh tinh trang dt nhIc nhdn vidn vdo d c vi tii qudn ly khdng dung ngydi, ddng vipc, van de ndy se d i n d i n nhirng h^u qud khd lydng vd d tdc dpng x l u tnj-c tiep din hipu qud hogt dpng d a dan vj - Xdy dgng h0 thing danh gid hieu qua ldm vfft; c l n thyc htpn Idp bdng tidu ehuln nghidp vij cho h>ng logi nghipp vy, lidt ke dygc tat d nhOng ydu d u ehd y l u ddi vdi ngydi lao dOng, npi dung thyc hidn d n g vipc d n g djnh lyong nhieu thi v i ^ ddnh gid d n g chfnh xac, d n g viee tiiydng tiiay dli, bd sung, nen bdn tidu chuan cung d n dygc c|p nhgt bd sung v l ndi dung cdng vide cho phd hgp - Xdy dgng chiin iu^c phdt triin ngudn nhin li/c ngdnh BHXH Theo dd phdi t l chirc dygc mgng lydi tgi co s6 ft nhlt Id d i n d p xa, hodc d d n b$ ehuyen Idm edng tdc qudn la bdnh dap img yeu d u ve cham sdc sire khde vd chit lygng kham ehd'a bpnh, dde bipt Id y te ea sd thdng qua thye hipn D l dn gidm tdi bdnh vidn vd Quy h o g d phat trien ngdnh y t l tinh Khdnti Hda d i n ndm 2020 Tang cydng thye hidn x§ h^ hda d n g tde y te, da dgng cdc logi hinh khdm chua bdnh d l tilde d l y ndng eao chat lugng khdm chira bpnh BHYT Xdy dyng vd tiiln khai chyang ti-inh ndng cao chit lygng khdm chira bdnh BHYT Vide trien khai chinh sdeh BHYT phai thyc hidn tCrng byde vd d6ng bp vdi vide edng cd ndng eao chat iygng khdm chiia bdnh BHYT, d i d c h thu tyc hdnh chinh, nang cao dgo ddc nghl nghidp Cd gidi phdp thiet Uiyc ndng eao y dire ti^ng dpi ngu d n bO nganh y t l ndng eao y ddc chinh la ndng cao chit lygng khdm ch&a bdnh, d l y mgnh tuydn truyen han n&a dOi ngu d n bd ngdnh y t l ve y ddc, dgc bipt Id d n b^ Tgp chi Khoa hgc - Cong ngh4 Thuy sdn bd, d l y mgnh cdng tac nghien cdu khoa hgc, sdng kiln d i tien ky thu$t, thye htpn nghiran d c quy d e ehuydn mdn, dgc bidt chu y den tiidi dp giao tilp vdi ngirdi bdnh vd ngydi nha bpnh nhan Xdy dyng gdi djch vy cham sdc sdc khde ban diu, gdi quyen Igi CO ban Xdy dyng ede vdn bdn vd tidu d u a n eg t h i d& vdi ea sd kham d u ^ bdnh BHYT d l dam bdo chit lygng vdi ca sd cung d p djeh vy y te, ehinh s d d eung d p thudc cho ngydi bdnhh BHYT 2.3 Tdng cuong cdng tdc tuydn truyin van dgng tham gia BHYT vd kiim tra - Tuyen tmyen v$n ddng Ngdnh BHXH d n tang cydng han nira eong tde tuydn truyln v|n dpng, vdi nhilu hlnh thdc phong phu vd da dgng, ndng cao nhdn thdc eda ngydi ddn Cdng tdc tuyen truyen phdi dgt v l d diieu r$ng lin chieu sdu Khdng chi ndng cao nhan thirc d a ngydi ddn d n phai ndng cao nhan thirc ti> chinh edn b^ qudn ly, d c d p ede ngdnh vd d cdn bp thyc hien lien quan den BHYT Phil hgp lidn ngdnh, huy ddng sy tham gia cua d c dodn t h i , cdc t l chut: phi chfnh phd ddng gdp, thuc day sy Uiam gia BHYT Ben canh dd, ngdnh BHXH qua binh tiiyc hipn nhidm vy, tdng hgp ^ kiln, phan dnh, nhirng khd khdn virdng mde, kip tiidi de xult, kiln nghj cae d p ngdnh thdo gd, dieu ehlnh, t]d sung, sira doi d e quy djnh cho phu hg^ vdi thye te TSng cydng d i u tir xdy dyng mgng lydi cdng tdc vidn BHYT, Uidng qua ddi ngu dgi IJ d i ba BHXH, dgi ly thu BHYT, thudng xuydn p h i biln, tgp huan nghipp vy, ehi dp chinh sdch cho dpi ngd cdng tae vidn Phdi hgp ehdt d d vdi tat d cdc d p , ngdnh, d c CO quan thdng tin, bdo d i , tnjyen thdng cdng tde tuydn truyen van d$ng, t$n dyng dpi ngu cdn t>d din tuyln ea sd d a ede hOi, dodn Uie d l Idm d n g vidn tuydn buyin d l dp BHXH, ding Uidi d chi dd ddi ngd thich ddng nham ddng vidn khuyin khfeh ddi ngd ndy thyc hidn chdc nang tuyen truyln vgn ddng bdn cgnh nhidm vg chinh tii eua hp Cdng tde buyen thdng, tiiyen truyln d n dygc tiln hdnh vdi tat d d c nhdm d l i tygng, bao gom d d c d p chinh quyln, dodn t h i , tnjdng hpc, d c d i bp, ddng vidn vd thyc hien tiiydng xuyen, lidn Kic vdi nhilu hinh thire phu hgp, bdo ddm d e ddi tygng d a truyln tiling tiep d n dly du vdi thdng tin So 1/2014 v l ehinh sach BHYT va d c h Uidc tham gia - Tdng cirdng cdng tdc tra kilm tra vide thye hipn BHYT d o ngydi lao dpng Dya bdu chi tham gia BHYT cho ngirdi lao dpng nhy Id mot ydu d u bit bupe vipe d p phep hogt dpng san xuat kinh doanh, tiiydng xuyen kiem tra, ddn doc nhac nhd, xd phat nghiem minh d e hdnh vi tron ddng, ne banh vide tham gia BHYT, ede hanh vi vi phgm v l quyln vd nghTa vg d a d c bdn tham gia vd lien quan den vipc thyc hipn BHYT Phan djnh rd t r a d nhidm vd tang cydng d n g tdc tra, kilm tra thyc hidn chinh sdch BHYT cua ca quan qudn ly nhd nude d e d p dde biet Id vai trd d a UBND tinh vide ehi dgo ede sd, ngdnh lidn quan td chdc tra, kilm b^ vide thye hipn ehinh sdch BHYT tren ^ a bdn finh IV K^T LUAN Cai thipn cdng tdc bao hem y t l todn ddn tgi tinh Khanh Hda se gdp phan quan trpng d n g cupc d l i mdi sy nghidp chdm sdc vd bdo vp sd-c khde nhdn ddn bong tinh O l khai thde nhyng k i t qud dat dygc, hgn c h i nhirng tdn tgi, nghien cdu d l xuat mpt sd giai phdp gdp phln nang eao edng tde bdo hilm y t l todn dan tgi tinh Khdnh Hda: Cdi tiln vd thay d l i manh me phirang thde va ty quan ly ^eu hdnh cua ea quan BHXH, nang eao chit lygng vd ddp dng nhu d u khdm chira bdnh BHYT, tdng eirdng edng tde tuyen tmyen v | n ddng tham gia BHYT vd kilm tra Trong gidi phap d i tien vd thay d l i mgnh me phyang thirc vd ty qudn ly dilu hdnh d a eo quan BHXH ed y nghTa rat quan trpng, cd t h i coi nhy d m nang thye hien y te todn ddn tgi tinh Khdnh Hda Vdi nhirng kit qud nay, nghidn ed'u dd giai quylt t i t mgc tieu nghien cdu da d l Tuy nhidn nghidn ciru van ed mpt sd hgn che nhlt dinh Nghidn eiru chi ddng Igi d phdn tieh thyc trgng, phdng v i n ehuydn gia chi dilm hgn che vd de mdt s6 kiln nghj gidi phap d l gdp phln nang eao d n g tde bdo hilm y t l toan ddn tai tinh Khdnh Hda Trong nhirng nghidn ei>u tuong lai d t h i dygc md rdng theo hydng phdn tich cac nhan td dnh hydng d i n cdng tdc bdo hilm y t l toan dan tai tinh Khdnh Hda vdi sd mlu du Idn de d mot md hinh hodn tiiipn han TAI L i f u TH.4\1 KHAO S Bao hiira xa hpi Vi?t Nam, 2010 Ky yiu nghien ciiu khoa hoc Ha Ngi Bao hifem xa hpi KhSnh H6a, 20 U Bao cao danh gia nam thyc hi?n Lu|t Bao hiem y le tren dja ban tinh Khanh Hoa Ph^m Dinh Thanli, 2004 Bao hilm y ti va tien trinh t h ^ hi?n bao hiem y tk toan dan Vift Nam Lu^n vSn Thac sT Kinh t6 Trudng Dai hpc Kinh tl TP.HCM Nguyen Thi Tii, 2008 Phit triln va hoan thi?n h? th6ng y td t?i Viet Nam Luan v5n Thac sT Kinh tl Truemg D91 hpc Kinh tl TPHCM Vifn Clucn lu
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