hgc sd (135) 2016 M(3T SO TRCJ NGAI TRONG Xm/C HIEN L Q TRINH TIEN T I B A O H I E M Y TE T O A N DAN MAI LINK" NGUYfiNTHI KIM HOA" Tdm td,: Trong thai gian qua, chinh sdeh bdo hiim y ti d nude ta dd dgt dupe nhiiu Ihdnh t\ru, khdng chi hd trp ve tdi chinh y te md cdn tdc dpng tich cue den cdng Idc khdm chira bfnh cho nhieu ngudi ddn Thuc hifn chinh sdeh bdo hiem y ti hd trp nhiiu ngudi gdp hodn cdnh khd khdn, giup hp cd ca hpi dupe tiip cdn vdi cdc djch vy cham sdc sue khde Tuy nhien, qud trinh thuc hifn chinh sdeh bdo hiim y ti cdn mpt sd khd khdn ddi vdi cdc nhdm ddi tupng ddc thii nhu cdc doanh nghifp, hpc sinh, sinh viin, tre em dudi ludi ddi tupng cgn ngheo, hp gig dinh NhOng khd khdn niu dupe khdc phifc sl ndng cao chdt lupng chdm sdc site khde cug ngudi ddn, ddm bdo thi/rc hifn binh ddng va cdng bdng xd hpi Tir khda; bdo hiim y ti chinh sdeh khd khdn Dftvandi Bdo hiem y ti (BHYT) Id mpt chinh sdeh xd hf i quan trpng, mang ^ nghia nhdn dgo cpng ding sdu sdc gdp phin quan frpng tfiyc hifn cdng bdng xd hpi frong chdm sdc vd bdo vf site khde nhan ddn (Chinh phu, 2013) BHYT dd vd dang cd nhihig chuyin biin tich eye vifc ddng gdp vdo sy nghifp bdo vf vd chdm sdc siic khde ngudi dan vd tfiyc sy Id mft ttv cpt ciia an sinh xd hpi d Vift Nam (Anh Thu, 2016) Xdc dinh tim quan tttpng ciia BHYT todn ddn, chinh phCi dd ndng myc tifu bao phu BHYT vdo ndm 2020 tir 80% ddn so len 84.3% vd gin day Id hon 90% (Chinh phd 2015; Hd Trang 2016) Din giOa ndm 2016 dd ed 78,3% ddn si tham gia BHYT (Ha Trang, 2016) Tuy nhi6n df dat myc tieu dfn ndm 2020 cd nude cd ttfn 90% dan si tfiam gia, tgo tiin df cho BHYT todn ddn Ig, khdng phai Id mpt myc tifu dl ddng Theo Chiin lupc phdt ttiin ngdnh Bao h,im xd hpi Vift Nam din ndm 2020 gidi phdp diu tien nhdm dgt myc tifu Id phat ttien doi ttipng tfiam gia bdo hiim y ti bdng cdch diy manh truyin tf,dng v|ln dfng nang cao nhgn tf,iic phdi hpp chdt che giiia cdc ca quan chirc ndng vdi cdc doanh nghifp (cwiS; h-"2o'n^ "^'"'^^ "*" "^^ "^^ ^^ '**^'" " ^ ^ '"^ ^^""^ ^^ ^^ "•" **"** ^ *" t r ^ ! ^ K * ^'^J^""'^^ *» Ap' "o Nhdn vdn ihugc Dgi hgc QuSe gia Hi Ngi rCich,inh U«o Quy& d,nh 09/2011/QD-TTg ngiy 30/0l/20'l I lim c i ^ S n g h t o Mai Linh, Nguyin Thi Kim Hoa BHYT E '^y^\'}^°^ °h™8 '^ 37 ^ vice quan ly quy BHYT gidm dmh khong It tta ngai, nhat Iddmdtsd nhdm diittrpng ddc tfiii n h i r / « , ^ d t , ; o „ ^ ^ Nhung kho khan viec md rpng bao phu BHYT a mpt s i nhom 2.L Ngudi lao dpng cdc doanh nghifp q u y i n ^ v ^ J S T c t ' " '^'f^^:''^ '^'^ "^'^ nghifp quan tam vdtfiuchien di dam bao quyen va Ip, ,ch cho nguo, lao dpng Vifc ngudi lao dpng tfmi gia BHYT kbonJ^Tv nghia nhan vdn ma Id quy dinh ciia I i.3t RHVT XA• A^.T^^ ^ chi co y ndy hifn nav Id fi"/ J i u T ^"^ ^°°8 BHYT quy dinh cho nhdm J'^c doanh nghifp np vd trdn ddng bdo hiim hifn diin rd, phd biin chu yeu van la ngudi su dung lag dpng chug thdy duftctrdch nhiim ThAild ohongudilaodpngsndmgidmlpinht.4ncuZdZlth^ "^ (Nam can bp Bdo hiim xd hpi Vif, Nam) Ngn^n nhdn cua tinh trgng np, chdm ddng BHYT thi rd, nhiiu nhung mdu chdt Id che ta xuphgi chua du mgnh mdc xd phat hdnh chinh thii^rT^ (Nam cdn bp Tdng Lifn doan Lao dpng Vif, Nam) 38 Mgt so trd nggi thuc hifn Ig trinh tien tdi Miic chi ,ai xir pha, dii vdi nhiing doanh nghifp chua tfiyc hifn , i , BHYT chua mang tmh idn de Hon niia ldi suit tir khodn np BHYT cdn tfilp (9%/ndm) nfn nhiiu doanh nghifp tfii hifn chdm tre ttong vifc ddng ky BHYT "Chi tdi xuphgt hdnh chinh qud thdp, miic tinh ldi chdm ddng BHYT cUng thdp nen cdc doanh nghifp khdng ddng trdn ddng hope ddng khdng du BHYT cho nguai lao ddng Tiin cda hp cdn uu tien cho vifc kinh doanh, trd luang chd BHYT khdng phdi uutienhdng ddu " (Nam, 36 ttiii cdn bp BHYT Hd Npi) Dii vdi nhiing doanh nghifp, cdc nha hogch dinh chinh sach da dua m§t si giai p h ^ cho tinh trgng nhu: giao chiic ndng tiianh tta tiiu cho co quan Bdo hifm xd hfi (BHXH); de nghi bi sung vdo Bp Lug, Hlnh sy ,01 ttdn ddng BHYT, ,pi chiem dyng tien BHXH ciia ngudi lao dpng; quy dinh ngudi lao dpng cd tfie ttinh hpp dong lao dpng di bdo CO quan BHYT minh tfiufc doi tupng tham gia BHYT bdt bupc; tiip tyc cdi thifn mfi ttudng dau tu, kinh doanh di ho trp doattfi nghifp phdt ttiin; di tdng difn bao phii BHYT can cd sy hi ttp ciia Chinh phii dii vdi ngudi lao dpng thuic nhdm doi tupng phi chinh tfnic Ngdy 6/10/2015, BHXH Vift Nam ciing Phdng Cdng nghifp vd Thuong mgi Vift Nam (VCCI) dd ky kit chuong ttinh phii hpp giai dogn 2015-2020 nhdm «ng cudng ttdch nhifm vd sy phii hpp ttxing chi dgo, hudng din vd t i chiie thyc hifn chinh sdeh, phdp ludt ve BHXH, BHYT (Trin Kifn, 2015) Tuy nhifn cho din nay, nhihig gidi phdp ndy vin chua thyc sy phdt huy hifu qua Ben cgnh dd, chinh ban thdn nhieu ngudi lao dfng ciing khdng hifu rd dupe quyin vd ngWa vytfiamgia BHYT ciia minh "Ndi thdt vdi chdu Id cd ding khdng diy niia, vifc ciia minh thi minh cu ldm thdi Hdng thdng vdn thdy trd luang diu nen cd ciing khdng quan tdm ldm BHYT thi co ich ^ cho cd nhi ? " (Nti,40hiii.PTTH,HdNii) "Anh cUng cd nghe ndi din chuyfn ddy nhung cd Idn len hdi thi hp bdo Id khdng ddng BHYT cSng khdng cd chd dnh hudng gi din anh vd cong ty nen anh cUng thdi ludn cdng ty ndy ngodi luang thinh thodng cUng dupe thuang nen mgi ngudi cUng khdng de y ldm ddu em g " (Nam 33 ttiii, cdng nhdn, FTTH, Hd Nfi) Do dd d n cd nhihig bifn phdp hiyfn ttuyin sdu rpng dh nhihig ngudi lao dfng hiiu bifit vf nghia vy vd quyen Ipi ciia mmh tfiam gia BHYT Cd nhu tiif till vifc tdng t^ If tfiam gia BHYT vdi nhihig ngudi lao dfng mdi fliyc sy cd hifu qud Nhu vgy, cin tfiiit phdi tiip tyc hodn tiiifn co chi chinh sdeh,fewdiiu kifn cho cdc doanh nghi?p phdt ttifn vd phdt huy diy du quyin Ipi, nghia vy cua minh frong vifc bdo ton quyen Ip, cho ngudi lao dpng; quy dinh chi tai xir ly vi phgm BHXH mgnh, cd tinh rita de, de doanh nghifp chd dpng tfiyc hifn ti, chinh sdeh BHYT; tdng cudng ttiyfn truyen phd b,in phdp lu|t vf Unh vyc BHYT; diy mgnh cdi cdch hdnh chlnh cQng nhu Ma Linh NgayAi Thi Kim J Hoa 2.2 Nhdm hpc sinh, sink vien ^ J ! ! l ' ^ - " i " " ^ ° ' ^ ' BHYT hpc sinh, sinh vi&i (HSSV)timehienflieoLudt BHYT sua St^t""'^'^^'^.'^^^^^'^«^3%len6%muchiang^sdri^^ hott^mp., W u c ddng MSi ndm mdt hpc sinh til b&tiiuhoc din b«^ S / ^ ^ V '^T' '"'''ã ô^ * ^ BHYT fi df myc tifu d ^ a ^ ' t m , i ^ ^ ^ - ' ^ ' ^ ' ^ ^ ^ " ^ ' " ^ ^ S trongtf,ycteehi dat 80% Cllianh Quy, 2015) h^o^ nhung nguy«i nhan xuat phatttrsutfriiutinttidngvakhdng mudn s u L g s S ^ ^ contonte,nhungba,capxua,phattiichinhsaehvacachittifnktoL Vngô"Yt thi van ã^Phdt hpp giuaBp Gido due vdDdotgovd BHXH r,it Nam cong tdc chi ^ ^ '^^chg.chevahtfuqua.nhdtldkhdicdctrudngchu.innghifp.caoddngdgihpc" in ^-awJI (Nam, 46ttidi,cdn bp BHYT, Ha Npi) ^ » ^ ""\^,^.'P*''^''''''''''S'na nhd trudng dupe "cd," Igi cOng khong ddng ki nen ^^ ^t?c don doc cgc em mua BHYT Igi CO phdn chgm ,ri" clZ (Na, 54 hidi, gido vifn, Dgi hpc, Hd Npi) Ichof f rdng ? " tdo ^ -la " *vifc ^ ' rieng ' ^ ^ ngdnh '"•^'' **"'• ^'"'^ ^'^^^ BHTT khd khd khdn, nhd iruang trudng BHXH" '^'^nna ^ ' ' (cdn bp BHYT, Hung Yfn) w ^ ^ ^^^ "^"'^^^ *^y '* "^* '^ trudng hpc cdn xem nh? va chua tf,yc su ng lyc ttong cong tdc ddn ddc HSSV tfiam gia BHYT Cdng tdc h t y r t t u y i n X s v vS Khodng 20/o sd HSSV chuatfmmgia BHYT (ttiong duong 3,2 ttieu HSSAA Xn ,hi A bao phu vin chua vupt ttpi so vdi cdc nhdm ddi J p T ^ M d T l bTlSh T'nToco, '=•'"' '^'' ^ ^ ' ^ *™"8 ''inh vien khd khdn nhifu Idp hpc tf«, tin I S tx^ tt^2'c^ "^Mr ^'^'^'^ truem^ch::^ itttS mq«n ve BHYT nen cd smh vien khdng khd khdn ciing khdngtfiameia BHYT " m l ! t t ' ' f T f ""^u'JS: ^ - ^ ^^' ngdnh gido dy^ d n i L T ^ T d i ^ ^ g H S V ^ n Ig, chua tfiam gia BHYT tfiupc difn ndo cd khd khdn hay khdng di T S J ^ ttiyfnttuyenhodc ho ttp phu hpp •"/"iwig ae cd g,d phdp •Hifn vdn khodng 20% HSSV chua thgm gia chd yiu Id sinh vien d khu VKc nong than Nguyen nhdn Id vi khdng cd chi tMvdi nhd^Xll^Z^^ '^/^^''"S^^^^'hdnhthivdndngthdnldnhunha^l^Z.sdZo ^'^-'^^nu^i'h^hifnbdohiimchohpcsinhsinhviencdTc,^^ (Nam, 51ttidi,cdn bp BHYT, Ha Nf i) 40 Mdt sd trd nggi thuc hifn Ig trinh lien ldi Khi nhiing HSSV hay cac trudng chdm tre ttxing vifc ddng va tiiu BHYT chi dimg lai d vifc nhdc nhd tfii kho ed tfii hodn tfianh dupe tien dp Mdt ttd nggi khdc cua BHYT hpc sinh, sinh vien la ca chi tai chinh ho ttp chua phii hpp Vdi nhiing gia dinh kinh tf khd khdn, miic ddng mdi 434.700 ding/nam (2015) vd 457.380 ddng/ndm (2016) la cao hon ddng ki so vdi miic cu la 289.800 ding/ ndm (2013) "Miic ddng mdi ndy tgi khu -vitc thdnh phd neu so vdi cdc tinh mien niii, vimg sdu vung xa Id rdt cao, dd cdn cd su dieu chinh de HSSV viing sdu, vimg xa, vimg ndng thdn duac hd trp nhieu han " (Nam, 36 ttiii, can Bp BHYT, Hd Npi) Cimg quan diem nay, cd y kiin ciia nhd qudn ly cho rdng "Miic hd ttp cda ngan sdeh ding diu 30% Id chua hifu qud BHXH Vift Nam dd nhiiu lin df nghi nSng Ifn hodc cd tfii van tri 30% nhung khu vyc thdnh thi 20%, gianh 50% cho cdc dii tupng HSSV khd khdn d khu vyc ndng tfidn" (Bdo hiim xd hpi Vift Nam, 2015) Nhu vay cd thi thiy rdng vifc md rpng dii tupng BHYT la hpc sinh sinh vifn van cdn nhieu khd khdn Can thiit phdi cd sy tfiay dii vf chinh sach ndng cao y thiic hpc sinh, sinh viSn, vd tgo diiu kifn cho nhdm ndy tfiam gia diy du BHYT Chdn hgn nfn xem xft giao ttdch nhifm chi tieu cho cdc tmimg vd kit qud tham gia BHYT se Id tieu ehi danh gia tfii dua ciia nhd tnidng va rfn luyfn cda hpc sinh ndng mite vay tin dyng cho sinh vifn di hp cd diiu kifn tfiam gia BHYT 2.3 Nhdm tre em dudi tudi Ludt Bdo vf Chdm sdc vd Gido dye ttf em quy djnh: "Tr6 em dudi ttiii dupe chdm sdc sure khde ban diu, dupe khdm bfnh, chOa bfnh khdng phdi tti tiin tgi cdc co sd y ti cdng ldp" Khdng it ngudi dan cd tfif hiiu la tre em dudi hiii dupe khdm chiia bfnh tgi mpi ca cd y te cdng ldp md khdng phdi tta tiin, fliam ehi khdng cin cdtfi6BHYT Tuy nhifn, Thdng tu li«i tich si 41/2014/TrLT-BYT-BTC cua Bp Y ti vd Bp Tdi chinh quy dinh: 'Trf em dudi hidi den khdm bfnh, chira bfnh chi phdi xudt ttinh tfif BHYT " (Pham Thanh Binh, 2015) Theo quy diitfi tgi Dieu 22 Lugt Siia dii, bi sung mit si diiu Lugt Bdo hiim Y ti tfii mire hudng bdo hiim y ti dii vdi tt6 dudi ttiii dupe quy djnh: "Ngudi tfiam gia BHYT cd quyin ddng ky khdm bfnh, ehiia bfnh BHYT ban diu tgi cdc CO sd khdm bfnh, ehiia bfnh ttjyin xd, ttiyen huyfn hodc hiong duong " Nhu v§y, ttf dudi hiii ciing phdi ddng ky noi khdm, chiia bfnh ban dau, khdm chiia bfnh ttdi hiyin hodc vupt hiyin sS phdi tfianh todn vifn phitfieohgng bfnh vifn: 30%, 40%, 60% vd chitfianhhidn chi phi khdm chiia bfnh BHYT cdn cutfieodanh myctfiudcvd vg, hi y ,i Bp Y ti ban hdnh "Chung ldi rdt hiiu vi vdn di ndy nhung khdng ldm cdch ndo dupe Nhiiu bdc cha tnf khdng ndm dupe Lugt BHYT vd nhOng uu tien cho cdi minh Vifc ddng ky u- T f^'""" "^'^ ' ^ *^''" "^' '^" '" ^^' ^« vao nhiing dip chung tdi in, phat the BHYT a dia phuang Ddng ndy cu din luc nd bi dm Igi cudng cudng di ldm the de huang chmh sdeh thi ldm chiing tdi gidi quyit dupe " (Nam, 38 hiii, cdn b i BHYT, Hd Nii) Mai Linh Nguyin Thf Kim Hoa 41 =• A> ^i "fi'"^* '^ " ^ ^ ''^' * ^ "^^ 'y ** "^"S ^ BHYT la su tUiu hiiu biit ve ddng ky kha sinh vd cdc chinh sach Uen quan cua bdc cha me tditfiam'giabao hiim y te va V.PCteeem dudi hidi du difu kifntfiamgia bao hiim y ti "^'t!"^T''V'^'-"^"'''^''^'"^^^^"^'^'^^^-^omptsd thmgUumg dupe tham gia BHYT ly Id cdn thiiu mdt sd thdng mdi vdo hpc lap sZlZ^'l ^^-'i""^^"^'""'^'' "^"'^"^^^t^^g'np s^naove khan, chda binh BHTT Vdn di ndy thudng rai vdo trudng hap cdc tre ^^ smh rata thdng I den thdng hdng ndm" (Nii, 33 mdi, can bp BHYT, Hd Npi) gilv k^f.^T'"^'"v ^'''*'^'"°'* " ^ ' ^ ' ' ^ ^ ' ^ " ^ - e - ^ the BHYT, su dung ludn dyngtfieBHYT,tfianhquyet todn chi phi khdm chiia bfnh BHYT P Z ^ ^ ' 1'^:? "J^ *^' ""^ ^'^ ""^ """ -"^ ^- *- -^ cZ!^dik7^''' ' ^ly^"."^ '^'" "'""^ "^ "^ ' ^ '^^'' «*- v«V /ô Chung toi rat kho kiem '^ sodt"vd*'ã qudn (Nam, 30 ttiii, can bp BHYT, Hd Nii) Nhu v|y, vifctfiamgia BHYT cua cdctt^dudi 6ttiditfiyechit Id phy tfiupc ^ y tfiuc cua cdc bac cha mp Difu ndy vd hmh Chung Igi ,aorakhd k h ^ cho el^ cdn bp f a ! r ? r *™''° "^ " ' ' ' ^ "°" '^^ P*^ "'"^ "^y mgnh Ben canh dd cdng tdc ^p danh sach ban giao danh sach tte dudi mii giiia UBND d p xa/phudng phdng Lao ttm^'^t t "^""'' :r ""^ '"^'''' -^ chrt h?nh K ' 4a phuong, nhieu ttudng hpp tfie BHYT da dupe ca quan BHXH p S oquy t fttinh ^ Hday T du ttong '^" "'""'' '^ '*"'« '*^" ' ^ '^y ^ ^' tupng "u