NQHIEN CflU - TRAO DOI De bao dam an sinh xa hoi cho nong dan ThS PHAM TH! HONG HOA TrUdng Dfii hoc Sao Do Htfn h^t, n6ng dSn la life Itftfng d l bi tdn thiftfng va d l rert vao canh ngheo doi, bdi vay bg la dd'i trftfng rat c^n tdi sif h§ tr(? cua Nha nufdc 6i bao dam cuOc s6'ng dn ^ " h Nhtfng nam qua, an sinb xa hOi (ASXH) dd'i vofi ndng dSn la mot nbffng chinh sach quan trpng drfgTc Chinh phu quan tSm, thtfc hifen Tuy nhien, h$ thd'ng vIn nhi^u bS't c$p, chrfa phat huy hi$u qua thi^c t§' THLfC TRANG Chinh sdch ASXH ddi vdi ndng ddn la tao Iffdi an todn gdm nhieu tang, nhidu Idp cho nhffng ngffdi lao ddng ndng nghiep trffdng hdp bi giam, ma't thu nhdp hay gap phai nhffng riii ro khdc, nham thiJfe hien chffc nang phong ngffa, ban che' va khdc phuc rui ro, bao^ddm an toan thu nhap va cudc sdng dn dinh d nffdc ta, nhffng ndm gan day, vide thu hdi, hoac chuydn ddi muc dich sff dung dat nong nghidp didn ngdy cdng nhieu, vdi quy md Idn Binh quan mdi nam cd khoang 73.000 dd't nong nghiep bi thu hdi de phuc vu cho cdng cudc cdng nghiep hda, hien dai hda dd't nffdc Didu anh hffdng tdi ddi song va viec lam ciia khoang trieu nong ddn, tifdng dtfdng vdi khodng 700.000 hd gia dinh Vdi nhieu ly khdc nhau, nen chi khoang 80% sd nong ddn cd viec lam, cdn khoang 20% chffa cd vide lam, hoac vide ldm khdng dn dinh Do dd, thu nhap cua khoang 50% sdhp nong dan bi suy giam (Phiang Thi Minh Dffdng, 2013) Mot bp phan nong ddn it dffdc hffdng thu thdnh qua cua tang trffdng, khd tid'p can vdi cdc dich vu xa hdi ed ban Trong bdi canh nhff vay, he thdng ASXH chinh la "phao cffu sinh" giup ngffdi ndng dan vffdt qua khd khdn, the hidn muc tidu chien Iffdc cua Ddng vd Nha nffdc phdt trien da't nffdc Hidn nay, he thong ASXH dd'i vdi ndng ddn d nffdc ta, gdm: Bao hiem y te' (BHYT) tff nguydn; Bao hiem xa hdi (BHXH) tff nguyen; Trd giup xa hpi; Xda ddi giam ngheo; Cung ffng dich vii xa hpi cd ban Tuy nhidn, cho den he thd'ng ASXH cho ndng dan d mffc sd khai, dd bao phu mong; cdc Idi ich cua ASXH chffa dffdc phdn phd'i cdng bang, thidt thdi vdn thuoc ndng ddn Cu the la: - BHYT tu nguydn Nha nffdc thffc hidn khong vi muc dich Idi nhuan Theo nghien cffu ciia Vidn Nghidn clJu lap phdp, hien van hdn 30% ddn sd'chffa tham 32 gia BHYT, cd ca nhffng ngffdi thudc dd'i Iffdng cd trach nhiem phai tham gia BHYT theo quy dinh cua phdp ludt, ngffdi thudc ddi tffdng dffdc Nhd nifdc h5 trd ddng BHYT Du da dffdc Nha nffdc, cdc to chffc quo'c te hd trd tff 70%-90% kinh phi mua the BHYT, nhffng Men mdi cd gan 1,7 tridu ngffdi/khoang trieu ngffdi cdn ngheo (khodng 28%) tham gia BHYT Nhdm ddi tffdng thudc hd gia dinh Idm ndng, lam, ngff nghidp va didm nghidp ed tdi 20 tridu ngffdi, nhffng cung ed ty Id tham gia BHYT mffc thdp Nguyen nhdn la thidu nhiJng quy dinh chat che, ro rang vd du manh Luat BHYT vd cdc van ban dffdi Luat Cu the, theo Luat BHYT, tff ngdy 01/01/2012^, ndng dan la nhdm dd'i tffdng dffdc "H6 trd tdi thieu 30% mffc ddng BHYT tff ngdn sdch nha nffdc" Tuy nhidn, chinh sdch tffdng nhif ffu vidt lai rd't khd thffc hidn Tra Idi phong vd'n tren bdo ehi, ba Tdng Thi Song Hffdng - Vu trffdng Vu BHYT (Bd Y td') thffa nhdn, rieng ddi tffdng ndng ddn vdn chffa cd tieu chi xac dinh, ndn de'n gid chinh sdch hd trd phi BHYT tff nguydn cho ndng dan vIn nam tren "van ban" (Didu Linh, 2013) Nguyen nhdn la Bd Lao ddng, Thffdng binh vd Xd hpi chffa xay dffng xong "Tidu chi ndng dan", "Tieu chi xac dinh hd cd mffc sdng trung binh" Quy tnnh rd sodt cung chffa dffdc ban hdnh nen chffa cd cd sd de tridn khai BHYT vdi nhdm ddi tffdng Trong nam (2014), BHYT tff nguydn cung se chuydn sang BHYT bat bupc Ben canh dd, thffc te, nhieu ngffdi ddn ndng thdn ngheo vd nhffng vung sdu, viing xa dffdc cd'p mien phi the BHYT, nhffng khdng sff dung vi benh vien nam qua xa dia bdn sinh sd'ng - BHXH tu nguydn cho ndng dan BHXH da dffdc xdy dffng ludt vd da dffdc Qud'c hdi thdng qua, cd hieu Iffc tff 1/7/2007 Ludt BHXH bao gdm BHXH bat bupc, BHXH tff nguyen, bdo hiem thd't nghiep, bao hiem tff nguydn chii yd'u cho dd'i tffdng la ndng ddn Ndng ddn ldm vide ndng nghidp, ndng thdn la khu vffc cd ra^t nhieu rui ro, vide Idm khdng dn dinh, nang sud't va thu nhdp tha'p, rdt dd bi tdc dpng cua gid ea thd' gidi vd tranh chd'p qud'c td' (sff gia tang eiia gid dau thd' gidi, cac vu kidn quo'c td' ve chdng phd gia cae nong san xuat khau ) Thd' nhffng, hidn nay, mffc dd tham gia BHXH lai rat tha'p, vi theo quy dinh ve tham gia BHXH tff nguyen, mffc ddng thdp nhat cua loai hinh Id 20% Iffdng tdi thidu, ngffdi nong ddn khdng chiu sff dieu chinh eiia Iffdng tdi thieu Hdn nffa, ddi vdi ngffdi ndng ddn, nd'u Id'y Iffdng td'i thieu cua hd thdng cdng chffc, vien chffc, hay doanh nghiep, thi cung qud cao, nhd't Id vdi hd ngheo va can ngheo Ben canh do, cdng tac tuydn truyen vd BHXH chu'a difdc quan tam diing mffc, nen so' ndng dan nhdn thffc day dii ve vai trd va ndi dung cd ban cua chinh sdch BHXH rd't it Ngodi ra, cdng tdc td chffc thffc thi khdng it bat cap Do do, ngffdi ndng dan thie'u tin tffdng vd sd Iffdng tham gia vao thi trffdng ndy cd chidu hffdng "dam chdn tai cho!" - Tr^giup xa h^i cho nong ddn Hidn tai, nffdc ta chffa cd chinh sdch khuyd'n khich cham sdc dd'i tffdng dffa vdo cdng ddng; mffc trd ca'p xa hpi cua Nhd nffdc thd'p, chi bang 1/2 chudn ngheo, mdi ddp ting dffdc 60% mffc sdng tdi thieu cua ddi tffdng He thdng cung ca'p dich vu bao trd xa hpi phii hdp vdi cd che' thi trffdng chffa phat trien Trong thidt hai vd ngffdi va cua thien tai thffdng rait Idn; vide hd trd, phdng tranh vd khac phuc hau qua mdi chi dap ffng dffdc mot phdn rd't nho Thffc te, mot so quy hd trd xa hpi dang dffdc van hdnli, nhff: Quy Hd trd tudi gia, Quy Tham hdi cua eac td chffc chinh tri xa hdi, Quy Bao dam xa hpi, Quy Dff phdng, cffu trd thidn tai vd cffu ddi liic gidp hat Da phat huy tdc dung trdng Economy and Forecast Review vide tri, bdo dam ASXH cho ndng dan Ben canh do, cdc quy da giup ndng ddn giam thieu nhffng ton thd't sau cae dot thidn tai, hoac trd gitip eac gia dinh nong dan dang phai dffdng dau vdi nhffng khd khan ve kinh td' Tuy nhien, van nhieu bd't cdp qudn ly, sff dung cac quy hd trd Thffdng thi khong xdy thidn tai, cdc dia phffdng c6 xu hifdng sff dung quy khdng dung muc dich, lam cho quy luon d tinh trang thieu hut, dd'n xdy thien tai, khong ddp ffng du'dc nhu cau cffu trd, tham chi bi thd't thodt Vi vdy, da phan nong ddn gap khd khan thidn tai chffa du'dc hffdng day du sd den, ma Nhd nffdc vd xa hpi trd cap cho hp - Xda doi gidm ngheo la chu trffdng thd hien sff nha't qudn cua Ddng va Nha nffdc ta nham cdi thien ddi sdng vat chat va tinh than cho ngffdi ngheo, thu hep khoang each vd trinh dp phdt trien giffa cdc viing, dia bdn vd cdc nhdm dan tpc Kd't qua ciia cdng cudc thffc hien eac ehifdng tnnh giam nghdo nhffng nam qua la ty Id hp nghdo giam nhanh, bp mat nong thdn cd nhidu thay ddi, ddi sdng nhan dan dffdc cdi thien ro ret Theo B6 Lao ddng, Thffdng binh va Xa hpi, ty Id hp ngheo gidm nhanh tff 17,2% (so hp ngheo Id 2,8 tridu) nam 2001 xudng 9,6% (vdi 2.149.110 hp) nam 2012 Vidt Nam dffdc ddnh gid la qude gia cdng nhat ITnh vffc xda ddi giam ngheo Hidn nay, Chifdng trinh muc ddu qud'c gia ve xdy dffng ndng thdn mdi cung dang dffdc trien khai Bang eac chffdng trinh khuyd'n nong, ngdnh nong nghidp tai cdc dia phffdng da vd dang trien khai xdy difng cdc mo hinh tap trung ffng dung khoa hpc - ky thuat, gid'ng mdi vao sdn xud't; qua do, giiip nhieu dia phffdng tang gid tri san xua't ndng nghiep Tuy nhidn, cdng tdc giam ngheo vdn dang dffng trffdc nhffng khd khan, thdch thffc, ke't qua giam ngheo chffa bdn vffng, ty Id tdi ngheo vdn cao, dac biet la tren dia ban khu vffc mien niii Tinh chung ca nffdc, cff hd dd dffdc thodt ngheo, thi cd mdt hd tdi ngheo (P.Thdo, 2014) - Chinh sdch cung cap dich vu xd hQi cd bdn ddi vdi ndng ddn Trong he thd'ng chinh sdch cung cap dich vu xd hpi cd ban, quan trpng nhd't la chinh sdch gido due, cham sdc sffc khoe, cd'p nffdc sach sinh hoat dd'i vdi khu vffc nong thdn Tuy vay, dp bao phu tha'p, cha^t Iffdng dich vu chffa ddp ffng dffdc ydu cau Ngffdi nong ddn cdn khd khan tid'p can cdc dich vu xd hpi cd ban cac khoan phai ddng gop ngoai quy dinh khd Idn Dien hinh nhff thdi diem cud'i thdng 9/2012, hang ehuc hd ddn thudc xa Ndng Trffdng, huyen Trieu Sdn, tinh Thanh Hda da cd ddn kid'n nghi vffdt cap len chinh quyen huyen dd kien xd ve ede khoan thu vd ly tai dia phffdng Theo ngffdi dan, mdi nam, cdc hp gia dinh deu phai ddng gdp cho xa hdn chuc khoan thu vdi so' tien Idn tdi gdn tridu ddng/ hp/nam, thu nhdp binh quan dau ngffdi tai xa chi la 4,5 trieu ddng/ngffdi/nam Chffa dffng lai d dd, chinh quyen xa cdn tie'n hanh cffdng chd' 33 f^GHIEN ecru - TRAO DOI viing ddng bao dan tdc thieu sd', viing Men gidi va hdi ddo Tid'p tuc trien khai cdc chffdng trinh muc tieu quoc gia vi y CAN THIET KE MOT KHUNG CHINH SACH td Sffa ddi, bd sung Ludt BHYT, Ludt BHXH theo hffdng khuyd'n khich nhieu PHU HOP nong ddn tham gia; tang cffdng hidu qua Chinh sdch ASXH dd'i vdi nong dan, nhiJng quan ly nha nffdc vd BHYT, BHXH Ngoai ra, can xay difng mffc sdng nam tdi, phai bao dam ket hdp giffa giai quye't cdc van de xa hpi cd bdn vd Idu dai ndng thdn vdi nhieu vd'n to'i thidu, mffc sdng trung binh, chuan de ndng bong, cd'p bach hffdng vao phdt trien ben vi?ng ngheo, can ngheo phii hpp vdi dieu kidn xa hdi ndng thon Tang trffdng kinh te phai di ddi vdi kinh td'- xa hpi tffng thdi ky dd lam phdt tridn xd hpi, van hda, nha't la vd'n de giao due, dao cd sd xac dinh cdc ddi tifdng, mffc chuin lao, day nghe, gidi quyd't vide lam, gidm ngheo vd hoa cua cdc chinh sach ASXH Bp Lao dpng, Thffdng binh vd Xa hdi nhdp cua nhdm xa hpi ye'u the' Dd dat dffdc nhiJng muc tieu do, theo chiing tdi phai tap trung giai quye't nhffng nen thdng nhat vdi Tong cue Thdng kd nhidm vu cd bdn sau: vd chuan ngheo (cd tinh trffdt gid theo Tha nhdt, the chd hda chinh sdch ASXH, phdt trien ehi so' lam phat CPI), de cd kdt qua danh he thdng ASXH da tang va linh hoat, tao cd hpi cho gia ty le ngheo ddi thffc td' vd chinh xac ndng dan tie'p can; sffa ddi chinh sdch ho trd ngffdi Tff dd, mdi de chinh sdch diing, sat nghdo ve y te', gido due, day nghd, nha cf phu hdp vdi thffc te thffc td' ciia ngu'di nong ddn; xay dffng quy dff phdng Ddi mdi ndi dung hd trd ngu'di ngheo, thien tai tai dia phffdng hoan thien vide theo ddi, gidm sat va ThU hai, thffc hidn ddng bd cae nhdm gidi phap ddnh gid eac chu'dng trinh giam nghdo; vd giam ngheo Tie'p tuc trien khai cd hidu qua Nghi xa hpi hda ngudn Iffc cho xda ddi, giam quyd't sd 80/NQ-CP, 19/5/2011 cua Chinh phu ve nghdo; ndng cao nang Me va didu kidn dinh hffdng gidm ngheo bdn vffng thdi ky 2011-2020; lam viec cho dpi ngii cdn bp cd sd de dap Nghi quye't sd 30a/2008/NQ-CP, 27/12/2008 ve ffng dffdc ydu cdu cdng vide Chffdng trinh giam ngheo nhanh va ben vffng tai cdc ThU ba, tang dau tff vd ngdn sach cho huyen ngheo va Chffdng trinh muc tidu qud'c gia gidm thffc hidn hieu qud chinh sach vd cac ngheo ben vffng; nghien cffu sffa ddi, bd sung chinh chffdng trinh ASXH cho ndng dan Nha sdch hd trd dd'i vdi hd can ngheo nffdc can tang cffdng ngudn life thffdng Tie'p tuc thffc hidn ddng bp, long ghep cdc chffdng xuyen, du manh dd thffc hidn td't chinh trinh, chinh sdch hien hanh co dieu chinh, nhif: Hd trd sdch ASXH dat nffdc ndi chung va khu lao dpng nghdo, ngffdi thd't nghidp vd thid'u vide lam d vffc ndng thdn, ndng nghiep vd ndng dan ndng thon; Ho trd ddn cff ndng thon de dang tid'p can ndi rieng dd'n cdc dich vu xa hdi cd ban; Tuydn truyen, hd trd ThU tu, tang cffdng cdng tac tuydn ddi vdi 40% dan so' nong thdn Men chifa tham gia truydn, vdn dpng nham ndng cao nhdn BHYT; Bd sung nhdm dd'i tifdng ngheo kinh nien dffdc thffc, hidu bid't, thay ddi thdi va hanh hffdng chinh sach trd giup xa hpi thffdng xuydn vi cua ngffdi dan Viet Nam ndi chung, Cling CO va tang cu'dng mang Iffdi y td' cd sd, ffu ndng ddn ndi rieng, ve nhffng vd'n di lien den cdc huyen ngheo, xa ngheo, vung sdu, viing xa quan dd'n ASXH.a dd'i vdi nhffng hd gia dinh chffa hodn cdc khoan ddng gdp (Gia Dat, 2013) TAT T JF.TI THAM KHAO Vien Nghien cffu Idp phdp (2013) Bdo hiem y te toan dan: Thffc trang va kie'n nghi, Thdng tin chuyen de, thang 10/2013, Ha Ndi Phiing Thi Minh Dffdng (2013) Chinh sdch ASXH ddi vdi ndng ddn d nUdc ta hien nay, truy cap tff http://www.tapchicongsan.org.vn/Home/Nghiencuu-Traodoi/2013/23618/Chinh-sach-ansinb-xa-hoi-doi-voi-nong-dan-o-nuoc.aspx Didu Linh (2013) HS tra phi BHYT eho ndng ddn kho ldm vi thieu tieu chi, tiny cap t& http://danviet.vn/thoi-su/ho-tro-phi-bao-hiem-y-te-cho-nong-dan-kho-Iam-vi-thieu-tieuchi/105449plc24.htm P Thao (2014) Ngudi ngheo duac hd tra 30.000d, di xe dm de'n lay tdn SO.OOOd, truy cap tff http://dantti.com.vn/xa-hoi/nguoi-ngheo-duoc-ho-tio-30000d-di-xe-om-den-lay-ton50000d-840901.htm Gia Dat (2014) Ndi lo lam thu, ttuy cap tff http://suekhoedoisong.vn/kinh-te-xa-hoi/noi-lolam-thu-20121211103212174.htm 34 Kinh te'vaDJ bao ... Economy and Forecast Review vide tri, bdo dam ASXH cho ndng dan Ben canh do, cdc quy da giup ndng ddn giam thieu nhffng ton thd''t sau cae dot thidn tai, hoac trd gitip eac gia dinh nong dan dang... chffdng trinh ASXH cho ndng dan Nha sdch hd trd dd''i vdi hd can ngheo nffdc can tang cffdng ngudn life thffdng Tie''p tuc thffc hidn ddng bp, long ghep cdc chffdng xuyen, du manh dd thffc hidn... cau Ngffdi nong ddn cdn khd khan tid''p can cdc dich vu xd hpi cd ban cac khoan phai ddng gop ngoai quy dinh khd Idn Dien hinh nhff thdi diem cud''i thdng 9/2012, hang ehuc hd ddn thudc xa Ndng