TRifiT HOC, SO 11 (282), THANG 11-2014 O^.yt.i'i ,'ii VE VIEC XA Hpl H O A Y TE VIET NAM HIEN NAY^'^ NGUYfiN NGOC TOAN'"' Lfi THUY HANH'"'' Xd hgi hoa y tela qud trinh dinh hUdng vd khuyin khich cdc thdnh phdn kinh ti, cdc tdng Idp nhdn ddn ciing chung tay xdy dUng ngdnh y te nhdm ndng cao hdn nUa mUc hUdng thu vi chdm sdc sjic khoe cua ngUdi ddn Chit trUdng ndy dUdc Bdng vd Nhd nUdc ta nhdt qudn thiic hien nhUng ndm qua vd dd dgt dUdc nhUng thdnh tiiu quan trgng Tuy nhien, hiin nay, edng tdc ndy vdn chgm chap, hi lam dung, ldm tdng thim nguy cd hdt binh ddng, Vi vgy, cdn thiet ndng cao vai tro qudn ly cua Nhd nudc, chdt lUdng kham chUa binh, hodn thiin cdc chinh sdch hdo hiem y ti' nhdm day mgnh vd Idnh mgnh hoa cdng tdc xd hgi hda y tid Viet Nam hiin J et tren binh dien nhd nUdc, xa hdi boa la chi trUdng huy dpng mpi ngudn lflc xa hpi ben canh ngudn ngan sach nha nu6c dl diu tU eho cac linh vfle thiet yeu cia ddi sd'ng xa hpi Day la bien phap quan trpng cia moi qud'c gia nham huy ddng cac ngudn lflc xa hdi vi mue tieu phat triln, rad nhfl each chung ta van thfldng noi, la chi trfldng phat huy sQc manh toan xa hdi nhdm tao dieu kien cho cac linh viic cia ddi sd'ng xa hdi phat trien nhanh hdn Vdi Viet Nam, xd hpi hda la chfnh sach lau dai, la phQdng cham thfle hien ehfnh sach phat trien xa hpi eua Dang va Nha nfldc Thfle hien xa hdi hda khdng phai Nha nfldc thieu kinh phi, va cung hoan toan khdng phai la bien phap tam thdi, ehi cd y nghia tinh the trflde mit, ma la chi trfldng lau ddi cong tac huy dpng ngudn lflc toan 26 dan cho phat trien xa hpi Mdt dat nfldc phat triln, nhan dan ta ed mflc thu nhap eao, ngdn sach nha nfldc ddi dao thi chfnh sach xa hdi hda vin ein phai tie'p tuc dfldc thfle hien Sd di ndi nhu vay la bdi vi, xay dflng dit nfldc va phat trien xa hdi khdng phai chi Id cdng viec cia Dang, eia Nhd nfldc hay cia bit ky mdt ca nhan ndo, raa dd edn la sfl nghidp c i a toan dan, la trach nhiem cia cac phin kinh tl Trong qua trinh thfle hidn xa hdi hda, trach nhiem c i a Nha nfldc khdng nhQng khdng giam di ma ngdy mdt (*) Bai viet la ket qua thuoc dd tai ca'p Bo "Chinh sach xa hpi h6a gi^o due va y td d Viet Nam hign nay: Mpt sdva'n de Iy luan vh thUc tidn" (**) Tien si, TrUdng phong, Phong Quan ly khoa hgc va Hdp tac quoc te, Vien Tridt hpc, Vign Han lam Khoa hoc xa hpi Vigt Nam (***) Thac si, Phong Tridt hoc van h6a, Vign Tridt hoc, Vien Han Mm Khoa hpc xa hoi Vigt Nam NGUYEN NGOC TOAN, LE THUY HANH The ehl hda cac quan diem eua nang ne hdn Dilu the hidn d chd, Nha nfldc phai thudng xuydn tim them Dang, tfl nam 1989, Qud'c hpi da cac ngudn thu dl tang ty le ngan sach eho phep nganh y te thu mdt phin vien chi cho cac hoat dpng nay, ddng thdi phf; ban hanh Luat Bao ve sflc khde quan Iy tdt de nang cao hieu qua s i nhan dan nam 1989, Luat Kham ehfla benh nam 2009, Phap lenh hanh nghe y dung cac ngudn kinh phf dd(l) Vdi tu each la mot phin khdng the dupc tu nhan, Luat Bao hilm y te thidu hoat ddng xa hdi hoa noi Ngoai ra, nhieu Luat, Phap lenh khac ehung, xa hdi hda y t l chfnh la qua cung CO cac quy dinh lien quan, tao trinh dinh hUdng va khuyin khfch cac hanh lang phap ly de xa hdi hda cac phin kinh te', cac ting Idp nhan hoat ddng y te, nhU Nghi quylt 90/CP dan cung chung tay xay dflng nganh y va Nghi quyet 05/2005/NQ-CP Vi day te' nhim nang cao hdn nfla mflc hudng mgnh xd hgi hda cdc hogt dgng gido thu ve cham sdc sflc khoe ca vl the due, y te, vdn hda, the thao; Nghi dinh cha't va tinh t h i n cia ngfldi dan Dd 43/2006/ND-CP quy dinh Quyen tU chu, ddng thdi cung chinh la qua trinh xay tu chiu trach nhiim ddi vdi cdc dan ui dflng trach nhiem eia cpng ddng vl sU nghiip cdng lap; Nghi dinh 53/2006/ viec xay dung v i cai thien cac dilu ND-CP Ve chinh sdch khuyen khich kien can thie't, mdi trfldng lam viec phdt triin cdc ca sd cung itng dich vu giup cho nganh y te' thfle hidn tdt hdn ngoai cdng lap; Nghi dinh sd' 85/2012/ vai trd vd sQ menh cia minh tiln ND-CP Ve ca ehe hogi ddng, ca che tdi trtnh phat trien xa hpi, tiln Ien hien chinh cua cdc dOn vi sU nghiep y ti'cdng thfle hda cdng cudc chdra sdc va bao ve lap vd gid dich vu kham chUa benh cua sflc khde toan dan, hudng tdi muc tieu cdc ca say ti'cdng lap; cao nhit \a dap flng nhu eiu va dam Ben canh viec ban hdnh he thd'ng bao ldi fch linh vfle y td' eia mpi van ban, Chfnh p h i trfle tie'p chi dao ca nhan xa hdi nganh y te' va eae dia phUdng tang Chi trfldng xa hdi hda y te' dfldc de cfldng thfle hien cdng tac xa hdi hoa cap lin dau tien Van kien Dai hpi cham sdc sflc khoe nhan dan Nhd dd, Dang lin thfl VII Chi trfldng tilp nhflng nam qua, eae loai hinh tuc dflde khang dinh van kien cac cham sdc sflc khde nhan dan cdng Dai hpi Dang lin thfl VIII, IX, X, XI van kien Dai hdi Dang lin thfl XI (1) Xem: Nghi quye't ciia Chfnh phu So' 90-CP 21 - - 1997 Vi phuang hudng vd chd trUdng xa hgi khang dinh: "Tdng diu tU nha nUdc hda cdc hogt dong gido due, y ti, vdn hoa Bao dien ddng thdi v6i day manh xa hdi hda cac tit Dang Cong san Viet Nam; http;//www.cpv.org.vn/ cpv/Modules/News/NewsDetail.aspx?co_id=10008& hoat ddng y tl ; mpi cdng dan cd cnjd=185142 nhu ciu vd kha nang diu dUde dap flng (2) Dang Cong san Viet Nam Vdn kien Bgi hgi dgi biiu todn qud'c ldn thUXI Nxb Chfnh tri Quo'c gia, dich vu y t l chit ifldng cao"(2) H a N o i , 2011, tr.230 27 VE VIEC XA HOI HOA Y TE d VIET NAM HlfiN NAY phat trien Trong sfl da dang cac loai hinh cham sdc sflc khde do, he thd'ng y td' edng lap van tiep tuc phat trien va giQ vai trd ehi dao vide eung ed'p dich vu y te' nhim dam bao tdt nhiem vu bao ve, chdm s6e va ndng eao sflc khde toan dan va eo xu hfldng tdng dan ve sd lUdng theo thdi gian Trong khoang tfl ndra 2002 den 2008, sd benh vien da khoa, chuyen khoa tang tfl 770 Ien 910, benh vien y hpc ed truyen tQ 43 tang ldn 51, trara y t l tang tfl 11.103 Ien 11.576 va tdng sd' cd sd y te' edng lap tang tQ 13.054 Ien 13.423(3) Ve cd ban, mang Ifldi y te' edng lap p h i kfn de'n cac xa, phfldng; hiu het cac xa c6 tram y tl, ty Id xa dat chuan qud'c gia vl y te' tang Ien; quy md gifldng benh cung tdng theo ty le thuan Din cudi nam 2013, 98,9% xa, phfldng, thi trd'n da ed nha tram(4) Cung vdi phat trien he thd'ng y te edng lap, he thd'ng y te tQ nhan cung cd nhQng bQdc phat triln dang kl Nlu nhfl nam 1989, ca nfldc ehi cd 19.809 ed sd hdnh nghe y te tQ nhan(5) thi din nam 2013, theo bao eao cia Bd Y te, ca nfldc da ed 157 benh vien tu nhan (trong cd 06 benh vidn cd vd'n diu tU nude ngodi), hdn 30.000 phdng kham tU nhan va cd sd dich vu y te (trong dd 30 phdng kham da khoa, 87 nhd hd sinh, sd edn lai la phdng kham chuyen khoa, dich vu y tl, 30 phdng kham cd vd'n diu tu nude ngoai, 29 cd sd kham benh, ehfla benh cd ngfldi nfldc ngoai tham gia kham benh, chQa benh)(6) Chi trfldng da dang hda cac ngudn lflc phuc vu cong tac xa hpi hda y t l 28 cung dfldc day manh nhflng ndm qua Vdi hinh thQc lien doanh hen kit, tai cac bdnh vidn edng lap, viee thfle hidn ehuyin giao dich vu ngoai chuyen mdn ky thudt cho cac to chflc, ea nhan ngoai edng Idp dam nhan da dfldc triln khai va mang lai nhiing hieu qua to ldn Cac benh vien ciing da huy ddng dfldc mdt Ifldng tien 16n de trien khai cac ky thuat eao, nhQ chan doan hinh anh, xet nghiem, npi soi chan doan, can thiep giup phat triln ky thudt cao tai eae bdnh vidn Hau het cac benh vidn trfle thudc Bp Y t l da thfle hien xa hdi hoa de diu tU mua sim va lien doanh, lien kdt lip dat trang thidt hi vdi td'ng so tien khoang 700 ty ddng tinh de'n ndm 2012(7) H i u hit benh vien cap tinh d cac dia phfldng cung thfle hidn huy ddng vd'n, vay vdn, lien doanh, lien kit dat raay dl dau tfl cd sd tang, ndng eip budng benh, mua sira trang thiet bi y te Thu hut diu tfl nfldc ngoii thdng qua viec triln khai thfle hien cac dfl an ODA, du an eia cac td chflc phi chfnh (3) Bdo cdo tong quan ngdnh y ti ndm 2010 (JAHR2010) ciia B6 Y td va Nhom ddi tac thdc hien, tr.42 (4) Bdo cdo tom tdt cdng tdc y te ndm 2013 vd nhiim vu trgng tdm nam 2014 cua Bg Y ti, tr.8 (5) 5do cdo nghiin cUu "Tii'p can cua ngUdi ngheo din dich vu y tivd gido due boi cdnh xd hgi hoa hogt dgng y te vd gido due tgi Viet Nam" Actionaid Vietnam thUc hign, tr.22 (6) Bdo cdo torn tdt cong tdc y te ndm 2013 vd nhiim vu trgng tdm ndm 2014 cua Bg Y ti', tr.5 (7) Bao cao so 1048/BC-UBVDXH13, 06 • 2012 cua ^ y ban ve cac va'n dd xa hoi, Quoc hpi kh6a XUI Vi kit qud phien hgp gidi trinh cua Bg trUdng Bg Y ti'vi viic thUc hiin xd hgi boa cdng tdc kham, chOii binh, tr.4 NGUYEN NGOC TOAN, LE THUY HANH p h i trd nhiing kenh quan trpng edng tac xa hdi hoa y t l d Viet Nam So' Ifldng cac du an, sd vdn cam ket cho y te' cdng tang, tap trung eho mdt sd' Uu tien eua ngdnh, nhU nang cip, eing cd' mang lUdi y td' eho ngUdi nghdo, viing sau, vung xa, y te' cd sd, phdng, chdng dich benh, tiem ching md rdng De'n ndm 2013, Bd Y te' dang quan ly 43 chfldng trinh, dfl an ODA, trdng dd cd 27 dfl an vien trd khdng hoan lai, 12 dfl an vd'n vay va 04 dfl an hdn hdp vdi tdng kinh phf tfldng dfldng 1,6 ty USD Ngodi ra, edn quan ly 106 dfl an vien trd phi chfnh p h i nfldc ngoai, cd 40 du an mdi dfldc phe duyet nam 2013, vdi tdng kinh phi khoang 255 nghm USD(8) Cac dfl an vidn trd nhin ehung trien khai tdt, dat cac muc tieu, chi tieu dl ra, gop phan quan trpng vao cac boat ddng eia nganh y te' tiiu ndi tren, cdng tac xa hpi hda y te d Viet Nam hien cdn eo nhQng han ehl nhit dinh Dd la: Tha nhdt, xd hgi hda y te diin chgm chap, chUa tuang xitng vdi tiem ndng vd muc tiiu dinh hUdng ehinh sdch ve ocd hdi hda y tecua Bdng vd Nhd nUdc Du ring sd' Ifldng cac cd sd y t l tdng Ien ca edng Idp lan cd sd ngoai cdng lap, nhUng vide qua tai cac bdnh vien, dac biet la cac benh vien tuyd'n trung fldng la mdt thfle te nan giai Cac benh vien cdng lap van mang minh cdn benh cia eae cd quan nha nfldc, ehfla chi ddng chfnh sach quan ly, phan bd ngudn lflc, ehfla tira kidm ed hieu qua eae ngudn vd'n ngoai ngan sach gdp phin ldm giam ganh nang cho Nha nfldc eung nhfl ganh nang kham chQa benh cho ngfldi dan Dac biet, edng tac sip xip vd doi mdi cd ehl quan Nhfl vay, sau hdn 20 ndm thfle hien ly eae benh vien cdng mang nang ehi trfldng xa hdi hda noi ehung, tren tinh hinh thfle va ehfla thfle sfl dfldc linh vfle y te' ndi rieng, nhflng ket qua day manh dan de'n viec diu tQ, ddi mdi dat dflde thfle te' da chflng minh va phat trien he thd'ng cac benh ring day la mpt c h i trfldng dung din vien khdng dap Qng dQde yeu eiu cia Nhan thfle vl xa hdi hoa cdng tae y te' xd hdi, khdng dat chi tieu dat cia xa hpi da eo sfl chuyen biln theo nganh va cia Nha nfldc Dieu gdy hfldng tich cflc Sfl chung tay gdp sflc nen nhiing kho khan khdng mong mud'n cia cac td chQc vd ca nhdn cdng qua trinh trien khai cdng tac xa tac da bd sung dang kl nhflng hdi hda y te' Chang han, theo bao eao ngudn lflc kinh te va ky thuat cho cia Uy ban nhdn dan phd' Ha ngdnh y tl, giai quylt mdt phin dang Ndi, vdi 41 benh vien cdng lap, de thfle kl nhiing vin de xa hdi ndng bdng hidn Nghi quylt sd' 06 cia Hdi ddng sinh cong tac chdm sdc sflc khoe nhdn dan Tuy nhien, ben canh nhiing thdnh (8) Bdo cdo torn tdt cong tdc y ti ndm 2013 vd nhiem vu trgng tdm ndm 2014 cua Bd Y ti, tr.l4 29 VE VIEC XA Hdi HOA Y T^ d VIET NAM HIEN NAY nhan dan vd de an 100 cia Uy ban nhan dan phd' giai doan 2009 - 2015, nganh y te Ha Ndi dat muc tieu huy ddng hdn 1.700 ty ddng tfl cac dl an xa hdi hda, hien dai hda trang thilt bi Tuy nhien, tinh din thang 2014, hien ed 13 benh vien cdng Idp dang trien khai hoat dpng xa bdi hda vdi 40 dl an, thu hut hdn 170 ty ddng, mdi dat 10% so vdi tid'n dp(9) Cin phai ndi them ring, xa hdi hda y t l mdi tap trung chi ye'u tdi vin dl da dang hda eae loai hinh eung cip dich vu cham sdc sflc khde ngUdi dan, md ehUa that sfl chu trpng tdi vin dl ldi ieh ehung cia ngfldi dan tham gia chi trfldng Vide nang cao kha nang tie'p can vdi cac dich vu kham ehfla benh tien tie'n mdi chi diing lai d rapt nhdm ngfldi cd kha nang vl tdi chfnh eung nhfl mpt so' vung cd dilu kidn vd nhan dfldc sfl quan tam cia chinh sach phat trien eua Nha nfldc Trong do, dai bd phdn ngudi nghdo, nhflng ngUdi it cd dieu kidn tiep xuc vdi eae dieh vu va md hinh xa hdi hda y te' nhUng cd nhu ciu khara chQa benh cao lai dang hi can trd vide thfle thi chi trQdng xa hpi hda y te, eu the la van dl vidn phf, bao hilm y t l va kham benh theo yeu eau tai cac cd sd kham chQa benh, dac bidt la cac cd sd edng lap hidn Trong dd, he thd'ng kham chQa bdnh ngoai edng Idp phat triln ehfla tfldng xflng vdi tiera ndng, mdi chi dflng lai d quy mo nho, ddi cdn bam viu vao cac cd sd cdng lap, tao nen tinh trang raanh mun, khdng dap Qng va 30 dam bao dflpc nhu cau kham chQa benh eia dai chiing Sfl lin ldn "cdng - tfl" cac benh vien ed ye'u td' lien doanh lidn ket ciing ddn de'n nhilu b i t cdp vide phan ehia quyln ldi va nghia vu cham sdc sflc khde nhdn dan, hinh ndn nhiing nhdm ldi fch vi muc tieu ldi nhuan eao nhat da vi pham cac nguyen tie cia hoat dpng y t l dfldi nhilu hinh thfle khae Theo do, mpt so' ddn vi (cdng lap) ehfla thfle hien dung quy trinh, t h i tuc, ehfla xay dflng dl an minh bach, edng khai; ehfla xay dflng cd eiu gia dich vu theo quy dinh, ehfla edng khai gia de ngfldi din biet, Ifla ehpn; mdt so' ddn vi cdn de xay tinh trang, hien tfldng lara dung ky thuit, v.v.(lO) Mdt nhflng khd khdn gay can trd he thoiig y te' tU nhan phat trien ndi ehung va cdng tac xa hdi hda y td' hd thd'ng ndi rieng ehfnh la chUa cd nhQng chfnh sach, phap ludt dam bao cho he thd'ng phat trien lanh manh, an toan Chfnh vide thilu mpt hdnh lang phap ly can ban hd trd cho vide dilu hanh va quan ly cac cd sd cham sdc sflc khde thupc he thd'ng da khien cho quy che' hoat ddng eia cac cd sci kham chQa bdnh, cac bdnh vidn tfl nhan ehi ydu dfla tren Luat Doanh nghiep raa ft ed sfl dieu ehinh phu hdp vdi dac thu cia nganh Dilu tnic (9) Bao Nhdn ddn, 05 - 05 • 2014 (10) Xem: Chi thi so 05/ CT-BYT 22 thang 05 nam 2014 Vi viic tdng cUdng kiim tra, chdn chinh cong tdc xd hgi hda kham chUa benh theo yiu cdu edc cd sd khdm, chUa binh cdng lap NGUYEN NGOC TOAN, LE THCTY HANH tid'p tao nen nhiing khd khdn qua trinh huy ddng v5'n xa hdi phue vu cho chi trUdng xa hdi hda y t l eia hd thd'ng ngoai cdng lap, khdng khuyin khich cac td chQc vd ca nhan cd d i nang iQc tai chinh va chuyen mdn san sang tham gia edng tac chdm sdc sQc khde ngfldi dan ThU hai, viic xd hdi hoa y te chUa phdt trien theo dung chudn mUc vd Id trinh quy dinh tgo nin tinh trgng ldn xgn, tu phdt viee thUc thi chu trUOng ndy Hinh thfle hpp tac, hdn doanh lien kit gifla cac ed set kham ehfla benh cdng lap vdi cac ddn vi va ea nhan eo kha nang cung cap cac dieh vu, may mdc thiet bi kham ehfla benh la mdt hinh thfle can ban cia hoat dpng xa hpi hda y te' Hoat dpng khdng nhflng nang cao chit lUdng kham ehfla bdnh cac ed sd y te' cdng lap nhd cung cap eae thiet bi kham ehfla benh tien tiln, hien dai, ma cdn gdp phan giam ap lflc cho cac benh vidn cdng thdng qua cac hinh thQc kham chQa benh theo yeu ciu, chi tra vien phf theo dich vu, v.v Tuy nhien, thfle t l tai eae benh vien edng lap cho tha'y, hoat dpng diln tien, tii phat, sQ giam sat thilu chat ehe tQ cac cd quan chfle nang eia Nha nQdc, cia nganh y tl Vide dQa raay mdc thilt bi hen doanh hen kit vdo khai thac anh hfldng trfle tiep tdi viee s i dung, sia chQa va bao dQdng eae may mdc thilt bi dflde trang hi tfl ngudn ngan sach nha nfldc Vdi mflc phan chia ldi nhuan tfl cac thilt bi y te thupc chfldng trinh hen doanh hdn ket tai cac bdnh vidn la 50% - 50%, ed nhflng ndi ldn tdi 70% - 30% (70% cho doEinh nghiep, 30% cho benh vien) thi vide tang cudng s i dung may mdc thiet hi cia doanh nghiep, ban che s i dung cac thilt bi dUde Nha nudc trang bi la hien tUdng khd biln(ll) NhQng chi phi phat sinh tQ vin dl dfldc "ehia se" sang ehi phi khara ehfla benh cia ngfldi dan du6i hinh thfle "tfl nguyen", dd bao hiem y t l vdi nhflng tfnh chat Uu viet eia nd tie'n trinh dam bao cdng bing xa hdi linh vUc y te' lai khdng dupe phat huy Hinh thfle kham ehfla benh tfl nguyen hay cdn gpi Id kham ehfla benh theo yeu ciu cung tdn tai nhilu bat cap tinh trang quan ly vi thfle thi ehfnh sach xa hdi hda y te ehfla that sfl dat yeu eiu nhfl mong mud'n Vide xay dflng he thdng kham benh theo yeu ciu tai cac benh vien nha nfldc nhQng thu phi benh nhan nhU cac cd sd tU nhan tao nen tinh trang "tU cdng" tai cac cd sd ndy Cac bdnh vien s i dung ngudn ngan sach nha nude, s i dung ed sd vat chit dUdc trang bi sdn nhU dat dai, nha cia, trang thiet bi y te', v.v la nhQng thQ cd dQde sfl ddng gop tfl cac ngudn thue' cia dan vao hoat dpng kham ehfla benh cd thu phi Dilu ndy vd hinh trung dUa de'n tinh trang bit cdng bing ngUdi dan khdng nhflng khdng nhan lai dfldc edn phai tra tiln cho nhflng gi rainh da ddng gdp eho xa hdi Ben canh do, sfl phan biet ddl x i ddl vdi benh (11) Xem: http://dantri.com.vn/suc-khoe/tieu-cuc-taibenh-vien -k-benh-nhan-phai-chay-de-duoc-dieu-tri337341.htm VE VIEC XA HQI HdA Y TE O VIET NAM HIEN NAY nhan kham benh tfl nguyen vd bdnh nhan kham benh theo chi dp chfnh sach, theo bao hiem y te eung xuit hien chinh cac benh vien tao nen nhflng bit cap, gay khd khan viec x i ly cac cdng vide eo Hen quan tdi cdng tac cham sdc sQc khoe, dam bao sfl edng bing gifla cac benh nhan Thii ba, vien phi chinh sdch xa hgi hda y ti'- "edi hay cua sU ngheo ddi" Thu vien phi la mdt nhflng chinh sach tai ehinh dai han cua nganh y te, phat huy tae dung giup giam tai ganh nang chdm sdc sflc khde nhan dan cho ngan sach nha nfldc Ddng thdi, day cung la chinh sach bo sung ngudn ngan sach nha nUdc danh cho y te, dam bao cdng bing va binh dang xa hdi Trong nhQng ndm gin day, edng tac thu mdt phan vien phi dUdc trien khai vdi tfl each la mdt bp phan eiu cia chi trfldng xa hpi hoa y te, da giup giam thieu mdt phin dang ke sfl bao eip cia Nha nfldc, han ehl viec s i dung cac dich vu y te' cdng cpng mpt each tfly tien, khdng cin thiet Thu mpt phan vien phi cung giup eho cac cd sd kham chQa benh ehi ddng hdn viec tao ngudn kinh phf eho hoat ddng, thfle hien miln giam vien phf nghiera tue, c6 hieu qua Ben canh dd, thu vien phi cung tao dilu kien cho ngfldi benh cd cd hpi tidp can vdi nhQng dich vu y t l theo yeu eau, tfl iQa ehpn ed sd kham chQa benh, iQa ehpn thay thud'c va cac phfldng phap dieu tri theo nhu eiu cia minh Mac du cd nhQng hieu qua nhat dinh, nhUng xet vl tdng the, vide thu 32 mdt phan vien phi tao nen nhQng hieu flng tieu cUe ddi sd'ng xa hpi Ndi each khac, nlu xet tren binh didn cdng bang va hieu qua hoat ddng, vin dl thu mdt phin vien phi ehfla dap flng dfldc ddi hdi vl mdt he thd'ng y te' edng bang Nhflng ea nhan cd thu nhap thap khdng cd cd hpi tie'p can vdi nhflng dieh vu y te tien tid'n neu ap dung chinh sach thu vien phf kham ehfla bdnh, dac biet ddl vdi nhflng can bdnh truyin nhidm, benh nguy hiem va hiem gap Tae dpng xa hdi cia van dl nay, khdng ehi xet trdn linh vfle cdng bang xa hpi md cdn xet sfl anh hfldng cia nd ddl vdi ngUdi than cia benh nhdn, cua mpt nhdm cdng ddng xa hpi la dilu eo thd nhin thiy dfldc Bdn canh dd, vdi nhQng tac ddng cia cd che' thi trQdng hoat dpng kham chQa benh, t£ii eae cd sd ldn, cd uy tin, vdi ehfnh sach flu tien nhQng ngUdi dong vien phi cao, ngQdi giau ehinh la nhQng ddi tQdng dQde quan tara dae biet, bcii hp dfldc xem la ngudn thu ehi yeu Dieu dfla dd'n nhflng bat cdng cdng tac cham sdc sQc khoe nhan ddn, tao dflng khoang each va lam gia tang nhflng bit binh dang xa hdi Nhilu chuyen gia khang dinh, vien phi chinh la "cai bdy eia sfl ngheo ddi" tiln trinh phat triln cia chinh sach xa hdi hda y te Cai biy anh hQdng tdi cac ddl tfldng ngheo va can ngheo xa hdi, bdi vien phf dfldc toan khdng phu thudc vdo nang lflc, gia canh ma • phu thudc vao can benh hp ehfla tri Viec khanh kiet NGUYfiN NGOC TOAN, LE THLTY HANH qua trinh dieu tri bdnh dfla hp vao tinh canh tflng quin hdn Neu khdng thudc dien "chQa thoat nghdo" theo tidu chuin qud'c gia thi van de ganh nang vien phi vin la eon dudng ngin nhit dQa hp trd ve vdi vdng luan quan ngheo ddi va benh tat, trd ganh nang khdng dd tQ bd ddl vdi gia dinh va xa hdi De gdp phin giai quyet nhQng bat cdp neu tren, chung tdi eho ring phai xuit phat tQ ehfnh nhQng ban che chfnh sach xa hdi hda y te' cia Nha nfldc de giai phong eae nguon lflc xa hdi ciing chung tay xdy dflng ngdnh y te TrUdc hdi, cac phin ngoai cdng lap cin dfldc ddl x i cdng bing, binh dang cac chinh sach phat triln va dau tu, eae chinh sach Uu dai vl thul, mat bing, ed s6 vat chit can ban phuc vu cdng tac tai diu tU cham sdc sflc khde nhan dan Co nhfl vay hp mdi c6 ddng lflc vd dieu kien diu tu cho y te', giam tai ap lflc cho nganh va ap lflc ngan sach cho Nha nfldc Thii hai, phai cd chinh sach phan biet ro rang gifla viec khara benh cdng lap va cac dich vu khara benh theo chQdng trinh xa hdi hda Dilu cd ban la phai tach rdi khu vfle kham chQa benh theo cac tfnh chit neu trdn de de dang kilm soat ve thdi gian lim vide cung nhfl trang thilt hi nhim tranh sfl lam dung dieh vu y t l nhim thu ldi nhanh ma quen di nhu eiu khdm ehfla bdnh cia ngfldi dan Ben canh do, can ndng cao vai trd quan ly cia Nha nfldc, thfle hien tot viee tra, kiem tra, giam sat; nang eao chat Ifldng kham chQa benh d cd sd cdng lap, nang lflc y td' tuyIn dudi; v.v ThU ba, tie'p tue xay dflng va hoan thien cac chinh sach bao hiem y te' TrQdc he't phai dinh hfldng, xay dflng chinh sach bao hiera y t l theo chieu sau, nghia la lam tdt hai ye'u to' giam chi tQ tien tiii ngQdi benh va bao dam quyen ldi cia ngfldi dan tham gia bao hiem y te' Vdi ddl tUdng kham ehfla bdnh la nhQng ngfldi ngheo, thupc dien gia dinh chinh sach, bao trd xa hpi, Nha nfldc nen thiie hien kham ehfla bdnh midn phi Vdi ddl tUdng khara chQa benh la nhQng ngQdi cd kha ndng tai chfnh, du dieu kien de mua bao hiem y tl, Nha nQdc phai quy dinh theo hudng bat bupe Tren day la nhflng vin de chUa phan anh that sfl diy d i ve tinh ehit xa hdi hoa y t l tieh trinh xdy dung va phat triln dat nude nhflng eung dat cho chung ta kha nhieu suy tfl vl dinh hfldng tim kilm nhflng giai phap thilt thfle hdn, ed hieu qua hdn dl nang eao chit lUdng cia qua trinh xa hpi hoa y tl Tfl nhflng ldi feh thilt thfle rad qua trinh xa hdi hda y te mang Iai, chiing ta cd t h i tin tfldng ring vfldt qua dfldc nhflng trd ngai chinh sach y tl, khic phuc dfldc nhflng yeu kem edng tac quan ly vs kham ehfla benh hien se la yeu to then chdt thuc day sfl ehung tay gop sflc eua cac phan xa hpi vao edng tac xa hdi hda y te vi muc tieu nang cao chit Ifldng cham sdc sQc khde nhan ddn Q 33 ... quy dinh lien quan, tao trinh dinh hUdng va khuyin khfch cac hanh lang phap ly de xa hdi hda cac phin kinh te'', cac ting Idp nhan hoat ddng y te, nhU Nghi quylt 90/CP dan cung chung tay xay dflng... Ifldi y te'' edng lap p h i kfn de''n cac xa, phfldng; hiu het cac xa c6 tram y tl, ty Id xa dat chuan qud''c gia vl y te'' tang Ien; quy md gifldng benh cung tdng theo ty le thuan Din cudi nam 2013,... chinh sach y tl, khic phuc dfldc nhflng yeu kem edng tac quan ly vs kham ehfla benh hien se la yeu to then chdt thuc day sfl ehung tay gop sflc eua cac phan xa hpi vao edng tac xa hdi hda y te vi