Một số yếu tố ảnh hưởng tới việc sử dụng bảo hiểm y tế của người dân nông thô.pdf

TAP CHf KHOA HQC XA H Q I so (193) 2014 MOT S6 Y U T A N H HUdNG TO'I VIEC SU DUNG BAO HlfiWI Y Te CUA NGUai DAN NONG THON NGUVeN TH! cue TRAM Bai viit dwa tren kit qua nghien ciru nam 2013 tai xa My An, huyen Mang Thit, tinh Vinh Long nhdm tim hieu mdt so yiu to tac dgng toi vigc s u dung bao hiim y te cua ngw&i dan ndng thdn Kit qua nghien cwu cho thiy cac yiu td chinh anh hwong t&i viec sw dung bao hiim y ti cOa ngw&i dan ndng thdn hien la: chat Iwgng kham chira benh; thdl quen va tam ly cua ngw&i dan; mang Iwoi xa hdi; mirc song; cae chinh saeh, to chirc va thu tuc bao hiim y te Trong nhCrng nam gan day viec md rpng bao hiim y t l cho ngudi dan cang dugc su quan tam cua toan xa hpi Cac ca quan quan ly y te can dam bao viec cham soc sCrc khoe cho nhan dan va I n djnh b i n viing nguon quy; ngudi dan CO nhu eau eham soc siie khoe eang cao va ehi phi y te la mot khoan chi Idn, khong phai liic nao ngudi dan eung CO du Vi vay, bao hiem y t l toan dan dugc xem la bipn phap can thilt d l dung hda dugc nhiing nhu cau k l tren Theo Bao cao chung tong quan nganh y ti (Bp Y t l , Nhom D l i taeyte, 2011) d i n cuoi 2010 ty Ip ngudi tham gia bao hiim y te d D i n g bang song Cuu Long la 47,8% va cua ca nudc la 60% Rieng d tinh VTnh Long, Bao cao kinh ti xa hdi cua tinh nam 2010 cho thay mdi chi eo 45% dan so tham gia bao hiem y t l , 83,4% la d l i tugng tham gia bao hiem y te bat buOc va ehi c6 16,6% d l i tugng tham gia bao hiim y t l tu Nguyen Thj Cue TrSm Thgc sT Trung tam Xa hpi hoc, Vi^n Khoa hpc Xa hgi vung Nam Bp nguyen Nhu vay, nhin ehung ty le tham gia bao hiim y t l cua tinh VTnh Long eon thap va tgp trung chu y l u d nhom doi tugng bao hiem y t l bit bupc Nam 2010, Vien Khoa hpc Xa hpi vung Nam Bp da thyc hien d l tai: Khao sat ca ciu xa hgi, van hda va phuc Igi ngw&i tinh VTnh Long DCr lieu dinh lugng thu thap dugc tCr 4.796 nhan khau thugc 1.050 hp gia dinh cho thay hipn trang tham gia va su dyng bao hiem y t l cua ngudi dan VTnh Long nhu sau: - 52,6% ngudi dan co bao hiim y te, do: + 43,3% CO su dung thudng xuyen + 13,5% thfnh thoang mdi su dyng + 28,5% khong su dung vi khong dau benh + 14,7% khdng su dyng vi cac ly khae - Va 47,4% ngudi dan khong co bao hiem y te DCr lieu tu cupc khao sat tren cung eho thay mpt s l y l u t l ehinh anh hudng tdi viee tham gia bao hiem y t l cua ngudi dan VTnh Long la: viee lam, dilu kipn N G U Y £ N THI cue TRAM - MOT SO Y^U T Q A N H HUO'NG kinh te, nhan thiie v l bao hiim y te, vipc trien khai chinh sach, Tuy nhien nguyen nhan nao khiln ngudi dan CO hoac khong tham gia bao hiem y t l va sii dyng bao hiem y t l ? Ngudi dan dang su dung bao hiim y t l vdi tam t h i nhu t h i nao, la v l n d l cung c i n dugc giai dap Tai VTnh Long, nlu muon hien thye hoa mue tieu bao hiim y t l toan dan trudc het phai md rong di?n bao hiim y t l ty nguyen, dac biet la doi tugng dan cu nong thon vi VTnh Long co khoang 84,6% dan so sing d nong thon va chu y l u lam viec ITnh vuc nong nghiep (Ting cue Thong ke, 2009, tr 60) TCr nhCrng ly tren, tac gia bai viet da tien hanh mgt nghien eiru djnh tinh nham tim hiiu ky han v l n d l sii dung bao hiim y te eua ngudi dan nong thon tCr suy nghT cua ehinh ngudi dan Cy t h i ehung toi da phan tich thong qua 24 trudng hap phong van sau chinh thiic, gIm: 14 trudng hgp eae nhom hg gia dinh dugc chgn theo tieu ehi phan tang mCre song va c6 hay khong co bao hiim y t l ; trudng hgp nhCrng benh nhan dugc hoi dang di kham tai tram y t l ; cuge phong v l n cac nha quan ly va chuyen mon ve v l n de bao hiem y t l ; kit hgp vdi viee quan sat cua nhdm nghien ciiu tgi thyc dia C H A T L U O N G K H A M CHIJA BENH BAO H I £ M Y T S Theo y kiln cua ngudi dan, chat lugng kham chu-a benh la yeu t l hang dau quylt djnh viee SCP dung bao hiim y t l cua hg Ngudi dan ehu y l u phan anh nhCrng han ehi cua kham chCra benh bao hiim ve eac mat: ehd dgi lau, kham bao hilm kem han so vdi kham djeh vu; ehit tugng thulc khdng tot; trinh chuyen mon theo tuyen dugc bao hilm khong dam bao (a) Nhgn xet van de "ehd dgi lau" d eac nhom hp gia dinh eo s y khae Nhom hp ngheo s u dung bao hilm y te d l di kham ehCra benh thudng xuyen han so vdi nhom kha va trung binh va hp chu yeu sii dung d tuyen xa, mgt so trudng hgp co len tuyen tinh Khi din y t l tuyin xa, h l u h i t benh nhan deu c6 bao hilm y te nen cam nhgn chung la khong eo sy khac biet gi co hay khong su dyng bao hilm y t l Tuy nhien, v l n CO y kiln ngugc lai va eung co ngudi da tCr ehii s u dung djch vu bao hilm y t l vi cam thay phai chd dgi lau: "£)/ kham djch vu thi tien han, nhanh han bao hiim, khong co doi nhiiu vi ben bao hiim dgi lam giay to, ghi rdi bat so nira Con di dich vu thi ndi chung vd hg ndi benh gi cai la lay thuoc hay chich thude vi, hong ed bao hiim thi di chd nao cung nhanh hit tran" (NCr, hg ngheo, khong bao hilm y t l ) NhCrng hp eo mure sing trung binh va kha t h i hien xu hudng phan Crng manh me han d l i vdi vipc phai chd dgi lau kham chu'a benh bang bao hiem y t l Hp c6 sy so sanh va khong hai long vi phai chd dgi qua lau so vdi kham bang djeh vu Ong T.B, hp trung binh, da tCrng dua ngudi nha di kham bao hilm y te d b$nh vien R tgi TPHCM eho bilt: "Sao hiim y ti ma di len t&i (TPHCM) la rit kho cho ngwai ed bao hiem Neu kham dich vu ch! phai mat mgt buoi kham bao hiim y te se mit ehirng mgt ngay" (Nam, hp trung binh, eo bao hilm y tl) Mgt trudng hgp khac cung chia se: TAP CHi KHOA HOC XA H O I SO (193) 2014 "O tram y te xa cung phai bat s6 doi rit lau, wu tien ngw&i kham dich vu, cdn di t&i bgnh vien tinh cung thiy nh&ng ngwoi kham dich vu kham hay ehup hinh thiy le lim" (NCr, hg trung binh, co bao hilm y tl) Nhiing y kiln tren the hien sy khong hai Idng doi vdi ca y te tuyin xa, tuyin tinh va cao han Tuy nhien theo ghi nhan cua chiing toi, chi trudng hgp phan nan v l sy khac giCra hai djch vu kham ehCra benh d tuyin xa, nhung d eae tuyin tren thi hlu h i t deu cd y kiln phan nan Trong thyc t l viec kham chu'a benh tgi tuyin xa khong phai la v l n d l Idn, vi theo mo ta eua can bp y t l tgi tram: sau l l y s l thir tu nlu thiy lau hg c6 the dl chg va sau quay lai kham, vi vgy cung it phan nan Chung toi eung quan sat va ghi nhan it trudng hap ngudi dan phan Crng ve viec chd dgi qua lau tai trgm y t l xa Mae du vay, v l n d l Idn dan han d m i l tuyin tren eua bao hiem y t l Chj N.B, cd bao hilm y t l nhung lai khong sii dung d l kham chu-a benh, cho chiing toi bilt: "Nhirng lin len phd kham benh thi di ben dich vu khdng a Tai vi di ben ddng qua chen lin t&i lui sa xlu khong cd di ben djch vu cho nd le, no khoe chut Tranh thu di djeh vu cho nd mau ve cho kip xe vi & trin khdng cd ehd" (NCr, hg kha, cd bao hiem y te) Cung noi v l ly ngudi dan tCr chii sir dyng bao hiem y te co y kiln khac nhu sau: "Tro ng^i l&n nhit ngwoi ta khdng mua bao hiim y ti, theo tdi la hg cha hoai nen chan, met, kho chju, ehi trir benh qua nang thi moi di" (Nam, ho kha, c6 bao hiem y tl) Nguyen nhan viec chd dgi lau theo ngudi dan vi djch vy kham bao hiem y t l liiC nao cung qua tai, do "kham bao hiim y te ngw&i ta cd ve iu han, thi du mdt lam 100 ngw&i, lam mai cho hit 100 ngw&i nen cin nhanh, vi thi nen au" (NCr, hp kha, khong dung bao hilm y tl) NhCrng nhan xet, mo ta ngudi tra Idi nhan manh chu y l u d tuyen tren, la cac benh vien chuyen khoa tai TPHCM Ngudi dan d xa My An mac dCj duge uu tien ehuyin tuyin thing len benh vien tinh VTnh Long (do dja ban gin phi, hg khong phai ehuyin qua tuyin huyen nhu thong thudng) song cho biet hp se phai ehd dgi rat lau m l i lan kham Nlu hp phai lam them eac xet nghiem thdi gian se eang lau va thdng thudng co the keo dai ca mdi kit thiic Nlu hp phai su dyng djch vu d tuyin cao hgn nu-a (vi du tai TPHCM) thi kho khan cang Idn ban: "Niu mudn di kham cung phai di tir khoang gio sang, toi noi bit so khoang gi& thi so thir tw cung da xip hang sau ehirng 300-400 ngwoi Niu tai bit so khoang 7-8 gi& thi cd ca eung chwa kham xong, se cdn lau hon niu sw dung bao hiem y ti" (NCr, hp trung binh, ed bao hilm y tl) Vi vay nhilu trudng hgp dugc phep chuyen tuyin nhung khong su dung bao hilm y t l vi nlu kham benh lau, kit thuc qua muon thi hp khong the v l va cac chi phi phat sinh nhu tiln an, d cho ca ngudi benh va ngudi cham soe se vuot nhilu l l n ehi phi dugc bao hilm y t l toan Do do, nhilu ngudi phai chgn kham djch vy chT vi d l ve cho kip NGUYEN THj COC TRAM - MQT S6 Y £ U TO ANH H U O N ^ Viee kham ehCra benh chd dgi qua lau khong chi anh hudng tdi viec hudng dyng bao hilm y t l cua nhdm cd the bao hiem y t l ma cdn tgo nen tam t h i e ngai eua rit nhilu ngudi khac chirng kiln hoac nghe v l nhCrng trai nghiem kham chu-a benh nhu vay Mgt bg phan ngudi dan da tCr choi sir dung djCh vu bao hilm y te hoae mua bao hilm y t l "ehi d l do", (b) Chit lugng thude bao hilm y t l khong t i t cung la phan anh chung ciia nhCrng ngudi duae phong v l n Ngudi dan d day nhin ehung co quy trinh kham chCra benh bang bao hilm y t l nhu sau: CO bpnh nhe se tram y t l kham va lay thulc (uong khoang ngay) sau nlu khong hit se tai kham va lly them thulc, sau 2-3 lan tai kham nlu khdng hit benh se CO t h i xin gily chuyin vien len kham d benh vien tinh VTnh Long (phong v l n sau can bg tai tram y t l xa) Tuy nhien nhieu ngudi dan cho bilt uIng thuoc bao hiem y t l lln diu khong hit thi hg se ty mua thulc ulng Nlu v l n khong hit benh thi hg quay trd Igi trgm y t l tai kham vdi mye dich ehinh la xin gily ehuyin vien Dieu thil vj d day la mac du ngudi dan khong bilt rd ve chit lugng thulc thupc dien bao hilm y t l : "thulc bao hilm minh khong bilt sao", nhung rit nhieu y kiln cam nhan "thulc bao hilm nhe", "thuoc bao hilm ulng khong h i t benh" Ba T.N eho bilt: "khdng xai bao hiem thi ndi ehung nd le lang va hai quan tam nhiiu cdn xai bao hiim thi hoi lau, kham cung lau va cham sdc hay gi cung lau Tw thi san sdc hai chu dao han, tiin bac hay thuoc thi cung hoi nang han cdn bao hiim thi cai gi eung nhe han" (NO', hp trung binh, eo bao hiem y t l ) Mdt ngudi dan bj dau mat eo kham tgi tram y te va duac c l p thuoc nhung khong h i t benh, nhung di ngoai mua thuoc ve dilu tri Igi h i t benh tra ldi: "Mua bao hiem y ti thi dS dd eho co hinh thirc, phdng bgnh nhiiu phai ehuyin len tuyen tren nam vien thi phin nao edn binh thw&ng thuoc bao hiem y ti khdng dimg dwac vi dieu tri lau va khong hl$u qua" (NCr, hp trung binh, co bao hilm y te) Mgt so trudng hap khac mgc du chua trai nghipm ve viec dCing thulc bao hilm y t l song "nghe may ngudi xai bao hilm y t l noi", hay "thiy ngudi ta ulng hoai khong hit" nen cung thieu tin tudng ve chit lugng thuoc bao hilm y t l Ro rang nhu'ng y kien thilu tin tudng v l chit lugng thulc bao hilm y t l dang tgo du luan khong tich cue doi vdi viec tham gia bao hiem y t l va su dung bao hiem y t l d mgt bg phan ngudi dan (e) Khao sat tai cgng dong, chiing toi cung ghi nhan sy ban khoan eua ngudi dan ve trinh dp eua dpi ngu y bae sT va ea sd vat chat theo tuyen bao hiem y t l Tai tram y te xa hau h i t ngudi dan diu hai long vdi thai dg phye vu cua y bac sT Khong ghi nhan y kiln nao phan anh thai dp khong tot cua nhan vien y te doi vdi ngudi dan D i n y te tuyin tinh va d cae Idn thi da khac Ngudi dan phan anh cd sy phan biet doi xCr d l i vdi hai loai hinh kham bao hiem y te va kham djch vu cung mpt benh vipn Ba H.G, hp trung binh, k l vdi chung tdi ve l l n kham chiia bpnh tai bpnh vipn tuyin tinh; "VTnh Long wa eai ehuygn ndi ehuyen khdng cd hda nha, eoi bgnh nhan re lim Noi chuygn nghe tiing tiing TAP CH( KHOA HQC XA HQI so (193) 2014 khdng a, nhiiu minh nghe hong ro minh hoi lai no n^t nira T^i vi nd noi uong eai nw&c dd, nw&c do, nhiiu ddng qua dang i xeo minh nghe khdng rd hoi l^i [bj] n^t liin Bai v$y cd thiy nhiiu cung hai buon eho dd, nhwng ma minh buon kg minh chir eung dau eo anh hwang gi t&i nd Thanh kg di, minh benh minh phai chju Luc kham bac sT cung it ndi chuygn lim nen nhiiu cung khong dam hoi" (NCr, hg trung binh, CO bao hilm y tl) Mgt trudng hop khae cho bilt: "Neu ma tui co tiin tui di kham dich vu vi nd tdn tinh, diy du, tie hanh Bao hiem thi cung tan tinh nhwng gi&i han cai bao hiem Ben tw thi tiin minh budng ra, bac sT tan tinh vol minh, cho nao minh khdng biet thi ngwoi ta tw van, hw&ng din cho minh cdn ben bao hiem thi eh& ben lo Gliy to ben bao hiim thi minh chay cdn ben day thi hg ehay hit, minh khdi chay Hg dit minh di roi lam lam hg lam khong a Ben bao hiim la ho ehi minh & chd dd cho dd, liu may lau may la tw ddng minh di Cdn ben djch vu la cd ngwoi nhan vien ngw&i ta hwang din minh diy du Gia sw minh di ben bao hiem chirng thi ben dich vu buoi la minh kham xong" (Nam, hp trung binh, khong bao hiem y tl) Mae du cam thay chua dugc hai Idng mgt s l ngudi dan v l n c6 tam ly chap nhan, cho rang su' dung bao hilm y t l thi chi dugc phue vy hgn ehe nhu vay Ong T.H lam nghe chay xe 6m, da tirng dua mp 91 tuoi di kham tai benh vipn tinh cho bilt: "Thiy kham bio hiem ngwoi ta phan biet tir khau kham benh Thi du nhan phiiu dong tiin thay vi hg chi minh din quiy ng quay thi hg ndi 'di l$i dang dd', minh khdng biit cho nao, hoi lai thi hg ndi 'di lai dang dd do, hoi hoai on ao ngw&i ta khong lam du'p'c vigc' Hoac vi du nim vien thi diing bac sT se di tham benh lin nhwng thay vi vay minh kham bao hiem chi cd y ta xuong thdi ho0c th$m chi la khdng cd Thiy o day nhiiu ngoai mat ngwoi ta khdng ndi ehCr ngw&i ta thiiu tin twong kham bio hiim y te dir lim Thi du ngw&i ta khdng bi dau rudt thira cung de mo eudi eung kiim tra phat hien ngw&i ta chan doan nhim Nhieu trwong hgp kham bao hiem bgnh nang thay vi dang le phai ehuyin ngw&i ta len nhwng bao hiim cu giir theo ddi, theo ddi t&i lue ngw&i ta di thi cd da mudn Ndi chung tui khdng tin twong tay nghi cua bae sT & day" (Nam, hg trung binh, khong eo bao hilm y tl) Theo ong T.H, nhan vien y t l hoi "Co bao hilm y t l khong?" tire la da eo su phan biet rii, do bien phap giai quylt theo ong la chi d i n toan vien benh nhan mdi c i n khai bao eo bao hilm y t l hay khong Mpt trudng hgp khac, ong N.L, hp kha, cung tCrng dua me di mo mat tai bpnh vien tinh nhung khong dat kit qua tit Sau xin gily ehuyin len benh vien chuyen khoa d TPHCM nhung bj tir choi Du vay, ong v l n dua ngudi nha di thang len TPHCM tham kham tai benh vien chuyen khoa M (Nam, hg kha, eo bao hilm y t l ) Trong ea hai trudng hgp tren ngudi dan d i u mua bao hiem y te ehi di phdng hd "qua nggt ngheo", cdn h l u h i t hp khdng sir dyng de di kham bpnh NGUYEN THI ClJc TRAM - u()T SO Y£U TO ANH HLfONG Ve v^n dg nay, mgt s6 can bo quan iy y te cho rang: khong co bac sT nao mu6n giu" benh nhan lai d l hp gap nguy hilm va ngu-ai dan bay gio du hieu biet de l