Một số chiều cạnh của hệ thống chính sách trợ giúp xã hội cho người cao tuổi ở nước ta hiện nay.pdf

9Crao tifi'i ngbifp bu xa hpi hoc s6 (127), 2014 77 M O T S O C H I E U C A N H C U A H E THONG CHINH SACH TRO GIUP XA H O I CHO NGU"6l CAO TUOI NLTdC TA HIEN NAY TRINH DUY LUAN" Gia hoa dan so d Viet Nam va nhihig thach thve chinh sach trg giiip xa h$i cho ngudi cao tuoi Nhieu nghien eiiu dan sd hoc da eho thdy ngudi cao tudi (NCT) tren khdp thi gidi dang gia tang nhanh va xu hudng ndy se tiip tuc tiong nhiing nam tdi Theo dy bdo cua Lien Hap Qudc nam 2010, sd lupng NCT (tii 60 tuditidlen) se tang tii 760 trieutiongnam 201016n khoang ty ngudi vao ndm 2050, tuong ling tang tir 11% din 22% tdng dan sd thi gidi (UNFPA, 2011) O cdc nude dang phat trien, noi ma thu nhdp binh quan ddu ngudi van cdn thap thi dan sd gid dang dgt nhieu thdeh thirc chinh sdeh cho cdc chinh phutiongviec chdm sdc NCT md he thdng an sinh xd hdi cdn ban chi vl dp bao phu O Viet Nam, theo dy bdo dan sd cua Tdng eye Thdng ke ndm 2010, ty If dan sd tir 60 tudi ttd len se cham ngudng 10% tdng ddn sd vdo nam 2017, tiic la dan sd Viet Nam ehinh thirc budc vdo giai dogn "gia hda" tir ndm 2017 (Giang Thanh Long, 2010) Viet Nam se ddi mdt vdi nguy ca "gid trude giau", tdc dp gia hda dan sd tiep tuc tang nhanh ttong GDP binh qudn ddu ngudi mdi d miic trung binh thdp, vdi 1.911 ddla My vdo ndm 2013 (De so sanh, hay lay Malaysia cimg nam 2013, vdi GDP binh qudn ddu ngudi Id 10.514 ddla My - gap 5,5 lan ciia Viet Nam - cdn ty le ddn sd tu 65 tudi tid len chi mdi 5%) Day thye sy la mdt thach thiic rat Idn ddi hdi Viet Nam can phdi tir bdy gid chudn hi chinh sdeh, chien lupc dap irng phii hop (Pacharawalai va cdng sy, 2014) Tir thuc te ndy, xudt hien nhu cau rd sodt va phan tich hp thdng cdc chinh sdch hien cd ddi vdi NCT, ddc biet Id cac chinh sdch tip giiip xa hdi (TGXH) Bdi viet se diem qua mpt sd kit qua phan tich he thdng chinh sdch TGXH cho NCT d Viet Nam hien nay, theo ede chieu canh nhu: tinh he thdng, ddy dii va khd thi, miic dap irng cac quyin vd cae nhu cdu tdi thieu cua NCT; viec ho tip cdc quan he xa hpi va mtmg ludi xa hpi ciia NCT Tir dd se de xudt eac khuyen nghi hd trp viec hodn thien cdc chinh sdch ttong ITnh vyc ndy Cdc chinh sdch TGXH cho NCT hien nhu mot h | thong 2,1 Tinh he thong Gdn nam qua, tir ed Luat NCT (ban hdnh thdng 10/2009, cd hieu luc tir thang 7/2010), Id khodng thdi gian tuong ddi ngdn, nhung tap hpp cdc chinh sdch ' GS.TS Vi?n Xd hgi hgc 78 Mot s6 chieu cgnh ciia he thong chinh sdch dupe triin khai sau Luat da bao triim nhieu ndi dung, vdi nhieu the che tham gia vd cae edp ban hdnh Theo ehilu dpc phan cdp quan ly, d cdp Chinh phu, cd Nghi dinh 06/2010 (Hudng ddn thuc hien Luat NCT), vd mdt sd Nghj dinh khde eua Chinh phii Cdc hoat ddng chi dgo vd gidm sat viec ttiln khai thuc hien cdc chinh sach vl NCT cua Chinh phu cung dupe thye hien thdng qua ede hoat ddng cua Uy ban Qudc gia vl NCT vd Chuang trinh Hdnh ddng Qudc gia vl NCT giai doan 2011- 2020 Tir Nghi dinh 06, cac Bd, ngdnh da xdy dyng cdc Thdng tu, cdc dl an triin khai thyc hien chinh sach tir gdc dp cua cac eo quan quan ly nganh Bdt ddu tir thdng 11/2011, mdt loat Thdng tu ciia cdc Bd dd Idn lupt dupe ban hdnh vdi npi dung lien quan tryc tiip din link vuc TGXH cho NCT Tiip dd, tai cac dia phuang, bdt ddu tir edp tinh, nhiiu D I an, md hinh vl chdm sde NCT eua cdctinh/thanhdd dupe xdy dung vd triin khai Cae Ban edng tdc NCT cdp tinh/ thdnh Cling dupetiianhlap theo Thdng tu 08/2009 cua Bp Ndi vu Theo chiiu ngang, hon mudi Bp chdng ban nhu Lao ddng - Thuong binh - Xa hpi (LD-TB-XH), Tai chinh, Giao thdng Van tdi, Van hda - Thi thao - Du lich, Ndi vu da cd thdng tu vdi cac quy dinh khdc ve ehinh sdch TGXH, true tiep hoac gidn tiep, danh rieng eho NCT hoac cho nhiiu nhdm ddi tupng khde nhau, tiong cd ddi tupng NCT Ngoai ra, ben canh Lu|it NCT, hang loat cdc bp Luat chuyen nganh khac tiong nam gdn ddy (nhu Luat Hdn nhdn vd Gia dmh, Luat Lao dpng, Luat Dan sy) dSu cd nhimg dieu khodn ddnh rieng cho ddi tupng NCT Dieu ndy, cimg vdi Luat NCT, dd gdp phdn dam bdo ngdy mdt tdt hon ddi sdng v$t chat, tinh than, cham sdc siic khde va phat huy vai tid ciia NCT d nude ta hien Nhin ve quy md, sd luong, cdc chinh sdch TGXH cho NCT tiong ndm qua da it nhiSu mang tinh he thdng, theo ca chieu dpc va chieu ngang eua he thdng qudn ly 2.2 Tinh todn di^n, ddy du cua chinh sdch Theo Luat NCT, hp thdng chinh sdch ddi vdi NCT bao gdm ITnh vyc chu yeu: Phyng duong, Cham sdc NCT va Phdt huy vai tid cua NCT tiong cudc sdng Linh vyc "cham sdc", vl ly thuyit, cd npi dung khd rpng, song tuong ddi gdn vdi khdi niem TGXH, vdi cdc ndi dung/hogt dpng sau: - Bdo tip xa hdi - ddm bdo nhu cau vat chdt tdi thiiu cho nhdm ddi tupng NCT ySu the nhdt, bdo dam miic sdng tdi thieu, nha d cho NCT cd don, nha dudng lao - Chdm sdc siic khde: uu tien kham benh, cdp the BHYT, hoat ddng eua ede cdu lac bp sire khde NCT - Chdm sdc ddi sdng van hda tinh thdn: chii y din nhu cdu tinh thdn - tdm 1;^ tinh edm, van hda, nhu chiic thp, mimg thp, mai tang, Cdu lac bp thg he giiip nhau, Chdm sdc NCT dua vdo cpng ddng - Cac dich vu ddi sdng; nhirng chinh sdch uu ddi NCT tiong sir dung djch vy cdng cdng nhu giao thdng di lai, tham quan Trinh Duy Ludn 79 LTnh vyc "Phdt huy vai ttd NCT" cho den it duoc cac vdn bdn chinh sach de cap den mpt each ddc lap,riengr6 Nhin chung, he thdng cdc van ban chinh sdch, ddc biet Id ede chinh sach d cap qudc gia dd bdm sdt cdc diiu khodn eua Luat NCT, bao quat nhieu vdn dg ciia NCT diiu Men phdt trien kinh ti hien eiia nude ta, cung nhu tuong quan vdi viec gidi quySt cac van dl xd hpi khde vd ede nhdm xa hpi khde Tuy nhien, tr^n thuc te, vdi sd luong cdn khiem tdn cac van bdn chinh sdch TGXH cho NCT dang cd hieu luc hien nay, thi cac quy dinh tro giiip cua ehinh sach cdn khd ban che Ndi dung ehii yeu mdi tap trung vdo cdc che dp TCXH thudng xuySn cho NCT ed hoan canh dac biet, khd khan; mdt sd uu dai ttong dich vu khdm chira benh, su dung phuong tien giao thdng edng edng; phi thdm quan, hay cac thu tuc mang tinh nghi thiic nhu chiie thp, mimg thp hodc mai tdng NIU nhu nhdm ehinh sdch edp Chinh phu thudng bao tnim ddy du vl ndi dung, thi nhdm chinh sdch tir cdp bd/ngdnh tid xudng thudng cd npi dung can thiep khd don gidn, thdm chi ngheo nan, "vun vat" va phan tan Dieu cd the thdy qua ede Thdng tu cua mpt sd Bp cd lien quan true tiep tdi ITnh vyc TGXH cho NCT nhu: Thdng tu 35/2011 eua BpYtl; Thdng tu 71/2011 cua Bd GTVT; Thdng tu 17/2011 eua Bd LD-TB-XH Vi du dien hinh la Thdng tu 127/2011 eua Bd Tai ehinh chi gdi gpn mdt quy dinh: "Muc thu phi thdm quan di tich vdn hod, lich sir, bao tdng, danh lam thdng cdnh ddi vdi NCT bdng 50% miic thu phi hien hanh" 2.3 Cdc chu the chSm sdc NCT chinh sdch TGXH Theo Md hinh chu thi cham sdc (Ochiai, 2009), ddi chieu vdi ndi dung cua cdc chinh sdch TGXH cho NCT d nude ta, thi hien dudng nhu vai ttd/chiic ndng cua chu thi nha nude dang dupe chii trpng nhieu hon so vdi vai trd cua cdc td chirc xa hdi, khu vye khdng chinh thiic (gia dinh, ddng hp), eua cdng ddng va thi trudng (doanh nghipp, khu vyc tu nhdn) Ndi cdch khac, xet theo muc dp todn dipn, ddy du cua h? thdng chinh sach TGXH cho NCT thi d ddy cdn tdn tai nhiing "khoang tidng" hay nhiing ban chi nhdt dinh: chua cd sy cdn ddi giiia vai trd cua "4 chu thi chdm sde", hay gifl-a ITnh vyc Chdm sdc vd Phat huy vai tid NCT Vdi sy phdn tang xd hpi hien d nude ta, ben canh bp phdn NCT gap khd khdn, cdn sy TGXH ttyc tiep tir ngdn sdeh Nha nude, ludn cd mpt bd phdn NCT cd kha nang sii dung ede dich vy trd ti§n, vdi nhung miie dp khdc nhau, thj trudng (khu vyc tu nhdn) cung edp Nha nude chi cdn ed cac ehinh sach "tao dieu kien" eu the, bdp ddn de gian tiep h5 tip eho nhdm NCT Chdng ban, vdi de an hd tip viec thdnh lap eac ca sd bao trp xd hdi cho NCT, md hinh cac trgi dudng Ido hodn toan cd thi dupe xem nhu la cdc doanh nghiep xd hgi vdi nhiing uu dai chinh sdch nhdt dinh Da cd mdt sd chinh sdch doi vdi hoat d^ng nay, song tinh phirc tap vd tinh lien nganh cua vdn dl, nen ddi hdi nhiiu nd luc ban tir cac ngdnh, cac cdp cd lien quan 80 Mgt so chieu cgnh ciia he thong chinh sdch Hinh Md hinh chii the chSm sfic (Care Diamond) f t Nha smifc y C4c t6 chiic tinh nguy?n dpc l?p, phi chinh phu, phi Ipi nhuan , Cac nh6m ty tuong O-g / Cac t6 chirc t6n giAo tin nguOng / /^Cpngdoijg ^^ Cdc dich vy ctia nhi nu6c Bdo hi^m su6t dfti/ddi ban '; TCXH thudng xuyfin ^ f Ngirdi can X ( cham soc / \ v X Thi ^ \ ' Doanh nghi|p; Djch vy giiip • /f, v i ^ c i n syxShOi /\^^ Khu v\rc tir nhSn /^Hadipfi D6nghp\ VH931 Nguon: Ochiai 2009 Doi vcfi gia dinh va cong dong - nhu la chu the khac, lihong Item phan quan trong cham soc NCT, cdc van ban chinh sach ve TGXH, tir Lu^t, Nghi djnh hien dang de cap chu yeu duoi hinh thiic "dpng vien", nhac nha trach nhi6m dao diic, ma chua dugc "the che hoa" cac quy dinh ro rang nen Icho Iciem tra va giam sat ket qua thuc hien 2.4 Tinh hgp ly cua chinh sdch vd muc bao phu ddi tirdng Luat NCT la van ban cao nhat, ap dung cho toan bo NCT Trong qua trinh trien khai thuc hi?n da hinh nhom chinh sach TGXH tuong ling voi nhom d6i tuong NCT Nhom chinh sach TGXH khong diSu kien, danh cho toan bo NCT Vi du nhu cac quy dinh cac Thong tu cua Bo GTVT va cua Bo Tai chinh vi uu tiSn va giam gia ve cho NCT tham gia giao thong, ve tham quan di tich; chi phi chiic tho, ravmg tho, mai tang dugc ap dung cho moi NCT Nhom chinh sach TGXH co diiu kien, danh rieng cho bp phan NCT vai nhtag diSu ki$n nhit dinh NCT v6n thuoc nhom xS hoi ySu thS (chang han, so voi nhom ngucri tuoi lao dong) Song lai co nhiing nhom NCT y6u thi hem, yiu thi nhit, can dugc uu tien TGXH Mpt chinh sach theo cac nhom muc tieu nhu vay (khac voi nhom chinh sach khSng diju kien tren) la can thiet va hpp ly, va phCi hgp voi diiu kien phat triin kinh tl - xa hpi cua dit nude timg giai d o ^ Vi du cho nhom chinh sach la cac Nghi dinh 67, 13 va 136, Quy djnh cac chinh sach TGXH Trinh Duy Ludn 81 ddi vdi ddi tuprng BTXH, theo dd, chi cd nhdm ddi tupng NCT ey the (dupe quy dinh d myc 5, Di6u eua Nghi dinh 136) dupe hudng ehe dp TCXH thudng xuyen va dupe edp the BHYT miin phi Nhirng nguyen tac nhu vdy cua chinh sdch TGXH da dupe neu ro tiong Nghi dinh 136: "Chinh sdeh TGXH duac thyc hien edng bdng, cong khai, kip thdi theo miie dp khd khan vd uu tien tai gia dinh, noi sinh sdng" va "dupe thay ddi tiiy thudc vdo diiu kien kinh tl dat nude va miic sdng tdi thiiu ddn eu timg thdi ky" (Diiu 3, Nghi dinh 136) 2.5 Tinh khd thi cua chinh sdch Ddi vdi cac chinh sdch Chinh phii ban hanh, nhd tinh chdt phd quat vd bao triim, vdn dl tinh khd thi it dupe dat Tir Luat NCT tdi eae Nghi dinh hudng ddn, hay cac hoat ddng chi dao cua Uy ban Qudc gia vl NCT vd eua Chuang trinh Hdnh ddng Qudc gia ve NCT da vd dang dupe triin khai, diu hiia hen tinh khd thi eao vl mdt ly thuyit ddi vdi he thdng ehinh sach ve NCT Bdt ddu tir eac ehinh sach d edp bd, cap dia phuang va den cdp co sd, tii thuc te van dyng ede ehinh sach mdi Ip nhiing khoang ttong, bdt cap, vd miie dp kha thi cua cdc chinh sach Tinh khd thi thudng cao hon ddi vdi cac chinh sdch cd cdc quy dinh cy thi, ro rdng Ddc biet, cdc ehinh sdeh, che dp cd ndi dung gdn lien vdi nhu edu thiit than vd Ipi ieh true tiep cua nhdm NCT muc tieu, thi su quan tdm, ddi hdi thudng cao ban va vdy tinh kha thi ciing cao hon Chdng han, viec thyc hipn ede che dp eho nhdm ddi tupng NCT ghi tiong cac Nghi dinh 67, 13, 136; hay cdc quy dinh ve chiic thp, mimg thp, mai tang phi cae Thdng tu 21 cua Bd Tdi chinh, Thdng tu 17 eua Bd LD-TB-XH Mot yeu td khdc cd anh hudng tdi tinh khd thi cua cdc chinh sdch d cap bd - dd Id sy phoi hpp lien nganh td khd yeu, mac du Bd LD-TB-XH da dupe giaottdchnhiem chu tri vdphdi hgptiongITnh vuc Hdu nhu khdng ed Thdng tu lien bd ndo ttong danh muc cdc chinh sach TGXH cho NCT hien Tr&n thyc tl, cdc bd cd lien quan thudng ban hanh cac Thdng tu mpt each ddc lap, ed ddi vdi nhung hoat dpng can sy phdi hop lien ngdnh Dieu ndy khien eho cdc dia phuang gap khdng it khd khan trien khai thyc hien Tinh khd thi ciing cd the bi hgn che hem, miic dp vd thdi diem thue hien chinh sdch cdn phy thude vdo dieu ki|n vd tham chi "thien chi" cua cac don vi cung c%) dich vu (nhdt Id cdc don vi thupc khu vyc tu nhdn) Chang hgn, quy djnh ciia Thdng tu 71/2011 cua BO Giao thdng Van tdi vl gjam gia ve, gia dich vu cho NCT sii dung phuongtiengiao thdng, ho^ic Thdng tu 127/2011 eua Bp Tdi ehinh quy ^nh gidm 50% miic phi thdm quan diti'ehvdn hod, lich su, ddi vdi NCT Thoat nghe, ddy Id nhimg uu ddi rdt ey thi cho mpi NCT Song tinh khd thi phd quat se khdng phdi dl dang dgt dupe vi Thdng tu 71 neu tren cdn cd ghi chu mang tinh hgn che kem theo Id: "Miec gidm gid ve cu thi Thu trudng cdc td chuc Mnh doanh vgn tdi edn cu diiu M^n thuc ti vd thdi diim ey thi xdy dung, cdng bd thuc hi^n " Nhiiu guy dinh ciia Luat NCT vd cac van bdn dudi luat dd dh nghTa vy/tiach nhiem ehu yeu cua gia dinh tiong chdm sdc NCT, hay tiach nhiem cua con, chdu phdi phung dudng, cham sdc bo me gia, hogc dng bd Song tinh kha thi thue tl se phu thupc 82 Mgt so chieu cgnh cua h? thong chinh sdch vao nhiiu yiu td, dae biet la nhdn thiic va thai dp cua cdc ca nhan vd cdng ddng dan cu ttong ITnh vye ndy Cho din nay, cac trach nhiem ehii yeu chi dupe xem nhu nhung gia tri dao diie Chiing dupe diiu tiet chu yeu bdi du l u ^ xd hpi, bdi "tda an luong tam", hay bdi nhung nilm tin tdn giao (nhu quan nipm qua bao ttong dao Phat) hon la bdi ede diiu luat hay ehinh sdch hien hanh Ngay ca ddi vdi nhiing quy dinh neu d Dieu 147, bp Luat Hinh sy - "Ngudi ndo nguac ddi nghiem trgng hogc hdnh hg cha me thi bi phgt cdnh cdo, cdi tgo khong giam giU din ndm hogc phgt tit tic thdng din ndm " - thi tin khd thi cua diiu khodn ciing rdt khd danh gia Mpt sd quy dinh, rdt eu thi, nhung Igi khdng kha thi tir mpt eon sd tinh nhdm Chdng han, ehi dp hd tip can bp y tl xa din kham chiia benh tai nhd cho NCT e6 don, bi benh.ndng Id: "Miic hd tra tdi da 3.000 ddng/km ddi vdi vung miin nui, vimg sdu hdi ddo; tdi da 2.000 ddng/km ddi vdi ede vung edn lai", va di kem Id rdt nhiiu chiing tir, thu tue dl dupe todn (Diiu 3, muc d, Thdng tu 21/2011 cua Bd Tai chinh Quy dinh qudn ly vd su dy.ng kinh phi chdm sdc sue khoe ban ddu cho NCT tgi nai cu tru) 2.6 Chinh sdch TGXH vd cdc quyin cua NCT Diiu 3, Luat NCT da ghi nhan quyin cua NCT Hai tiong sd nhung quyen da vd dang dupe triin khai thuc hien ttong ede nhdm mye tieu phu hpp Dd Id quyen "Duge bdo ddm cdc nhu cdu ca bdn vi dn, mac, a, di Igi, chdm sdc sire khoe " Day Id quySn ddu tien vd eo ban nhdt ddi vdi nhdm NCT ngheo khd, khdng noi nuang tya De NCT thyc hien quyin nay, da cd mdt logt chinh sdeh quan tipng nhu: tip cap xa hdi thudng xuyen, cdp the BHYT miin phi vdi nhdm NCT ngheo, khdng noi nuong tya hogc NCT tir 80 tudi trd len khong cd BHXH hay tip cdp xa hpi (Nghi dinh 136); cac chinh sach uu tien kham benh, bao dam s6 giudng benh cho NCT, c6 chuyen khoa lao khoa d cac benh vien eae tuyen Tiep den la quyen "Dugrc tham gia Hgi ngudi cao tudi Viet Nam theo quy dinh ciia D 1$ Hgi" - dd dupe thue hien rdng khap Theo thdng ke gan ddy nhat, ed tdi 50/63 tinh thdnh tren ed nude cd du cdc co sd Hdi NCT d ca cap (tinh/ thanh, quIin/huySn, xa/ phudng) Bdy quyen khdc dupe de cap ttong mdt sd chinh sdch vdi miic dp ttien khai thyc hien vd tinh khd thi rdt khdc Quyen dupe "Quyit dinh sdng chung vdi con, chdu hogc song rieng theo y mudn " ngodi Luat NCT, cdn dupe Luat Hdn nhdn va Gia dinh, Lugt Dan su va Lugt Hinh sy hS trp Tuy nhien miic dp kha thi vdtti^nkhai dudng nhu edn nhiSu diiu ttanh cdi Mdt sd quySn khde Uen quan den sit dyng cdc dich vy, chi phi cho nhu.cdu vdn hda tinh thdn, dd dupe tiien khai thuc hien qua Thdng tu eiia cae Bd nhu Y tl, Giao thdng vgn tai, Tdi chmh, Van hda - The thao - Du ljch, hogc ttong cdc dt an, md hmh cham sde siic khoe NCT, cdc cdu lac bp sue khde NCT Tuy nhien, mire dp ddy du, tinh khd thi va miic dp trien khai cdn nhieu hgn che, hoac chi dat dupe mpt phdn (thudng la nhd) so vdi yeu cdu Quyen "Duac tgo diiu kiin lam viec phii hgp vdi sice khoe, nghe nghiep vd cdc diiu ki^n khdc di phdt huy vai trd ngudi cao tudi" -thudc ITnh vyc "Phat huy vai trd cua NCT", chi ddnh cho nhdm NCT cd diiu kien, song ciing dupe trien khai chua day du, tir cd phia chinh sdch Idn phia cdc chii thi hd ttp Luat Lao ddng la mdt van bdn chinh sdch hilm hoi cd diiu khodn lien quan din NCT dang tham gia lao ddng, nhu uu ddi vl nit ngdn tiidi gian lam vi?c hodc dupe dp dyng chi dp Idm viee khdng trpn thdi gian (Diiu Trinh Duy Ludn 83 166); khdng 1dm nhung edng viee nang nhpc, ddc hai, nguy hiem, hay de cao ttach nhiem eua ngudi su dung lao ddng phdi quan lam chdm sde sice khoe cua ngudi lao dong cao tudi tgi nai lam viee (Diiu 167) Hai quyin khde dupe ghi tiong Luat NCT: 1) Dupe mien cdc khodn ddng gdp cho cdc hoat ddng xa hgi; va 2) Duoc uu tien nhdn tien, hien vdt eiiu ttp, chdm sdc sire khde vd cho d nhdm khac phyc khd khan ban ddu gap khd khan hdu qua thien tai hoac riii ro bdt kha khdng khdc Song qua soat, chua thay cdc chinh sdch cy the trien khai thye hien cdc quyen ndy mdt edeh rd ret Nhin ehung, ttong he thdng chinh sach TGXH eho NCT, viec thyc hien cdc quyin eiia NCT dupe ^ ttong Lugt NCT mdi chi d miic ddm bdo nhu cdu tdi thiiu cho nhdm NCT gap khd khdn, hay viee tham gia Hdi NCT, vd mpt sd dich vu edng cdng hgn chi Trong tuong lai, theo miic dp phdt ttien kinh te - xa hpi, viec thyc hipn cdc quyin ghi tiong Lugt NCT se can dupe md rdng cd pham vi Idn miic dp bao phu cua cac chinh sach Chinh sdch TGXH viec dap ung cae nhu cau eua NCT 3.1 Ddp ung nhu cau vat chat toi thieu Bao dam cac nhu cdu tdi thieu ve dn, mac, d, di Igi vd cham sdc siie khde Id quyin ddu tien cua NCT dupe ghi ttong Luat NCT Tiep dd, eac van bdn dudi luat da quy dinh nhieu ehe d6 cu the The hien rd nhdt la cac Nghi djnh 67, 13 va 136 - Quy dinh cdc chinh sdch TGXH ddi vdi ddi tugng bdo tra xd hdi,ttongdd ed NCT Trong he thdng ehinh sdch TGXH cho NCT, nhdm cae Nghj dinh cd vai tid quantipngnhdttiongviec ho trp (bang tien) de dap ling nhu cau vgt chat tdi thieu hay mice sdng toi thieu cho cdc nhdm ddi tupng NCT phu hpp Theo bdo cdo cua Uy ban qudc gia ve NCT Vipt Nam, nam 2013, da ed khodng 1,5 trieu NCT duoc hudng ttp cap xd hpi hdng thdng vd dupe c ^ the BHYT miin phi Khai nipm "nhu edu tdi thiiu" hay hpp hem - "Nhu cdu vgt chat tdi thieu" chua dupe quy dinh rd cdc vdn ban ehinh sdeh Tren thyc te, miic ttp cap xd hdi eho nhdm NCT idid khdn vdi he sd 1,0 Id 270.000 ddng/tiidng (dd cap nhap theo ND 136, nhung chua dupe thyc hien), thi van cdn thdp xa so vdi "chudn ngheo" giai dogn 2011 - 2015, theo Quyit dinh 09/2011-TTg (400.000 ddng cho khu vyc ndng thdn va 500.000 cho khu vyc dd till) Cdc sd eho thdy, hien nay, ban chi vl ngdn sach, che dp TGXH cho nhdm ddi tuong NCT cd hoan cdnh khd khdn van cdn thdp so vdi nhu cdu vdt chdt tdi thiiu ciia nhdm ddi tuong NCT ndy 3.2 Tinh den nhimg dgc diem tdm sinh ly cua NCT Tren thyc te, ehinh sach TGXH cho NCT nude ta hipn mdi uu tien dp dyng eac ehe dp TGXH thudng xuyen (bdng tien hay hipn vat), nham dap ling m^t phdn nhu cau vat chdt tdi thiiu cua nhdm ddi tupng NCT khd khdn Song, vdi nhieu nhdm NCT, nhiing ddc diim thi chat, tinh thdn va tdm ly cua hp, nhiing tra giup tdm ly, tinh thdn, tinh edm cung khdng kem phdn quan trpng, thgm chi nhieu trudng hpp cdn ndi len nhu la yeu td cdn dupe uu tien hang ddu doi vdi hp Nhu edu thudng gia dinh va cdng ddng dam nhiem Tuy vdy, tiong Chuang tiinh Hdnh ddng qudc gia vl NCT Viet Nam giai doan 2012 - 2020, da de hoat ddng "Chii dpng chudn bj eho tudi gid", ttong cd eac chi dan cy the nhu sau: "Cdc thdnh vien ttong gia dinh chu dgng tim hiiu vi tdm ly vd nhiing nguyin vgng chinh ddng cua ngudi cao tudi; hgc hdi ky ndng chdm sdc nguai cao 84 Mgt sd chieu cgnh cua h? thong chinh sdch ludi" Them vao dd, cd the quan sdt thay nhung boat ddng trp giiip/tu vdn nhu vdy qua cdc phuong tien truyen thdng dai chiing (vdi cdc chuong trinh ddnh ri6ng cho NCT), hay qua hogt dpng eua ede cdu lac bd eua Hpi NCT cdc cap 3.3 Vai tro cua cdc quan he xa hgi vd mgng lu&i xd hpi cua NCT Gia dinh, ddng hp va edng ddng Id nhihig thiet chi xa hdi quan trpng, hinh nSn mpt mgng ludi xd hpi, cd the mang den cho NCT nhimg siie manh tinh than to Idn, nhdt la hg gap khd khan, dau dm Ddy cung Id thiet che - chu thi cham sde NCT ed nhieu tiem nang hd ttp ve tdm ly - tinh thdn md cac chinh sdch TGXH cho NCT hien chua khai thdc hieu qud Gia dinh NCT, nhu Luat NCT quy dinh '''^cd trdch nhiem chd yiu ph^ing dudng NCT' (Dieu 5, khoan 3) ciing dupe the hien ttong mpt sd dgo luat khde, ttong dd da cu the hda trdch nhiem dgo diie ndy eua eon vd chdu ddi vdi NCT Nhieu NCT, phy thudc ve kinh te nen cdn sy chdm sdc, ho trp ve vat chdt tir chdu Song hp ciing ludn mudn dupe quan tdm ve tinh thdn, tdm ly, tinh edm Chang hgn, khdo sdt ciia Trung tdm nghien cihi NCT thudc ViSn Khoa hpc Xa hpi Quang Ddng (Trung Qudc) nam 2010 vdi 1.300 NCT cho thdy: 48% NCT mong dug'c cdi vi thdm Idn/tudn, 28% mong dupe cai ve tham I lan/thang vd 24% ehi hy vpng dupe cdi ve tham Idn/ndm 75% ngudi cao tudi mong mudn eon cdi hd tra cha m? ve mat tinh edm, tinh thdn nhiiu han (Zhang Yuehen, 2010 - dan lai tii Le Ngpe Lan, 2012) Dang tiee la, cimg vdi qud trinh cdng nghiep hda vd hi?n dgi hda, the he cdi dang cd xu hudng thdp gid tri vd nhu cdu ndy cua NCT, vd thay the vdo dd la cdc ho ttp thudn tiiy hien vdt hay tiln Ve vai trd cua thiet che cdng ddng, cac chinh sdch TGXH hien cd dl cap nhung khd md nhgt, khdng cd eac quy dinh rd rang hay cdc hoat dpng cu thi Mpt sd dl an nhu "Tu vdn va Cham sdc siie khde NCT dya vao cdng ddng", "Ho trp chdm sdc ddi sdng van hda tinh thdn ddi vdi NCT", hay md hinh "Cdu lac bd thi he giiip nhau" thi thudng mang tinh phong trao ban la nhiing dinh ehi chinh sdeh Mpt so de xuat khuyen nghi 4.1 NSng cao tinh he thdng, todn di§n vd ddy dii ciia cdc chinh sdch Hp thdng ede nhdm chinh sdch can dupe can ddi lai theo cdc chii thi chdm sdc khac Ngodi chii the nha nude, cdn khai thac cdc ngudn lye tilm ndng eua thi trudng, eua gia dinh vd cdng ddng Nhu vdy se giiip chia se ttdch nhiem vdi nha nude, ndng cao tinh todn dipn vd da dgng cua cdc hinh thiic chdm sdc, bdo ddm tinh hieu qua, chdt luong cao va tinh bin viing cho toan bd he thdng chinh sdch Can cd them nhieu chinh sach "tao diiu kien", gian tiep hd tip eho cae nhdm NCT Chang ban, tgo diiu kien phdt tiiln ede loai hinh cham sdc da dgng theo nhu cau ciia NCT, tiep tuc h5 trp cho viec hinh vd phdt triin cdc eo sd bdo tip xd hpi cho NCT nhu la cac doanh nghiep xd hgi, theo tinh thdn Nghi quyit TU* 15: "Ddy mgnh xg hgi hda, khuyin khich su tham gia cua khu vuc tu nhdn vdo triin khai ede md hinh chdm soe NCT\ 4.2, Thm nhin tdi 2020,2030 cua h$ thong chinh sdch BQ thich ling vdi cdc xu hudng gia hda dan sd, dinh hudng "chdm sdc", hoan thien he thdng an sinh xa hdi, xu hudng xd hpi hda, chinh sdch TGXH/Cham sdc NCT cdn phai Trinh Duy Ludn 85 mang tinh chii ddng cao hon, cd tdm nhin va Ip trinh ddi han hon so vdi hien Viee can ddi, ehia se ttdch nhiem vd sy tham gia giiia ede ehu the cham sde, dgc biet khu vuc tu nhdn, se giiip ttanh su qud tdi cho khu vye nha nude, ndng eao tinh tu chu tu chdm soc ciia NCT Ciing qua dd, tao diiu kien ket hpp siic manh eua eae gia tri truyen thdng nhu Idng hieu thdo ciia chdu (dang dupe tri bode bien the) vdi su TGXH cua nhd nude (vdn ed ngudn luc ban che), vd cdc dich vu ciia thi trudng (rdt phong phii va theo sat nhu cdu da dang eiia NCT) 4.3 Nhu eau tich hap ehinh sdch Nhin ehung, TGXH cho NCT ede ehinh sdeh hien cd cdn don gidn vd nhd le, Igi bi phdn tan d cae bp, nganh Nhu edu tich hpp ehinh sdeh, vi vay, thudng xuyen dupe ddt d cae dia phuang, nhdt la d cdp co sd, noi phdi tiep nhdn vd trien khai thue hien vd so cac che dp ehinh sdeh eho nhieu ddi tupng, nhieu ITnh vyc, tiong ngudn lye cdn bp rat han ehe Nhu mpt gpi y, he thdng chinh sach TGXH cho NCT cd the tich hpp tten nhdm chinh sdeh sau: - Mpt hodc mdt gdi chinh sdch tich hpp nhiiu (thdm chi tdt cd) cdc che dp TGXH tryc tiep (thudc nhieu ITnh vue) bangtien/hien vdt eho NCT - Gdi chinh sdch cho cdc TGXH phi tien te hodc vat chat (hd ttp tinh than, tinh cam, tgo diiu kien, co hdi ) - nhdm khuyen khich, tgo dieu kien cho sy tham gia eua ede chu thi truyin tiidng tiong chdm sdc NCT nhu: gia dinh, ddng hp, cdng ddng, mang ludi xd hdi, sy ehu dpng - ty an sinh ciia NCT - Gdi cae ehinh sdch cu thi nhdm khuyen khich, tgo dieu kien cho eae doanh nghiep, khu vue tu nhdn, hpp tac cdng tu, doanh nghiep xd hpi ITnh vyc chdm sdc vd tip giup NCT 4.4 Nang cao vai tro cua quan he xd hpi vd mgng ludi xa hpi cua NCT D I bao ddm tinh todn dien, ben viing vd tinh nhdn van cua ede ehinh sach TGXH cho NCT, cdn chii y nhiiu hon den nhung nhu cdu ve tdm ly, tinh cam cua NCT Tang cudng cac chinh sdeh tao diiu kien boat ddng truyin thdng, qua ede phuang tien truyin thdng dai chung (cac chuong ttinh ddnh cho NCT), hay hogt ddng cua ede CLB cua Hdi NCT Viet Nam Ngoai vife quy dinh ttach nhiem chii yiu ciia gia dinh tiong viec cham sde NCT, eac chinh sdeh cdn phdi tao diiu kien thuan Ipi cho viee trl vd cung cd moi quan h$ xd hpi tich cue, ddng vien ho trp NCT ttong cupc sdng hdng ngdy d cpng ddng Cdn cd them cdc quy dinh vd cae boat ddng eu the, mang tinh dinh che cao han ITnh vuc ndy, ciing nhu can cd them nhieu sdng kiin chinh sdch nhdm tdng cudng vai ttd va ddng gdp eua gia dinh va cpng ddng ttong cham sdc NCT tai cac dja phuong Tai lieu tham khao Chuang trinh Hanh dpng Quoc gia v^ Ngu&i cao tuoi Viet Nam giai doan 2012 - 2020 Giang Thanh Long 2010 "Toward an Agjng Population: Mapping the Reform Process in the Public Deliveiy of Social Protection Services in Vietnam" Background paper for the 2010 Vietnam Human Development report (YNHTS) Hanoi: VASS and UNDP 86 Mgt so chieu cgnh cua he thdng chinh sdch Le NgQC l^n 2012 Mdi quan he giiia ngudi cao tudi vd chdu gia dinh Vi4t Nam - Nhung vdn cdn quan tdm Vien Gia dinh \k Gicri Nghi dinh s6 06/201 l/ND-CP ngky 14/01/2011 ciia Chinh phii quy djnh chi ti6t VEI hudng din thi h^h m^t s6 di£u ciia Lu$t ngufri cao tuoi Nghj djnh s6 67/2007/ND-CP 13/4/2007 ciia Chinh phii ve chinh sach trp giiip cdc d6i tuong bao tn? xa hgi Nghi dinh s6 13/2010/ND-CP sua d6i, b6 sung mot s6 dik ciia Nghi dinh s6 67/2007/ND-CP ngky 13/4/2007 ciia Chinh phd ve chinh sach trg giiip c^c d6i tugng bao trg xS hOiNghi dinh so 136/2013/ND-CP ciia Chinh phii quy dinh chinh sdch trg giijp x3 h^i d6i vdi doi tugng bao trg x3 hgi Nghj quygt lan thii Hgi nghi BCH TU' ICh6a 11 Mgt so van de v^ chinh sdch xk h^i giai doan 2012-2020 {01 thdng 06 ndm 2012) Ochiai, Emiko 2009 "Care Diamonds and Welfare Regimes in East and South-East Asian Societies: Bridging Family and Welfare Sociology." International Journal ofJapanese Sociology No 18 Patchrawalai Wongboonsin, Patapom Sukontamam 2014 "Elderly and Child care: Family or State Responsibility?" Paper at Intenational Seminar on Care Relations in South East Asia Chulalongkom Univerisity, Bangkok, Thai Land Qu6c Hgi 2009 Lu^it NguM cao tuoi s6 39/2009/QH12 Qu6c Hgi 2000 Lu^t Hon nhan v^ Gia dinh s6 22/2000/QHlO Thong tu 21/2011/TT - BTC ciia BO Tdi chinh Quy dinh qu^ ly vd sii dyng kinh phi chdm soc sue khoS ban dau cho nguin cao tuli tgi ncri cu tni; chiic thg, mimg thg vd bilu ducmg, khen thudng ngudi cao tudi Thdng tu 127/2011/TT-BTC Bg Tdi chinh Quy dinh miic thu phi thdm quan di tich vdn hoa, ljch sd, bdo tdng, danh lam thdng canh dii vdi ngudi cao tu6i Thdng tu 35/2011/TT - BYT Bg Y te Hudng dan thuc hien chdm sdc siic khde ngudi cao tudi Thdng tu 71/201 l/TT - BOTVT Bg Giao thong Van tai Quy djnh ve hd trg Ngudi cao tudi tham gia giao thdng cdng c^ng Thdng tu 08/2009/TT - BNV cua Bg nOi vy Hudng dan vifc thdnh Idp Ban cdng tdc Ngudi cao tuoi Tinh, Thdnh tryc thugc trung uong UNFPA 2011 Gid hda ddn sd vd ngudi cao tudi d Vi^t Nam: Thyc trang, du bdo vd m^t so khuyin nghj chinh sdch  ... quan di tich; chi phi chiic tho, ravmg tho, mai tang dugc ap dung cho moi NCT Nhom chinh sach TGXH co diiu kien, danh rieng cho bp phan NCT vai nhtag diSu ki$n nhit dinh NCT v6n thuoc nhom xS... nude, ndng cao tinh todn dipn vd da dgng cua cdc hinh thiic chdm sdc, bdo ddm tinh hieu qua, chdt luong cao va tinh bin viing cho toan bd he thdng chinh sdch Can cd them nhieu chinh sach "tao diiu... ddnh cho NCT), hay hogt ddng cua ede CLB cua Hdi NCT Viet Nam Ngoai vife quy dinh ttach nhiem chii yiu ciia gia dinh tiong viec cham sde NCT, eac chinh sdeh cdn phdi tao diiu kien thuan Ipi cho