Xa hpi hpc s6 (127), 2014 43 M O T S O Y E U T O A N H HLTCiNG DEN CO HOI TIEP CAN DICH VU CHAM SOC SlTC KHOE CUA NGLTOI NGHfeo Ci VIET NAM HIEN NAY NGUYEN DINH TUAN' Ngheo ddi dugc coi la mdt nhiing rao can Idn lam giam kha nang phat triin ngudi cua moi qudc gia hay moi cdng ddng Ngudi ngheo thudng khdng cd diiu kien tiip can diy dii c^c dich vu xS hdi nhu viec lam, giao due, cham sdc siic khde (CSSK) va dieu dd lam hp it cd ca hpi thoat khdi tinh trang ngheo ddi Vi vay, md rdng co hdi lira chpn va nSng cao nang li^c cho ngudi ngheo la each tdt nhat giiip cho cdng tac xoa ddi g i ^ ngheo mang tinh bin vung Diiu dugc Ajab (2006) khing dinh la: mudn xoa bd ngheo doi, dudng diing nhat va nhanh nhat chinh la phai md rdng co hdi lua chpn cho mpi ngudi ciing nhu nang cao nang lire dS mpi ngudi nim bit dugc cac co hpi Md rdng co hdi va nSng cao nang lire lira chpn cho ngudi ciing chinh la quan diim phat trien ngudi cua Chuong trinh Phat trien Lien Hgp Qudc (UNDP) (2011) Trong dd, md rpng co hdi cd nghia la md rpng khdng gian lira chpn cho mdi ngudi dl hp cd thi tiip c|in vdi tri thiic (giao due), tinh trang dmh duong (luong thuc, thuc phim) va dich vu CSSK (y te), cd sinh ke dn dinh (kinh te), dugc bao dam an toan khdi tdi pham va bao lire, dugc nghi ngai phii hgp, cd tu chinh tri, vSn hda va quyen dugc tham gia, ddng gdp vao tao d\mg mdi trudng sinh sdng Cdn nang cao nang lire cho ngudi ve smh thi (siic khde) va ve tinh than (kien thiic, ky nang) dugc coi la dieu kien can tiuet de nhiing ca hdi hien thuc Khi cd nang luc, ngudi se cd nhieu co hdi de lira chpn hon cupc sdng va doi tii nang lire dd se tao nh&ng co hdi mdi de ngudi cd nhieu co hpi de lua chpn hon Vi?t Nam da cd nh&ng chinh sach va nd luc gdp phan md rdng co hdi lua chon va nang cao nang luc cho ngudi ngheo Song cho den nay, ngudi ngheo vin gap phai khdng it khd khan viec tiep c?in vdi cac djch vu xa hdi, cd dich vu CSSK Bao cao chinh tri cua Ban Chap hanh Trung uong Dang khoa X (2011) tai Dai hdi dai bilu toan qudc lin thii XI ciia Dang ciing da chi ra: "Chdt luong cong tdc bdo ve, cham sdc sire khoe cdn thdp, he thong y ti vd chat luong djch vu y te chua ddp img duoc yiu cdu khdm, chua binh ciia nhdn ddn, nhdt Id ddi vai ngudi ngheo, ddng bdo vung sdu, vung xa, viing ddn tdc thiiu sS" Nhung han che da va dang cd anh hudng khdng nhd din kha nang phat triin bin vimg ngudi d nude ta Bao cao Phat triin ngudi nam 2011 (UNDP) cung cho thiy, tudi thp binh quan d Viet Nam nhiing nam gin day dang cd xu hudng tang ch|m nhiiu yiu td, dd cd sir bat binh ding co hpi tiip can dich ' TS, Vi?n Nghien ciru Con nguai 44 Mgt sd yeu td anh hudng din ccr hgi tiep can vu CSSK giua eae nhdm mure sdng, giOa cae vimg midn De nang cao tudi thp, hudng ddn muc tieu phat tridn bdn vOng eon ngudi thi viee md rdng co hoi tiep can dich vii CSSK eho ngudi dan, nhit la ddi vdi ngudi ngheo la bdt sire e&i thiet Dua tren so lieu da cdng bd, bai vidt tong bop va phan tich mot vai yeu td ca ban anh hudng den co hoi tidp can dich vu CSSK eua ngudi ngheo d Viet Nam hien Chi phi kham ch&a benh qu4 cao so vdi miic thu nhap Mot nhiing vin dd c3n quan tam linh vue y te d Viet Nam hien la ve chi phi kham ehOa bdnh Theo Td chiie Y te Thd gidi {2iD00), ndu ehi phi y tl tir tidn tui' cua ho gia dinh bang hoac Idn hon 40% kha nang chi tra eua hd gia dmh (la pbSn thu nhap cdn lai eua ho gia dmh sau da ehi eho luong thuc thve phim) thi dd la chi phi y td tham hoa DiSu ciing gdp phan gay tmh Urang ngheo hda, chi tra true tiep cho y te ^ cho kha nang ehi cho cac khoan thiet yeu eiia hd gia dinh bi giam xudng dudi nguong ngheo ddi Hinh 1: Ty 1? cac nguk t i i chinh y te tir 1999-2010 aChltCrti^tljIhO gia dinh 2010 2009 2007 200! 2006 200S ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ B 2003 i ^ H ; ^ ^ K 2004 Zm ^ ^ B ^ ^ ^ ^ ^ ^ ^ B i ^ f c » » J BNgansAchdla ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ phuong ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ aNgfln sdch Hung 2002 H H W H H H H H 2001 90K SO% 70% 60K SOK 40W 30K 20W iVguon.BoYte, 2013 O Viet Nam Men nay, ngudn tai chinh cdng (chil ydu la ngan sach nha nude va bao hiSm y te) chi chiem ty nhd so vdi ngudn tai chinh tu (chi tra true tiep tir tiSn tiii eua ngudi benh) cdng tac kham chira benh Theo Bao cao tdng quan nganh y td nam 2013 (Bd Y t8, 2013:105), ehi phi tir tidn tiii eua hd gia dmh cho viec kham chua benh ehidm trdn 50% tdng ehi eua toan xa hdi eho y te Ty le mae dii da giam mSy nam gin day nhung vin eao hon dang kS so vdi mile 30 - 40% duoc Td chile Y td Thd gidi khuydn cao (WHO, 2009) T^ 1$ khdng chi cao hon kha nhiiu so vdi miic tnmg bmh eua thi gidi nam 2007 (54,8% so vdi 17,7%) ma eon cao hon ea eac nude thu nh^p trung bmh thip (54,8% so vdi 52,1%) Chi phi tir ti^n tui cho y te cua hp gia dinh thuOc nhdm chi hr (private expendinire) cho y te, tiic li chi trvc trfp cua timg hO ^ia dhihriSngbi$t, ph(i thu^c vio jdia n5ng chi tra cua hO gia dinh, khong c6 sv chia se nil ro nhu cSc nguon chi c6ng (public expenditure) - nguon a i chinh tir chi tri tnrdc da dirijc tip hgp thinh quy (Ngan sich nhi nude, quf BHYT, bio hilm xi hpi ) Ngoai cic khoan chi tri cho y te tir tiin nil cua hp gia dinh, chi tu gom cac Idioan chi cho BHYT tu nhan, cac khoin tii trp ciia c4c xh chiic xi hpi, tu Ihien vi cic khoin chi tri true tiip ciia chi sir dyng lao dpng cho cic dich vy y tl Nguyen Dinh Tudn 45 Mac du ngudi ngheo d nude ta da dugc cip miin phi the bao hilm y te, song tren thuc te, muc chi cho y te d nhdm ngheo nhung nam qua vin cao va cd xu hudng tang Bang cho thiy, miic chi phi cho y tl va CSSK cua nhdm ngheo va can ngheo tit nam 2004 din nam 2010 tang len gip hon 2,7 lin, nhdm giau tang len 2,1 lin Muc chi tieu cho y tl giua nhdm giau nhit vdi nhdm ngheo nhit nam 2010 chenh gap 3,6 Ian Bang 1: Chi phi binh quan nhan khlu/th^ngt^ tiln tiii cua ngvtin dSn cho y ti \h CSSK Vi^t Nam, 2004 - 2010 Dan vi: VND Nam Nhom ngh^o nhit 2004 2006 2008 2010 11.000 13.800 24.000 30.700 45.200 Nh6in gan ngheo nhat 16.300 19.500 31.600 Nhom trung binh 20.200 25.800 38.600 53.800 Nh6m gin giau nhit 27.900 34.200 54.500 68.900 Nhom giau nhat 51.100 53.500 77.200 110.400 Nguon: Tong cue Thong ke, 2011: 224-225 Ben cgnh do, ty I? chi tieu cho y te tdng thu nhap ciing cd su chSnh lech dang ke giira cac nhdm mure sdng Theo sd lieu cua Tdng cue Thdng ke (2011), nhdm ngheo nhat chi tieu binh quan dau ngudi cho y te va cham sdc siie khde so vdi thu nhap la 8,3%, cdn nhdm giau nhat la 3,2% So sanh ty le chi tieu cua cac hd gia dinh nam 2010 cho thay, nhdm can ngheo va nhdm ngheo cd ty IS chi cho y te la 6,3% va 6,2%, cao hon so vdi nhdm giau nhat (4,8%) BSng 2% T^ 1^ ngh£o h6a chi phi y te o^ Vi^t Nam Mm Nhdm kinh te 2002 2004 2006 2008 2010 Nghfeo nhat 4,6 6,2 5,1 7,5 5,4 C^n nghfeo 11,1 12,1 9,0 8,6 6,0 Trung binh 1,0 2,2 1,0 1,5 0,7 Khi 0,4 0,2 0,3 0,1 0,4 Giiu nhat 0,1 0,0 0,2 0,0 0,1 Nguon: Hodng Vdn Minh vd cong su, 2012 46 Mgt so yeu lo dnh hudng den ca hoi tiep can Khi miic chi tra cho djch vu y tl cua ngudi ngheo chiem mpt ty I? cao se dan din tinh trang ngudi dan roi vao "ngheo hda" Dieu cd nghia la vdi vi?c phai chi tra cho y te cao nhu hien nay, thi ngudi ngheo khd thoat khdi tinh tr^g ngheo ddi neu nhu gia dinh cd ngudi phai diiu tri ndi tni Nhan dinh ciing da dugc dua nghien ciiu ciia Hoang Van Minh va cdng su (2012) Sd lieu bang cho thay, mSc dii ty le ngheo hda ehi phi y tl cua nhdm ngheo va