Xây dựng và hoàn thiện hệ thống an sinh xã hội ở nước ta trong điều kiện hiện nay.pdf

I \ ^% TAP CHI KHOA HOC SO (26) 2012 XAY DUKG VA HOAN THIEN HE THONG AN SINH XA HQI ^\ NirOC TA TRONG DitU KIEN HIEN NAY ThS Phgm Thi Hdng' ThS Trinh Vumig Cu&ng' TOM TAT Tmng nhirng ndm qua, Ddng vd Nbd nu&c la ddc biil quan tdm phdt triin he thdng an sinh xd bgi (ASXH) coi ddy vdn de trung ldm chiin luac phdt triin ddt nu&c Sau han 25 ndm ttdi m&i he thong ASXH ngdy cdng hodn thien vd co dong gop quan trgng vdo viec on dinb vd phdt trien kinh ti-xd hgi, nhirng vdn eon tdn lgi nbieu hgn che Trong phgm vi bdi viel ndy, tdc gid lap trung dl vdo phdn lieh ldm rd cdu trite, chuc ndng, nhiim vu nhung the chi bdt huge vd nguyin tdc hogt dgng cua hi thong ASXH lir phdn lich thuc trgng ddnh gid uu diem, hgn che nguyen nhdn vd nhirng thdeh thirc dang ddt ddi vdi qud trinh xdy dung vd hodn tlii^n hi thdng ASXH a inr&c ta, Tren ca s& do, di xtldt mgt so gidi phdp ca bdn nhdm ndng eao chdt lucrng, hiiu qud hoal dgng cda hi thdng ASXH & nu&c ta thai ki' ddy mgnh cdng ngbiep hoa hien dgi boa vd hgi nhdp quoc ti Tir kh6a: An sinh xa hdi, bao hiem xa hgi, bao hidm y le, uu dai xa hdi, trg cap xa hgi, nii ro ABSTRACT Over the past yean, the State and Party have paid special attention lo developing the social security system, considering this as a central factor m the de^ elupment process ofthe countiy During the 25-year development process, the social securttv system has been gradually finalised, making significiint coniribution to the national socio-economic stabilisation and development However, the system still shows its weakness In ihe article, the author focuses on analysing structure, function, tasks as well as compulsoiy institutions and operation principles ofthe social security system This helps analyse the situation and assess strong points, weakness, causes and challenges Jdr the process of building and completing the country's social security This also helps to promote some solutions to boost quality and operaiicm effectiveness ofthe social security system in the industrilisalion, modernisation and global integration process Keywords: Social security, social insurance, health insurance, social pret"erences, social benefit, risk L NHAN THLTC CHUNG CUA DANG TA VE HE THONG ASXH Hidn phap nam 1946 ciia nudc Viet Nam Dan chti Cgng hoa da ghi nhan cac quyen ciia ngudi dan dugc hudng bao hiem xa hdi C6 thd coi ddla ddu mdc quan ddu tidn cua lich'su hinh ndn ASXH cua dat nudc Qua cac giai doan phat trien, nhdt Id tir thyc hicn cdng cudc ddi mdi dat nudc, he thdng chti tmong, chinh 'Bdo Dan tn S6 (nhd 48) Gidng Vo Qugn Ddng Da Hd Noi 'Khoa Van hoa vd Phdi men Hpe vign Chinh trj- Hank chinh khu vift I CHINH TRI - GlAO D(JC - XA HO! sach the hicn cac van ban phap quy ve ASXH Iudn dugc bd sung, hoan thien, den Dai hgi XL dugc nang len tam cao mdi, vdi nhung diem mdi loan dien hon ve ndi dung bao dam ASXH dd chi rd nhiing quan diem, djnh hudng ldn vdi nhieu ndi dung mdi, thuan lgi cho viec cu the hda, td chuc thuc hidn thdi gian tdi: "Tiep tuc sira ddi, hoan thidn he thong bao hiem xa hgi, bdo hidm y te, bao hiem thdl nghiep, trg giup va ciiu trg xa hgi da dang, Iinh hoat, cd kha nang bao ve, giiip dd mgi vien xa hgi, nhdt la cdc nhdm yeu the, de bi tdn thuong, vugt qua khd khan hoac cdc nii ro ddi sdng Tang ty le ngudi lao dgng tham gia cac hinh thiic bao hiem Day manh xa hgi hda djch vy bao hiem xa hdi, chuyen cdc loai hinh trg giiip, ctiu trg sang cung cdp djch vy bao ug xa hgi dua vao cgng ddng Bao dam cho cac ddi tugng bao trg xa hgi cd cugc sdng on dinh hoa-nhap tdt han vao cgng ddng, cd co hgi tiep cdn ngudn lyc kinh te, dich vu cdng thiet yeu Thanh tra, kiem tra, xu ly nghidm cac vi pham phap luat bao hiem xa hdi, bao dam thyc hien diing, day du che quy dinh ddi vdi mgi ddi tugng, "^ Budc tien quan trgng dudng Idi phat trien, hoan thi?n ASXH giai doan each mang mdi dugc Dang ta khdng dinh; "Tao budc tien rd ret ve thyc hien lien bd va cdng bang xa hdi, bao dam an sinh xa hdi, gidm ty le hd ngheo; cai thi^n didu kien cham soc siic khoe nhan dan"^ Bdo dam ASXH trd van de tmng tam chien luge phat trien dat nudc, bdi vi viec cham Io, khdng ngiing nang cao ddi sdng vdt chat vd tinh than ciia nhan dan la muc lieu cao nhat cua sy nghi?p xay dyng xa hdi XHCN d Viet Nam Va hi?n nay, chiing ta dang phdn ddu den nam 2020 he thong ASXH se bao phu khap loan dan CAU TRUC CUA Hf TH6NG ASXH •He thdng ASXH d nudc la dugc hieu Id mdt he thdng cac co che, chinh sach, giai phap cdng nham trg giup mgi vien xa hgi ddi phd vdi nhiing nii ro, hiem nguy cac nguyen nhdn kinh te, xa hgi vd mdi trudng ty nhidn mang den cho ngudi, nham gidra thieu nhung hau qua, ddm bao sy an loan ddi vdi cugc sdng ciia hg va su phdt tridn ben viing ciia xa hgi Chinh sdch ASXH Id mgt chinh sdch xa hdi co ban ciia Nha nudc nham thyc hien chiic nang phdng ngua, han che vd khac phuc riii ro bao dam an todn thu nhdp vd cugc sdng cho cac vien xa hgi He thong ASXH dugc tao dianh tnrdc het lir cdc chucmg trinh vd chinh sdch bdo hiem xd hgi vdi nhiem vu huy dgng sy tich gdp mgt phan thu nhap ciia cac vien xa hgi liic binh thudng de danh chi tidu gap khd khan, nii ro, nhu bi that nghiep; tai nan lao dgng, nghe nghiep; dm dau, gid yeu khdng cdn kha nang lao dgng v.v Vi vay, bao hiem xa hgi bao gdm ca bao hiem y te, bao hiem ngudi (nhan thg), bao hidm nii ro tai nan lao ddng (bdo hiem nghe nghidp), bdo hiem that nghiep va mdt sd hinh thiic bao hiem khac nham dam bao cho ngudi cd dugc mgt cudc sdng an toan theo nghe nghiep chuyen mdn hay theo nhung hinh thiic lao ddng minh da lua chgn Hai id, chucmg trinh vd chinh sdch uu ddi xd hdi Day Id hinh thuc bao dam cudc song ciia nhung ngudi da cd cdng vdi each mang cdc cugc khang chien trudc day, nhu cdc thuang binh, gia dinh liet st, cac me Vi?t Nam anh hung, gmp hg CO muc sdng it nhat tren trung binh so vdi mtic sdng chung ciia todn xa hgi Cdng hien cua hg vi Igi ich chung can 'Ddng cpng sdn Kfl Nam poil) Van kipt Dgi hot dgt biiu lodn qudclSn Ihii XI Nxb CTQG, Ild Vot ir;jX-:y 'Ddng C^ig'dn K^lNam Sdd, tr}:i TAP CHI KHOA HQC SO (26) 2012 phdi dugc ghi nhan va den dap mdt cdch thda dang va hg hoan toan xung dang dugc hudng dieu dd Ba la, chuang irinh vd chinh sdch trg cap xd hdi Dd ta nhiing chinh sach nham U-g giup nhung ngudi yeu the va de hi tdn thuang xa hdi, nhu ngudi tan tat, cd dan, tre em md cdi, tang thang co nho; u g cdp cho nhung ngudi lam viec irong mdi trudng dgc hai hay nguy hiem; trg cap thai san cho phu nO uong thdi gian sinh theo qui dinh: trg cap dao tao nghe cho nhirng ngudi dac biet khd khan; ug cap cho nhflng ngudi nhirng viing hi thien tei tdn pha dich bdnh hoanh hanh Bdn la chuong trinh vd chinh sdch tirang trg ua hot vd aru te xd hgi nham muc tidu quan trgng nhat la xda ddj giam ngheo, Giai phdng ngudi khdi ddi ngheo la mdt nhung ndi dung quan trgng va thiet thyc nhdt ciia ASXH Trong cac chfnh sach tuong trg xa hdi vd ciiu te xa hot Nha nudc vdi tu cdch ngudi quan 1^ se tao didu kien cho ngudi ngheo, nhiing ngudi gap nii ro bat hanh xd hgi cd ca hdi tiep c ^ binh dang ddi vdi nhung ngudn luc phat trien %a dich vy xa hgi nhu dugc vay vdn de lam an, dugc hudng cdc quyen Igi ve cham sdc sue khde, giao due dao lao de hg ty vuon ldn thoat ddi ngheo bang chinh siic luc cila minh Cac chuang trinh va chinh sdch he thdng ASXH cd mdi quan he gan bd eh^t che vdi gidng nhu nhung Idp tudng rao nhieu tdng nhidu Idp bao vd cac thdnh vien xa hgi khdng dc hg roi vdo tinh canh ban ciing hda ngheo khd va tuyet vgng CHUC NANG VA NHIEM VU CUA HE THONG ASXH phucmg dien tdng the he tiidng ASXr I cd chu'e nang co bdn la quan Iy va ddi phd vdi nii ro bao gdm ba ndc: Thir nhdt phdng ngira rui ro Day la lang tren cimg cua he thdng chirc nang ASXH cua nhflng chinh sach ndy la hudng tdi can thiep va bao phii todn bg dan cu; giiip cho mgi tang ldp dan cu cd dugc viec lam, thu nhap, cd dugc nang luc vat chat cdn thiet de ddi phd tdt nhat vdi nii ro Try cdt co ban ciia tang la nhirng chrnh sdch chuang trinh ve tht trudng lao dgng tich cyc nhu dao t^o n ^ e ; hd trg ngudi tim vi^c, ty tao vi?c lam hoac dao tao nang cao k^ nang cho ngudi lao dgng Thu hai gidm thiiu rui ro Day la tang thu hai, gdm cac chien luge giam thieu thiel hai nii ro cua he thdng ASXH, cd vai trd ddc bidt quan trgng Ndi dung quan Irgng nhat tang la cac hinh thiic bao hidm, dua tren nguyen tac ddng - hudng nhu: bdo hiem x3 hgi, bdo hiem y te, bao hiem that nghiep, v.v Nhdm chinh sach rat nhay cam ndu phii hgp se thiic ddy sy tham gia tich cyc ciia ngudi dan, tiet kicm ngudn lyc cho Nha nudc tang bao phii he thdng Ngugc lgi, neu chinh sdch khdng phu hgp ngudi dan sd khdng tham gia ho^c chinh sach se bj lam dung Tliu ba khdcphuc ruiro, bao gom cac chinh sach, chuang trinh ve ciiu trg va trg giiip xa hdi Day la tang cudi cung cua h^ thdng ASXH vdi chiic nang bdo dam an todn cho cac vien xa hgi hg gdp phai nii ro ma ban than khdng tir khdc phuc dugc nhu: thdt nghiep, ngudi thidu viec lam, ngudi cd thu nhap thap, ngudi gia, ngudi tan tdt, ue em md cdi, ngudi ngheo Ben canh nhirng chiic nang ca bdn dd, ASXH la mgt nhflng cdng cu qudn ly Nhd nudc thdng qua he thdng ludt phap, cac chinh sach va cdc chuong trinh quan trgng cda mdt (Judc gia nhdm muc ticu giii gin su dn dinh chinh tri, xd hdi ciia Dat nudc sy an loan cho ddi sdng cua ngudi bau khdng dan chu, binh dang giffa ngudi vdi ngudi hinh ddng vd gidi; xda ddi giam ngheo xoa bd sy phan hda giau ngheo su phdn tang xd hgi; CHINH TR! - GIAO DUC - XA HOI tir dd, tao sy ddng thuan cgng ddng tidn den thyc hien cdng bang xa hgi Dudi su id chuc, quan ly vd dieu hanh ciia Nha nudc he thdng ASXH cd nhiing nhiem vu sau day: Mgt la, dieti hda cdc mdu ihudn xd hgi da, dang va cd thd xdy bdng each xtr ly vd han chd cac nguyen nhan ldm sinh mau thudn, bdt dn eiia xd hdi; I iai la, ap dung cdc giai phap nham diiu liei phdn phoi lgi thu nhgp, dieu tiet sy phdn phdi lai gifla cdc khu vyc kinh Id, cac viing kinh te giua cac nhdm ddn cu: tfl dd, lam giam su bat binh dang giua cac VLing, midn, gifla cac vien xa hdi; Ba Id, diiu tiei phdn phdi lgi cua cdi xd hgi cdn ddi dieu chinh cdc ngudn luc (vdn khoa hgc cdng nghe ngudn nhan l u c ) nham tang cudng cho cac vung sdu, viing xa cdn ngheo khd chdm phat trien, til dd, tao ndn su phat trien hai hda giu'a cac vimg khac nudc, giam ddn su chenh lech gifla cac vung khdng chi vd kinh te md cd ve ddi sdng ciia ngudi dan; Bdn la he thdng ASXH phdi lien tuc m& rdng cdc ddi tugng llwm gia vdo cdc logi bdo hiem: bao hiem xd hgi, bao hiem y te bao hidm that nghiep md rdng chinh sach trg giup cac ddi tugng bao trg xa hgi nham lam giam bdi sy bat binh ddng giiia cac nhdm ddn cu Thyc hien lot cac nhiem vu tren day tiic la he thdng ASXH da hodn dugc cfic chiic nang phong ngua giam thieu va khdc phuc rui ro He thdng ASXH cang hoan thidn, cdng cd nhieu kha ndng lam trdn nhi?m vu vd chirc ndng cua minh Vdi mdt h? Ihdng ASXH lot sd co tac dgng manh me vd lich cue thiic day kinh Id phat tridn nhanh hon ben viing ban nhat la thdi ky hgi nhap kinh id nhu hien he thdng ASXtl cdng ddng v ^ tro to ldn hon ddi vdi sy phat tridn ciia Ddt nudc tnrdc het la phat trien kinh le Vi rdng, cdc nha ddu lu nudc va dac biet la cdc nhd ddu tu nudc ngoai dau lu vao phat uidn kinh td hg khdng chi chii y den cdc yeu td kinh td ma cdn rat quan tam den cdc yeu td xa hdi nhu su dn dinh, an ninh ASXH Ngodi cac yeu td kinh te, mgt xa hot dn dinh, an sinh tdt se la CO sd quan trgng giiip cho cac nha dau tiT yen tdm ddu tu phat trien lau dai, lam cho nen kinh te ldng trudng nhanh, lien luc vd ngugc lai Mgt dieu quan trgng niia 11 ban than sy phat trien ctia he thdng ASXH hidn dai cung la mgt ITnh vyc dich vu "'cd thu" nhu ITnh vuc bao hiem y te, bao hiem xd hOi bao hiem that nghiep dieu sc tao them ngudn tdi chinh gdp phdn vdo phat uien kinh td dat nudc Nhidm vu chinh vd quan trgng nhal ciia hd thdng ASXH la hudng den su dn dinh xd hdi Khi tham gia vao he thdng ASXH, moi vien xa hgi deu cd nghta va quyen lgi Trong cugc sdng khdng ludn gdp may man vd cflng khdngai Iudn g^priii ro, nhung thirdng ihl bat hanh hay ddn vdi nhQng ngudi ngheo vung ngheo nhung ngudi yeu the xa hgi, md da gap riii ro hg khd ed the tir vugt qua dugc bang ngudn tai chfnh eo hep ciia minh He thdng cac chinh sach ASXH se giiip cho mgi ngudi cung biet chia se trach nhiem xa hgi dc giam thidu vd khdc phuc cac nii ro nhflng vien xa hdi chang may gap rui ro; tu dd lao sy dn djnh, dong thuan xa hgi va dd la nen tang dd thyc hien binh ddng va cdng bing xa hdi n^n tang de phat trien kinh le - xa hdi ben vflng NHLTNG THE CHE BAT BUQC VA NGUYEN TAC HOAT DQNG CUA Hf T H N G ASXH D^ xay dung mgt he tliong ASXH hoat dgng mgt each cd hicu qua can phai tuan ihu nghidm chinh cac the che co ban sau: Mdt la, the.chi chinh sdch - can phai xac dinh ddi tugng tham gia ddi tugng didu chinh doi vdi cac loai vien khae xa hgi, vdi nhflng tieu chi cu the: xdc dtnh cac chd hudng ihu va nhung didu kien rang bugc; xac djnh trach nhiem ciia cac can bd nganh, dia phirong viec 102 TAP CHI KHOA HOC S (26) 2012 thuc hien chinh sdch Hai la, the chi tdi chinh - la the che quan trgng nhat cua he thdng ASXH Nhiem vu cu thd cua the chd tai chinh cua he thong ASXH la phai xac djnh dugc ca che tgo ngudn tdi chinh (cu thd la sy ddng gdp cua cac ddi tirgng tham gia, cua ngudi sii dung Iao dgng va cua Nha nudc); ca ehe qudn ly, sir dung nguon [di chinh; ca chi chi trd hgp ly Ba la, the cbe ve to chuc qudn ly vd cdn bg chuyin trdeh Phdi thidt lap mgt he thdng td chiic quan ly vdi dpi ngu can bg cd uinh chuyen mdn, nghiep \'u phu trach vice didu hanh he ihdng ASXH He thdng td chiic quan ly cd the dugc thidt lap cho timg trudng hgp cua ASXH hoac cung cd flid su dung ludn bg may chinh quydn hien cd dd thuc hien cdng vide nay, theo dieu kidn cu the cua timg qude gia, timg vung lanh thd, tirng dia phuong Tuy nhidn, dudi gdc quan ly nha nudc thi chi nen de mdt co quan, mgi he thdng td chuc quan Jy la phu hgp nhat dgng, trg cap cho tre em md coi, trg cap cho ngudi gia khdng noi nuong tua, cuu td xa hgi trudng hgp nii ro dot xuat De cd the thyc hien dugc cac the che cua he thdng cdc chinh sach ASXH can phai tuan thii theo cac nguyen tac co bdn sau day: Thii nhat: Hu&ng tai '"bao phii" mgi thdnh vien xd hgi vdo hi thdng ASXH Thii hai: Phdi ddm bdo tinh bin virng ve ldi chinh Thu ba: Phdi bdo dam on dinh ve the che to chuc qudn ly Thii tu: Nhd nu&c phdi id ngu&i bdo trg cho hi ihong ASXH hogt dgng co hieu qud vd dung phdp lugt5 V £ K E T QUA T H ^ C HIEN ASXH VA NHU'NG THACH T H C C DANG DAT RA DOI V(]n QUA TRINH X A Y DlTNG HE T H O N G ASXH HIEU QUA VIET NAM HIEN NAY * Vi thdnh tuu Thyc hidn dudng ldi Ddi mdi, hon 25 nam qua, cdng tac bao dam ASXH Trong ba the che tren, the cbe tdi d nudc ta da dat dugc nhieu ket qua quan chinh Id quan nhdt vi la co sd vat trgng He thdng ASXH cang ddng chat ciia sy tdn tai va phat tridn ben viing bd va hoan thien vdi dien bao phit khong cua he thdng ASXH Neu the che tai chinh ngimg dugc md rgng Ddi sdng vat chat vd khdng dugc thuc hien mgt each nghiem tinh thdn ciia nhan dan khong ngimg dugc minh, chat che minh bach hoac bi xam cai thien ASXH da trd cho dua viing hai thi he thdng ASXH cflng khdng the chac cho ngudi nghdo va ddi tugng dc hi tdn tai, cho du the che chinh sach va ihd tdn thuang xa hgi, gdp phan hinh che ve td chuc quan ly van Ngay xa hgi khdng cdn nhdm xa hdi bi the chd tai chfnh ciing ton tai nhidu loai trii va bao dam djnh hudng xd hdi chii CO che boat ddng, each thuc van hanh khac nghTa ciia sy phat trien dai nudc cd the che tai chinh van hanh theo co Ve mgi the ehe, nhung nam chd "co dong gdp cd hudng" (cd chi, tra), doi mdi vira qua, Dang va Nha nudc ta da miic huong phu thugc vao muc ddng gdp, hoach dinh vd tridn khai nhidu chinh sach chang han nhu bao hiem xa hgi; hoac c6 ASXH quan trgng, the hien uong cac van CO che "sd ddng bu sd it" hay "mgi ngudi ban phap luat vc ASXH kha day dii, ndu vi mgt ngudi va mdt ngudi vi mgi ngudi" bidu la Luat Bao hidm xa hgi va Luat Bao nhu bao hiem y te bao hiem that nghiep liiem y te, lao co sd phap ly \arng ehdc cho Cijng cd loai the che cd hudng nhung sy van hanh ciia he thdng ASXH, va chinh khdng cd ddng gdp, iniic hucmg khdng didu da huy dgng dugc nhieu ngudn phu thugc vao miic ddng gop ma chi phy [yc ciia loan xd hgi de u g giup cho cac thugc vao thu nhap nhu trg cap xa hgi cho ddi lugng (ngudi dan tdc thieu so, ngudi nhung ngudi tan tat ndng mdt kha nang Iao ngheo, ngudi gid cd don, tre em va cac ddi CHINH TRj - GIAO Dt^C - XA HQ! tugng de bj tdn ihucmg) w o n len Uong cugc sdng Cac chfnh sach vd giai phdp bdo dam ASXH dugc tridn khai ddng bg uen ca phuong dien: Giup cdc ddi tirgng thu huong tang kha nang liep can cac dich \'u cdng cgng nhdt Id vd y te gido due, day nghd trg giup phap Iy nhd d : hd Ugphat trien sdn xudt thdng qua cdc chfnh sach ve bao ddm thi irudng tin dung, vide lam; phdt trien ket cdu tdng thidt ydu cho cac dia phuang phuc vy ngudi dan tdt hon 103 thidn Miic trg cap un ddi ndm 2010 tang 2.2 ldn so vdi nam 2006 Thuc hien chfnh sach uu dai thudng xuyen cho hon 1,4 tri^u ngudi cd cdng Ddn hon 90% gia dinh ngudi CO cdng cd miic song bang hoac cao hon miic trung binh cua dan cu cung dia bdn Cdc chinh sdch tra giup xahgi {ihuimg xuydn va dot xuat) dugc thyc hien rgng hon ca ve quy md va ddi tugng thy hudng vdi miic trg giup cang tdng Kinh phi irg giiip thudng xuydn tir ngan sdch nha nudc va sd ngudi dugc thy hudng lang nhanh, tu 113 ti ddng cho hon 180 nghin ngudi (nam 2001) lang ldn 4.500 ti ddng cho hon 1,6 tridu ngudi (nam 2010) Hang nam Nha nudc cdn u g cap dot xudt hdng nghin ti ddng va hang chuc nghin ldn luong thyc thude men, chu ydu de trg giiip khdc phuc thidn lai dn dinh cugc sdng Cac phong trao "Tuong than, tuong ai", "Quy vi ngudi ngheo" "Den on dap nghta", '"Udng nudc nhd ngudn" dugc to chiic thudng xuyen va thu hiit sy hudng ling cda nhieu lyc Iugng xa hdi, dong gdp dang kc vdo viec nang cao ASXH cho mgi ngudi, nhat Id nhirng ngudi ngheo, vung ngheo Ngoai Nha nude dd khdng ngimg tang ddu lu cho phdt trien cac dich vu co ban bao gdm giao dye y le nhd d nudc sach va thdng tin truydn thdng ddc biet uu tien cho ngudi ngheo, ddng hdo dan tgc ihieu sd thugc cac huyen ngheo cac xa dac biet khd khan, lao ddng ndng thdn Iao dgng khu vuc phi chinh thiic va cac ddi tugng ydu the khdc Den cdng lac bao dam ASXH dd dat dugc nhidu tuu ndi bat, dugc nhan dan ddng tinh, qude td danh gia cao: bd hg ngheo giam lu 29% (nam 2002) xudng cdn 9,5% (ndm 2011): chi sd phat trien ngudi (I IDI) tang tur miic 0.683 (nam 200m ien miic 0,728 (nam 2011) xdp thu 128/187 nudc thugc nhdm trung binh cao ciia the gidi; nam 2011 nudc ta da hoan thdnh 6.8 nhdm Muc lieu phat tridn Thidn nien ky (MDGs) Licn hgp qude dc cho cac nudc dang phdt trien dcn.nam 2015 He thdng bdo hiim xd hgi dugc quan tdm phat trien vdi ndi dung va hinh thiic nga\ cang phong phu nhdm chia se nii ro va trg giiip thiet thirc cho nhflng ngudi tham gia Bdo hidm xa hgi dugc trien khai ddng bg vdi loai hinh la; bao hiem bat huge (bao hiem xa hgi va bao hiem y te) hao hidm ly nguyen va bao hidm that nghidp Sd ngudi tham gia bao hidm bdt bugc tang nhanh, tir 4.8 tridu (nam 2001) len 9.7 uidu (nam 2011) Sau gdn nam tridn khai bao hidm xa hdi ty nguyen, den ndm 2010 cd khodng * Hgn che, nguyen nhdn vd tiiach thitc 96.6 nghin ngutri tham gia Nam 2011 cd Den cdng tdc bao ddm ASXH d khoang 7.6 tridu ngudi tham gia bdo hiem thdt nghidp Bao hiem y id tang nhanh tir nudc ta vdn cdn nhieu han che: 13,4% dan sd (ndm 2000) Idn khoang 62% Cdng tac tao vide Iam chua ben vCrng (nam 2010) Dac bidt da thyc hidn chinh ty le that nghidp d khu vuc ndng thdn co sdch hao hidm y tc midn phf cho tre cm xu hudng tang tir 1.05% nam 2000 len dudi tudi mot sd ddi tugng chfnh sach 2,7% nam 2011 Chuydn djch co cdu lao ngudi ngheo vd hd trg bao hidm y id cho dgng cdn cham, nam 2010 lao dgng ndng cac hg can nghdo, nghidp vdn chiem 50% tdng so lao ddng d He thdng chinh sdch iru ddi ddi \di vung ddn tgc thieu so ty le la Ircn 92% ngudi cd cdng klidng ngimg dugc hoan Gidm ngheo chua ben vung ngudi ddn o TAP CHi KHOA HOC S6 (26) 2012 vimg dan ldc thieu so vung sau, vimg xa cdn nhidu khd khan, phan hda gidu ngheo, phan hda giiia cac vimg mien co xu hudng md rdng Ty le tham gia bao hidm xa hgi cdn thap, mdi chi bdng 20% lyc lugng Iao ddng (nam 2011) Theo Bao cao ciia Vdn phdng BHXH, tfnh ddn 31/3/2012, so ngudi tham gia BHXH BHYT bat bugc la to trieu ngudi, Uong cd gan trieu ngu'di tham gia BHTN, giam hon 16 nghin ngudi so vdi thdng 02/2012 Ngudn lyc de thyc hicn ASXH cdn ban che, chu yeu dya vao ngan sach nha nudc, vdi dien bao phii va muc ho trg thap, chua theo kip vdi su phat tridn ciia nen kinh te thi truong dinh hudng XHCN Kha nang cdn ddi giiia ngudn va su dyng cua h? thdng ASXH ke ca cac quy bdo hiem xa hgi, bao hiem y te vd cac che bao trg xa hgi han che va g^p thach thuc Idn cd trudc mat, cung nhu trung va ddi han Cac quy bao hidm xa hpi, dilc biet la quy bao hiem y te d linh trang bao ddng tucmg Iai gan Ngudn lyc dau tu cho ASXH ciia Nha nudc khd dap ung dugc yeu cau ASXH cang tang cua ngudi dan, dd huy dpng tir cac ngudn khac, dac biet bi cgng ddng cdn han chd, nhat la vung ndng thdn Cac hinh thiic bao hiem chua dap iing dugc nhu cau da dang ciia ngudi ddn; chdt lugng cac djch vu nhin chung cdn thap, van xay khong it tieu cyc, phidn hd Mgt so chinh sach ASXH cdn tdn tai nhung bat hgp ly chua c6 cac chinh sach dac thu va phu hgp vdi dan cu ndng thdn va cac vung dan tdc, mien nui co dieu kidn sdng khd khan Chdt lugng cung cap cac dich vu y te cdn ban che, chua ddp ling yeu cau phat irien kinh le - xa hgi va sy gia lang miic sdng ciia dan cu He thdng hanh chinh, sy nghiep cung cap djch vu ASXH chua theo kip yeu cdu phat trien, cdn han che nang luc to chiic va quan ly ddi vdi cac loai hinh ASXH quan quan ly cac cap va mdt bg phdn can bg, dang vien, td chiic, doanh nghidp va ngudi dan chua diing va chua ddy du; nang lyc xay dyng chinh sach ASXH cdn han che, viec td chiic thyc hien d cac cdp, nhat la cap CO sd cdn nhieu bat cap, sy phoi hgp, long ghep cac nguon lyc thyc hidn cac chinh sach thdp; muc xa hgi hda chua dii, chua huy dgng dugc sy tham gia manh me ciia cgng dong xa hdi vao vide thuc hidn cac chinh sach ASXH; vifC khuyen khfch va tao dieu kien de ngudi dan m an sinh cdn han che; vide tdng ket, danh gia de dieu chinh cac chugng uinh ASXH cdn cham ue; he thdng van ban phap iudi chua day du va chua hoan thien; cong tac tra, kiem tra, giam sal, xti ly vi pham cac quy dinh ve ASXH chua thudng xuyen; ddi ngii can bg lam cdng tac ASXH cdn thieu ve sd lugng va yeu ve tfnh chuyen nghiep; su phdi hgp giiia nganh chu qudn vdi cac co quan quaji ly nha nudc va cac dia phuong chua chg.t che Tat ca nhiing ban che tren da dat he thdng ASXH cua nudc ta trudc nhieu thach thirc ldn can phdi tiep tuc dugc nghien Cliu, hoan chinh chinh sach de vugt qua, cu the la: Thir nhdt: He thdng chinh sach, Iuat phap ve ASXH theo md hinh hien khdng theo kip vdi ddi hdi ciia nen KTTT dinh hudng XHCN va xu hudng hgi nhap quoc te Thir hai: Ciing vdi sy phat trien thi cac nguy co, nii ro kinh le va xa hdi ngdy cang cd xu hudng tang La nudc dang phat trien lai cd dac diem dia - ty nhien, dia - kinh te dac thu nen Viet Nam rdt dd gap phai nii ro, anh hudng den sinh ke va thu nhap Thti ba: Hidn tugng gia hda dan sd cung dat nhieu khd khan cho he thdng ASXH hi?n hanh va tirong Iai Theo udc linh cua Uy ban quoc gia Ngudi cao tudi, ty le ngudi cao tudi d Vi?t Nam se Nguyin nhdn cua nhieng ton tgi, hgnla 16% vdo nam 2020 va tiep nic gia tang ehe: Nhan thiic ve vai trd cua ASXH cua co nhirng nam sau CHfNH TRI - GIAO DIJC - XA H O I 105 lieu chu yeu den nam 2020 trd nudc cd muc sdng trung binh cao cua the gidi: thyc hien BHYT todn dan: ty le hg ngheo gidm binh quan % - 3%.'nain; phiic lgi, ASXH va cham sdc sue khoe cgng ddng dugc bao dam; thu nhap thyc te ciia ddn cu gap khoang 3.5 ldn so vdi nam 2010: thu hep khoang each thu nh^ip giiia cac viing va nhdm ddn cu Ro rdng de dat dugc nhung mye tidu dd tu bay gid chung ta phai khdn truang xaj' dyng hoan thien he didng ASXI1 hidn hdnh Day chinh la nhimg thach thiic dat ra, ddi hdi chung ta phai tang Thic nam: Cac nii ro kinh td, xd hdi cudng ho?t dgng nghien cim va dao tao vd tren toan cau ngdy cang da dang, phuc tap ASXH gdp phan cung cap co sd ly luan va va cd didn anh hudng rgng Tac dgng tidu thyc lidn chinh xdc cho qua trinh hoach dinh cue cua nhirng cii sdc khd ludng uudc ru chinh sdch ASXH giai dogn lidp theo ben ngdcft den quoc ke ddn sinh ngdy cang N H I T N G G I A I PHAP TRONG nhanh va manh Trong dd chung ta Iai TAM DE OOI M , HOAN THIEN HE chua cd nhidu kinh nghiem phdng ehdng THONG ASXH nii ro irong bdi canh toan cau hda va cdn Thir nhat, thdng nhdt vd tirng budc han che ve ngudn lyc gianh cho cac hoat ndng cao mirc ASXH Irong todn xd hdi ddng phdng chdng nil ro Thir tin Miic hudng Igi tii tang trudng kinh td giu'a cac nhdm ddn cu cdn nhieu bdt cap nhat la vdi nhdm ngudi ngheo, ngudi dan tgc it ngudi sdng d \-ung sau, viing xa He thong dich vu xa hgi chua hieu qud Cdc chinh sdch thi trudng lao ddng, chtnh sdch BHXH trg giiip xa hdi cd pham vi bao phu cdn thap Miic ddng, miic hudng BHXH cdn chua hgp ly chua dam bdo ddi sdng cho cac nhdm ddi tugng thy hudng Muc ben vung vc tai chinh tinh lien ket giua cac chd do, chinh sach ASXH cdn nhieu bat cgp Thir sdu: Cic nhdm yeu the ngd)' cang trd nen jeu the va de bj tdn thuong hon han che vd kha nang canh tranh ve phdng ngiia nii ro tren thuong irudng, Cac ddng di chuydn vide Iam, di chuyen lao dgng tu ndng thdn dd thi, lu viing sang viing khac, tu nudc nudc ngoai va ngugc Iai dien vdi cudng cang manh Xu hudng ndy tgo dp lire viec ddm bdo quyin vd ca hgi liep cgn cac djch vu xa hgi co ban quyen thu hudng cac chinh sach an sinh cua ngudi dan nhal la cac nhdm ddi tugng de bi tdn thuong Trong Chien luge ASXH thai ky201! - 2020, Dang va Nha nudc la lidp luc coi bao dam ASXH la mdt nhidm vy chii yeu thudng xuyen vdi quan diem "idng tru&ng kinh le kit hgp hdi hod vdi lien bd vd cdng bdng xa hdi, ndng coo khdng ngirng ehdt luang cudc sdng cua nhdn ddn phdi Irien hf thdng ASXH da dgng ngdy cdng ma rang vd hi?u qud" Muc Nhanh chdng thdng nhdt cac che dg hao hiem xa hdi khac danh cho ddi tugng khdc nhu can bg cdng chiic vien chiic va ngudi lao ddng ngoai nha nudc lao ddng ndng thdn mdt chd dd chung nham xda hd sy khac biet giua cdc khu vyc, cac ddi tugng thu hudng bao hidm De thyc hien muc tidu can giai quyet hai vdn dd chti yeu sau: (I) Chinh quyen cac cap phai chii dgng didu cht'nh thich hgp vd lgi ich dd hudng tdi hinh thdnh chd ASXH thdng nhdt pham vi ca nudc; (2) Sau thuc hi?n che ASXH thdng nhat phdi bao dam miic thy hudng ASXH vdn kha cao d khu vyc nha nudc khongbi cat giam Thir hai, iru lien phdi trien sir nghiep ASXH nong than vd cho ngir&i lao dgng ngodi khu virc nhd nir&c Ve xay dung che he thdng ASXI I ndng thdn va cho ngudi lao ddng ngoai doanh nghiep Nha nudc gdm ba ndi dung chii yeu; Mgt Id chd bao hiem xa hgi TAP CH! KHOA HOC SO (26) 2012 cdng ddng nham bao dam miic sdng tdi thieu, bao dam ddi sdng co ban cua ngudi cd thu nhap thap Hai Id chd y te cdng ddng, nham gidi quydl van dc kham, chua benh Ba la chd bao hiem huu ui nham bao ddm cugc sdng cho ngudi cao tudi Hien nay, chd bao dam mirc sdng tdi thieu da dugc xay dtmg, budc tiep theo la md rdng dien bao phu, dap irng ydu cdu cua da sd nhan ddn Ddng thdi thu hep khoang each giiia muc bao ddm ddi sdng ldi thieu d thi vd ndng thdn, giua ngudi Iao dgng khu vyc nha nudc va ngudi lao dgng d khu \arc nguai nha nudc Thit ba, xdy dirng be thdng hdo hiim huu tri nbieu ldng vd nhieu tru cot Dd iing phd vdi tinh trang gia hda ddn sd loan cau, Bao cao "Phdng chdng nguy CO gid hda: chinh sach bdo vd ngudi cao tudi va thiic day tdng tmong" cua Ngan hang The gidi ndm 2005 da de chd bao dam dudng ldo nhicu tdng bac Viet Nam cd the tham khao chd bao dam dudng lao de xay dyng he thdng.ASXH nhicu tang Dc chu ddng irng phd vdi tinh irang gia hda dan sd cCing vdi bidn phap neu trdn, cd the xem xdt dicu chinh tudi nghi huu \ a thdi han ddng bao hicm Can thuc hidn nghiem tudi nghi huu dc giam sd ngudi nghi huu trudc tudi, nang tudi nghi hini ddi vdi mgt sd nganh nghd, hnh vyc nhdt dinh Thir tu; rdi cdch dc'ing hd, giai quvil cdc vdn de hue xiic ve y li Sd di vdn de kham chfla bdnh khd va dat tdn lai dai ddng mgt phan Id vl nhan thuc chua day dti vd linh dac thu ciia dich \u y te Phuimg thuc cai each chd dp bao hiem y te tir trudc den la day benh vien TB thj trudng, day trach nhiem huy ddng vdn cua bao hidm cho ca nhan ngudi Iham gia bao hicm Dd tien hanh cai each y tc cdng can nhdn thirc dung ban chat, linh dac biel ciia dich \ u y tc Khac vdi cdc loai hang hda Ihdng thudng, dich vii y tc cd ba dac tnmg: \4dt id khd xac dinh dugc nhu cau Khdng al cd the bidt bao gid bj dm, mac benh gi Hai Id thdng tin khdng can ddi Dich vy y td la dich vu chuydn mdn chuyen nganh, giua bac sT va bdnh nhdn thong tin khdng can ddi, giiia cac bdc si cung thudng cd y kien khac ddi vdi each chua benh Ba Id tinh nii ro Idn Mdi ngudi chl sdng mgt ldn qua Irinh sdng khdng the dao ngugc, khd cd the dmh gid sue khoe cua ngudi Do tinh dac thu nhu vay cua djch vu y le, ndn thi trudng khdng the phat huy vai trd nhu ddi vdi cac loai hang hda thdng thudng Vi vay, vai trd ciia Nha nudc Uong quan ly gid ca, chat lugng dich vu, tbudc chiia benh bao dam viec cung cdp dich vu y td cho ngudi dan la dac bipt quan trgng Giai phap then chdt dc giai quyet vdn de kham chiia benh khd va dat la thiic ddy cai each the did quan ly y te khdi phuc tinh cdng ich cua cdc ca so kham, chiia benh trgng dicm la cai each inang Iudi co sd kham, chu-a bdnh cdng Diem then chdt Irong cai each co sd khdm chua bdnh cdng la bao dam tinh cdng fch cua benh vien coi trgng kicm soat gia ca va nang cao chat Iugng dich vu Dc khuyen khich bdnh vien va bdc -sT, chi dua vao dao dire nghe nghiep la khdng du, ma cdn phai xay dyng che khuydn khich, bao dam bdc si cd dai ngd lot Minh bach hda thu nhdp ciia bac st, phan anh diing gia tri cua bac st, ddng thdi tang cudng giam sat quan ly xu ly nghidm nhung hdnh vi irai quy dinh Thu- nam, tiep tue tlurc hiin xda ddi, giam ngheo biu viTng Hoan thien he thdng vdn ban phdp ludt vd CO che chinh sdch hen quan den cdng tac xda ddi, giam ngheo Tang cudng giao due luyen truyen de ngudi nghdo ndng cao nhan thiic vd hoan cdnh va cd quydt tam thoat ngheo Thudng xuydn xay dung, tridn khai thyc hicn cac du dn va cac chuong trinh hanh ddng ve cdng tac CHINH TRj - GIAO DIJC - XA HOI xda ddi, giam ngheo Cac doanh nghiep cd chinh sdch day nghd vd lao vide lain dn djnh cho ngudi nghdo Cd co chd bien phap kidm tra, giam sat bao ddm mgi ngudn lyc danh cho xda ddi gidm ngheo dugc su dung dung mye dich FAH- sdu, ddy manh cdng tac tmcn truyen bien phdp luat, nang cao nhan thiic cda todn xd hgi vd vj tri \ai trd lain quan trpng ciia ASXH ddi vdi sy phat tridn ben vung dat nudc O day, can nang cao nhdn thuc khdng chi ciia cac cap iiy dang, cdc cap chinh quydn, ma cdn cua cdc id chiic chinh tri - xa hdi, ctia chii sii dyng iao dgng va ban than ngudi lao dgng, cac lang ldp dan cu xa hgi ve vai trd, vi tri cua ASXH De thyc hien giai phdp nay, cdng ldc giao duc;idao tao, cac phuong lien iru\en thdng dai chung cd vai trd dac biet quan Irgng Trong dd, can lidp luc bien, gidi thieu cdc chfnh sach chuong trinh ASXH dang trien khai, ldng cudng cdng tac thdng tin truyen thdng ve ASXH, chii trgng den ngudi ddn, nhdt la cdc hd ngheo, xa ngheo huyen ngheo vd day manh cac phong trao cac cugc van ddng xa hdi nhu: "Ngdy vi ngu&i ngheo" "Tirang thdn tuang di", "Xdy dirng nhd linb nghTa " Thvr bdy, xay dyng va hoan thien he thdng phdp lual vd ASXH mdt each ddng bd dwig thdi quyel liet dua cac van bdn phap luat vao cudc sdng loan thien co chd chfnh sach phap Iuat bd sung, siia ddi he thdng hda cac van ban phdp lual hien cd Ircn CO sd ke thua va phdt iridn chlnh sach bao dam ASXH hidn hdnh xem xet dieu ki?n kinh td - xa hgi va tham khao kinh nghiem eiia cac nudc Can bao dam linh ddng bd gifla cac che ASXH trdnh chdng chco, mau thuan biio dam dc mgi ngudi dan ddu cd quyen hudng ASXH Tao co chd dc thyc ihi nghidnichinhAacdhicuquaeacchedd chinh sdch ASXH tren thyc Id Thir tdm lang cudng su Ianh dao ciia Dang, sy quan ly cua Nhd nudc dac biet ia ciia he thdng chinh tri cdp co sd ddi vdi 107 cdng ldc bao ddm ASXH Cu the hda cac muc tieu ASXH dugc de cac nghj quydt, chuong trinh kd hoach nhidm vy hang nam cua cac cap uy dang va phdt huy siic manh ciia ca he thdng chinh tri, tao sy ddng thudn cua loan xa hgi vi^c thyc hien cac chuong trinh chinh sach ASXH Tang cudng quan ly nhd nudc ve ASXH soat, danh gia loan didn cac chinh sach ASXH hien hanh ticp luc \i^c xdy dung he thdng phdp luat chuang trinh kd hoach thyc hidn ASXH Chinh quyen cdp CO so cac chu the hoal dgng san xual kinh doanh thyc hien cac van ban phdp luat cac chuong trinh ke hoach ASXI I Tang cudng sy kiem tra giam sal cua td chuc CO sd dang, cdc id chuc chinh irj - xa hgi, cac ihict che ty quan cua nhan ddn ddi vdi vide thyc hidn phdp ludt chuang trinh ke hoach ASXH Tang cudng sd lugng va chat lugng ddi ngu chuyen mdn nghi?p \'y va can su xa hdi Xdy dyng chinh sach khuydn khich khu vyc iigoai nha nude tham gia cung cap cac dich vu xa hdi ca ban ddng thdi hien dai hda edng lac quan l> ddi lugng ASXH KET LUAN Xay dyng va hoan thien he thdng ASXH tir vide xac djnh cac hgp phan co ban chirc nang nhiem \ u den cac the che va nguyen lac eo ban Id vd ciing khd khan, phiic tap va lau dai Tuy nhidn day )a viec Idm rat can thict boi nudc ta dung hinh nin kinh td thi trudng md da Id kinh te thi trudng thi phai cd canh tranh khoe liet ngudi dugc, ke mat nen nii ro khdn ludng Hon nfla nudc ta d3 bat ddu qua trinh hdi nhap toan cdu ve kinh Id tham gia vao WTO "Cai dugc" lliam gia vao WTO cung nhicu nhat Id vd mat kinh te nhung "cai mat" '*cai nii ro'" cung lam Nguai nhung rui ro lu kinh le, xa hdi, ngudi cdn phai chiu nhicu nii ro, tdn thai thien tai, vl nhflng didu kidn tu nhidn cang tro ndn khac nghiet ban Do vav dc on dinh TAP CHI KHOA H O C SO (26) 2012 xa hdi tao ca sd, lao da cho tang trudng tfch cue thuc hidn hai nhidm vy chien kinh td kdt hgp vdi thyc hien cdng bang luge xay dung va bao vd vu'ng chac Td xa hdi thi viec xay dyng va hoan thien quoc Viet Nam xa hdi chu nghTa vi muc he thdng ASXH la ddi hdi cap thidt va tidu dan giau nudc manh dan chii cdng quan trgng hon bao gid het dd ddng gdp bang, vdn minh TAt LIEU THAM KHAO Mac Tien Anh (2005), Ban chdt vd linh ldt yeu khdch quan cda an sinh xa hgi Tap chi Bao hidm xa hgi sd 2 Dam HO'u Ddc (2009), I7el Nam dang hirang den he thong ASXH ndng dgng vd bieu qud Tap chi Cgng s ^ , sd 13 Mai Nggc Cudng (2009) Xdy dung va hodn thien he thdng chinh sdch an sinh xd hgi & Viel Nam Nxb CTQG Ha Ngi Mai Nggc Cudng (2009) Xdy dirng vd hodn thien h^ thong chinh sdch an sinh xd hgi a Viet Nam, NXB CTQG Ha Ngi Pham Thr-Nggc Trdm (2009), Xdy dimg vd hodn thien he thdng an sinh xd hgi - mat cdng ci,i quan trgng nhdm thuc bien cong bdng xd hgi & nu&c ta Tap chi Triel hgc so 12(223) Nguyen Hflu Dung (2010) He thdng chinh sdch an sinh xd hgi & Viet Nam: Thuc trgng vd dinh hu&ng phdt iriin Tap chi Khoa hgc DHCXJHN, sd 26 Nguyen Trgng Dam (2010) Hi thong chinh sdch an sinh xa hgi nu&c la tmng giai dognphdl frien m&i Tap chi Lao dgng va xa hgi, sd 376