Thông tin tài liệu
CONG B A N G XA HOI TRONG CHAM SOC SLKC KHOfi N H A N DAN »AO VAN DUNG PHAM GIA CUCiNG " Tdm tit: Chita luge phat triin kinh tl xa hpi giai doan 2011 - 2020 dl cao quan diem phat triin va ttag trudng torn dien, cu tbi "tang ttutag kinh tl phai ket hgp hai hda vdi phat trita vta boa, thuc hita tiln bp va cong bing xa hpi, khdng ngimg ntag cao chit lugng cudc sflng cua nhta dta"''' Cham sdc sire khde la nhu cau va quyta ciia mpi ngudi dta va day ctag la mgt nhttng chuc nang xa hgi cfla nha nude Cdng bang xa hgi vl sue khde xa hgi la mgt tita chi dtah gia sue khde dta sfl cua quoc gia Viec xac dinh dugc cong btag xS bgi cham sdc sire khde se cung cap nhiing ca sd khoa hgc va thyc tita cho viec xay dyng va trita khai cac chinh sach, ehucmg trinb y tl dap tag nhu cau cham sdc sue Ichde nhta dan Hon the nua, cdng btag xa hgi dugc xac djnh la mgt muc deu trung tam cua cac chinh sach phat trita cia qudc gia Tir khda: Cdng btag xa bgi; cham sdc sire khde; ehita luge phat trita; ngudi dta; y te Khai niem cong bang xa hgi dan cd Igi the ve kinh te, xa hdi va it bi tdn thuong hon cham sdc sij-c khde Cflng bang xa hgi cham sdc siic Cd nhieu quan niem khac ve cflng bang cham sdc sttc khfle khde cd nghia la cd nhu ciu nhita thi each tiep can va muc dich khac Ci duac cham sdc nhita hem, chju thiet mdi quflc gia va d tttng giai dogn phat thdi (ve kinh te, xa hdi) phai dugc quan triin cflng cd nhftng quan niem khac tam nhieu ban, cdng bang khflng cd vl cflng bing xa hfli ndi chung va nghia la cao bang hay ngang bang'^' cong bang xa hgi cham sdc sttc Dfli vdi nhflng cflng dflng dan cu cd khde ndi rieng Viet Nam la mflt nude dieu kien kinh te, van hda, xa hpi khac nhdm cac nude thu nhap trung nhau, theo eac vflng dja Iy khac binh thap, ngufln lyc hgn che Do vgy, dl thyc hien myc tieu cflng bang xa hgi '*' Giao su, tien sT, Ban Tuyen giao Trung uong '"' Thac sT, Ban Tuyen giao Trung uong cham sdc sttc khde, cflng vdi viee '" Dang Cpng san Vipt Nam (2011), Vdn kiin dap ling nhu cau cham sdc sue khde cua Bgi hgi dgi bieu ladn quoc idn thir XI, Nxb mpi ngudi dta thi nhu cau cham sdc sire Chinh trj quIc gia Ha Npi, tr.98 khde cua ngudi dan chju thiet thdi (ve '^' Dam Vilt Cuong (2005), Tiin tdi thuc hiin cdng bdng chdm sdc sue khde nhdn dd kinh tl, xa hgi), dl bj tfln thuang phai Vdn di vd gidi phdp, Nxb Chinh tr; quIc gia dugc quan tam nhita hen so vdi ngudi Ha Npi, tr.32 - 33; 188 75 Tgp chi Khoa hgc xd hdi Viit Nam, so (86) -2015 Thu-c trang cong bSng xa hpi cham sdc sire khde 2.1 Bao pha bdo hiimy li Bao hilm y tl (BHYT) la mgt ttn cgt cfla an sinh xa hgi Theo Tfl chuc Y te thi gidi (WHO), BHYT dugc eoi la cdng cy quan trgng dl dgt duge myc tieu bao phi y tl toan dan Bao hiem cd vai tro dac biet quan ttgng ttong viec ttog doanh thu cho cac co sd cung cap djch vy eham sdc sttc khde, tap trung ngufln tai chinh va dam bao chia se cac rfli ro sue khoe gitta cae vien tham gia chuang trinh BHYT Tgi Viet Nam, BHYT dugc xem la quyln dugc eham sdc sttc khde cfla tit ca mpi ngudi Day cung la mgt cdng cu tao nen su cflng bang xa hpi ttong cham sdc sue khde ngudi dan Cac ngudn lye tai ehinh he thdng BHYT cung cip la ngufln tai chinh cflng va eo vai trd het sue quan ttgng ttong viec dam bao sy cflng btog xa hfli cac ddng Cd the hieu mflt each dan gian rtag, gdp tai chinh cho y te thflng qua he thflng cflng bing eham sdc sttc khde (hay ngan ngtta rfli ro cdn duge gpi la cdng bang y te) la sy BHYT cd the ehi tta hau het cac cham cdng bing phta bd ngudn Iuc eho sdc y te ngi va ngogi tni tgi cac ca sd y ii y te va tiep eta, su dyng djch vy y te nha nude, ngogi tru nhttng djch vu nam dua trta nhu eau cham sdc sttc khde; ttong dien hd ttg cia cac chuong trinh y theo dd, mpi ngudi khdng ke giau, tfl khac nhu HIV/AIDS, cac logi thuflc ngheo va tang Idp xa hpi khae deu men khong nam ttong danh myc dugc nhan duge djch vy cham sdc sttc khoe bao hilm Bg Y te quy djnh, cac djch nhu theo nhu eta; nhung ngudi vy "cao cap" nhu phiu thugt thim my, ngheo ban, sflng d -vflng khd khan hon nha khoa, hogc eai nghien Hien tai, thi nh^n duge sy hfl trg va bao cip cia mpt sd nhdm dfli tugng dugc BHYT ehi Nha nude nhieu han'^'tta khotag 80% tota bg cac chi phi chSm ndi den cflng bang xa hdi cham sdc sue khde nghia la dl cap tdi nhiing djch vy nao duac cung cap va la ngudi tra tiln cho djch vu dd Cflng bing xa hgi cham sdc sue khfle thi hien dudi hai hinh thai: cdng bing theo chieu ngang va cdng bang theo chilu dgc Cflng bang theo chieu ngang: cung cap nhung djch vu y te giflng cho nhttng eflng dflng, ea nhan cd nhu cau eham sdc sttc khde nhu va thu phi nhu dfli vdi nhttng cgng dflng, ca nhan cd kha nang chi tra nhu Cflng btog theo chieu dgc: eung cap nhftng djch vy y tl nhilu hon cho nhirng cgng ddng, ca nhan ed nhu eau cham sdc sttc khde nhita hem (so vdi cflng ddng, ca nhan ed nhu cau cham sdc sue khde it hon); mtte thu phi se phai cao hon vdi nhttng cgng dflng ngudi cd kha nang chi tra cao hon (so vdi cgng dflng ngudi ngheo hen) Bai viet chi de cap den thyc trgng tiep can va su dyng djch vy y te cia ngudi dta 76 '" Bp Y tl (2004), Chi sd theo doi, ddnh gid cdng bdng vd hiiu qud irongy ti, tr.6 - Cdng bdng xd hdi chdm sdc siic khde nhdn sdc y te va ngudi su dung tta phan 20% cdn Igi (mdt sd nhdm dfli tugng khac dugc BHYT chi tta 100% dd la: si quan quta dgi, ngudi cd cdng vdi each mgng, tre em dudi tufli, ngudi ngheo (sip tdi dy kita se cd them cac ddi tugng la: ngudi dta tgc thieu sfl dang sinh sflng tgi vung cd dieu kien kinh tl - xa hgi khd khto, vung cd dilu kien kinh tl - xa hfli dae biet khd khan; than nhan ehi ylu cua nguoi cd cflng vdi each mgng nhu cha dfl, me de, vg hota chflng, cua liet sy, ngudi cd cflng nufli dudng liet sy)'"" Ngudi can ngheo, ngudi dang hudng ttg cap xa hgi hang thtag duge BHYT chi tt-a 95% ngan sach cap mua BHYT) Tuy nhita, mflt sfl tinh cd dp bao phfl BHYT cdn thip, nhu: cdn 18 tinh cd ty le tham gia BHYT dudi 60%), dd cd tinh dudi 50% dan sfl tham gia BHYT (Nam Djnh 49%, Tay Ninh 49%, Kita Giang 48% va Binh Phudc 46%) Nhdm ddi tupng lam cdng an lucmg, eta bd cflng chtte khu vyc cflng, dflng bao dta tpc thieu sfl, ngudi ngheo, tte em dudi tufli, nhdm hiru tri, mit sttc lao ddng, ddi tugng bao trg xa hfli ngta sach nha nude hogc quy bao hiem xa hdi (BHXH) ddng tiln mua BHYT dta dat d mtte rat cao (gin 100%) Tuy nhien, mdt sfl dfli tugng bat Trong K I hogch nam (2011 - 2015) bugc phai tham gia BHYT nhung ty le Ngtah Y te Viet Nam dat muc tieu din dat thip, cu the la: ngudi lao dgng nam 2014 cd 76% dta sfl cd BHYT va cac doanh nghiep dat 54,7% (ttong dd ttag len 80% vao nam 2015 Mtte bao khu vye tu nhan chi dat 20 - 30%); hge phu BHYT la mpt chi sfl quan ttpng ttong sinh, sinh vita (HSSV) mdi dat ty le vi?c dtah gia muc dp bao phi ve dta sfl 80%i (ttong sinh vien d cac trudng eung nhu mtte bao phi tai ehinh ciia trung cip chuyen nghiep, cao ding, dai hpc, dac biet cac trudng tu cd ty le tham cac djch vu cham sdc siic khde Theo Bao cao so 525/BC-UBTVQH13 gia rat thap va vin cdn khotag 5% tte 14 thtag 10 nam 2013 cia Uy ban em dudi tufli chua cd the BHYT), mflt Thudng vu Qudc hfli khda 13 vl Ket qua sfl tinh ng ngan sach hfl trg mua BHYT giam sat viec thyc hign chinh sach, phap cho tte em, hgc sinh Ngudi thudc hd luat vl BHYT giai dogn 2009 - 2012, thi can ngheo duge Nha nude hd trg 50% ty 1? dta s6 tham gia BHYT nam 2012 la kinh phi mua BHYT va tang Ita 70% ttt 66,8% (Btag I) Nhilu tinh ca bta da thang nam 2012 nhung den cudi nam dat dugc BHYT toan dta (Bic Kan gan 2012 chi dat khotag 25%, cd noi ty le 100%, Lai Chau 99%, Ha Giang 96%, chi dat tu - % Nhdm ngudi thudc hg Lao Cai 95%, Hda Binh 93%, San La gia dinh Itoi ndng, lam, ngu va diem 92%, Tuyen Quang 88%, Lgng Son 85%, nghigp cd mtte sflng trung binh theo 16 Thai Nguyen 80%, Kon Tum 85%) Da trinh se tiiam gia BHYT tu nam 2012 s6 cSc tinh dgt gta 100% dta sd tham gia BHYT (do md rgng so doi tuc;mg dugc '^' Luat Sua dii, bl sung mpt so dieu ciia Luat BHYT 77 Tgp chi Khoa hgc xd hgi Viil Nam, sd 1(86) - 2015 tuyin sd tai da ban ehl kha ntog tiep cgn vdi BHYT c6 sy thay dfli mfli trudng sflng, vigc lam Hign nay, viee tota BHYT theo phi dich vy BHYT tra cho ed sd khtai chtta b$nh Cac trudng hgp chuyln-tuyln dugc chip nhgn nlu co sd dang ky khflng du dilu kien de dieu tri cho ngudi btah Nhung nhu vay ed the phat sinh tinh trgng ca sd y te tfly tita quylt djnh dita trj cho ngudi bfltih qua muc eta thilt dl tt-yc lgi BHYT Trong tuong lai, eta cd nhiing phucmg thuc chi tra hgp Iy ban nhu ixk theo nhdm chin dota (DRG) va tra theo djnh suat Khi cac tinh cd ket du quy BHYT thi lgi khflng dugc su dyng va quy dd lai dugc su dyng de toan cho nhung tinh cd tham hyt quy BHYT, ma cac tinh thudng cd dilu kien kinh te xa hdi phat trien hon eac tinh ed kit du quy BHYT Bang 1: Sfl lugng ngudi tham gia BHYT giai doan 2008 - 2012 dugc ngan sach hfl trg 30% kinh phi de mua BHYT, nhtmg ehua triin khai chua xay dyng dugc tieu ehi Mac dfl, da cd khoang 20 tinh hd trg them kinh phi (mflt sfl tinh hfl trg 100%) tir ngta sach dia phuang eho cac dfli tugng thuflc dien eta ngheo tham gia BHYT, nhung ty le tham gia BHYT cia nhdm ty nguyen, hd can ngheo cdn d mtte thip, mflt sd tinh ty le rit thap, dudi 10% Dfli tugng huong trg cap tuat hang thtag tit quy BHXH chua dugc hudng BHYT, chua quy djnh ngufln ddng BHYT eho phy ntt ttong thdi gian nghi tiiai sta dugc hudng BHYT Cdn phfl biln tinh trgng chi 6m ntog hay phat hi?n mac benh nan y, man tinh mdi mua BHYT ty nguyta dl di kham, ehfta benh Viec ngudi dan tham gia BHYT phii theo noi cu tni va dang ky kham ehfta benh ban diu btog BHYT d co sd y tl Nam 2008 2009 2010 2011 2012 Dansd (nghin ngudi) 84.752 85.847 86.950 87.840 91.519 Sfl ngucri tham gia BHYT (nghin nguiri) 35.595 48.589 52.407 57.982 61.135 Ty ip dan sd tham gia (%) 42.0 56,6 60,0 64,9 66,8 Ngudn: Dya theo sd lieu ket qua dilu tta muc sdng hg gia dinh Viet Nam nam 2012 Sfl ligu Ket qua Dieu tra mure sflng hg gia dinh nam 2012 cho thay, tflng sfl ngudi kham, chfta benh thi ty le ngudi ed BHYT hoac sfl kham, chtta benh mien phi d khu vyc nflng thfln, nhdm thu nhap thap thip ban d khu 78 vuc thtah thi, nhdm thu nhap cad Dita ed thi cho biet, ngudi d khu vyc nflng thfln, nhdm thu nhap thip vin ed hgn che tham gia BHYT, mac du da dugc hfl trg tham gia BHYT (Btag 2) Cong bdng xa hgi chdm soc site khoe nhdn d Bang 2: Ty le nguoi c6 BHYT hoac so kham, chfta benh miin phi da kham, chiia benh vong 12 thang qua £>c« v; tinh: % Chi sd Chung Ca nude 39,2 Thtah thi Ndng thdn 40,2 38,7 Nam Nu 34,6 43,6 Ngheo nhat Ngheo Trung binh Giau Gita nhat 35,5 38,3 39,5 39,6 42,9 Trong tflng sd Dieu tri ngoai ttu Dieu trj ngi tni Ty 1$ CO BHYT hoac Ty le cd BHYT Tyle Tylp hoac s6 kham, chua so khtai, chua benh dita tri dita tri mita phi benh mita phi 7,3 4,5 17,6 36,0 Thtah tbi - nong thon 19,1 6,5 4,2 37,8 17,0 35,2 7,7 4,6 Gidi tinh 15,8 6,0 31,7 3,7 19,4 40,1 8,6 5,2 nhom thu nh^p 31,0 20,1 8,3 5,4 16,8 34,8 7,7 4,6 15,9 36,4 4,4 7,6 17,3 37,0 6,6 4,1 18,0 40,6 6,4 3,9 Ngudn: Dya thed sfl ligu ket qua dieu tra muc sdng hg gia dinh Viet Nam nam 2012 Ty IS nam va ntt tham gia BHYT khflng cd sy khac biet, my nhita theo nghita cim thyc hien BHYT doi vdi phy ntt cho thay ty lg tham gia BHYT d nft thip hon nam tgi cac nhdm tham gia theo hinh thuc ca nhan va ty ddng (ty le phu nft/nam gidi tham gia BHYT: h§ cgn ngheo la 0,5/2,38%; hge sinh, sinh vien la 36/50%i, lao dpng doanh nghiep la 24/50% va cac dfli tugng ty nguyta khac 0/9,4%)"' Lugt BHYT xac djnh mflc thdi gian 01 thtag 01 nam 2014 la thdi dilm cae dfli tugng cd trach nhiem tham gia BHYT, nhung hien mdi ehi ed 66,8%i dta so tham gia BHYT Cd sy bit eta doi vl ty le bao phi BHYT giua eae vflng Vin edn mdt ty Ig dfli tugng bit bupc tham gia BHYT chua tham gia BHYT Ngudi d khu vyc nflng thfln, nhdm thu nhSp thap cd ty le tham gia BHYT thip hon d khu vyc thi, nhdm thu nhgp cao Viec thuc hien chinh sach BHYT cdn cd "' Bao cao s6 644/BC - BYT 29 thing nSm 2013 cua Bp Y tl vl ling ghep ydn dl binh ding gidi Dy an Luat sua doi, bo sung mOt si dilu ciia Luat Bao hiem y te 79 Tgp chi Khoa hgc xd hdi Viit Nam sd 1(86) - 2015 nhung bit cap, c6 su lya chpn ngugc tham gia BHYT 2.2 Tiip can va si dung djch vuy ti Ty le ngudi dan d thj cd kham, chfta hgnh nhieu hon d nflng thfln va chi ylu dilu tri ngogi tru Nhdm thu nhgp cang cao thi ty le kham, chfta benh ctag tang va chfl ylu kham, chfta benh ngoai tru Bdi vi, ngudi cd thu nhap cao thudng sdng d thj (noi cung cap djch vy y tl cd chit lugng, di Igi thugn tien) Ngudi cd thu nhap thap sinh sdng chfl ylu d khu vyc nflng thfln, cd benh mdi di kham, chua benh va benh ntag mdi nhap vi?n Sd lieu cflng eho thiy, ty le nft kham, ehfta benh nhieu hem nam gidi va chi yeu la dieu trj ngoai tni Do thyc hien ca ehl ty chu va xa hgi hda djch vy y te nen tgi cae benh vien cflng phat sinh nhung vta de eta phai quan ttai Dd la nhita benh vien hinh khu -vyc khtoi, chfta benh theo yeu ciu, danh 10%i sfl giudng Itai djch vu dl thu phi cao Vi thi, tai cflng mgt khoa hinh thtah ehe dg: ngudi benh bing BHYT vdi - ngudi/giudng va ngudi benh kham, chua bgnh theo yta ciu vdi ngudi/phdng cd day du tien nghi Sy tuong phan cung vdi yeu ciu vl y dttc chua duge eai thien cung gdp phta lam gia tang bat cflng bing ttong cham sdc sttc khoe 2.3 Chi tra phi dich vif cham sdc sire khde cua ngirdi dan Theo sd lieu Ket qua dieu tra muc Bang 3: Ty le ngudi ed kham, chfta sflng gia dinh nam 2012, ngudi d khu benh vdng 12 thang Dan vi tinh: % vyc thj, nhdm thu nhap cao thi cd ty le kham chfta benh ngoai tru cao Trong dd, dieu tri Chisd nhung chi tieu eho y tl, eham sdc sic Chung Ngi tru Ngoai tni khde binh quta nhan khau/thtag lai 7,3 36,0 Ca nude 39,2 ed mtte ehi Idn han muc chi tieu ehung 40,2 6,5 37,8 Thtah thi va cao han khu vyc nong thfln, nhdm Ndng thon 38,7 7,7 35,2 thu nhap thip Dilu cd thi Gidi tinh ngudi d khu vuc thj cd nhieu kha Nam 34,6 6,0 31,7 nSng tiep can vdi djch vu cham sdc sftc Nft 43,6 8,6 40,1 khoe va sii dung thi Igi stt dung nhdm thu nhap djch vu cao, ky thugt va thuflc dit tita 31,0 8,3 35,5 Ngheo nhat Nhu vay, ngudi d khu vyc thtoh thj, nhdm cd thu nhap cao chi cho y t l theo 34,8 7,7 38,3 Ngheo nhu eta cham sdc silc khde, cdn ngudi 36,4 7,6 39,5 Trung binh d khu vyc nong thon, nhom co thu 37,0 6,6 39,6 Giau nh$p thap chi cho y te theo dilu kien 6,4 42,9 40,6 Giau nhat kinh tl, chu khdng theo nhu ciu cham Nguon: Dya theo sfl li?u ket qua dita tra sdc sttc khde muc sflng hp gia dtah Viet Nam n3m 2012 Cong bang xa hdi chdm sdc siic khde nhdn ddn Btag 4: Chi tita y tl va cham sdc sttc khde binh quta nhta khau thtag Dan vl tinh: 1.000 ddng Chi sfl Ca nude Chung Thtah tbi Ndng thdn 78.0 101.0 68.4 Nam 75.8 NO 86.0 Ngheo nhat 36.3 Ngheo 59.3 73.7 Chi tita y te va eham sdc sue khde Sd tita chi cho kbtai, So tita chi cho y t6 ngoai ebOa benh kham, chua benh 58.2 19.9 74.0 27.0 51.5 16.9 Gidi tinh 57.5 60.6 18.3 25.4 nhdm thu nhap Trung binh Giau 84.8 Giau nhat 136.2 27.5 43.3 53.9 8.8 15.9 19.8 62.6 103.7 22.2 32.5 Ngudn: Dya theo sfl lieu kit qua dilu tta muc sflng hd gia dtah Viet Nam nam 2012 Khi khtai, chfta benh thi ngudi bgnh vin phii bd mot s6 tiln dtag ke dl ehi cho y tl ngoai kham ehfta benh, mue chi chung cua ca nude la 19,9 nghin dflng (chi cho mua thuflc ty chtta hoac dy trft la 13,1 nghin ddng, mua dung cu y tl la 1,2 nghin dflng, mua BHYT ty nguyta Ia 5,6 nghin dong), chilm 25,5% tflng ehi tieu y tl va cham soc sttc khde Ty le d khu vyc tiitoh thj (chilm 26,7%) cao ban d khu vyc ndng thon (24,7%) Ty lg chi tieu cho y tl ngoai khtai, chfta bgnh d nhdm thu nhap cao, cao hon ty le d nhdm thu nhap thip (ngudi ed thu nhgp thip, vung khd khan duge hfl ttg vl tai chinh khtai, chfta benh, kl ea tita di Igi) Sd lieu cung cho thiy, nu chi tieu cho y tl nhilu ban nam va cao hon mtte chi ehung cua ca nude, dd nam cd mtte chi cho y tl thap hen va thap hon mirc chi ehung cua ca nude Va hp cflng phai bd mgt ty 16 khflng nhd dl chi cho y t l ngoai kham, chfta benh, do, nft cd mtte ehi chiem 29,5% va nam la 24,1% cfla tflng ehi tieu y te va cham sdc sttc khde Ty le chi tieu cho y tl ngoai kham chfta hgnh gdp phin lam cho gia dinh bi ngheo hda chi phi y tl 81 Tgp chi Khoa hgc xdhgi ViitNam, sd 1(86)-2015 2.4 Chi phi thim hga vd ngheo hda chi phiy li Cflng tac eham sdc sue khde nhta dta da ed nhiing ket qua quan trgng (nhu mtte huong thu eac dich vu y tl cfla nhta dan tang Ita, dac biet vdi tre em, ngudi ngheo, ddng bao dan tgc thita sfl) gdp phan nang cao chi sd phat trita ngudi, hoan phan ldn cac Myc tieu Thien nien ky, gdp phan thyc hien cflng bang va tien bfl xa hfli Tuy nhita, he thflng y te cua Viet Nam vin cdn phai ddi mat vdi nhilu khd khan, thach thttc la sy pbSn hda ve mtte phat triin kinh tl - xa hgi d cac dan tdc, vflng, mien; su phta hda ea ttong cing mgt vung, mien, mdt tinh, gitta cac ca nhta cung tufli; dja vj kinh te xa hdi, khotag each ehenh Igch giau ngheo cdn kha ldn va cang gian ra; dau tu cdng chua dap iing duge yeu eau cflng tac kham, chtta benh; chat lugng eflng tac bao ve, eham sdc sic khde edn thap; he thflng y te va chit lugng djch vu y tl chua dap img yeu ciu kham, ehua benh cfla nhan dan, nhit la dfli vdi ngudi ngheo, ddng bao ving sSu, vung xa, vflng dan tpc thieu sfl; nhita ngudi dta ed hanh vi va Ifli s6ng chua phu hgp anh hudng tieu eye din sttc khde; d^c biet, bit cflng bing xa hgi ve y te, sue khoe gitta cac Itta tufli, gidi tinh, gitta cac vung cfla dit nude va gifta cac nhdm thu nhgp dang cang tang nhung nam gan day Dita do, da tah hudng tdi viee dat dugc mue tieu 82 cdng bang xa hpi va hieu qua cia hf thflng y te Hien nay, tgi Viet Nam, chi phi y tl chilm mpt ty ttgng nhit djnh ehi tieu hfl gia dinh Theo eac cufle dieu tra xa hdi hgc, sfl tuyet dfli chi phi cho y te khflng khac nhieu giua cac nhdm thu nhgp, nhung chiem ty ttgng tflng sfl chi tita lg khac biet Ngudi ngheo, ngudi thu nhap thap thudng phai ehi d ty trgng cao eho chi phi y te, hg khong cd dieu kien de khtai, chfta benh thudng xuyen cdng vdi nguy CO bj ngheo hda bdi chi phi y te Mgt so giai phap thu-c hifn cong bang xa hgi eham sdc sire khde Trong nhung nam qua, Dtag va Nha nude ludn quan tam lanh dgo, chi dao va tang dto ngufln lyc dta tu cho cflng tac cham sdc sue khde nhan dan vdi chu truong xay dung va phat ttiln he thdng y te cflng bang va higu qua cham sdc sue khde nhan dan Song qua trinh thyc hign cflng tac cham sdc sue khde nhan dan dang cd su bit cflng btog De cd dugc sy cdng bing xa hgi eham sdc sue khde cin thyc hi^n cac giai phap sau: Mgt la, thye hien dugc mue tieu BHYT toan dan Dl dgt dugc myc tieu can phai cd sy cdng bing ttong bta hilm, ddng nhilu hudng nhilu, ddng it hudng it dl khuyin khich ngudi mua th4 BHYT dap ung nhu ciu kham, chfta benh cia ngudi dan, chuyin tu diu tu cho ca sd eung cap djch vy y tl sang Cdng bdng xd bdi ciidm sdc siic khde nhdn ddn ngudi sii dung djch vy y te Do vay, eta xay dyng cac mtte mua BHYT khac theo gdi dich vu y te, mue thip nhat la ngudi mua the BHYT dugc hudng gdi dich vu y te ea bta va nhihig dfli tugng chinh sach duge huong gdi djch vy De khuyen khich ngudi dta mua the BHYT va dam bao quyln lgi khtai, chfta benh; Luat Sua dfli, bfl sung mgt sfl dieu cia Lugt BHYT da bd dieu kien ve hg khau va ngucri dan cd the den kham, chfta benh ban dau d bat cu ca sd y te tuyin ca sd nao tten tota quflc Tuy nhita, de dtai bao quyen lgi cua ngudi dto tham gia BHYT khtai, chfta bgnh thi eta xay dung va thye hien lg trinh phi hgp, md thdng tuyin huyen/xa ttong kham, chfta benh BHYT tu 01 thang nam 2016 Hal Id, ntag cao chit lugng kham, chfta benh, dgc biet y tl ca sd, dap ttng nhu ciu kham, chtta benh co bta cia ngudi dta Gitta cac tuyta y te eta ed sy Jita thflng va kit nfli chat ehe vi nhu eau cham sdc sttc khde cfla ngudi dan De bao dam quyln Igi cfla ngudi tham gia BHYT cin da dgng hda phin va djch vu tham gia kham, chtta benh Ba Id, xay dung cd ehl tai chinh ket hgp cflng tir ttong cac ca sd khtai, chua benh nhim hgn ehl lam dung xet nghigm, stt dyng ky thuat cao, dgc biet ngto ngira dugc chi phi tryc tiep chd y tl cua gia dinh nguoi benh Bdn td, tap ti-ung nguon lue cho chuang tiinh xoa ddi, giam nghta, xay dung mang ludi hfl ttg ngudi benh ttong cflng dflng nham giam khotag each thu nhap, giam quy hfl trg, ttong dd cd quy BHYT, ngto ngtta eac yeu td toh hudng den sttc khoe, giflp cac dfli tugng chinh sach thyc hien trach nhiem xa hgi ttong viec cham sdc sttc khde Tai lieu tham khao Bp Y tl, Bdo cdo sd 644/BC - BYT ngdy 29 Ihdng ndm 2013 vi long ghip vdn di binh ddng gidi Dir dn Ludt sira ddi, bd sung mgt sd diiu cua Lugt Baa hiim y ti Bp Y tl (2004), Chi sd theo doi, ddnh gid cdng bdng vd hiiu qud y ti Dam Vilt Cuong (2005), JY^n tdi thuc hiin cdng bdng chdm sdc sdc khde nlidn ddn: Vdn di vd gidi phdp, Nxb Chinh trj quoc gia, HilNpi Dang Cpng san Vipt Nam (2011), Vdn kiin Bgi hgi dgi bieu tadn qudc idn thir XI, Nxb Chinh tri qudc gia Ha Npi Dao Van Dung (chu bien) (2013), Y hgc xd hgi vd xd hgi hgc sdc khde, Nxb Chinh tn quIc gia Ha Npi Dao Van Dung, Pham Gia Cudng (2013), "Hudng toi cdng bang cham soc site khoe nhan dan", Tap chi Tuyin gido, so Dao van Dung, Pham Gia Cudng (2013), "Vl sy phan tang xa hpi cham soe sHe khoe ngudi dan", Thdng tin Khoa hgc xd hgi, Vien Thong tin Khoa hpc xa hpi, so 8 Dao Van Dung (chu bien) (2012), Chi phi y ti vd ddi ngheo d Viit Nam, Nxb Lao dpng Ha Npi QuIc hpi Khoa 13, Ludt sirg ddi, bd sung mgt sd diiu cua Ludt Bdo hiem y ti 10 Tong epc Thing ke (2012), Kit qud diiu tra mdc sdng hg gia dinh 83 ... hdi (BHXH) ddng tiln mua BHYT dta dat d mtte rat cao (gin 100%) Tuy nhien, mdt sfl dfli tugng bat Trong K I hogch nam (2011 - 2015) bugc phai tham gia BHYT nhung ty le Ngtah Y te Viet Nam dat muc... trgng ca sd y te tfly tita quylt djnh dita trj cho ngudi bfltih qua muc eta thilt dl tt-yc lgi BHYT Trong tuong lai, eta cd nhiing phucmg thuc chi tra hgp Iy ban nhu ixk theo nhdm chin dota (DRG)... 40,2 38,7 Nam Nu 34,6 43,6 Ngheo nhat Ngheo Trung binh Giau Gita nhat 35,5 38,3 39,5 39,6 42,9 Trong tflng sd Dieu tri ngoai ttu Dieu trj ngi tni Ty 1$ CO BHYT hoac Ty le cd BHYT Tyle Tylp hoac
Ngày đăng: 08/11/2022, 14:11
Xem thêm:
