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Xahoi hgc so (110), 2010 31 NGtfC)! CAO TUOI VIET NAM: PHUC Ldi XA HOI VA CAC MO HINH CHAM SOC St/C KHOE BE QUYNH NGA* Viet N a m la mgt d i t nfldc ngheo, ddng dan, va v l n cdn d a n g p h a i tiep tue p h a n da'u khdi phue s a u t h a p nien ehien t r a n h Sfl chuyen ddi tfl mdt n i n k i n h te ke hoach tap t r u n g s a n g n e n k i n h te thi trfldng da d a t dfldc sfl t a n g trfldng dang ke Tuy nhien, cflng vdi viee giam ddi ngheo ndi ehung thi sfl chenh lech ve mfle sd'ng cung tang len Khoang each gifla vflng ndng thdn va dd thi, t h a m ehi gifla d c hd gia dinh cflng dia phfldng cung t a n g len Sfl p h a t trien eua eae q u a n h e t h i trfldng, di dan ndng nghiep, sfl bien ddi eua mdt xa hdi ndng nghiep t r u y i n thd'ng sang mdt xa hdi edng nghiep da tao r a nhflng M n h thflc va mfle r u i ro k i n b te xa hdi k h a e n h a u ddi vdi h a n g trieu ngfldi, dd ed ngfldi eao tudi Qua t r i n h p h a t trien da k h i e n cho v a n d i a n sinh xa hdi ndi ehung va a n sinh ddi vdi ngfldi eao tudi ndi rieng, d a n g trd t h a n h mdt nhflng ehu d i h a n g d i u eua cac thao M a n ve chinh sach Bai v i i t n h a m d i cap den tinh h i n h d a n sd' ngfldi cao tud'i, cae v l n d i phue ldi xa hdi va c h a m sdc sflc khde ngfldi cao tud'i d Viet Nam Men D a n so' ngfldi c a o t u o i d V i e t N a m Ngfldi cao tud'i (NCT) bao eao n a y dfldc hieu la nhflng ngfldi tfl 60 tud'i trd len Mdt t i n h toan, dfla t r e n dfl lieu eua d i i u t r a mfle sd'ng hd gia dinh Viet N a m (VHLSS 2007), eho bie't nhflng ngfldi cao tud'i nhfl t h e chie'm k h o a n g 9,45% d a n sd' so vdi 63,78% nhdm ngfldi tud'i lao ddng (15 tdi 59 tud'i), va k h o a n g 36,22% tre em dfldi 15 tud'i ^ Sd ngfldi cao tudi d Viet N a m t a n g n h a n h , dae biet la sd' p h u nfl eao tudi K i t qua Td'ng dieu t r a d a n s d ' n a m 1989 cho biet Viet N a m ed 7,15% d a n sd'ia ngfldi eao tud'i, n a m 1999 la 8,12% va n a m 2005 la 8,82% Theo sd'lieu cua Td'ng cue thd'ng k e ' tinh den 01/4/2006 Viet N a m ed 8,05 trieu ngfldi eao tud'i chiem 9,45% d a n sd' Trong sd'ngfldi eao tud'i bao gdm: 3,92 trieu ngfldi tfl 60 - 69 tud'i chiem 4,61% d a n sd', 2,90 trieu ngfldi tfl 70 - 79 tud'i chie'm 3,41% d a n sd', sd'ngfldi tfl 80 tud'i trd n e n chie'm 1,43% d a n sd', dfl bao de'n n a m 2020 se cd k h o a n g 10,5 - 11 t r i e u ngfldi eao tud'i chiem * TS, Viin Xd hgi hgc ' http ://ww w gopfp gov vn/web/khach/solieu Tong cue Thong ke, 2007 32 Ngddi cao tudi Viet Nam: Phdc lgi xd hgi vd tren 10% dan sd ea nfldel Qua td'ng hdp eae ket qua diiu tra eho thay mdt sd' xu hfldng vi dan sd ngfldi eao tud'i d Viet Nam nhfl sau: ty le ngfldi eao tud'i tfl nam 2008 tang nhanh va se tang dot bie'n tfl nam 2010 Dfl bao se tang manh va vfldt ty le NCT ciia Thai Lan vao nam 2050^ Dieu la mdt thieh thflc ldn viec dap flng nhu clu cham sdc sflc khoe, phung dfldng ngfldi cao tud'i Ket qua eua ddt diiu tra mfle sd'ng hd gia dinh (VHLSS) vao nhflng nam 1999, 2004 va 2006 da eho thay ty le ngfldi eao tud'i tang cao Ty le ngfldi cao tud'i theo diiu tra nam 1999 la 8% da tang len tdi 9,92% nam 2004 va 10,4% nam 2006 Cung theo diiu tra nam 2006^ eho thay sd' ngfldi eao tudi ea nam va nfl diu tang so vdi nam 2004^ va ngfldi eao tudi nfl eao hdn ban nam (12,0% ngfldi cao tud'i nfl so vdi 8,7% ngfldi eao tud'i nam) Ty le ngfldi eao tud'i d ndng thdn da tang eao b i n g ty le ngfldi cao tud'i d phd' (10,3% ngfldi eao tud'i d ea ndng thdn va phd) Ne'u so sanh ty le ngfldi eao tud'i eiia Viet Nam (10,4% dan sd'nam 2006) vdi ty le ngfldi eao tud'i eua Thai Lan' (11% nam 2006) thi ty le ngfldi eao tudi Viet Nam da gin vdi ty le eua Thai Lan UNESCAP dfl bao tfl nam 2006, ty le ngfldi eao tud'i eua Thai Lan se tang nhfl sau: 11% nam 2006, 19% nam 2025 va 28% nam 2050 Ty le dan sd' ngfldi eao tudi Viet Nam dfl bao theo ket qua diiu tra mfle sd'ng hd gia dinh 2006 se nhfl sau: 10,4% nam 2006, 16,4% nam 2025 va 29,4% nam 2050® Cae ke't qua diiu tra eho thay mfle tang nhanh ty le ngudi eao tud'i tfl nam 2008 va sd' ngfldi cao tud'i d vflng ndng thdn tang nhanh va chie'm ty le xlp xi vdi ty le ngfldi eao tud'i d cac phd' ldn Phan bd theo tudi cua dan sd' ed sfl khac biet gifla d e vung, phan anh ca nhflng ye'u td' kinh te' va xa hdi tae ddng tdi tud'i thg, dae biet la ty le ngheo va tinh trang dan tde thieu sd' Tinh toan eua nhdm nghien cflu vfla din, dfla tren dfl lieu diiu tra mfle sd'ng hd gia dinh (VHLSS, 2004), eho thay vflng ddng b i n g sdng Hdng va Nam Trung bd ed ty le ngfldi tren 60 tud'i eao n b l t (9%) ty le tha'p nha't d vflng nui Tay Bic, Ddng Ble va dae biet la Tay Nguyen ehi cd 6% Ngfldi cao tudi Viet Nam sd'ng d nhflng loai hd gia dinh nao? Diiu tra mfle sd'ng hd gia dinh 2004 eho thay ty le eao nhat la nhflng hd gia dinh ed ngfldi tudi lao ddng va tre em chie'm 54% td'ng sd' hd gia dinh, gia dinh cd ngfldi eao tud'i sd'ng vdi ngfldi tud'i lao ddng va tre em chie'm 28,4%, gia dinh ehi ed ngfldi tud'i lao ddng chiem 8,8%, hd gia dinh cd ngfldi eao tud'i sd'ng vdi ngfldi ^ Theo Dii bao dan so Viet Nam den 2024, TCTK, 2000 " Hoi Y te cong cong Viet Nam., 2009 ^ Tong cue Thong ke (2006) ^ Tong cue Thong ke (2004) ' Tong cue Tho'ng ke (2006) Dieu tra mile song dan cil, Nha xuat ban Tho'ng ke ^ Hoi Y te eong cong Viet Nam 2009 Bi'Quynh Nga 33 tud'i lao ddng chie'm 7,8%, hd gia dinh chi ed ngfldi eao tud'i va hd gia dinh ehi cd ngfldi eao tud'i sd'ng vdi tre em chiem mdt p h i n nhd la 0,8% va 0,2% Cd mdi lien he gifla viee ed ngfldi cao tud'i sd'ng hd gia dinh vdi nang lfle kinh te eua hd gia dinh Nhieu nghien cflu xa hdi hgc ndng thdn eho thiy viec mua thud'c de dieu tri benh cho ngfldi cao tud'i eung ed the tieu td'n ngudn Mc tai chinh gia dinh ndng dan ngfldi ta phai ban mdt p h i n ldn hoa ldi thu hoach De tra ehi phi eho mdt ea md d benh vien, cac gia dinh ngheo d ndng thdn, dae biet la cac gia dinh eua ngfldi cao tudi ngheo ed the phai ban di mdt bd (hoae trau) hoae phai vay nang lai Ddi vdi nhflng gia dinh phai the chap de vay nd tiin chfla benh cho ngfldi cao tud'i, ne'u khdng the tra dfldc nd, gia dinh dd cd the se hi m i t tai san the chip, thfldng la rudng dit Tdm lai, "viec ed mdt ngfldi tren 60 tud'i trd len hd lam tang rui ro hi ngheo len khoang 4%, so vdi khdng ed ngfldi eao tudi"^ Nhflng hd cd ngfldi eao tudi ma ehu hd la nfl thi kha nang rdi vao canh ngheo eung cflc nhiiu hdn Tinh trang stifc khoe cua ngfldi cao tuoi Theo mdt nghien cflu edng bd' nam 1998, tinh trang sflc khoe ndi chung eiia ngfldi eao tudi khdng dfldc kha quan l i m vdi khoang 95% ndi r i n g hg cam t h i y met mdi va ed nhu eau cham sdc ve y te^" Sd' lieu ciia Bd Y te vao thdi gian cho thiy cd khoang 23% hoac 1,5 trieu ngfldi cao tud'i dang d tinh trang sflc khoe tdi te " Theo ket qua diiu tra cua Vien Lao khoa, Bd Y te', nam 2001, ty le ngfldi eao tudi cd sflc khoe kem (so vdi tudi) chie'm kha eao (22,9%), sd' cd sflc khoe td't chi chiem 5,7% Binh quan ngfldi eao tud'i ed 2,69 benh; 56,7% ngfldi eao tud'i cd cae benh tat anh hfldng dexi hoat ddng hang ngay; 24,9% phai di kham benh it n h i t la lln thang^' Mdt nghien cflu nam 2006 eho t h i y ngfldi eao tud'i thfldng mIe la cac benh man tinb; benh cd, xfldng khdp chiem 53,8% ngfldi eao tudi hi benh; benh dfldng hd h i p chiem 41,6%; benh tim mach chiem 31.3% va benh dfldng tieu hoa chiem 27,1% Ddi vdi nhdm ngfldi cao tud'i ed ddn thie'u diiu kien cham sdc sflc khoe tinh trang benh tat edn nghiem trgng hdn r i t nhiiu" Diiu tra y te qud'c gia (2001 - 2002) eho thay khoang 44% ngfldi eao tud'i d trang thai hoan toan khde manh, khdng mac benh hoae hi tai nan thfldng tieh gi thdi diem diin cudc diiu tra Trong sd' ngfldi eao tud'i hi d'm ed 34% hi mIe benh d p tinh Khoang 12% ngfldi eao tud'i bi tan tat, nhflng nguyen nhan khac nhau: ehien tranh (13%), tud'i gia (41%), d'm dau (35%) va tai nan (8,8%) Ty le ngfldi cao tud'i nfl hi tan tat d'm dau cao hdn ngfldi eao tud'i nam: khoang 20% ' '0 " '^ 13 Martin Evans va dong nghiep, 2005 MOLISA, 1998 MOLISA, 1998 Theo Ke't qua dieu tra cua Vien Lao khoa nam 2001 MOLISA, 2006 34 Ngddi cao tudi Viet Nam: Phuc lgi xd hgi vd so vdi 7,5% Cin ndi them ring, sd'nhflng ngfldi eao tudi hi tat ed tdi 20,4% can tdi sfl trd giflp hang Tai lieu eiia mdt eugc diiu tra ve sflc khde khac (2006)", tie'n hanh tai ba tinh Hai Dfldng, Ninh Thuan, Vinh long cung clp nhflng thdng tin tfldng tfl Ngfldi eao tud'i nam gidi ed sflc khde td't hdn ngfldi cao tud'i nfl Tud'i tae eung la mdt ye'u td' lien quan chat ehe vdi tinh hinh sflc khde cua ngfldi eao tud'i; tud'i cang cao sflc khde cang kem di Chang ban, ehi ed 2,9% nhflng ngfldi tud'i 60 - 64 eho biet tinh trang sflc khde kem, so' len den 3,8% ddi vdi nhflng ngfldi tud'i tfl 65- 69 tud'i, 5% vdi ngfldi tud'i tfl 70 - 74 Ty le tiep tue tang len dd'i vdi ngfldi eao tud'i ed tud'i tfl 80 - 84 tud'i (18,3%) va tfl 85 tud'i trd len (25%) Ngay d'm va sd ddt d'm nam la ehi bao cho tha'y tinh trang sflc khde cua ngfldi cao tud'i Tai heu thd'ng ke cho t h i y ngfldi cao tud'i tren 60 d'm dau nhiiu hdn ngfldi d eae nhdm tud'i thip hdn Con sd' trung binh lln d'm nam eua ngfldi eao tud'i la 2,4 lln Sd' nghi trung binh bi d'm ciia ngfldi eao tud'i mdt nam la 17 ngay, eao hdn cac nhdm tud'i khac^'' Viee sd'ng vdi gia dinh ed tae ddng ro net tdi tinh trang sflc khoe cua ngfldi eao tud'i Ngfldi ta nhan tha'y tinh hinh sflc khde cfla ngfldi eao tudi dang sd'ng ehung vdi eon chau td't hdn nhiiu so vdi nhflng ngfldi eao tud'i dde than hoae sd'ng chung vdi nhflng ngfldi cac tud'i khac Diiu tra y te qud'c gia cho t h i y 67% ngfldi cao tud'i dang sd'ng chung vdi ngfldi tfl 60 tud'i trd len hi d'm dau, ty le la 53% d nhflng ngfldi cao tud'i sd'ng chung vdi nhflng ngfldi dfldi 60 tudi Ngfldi cao tudi dang sd'ng chung vdi gia dinh (vdi vd hoae ehdng) cd ty le d'm dau thap hdn nhflng ngfldi eao tud'i gda phu, ly di hoae li than, ddc than Sd' l l n d'm dau binh quan 12 thang ctia ngfldi eao tud'i sd'ng ehung vdi ngfldi tre tudi la 2,2 lin/nam, sd' d nhflng ngfldi eao tudi ehi sd'ng vdi ngfldi tfl 60 tudi trd len la 3,2 lln/nam^^ Ket qua mdt nghien cflu eua ehung tdi v i gia dinh eung xle nhan tinh hinh nay, 79,8% sd'ngfldi eao tudi dfldc hdi mong mud'n sd'ng cflng eon chau" Ldi sd'ng eung tae ddng nhiiu tdi tinh hinh sflc khde cua ngfldi eao tud'i Diiu tra y te Qud'c gia eho bie't nhdm ngfldi eao tud'i khdng tap the due ed sd'lln d'm trung binh nam (2,6 lin/nam) eao hdn nhdm ngfldi eao tud'i cd tap the due (2,1 lan/nam) P h u c ldi xa h o i va ngtfdi cao t u o i Chuyen sang n i n kinh te' thi trfldng, cac d u true kinh te xa hdi d Viet Nam da va dang bie'n dd'i manh me Trong bdi eanh dd, ngfldi dan va xa hdi cd nhiiu cd hdi de phat trien, nhflng ben canh dd eung cd khdng it nhflng rui ro, b i t hanh ludn cd the " '^ ^^ " Vien Chie'n liide va chinh sach y te, 2006 Dieu tra y te quoc gia 2001- 2002 Dieu tra y te quoc gia 2001- 2002 Bui Quang Dung va dong nghiep (Tai lieu diin da), 2009 Be Quynh Nga 35 xay vdi hg, dae biet la vdi cac nhdm "ye'u the" Phue ldi va nhflng tie'n bd eua n i n kinh te' edn ehfla t i e ddng ddng diu xa hdi, d i n de'n mdt sd' nhdm trd nen ye'u the hdn Theo mdt bao eao eua Ngan hang The gidi nam 2000, nhdm 10% dan sd' ed mfle sd'ng eao n b l t kiem soat 29% td'ng thu nhap eua ea nfldc nhdm 10% dan so' ed mfle sd'ng t h i p n b l t ehi kiim scat 3,5% td'ng thu nhap^* Ngfldi dan ndng thdn, ngfldi dan sd'ng d vflng sau vung xa, ddng bao dan tde thieu so', va eae nhdm thiet thdi khac nhfl phu nfl eao tud'i va phu nfl goa khdng dfldc hfldng sfl sung tue nhfl mgi ngfldi Mae dfl eude sd'ng da thay ddi td't hdn so vdi trflde day, eude sd'ng eua nhflng ngfldi eao tudi van it may man hdn so vdi eae nhdm tudi khae xa hdi Cung ein phai n h l n manh rang, ty le ehi tieu eho mdt so' linh vflc xa hdi tdng chi tieu eua Chinb phu, dd ed khoan "trd d p hflu tri va cflu trd xa hdi" cang giam Bang Ty le chi tieu cho cac Unh vgc xa hgi tdng chi tieu cua Chinh phu 1996 1997 1998 1999 2000 2001 2002 Chi cho cdc Iinh vyc xd hpi 32,3 33,4 33,3 30,2 29,8 31,3 29,7 Giao dgc 8,7 10,1 10,2 9,4 9,6 10,1 10.4 Yte 4,4 4,3 4,1 3,7 3,4 2,9 3,0 Tro cdp huu trf va cOu tro xa hpi 13 13 11,7 10,6 10,4 11,2 9,3 Cac khodn khde 6,1 6,1 6,7 6,4 6,4 7,1 Ngudn: UNDP, Hdi thdo He thd'ng an sinh xd hdi Viet Nam, 7/2005 Tren thflc te viec di cfl tim kie'm viee lam eua eon cai da trfldng cd anh hfldng mang tinh hai mat ca tieh cflc ian tieu cflc de'n ngfldi cao tud'i Vdi sfl ehuyen ddi sang nen kinh te thi trfldng, dang ed n h i i u ngfldi tre tudi rdi thdn que de tim edng viee dfldc tra Ifldng va diiu dang lam giam di sfl cham sdc va hd trd eua gia dinh t r u y i n thd'ng ddi vdi cha me gia ma hg dang m i t dan kha nang tfl cham sdc minh tud'i cang cao Tuy vay, tren thflc te' nhflng ngfldi eon xa gia dinh dinh ky van ve tham hoae gxii t i i n v i trd giflp va ed lien lae qua thfl tfl, ban be, dien thoai tham hdi cha me gia ctia hg Cung gid'ng nhfl d Viet Nam, eae phfldng tien thdng tin dai ehung d Thai Lan da neu len nhflng lo ngai v i kha nang cham sdc cha me gia cua eon cai da trfldng di efl tim kie'm viee lam Mdt sd nghien cflu eua tae gia John KnodeP* da eho tha'y anh hfldng mang tinh hai mat eua viee di dan Mdt mat viee di efl eua eon " World Bank, 2000 " John Knodel va dong nghiep, 2007; John Knodel, 2009 36 Ngddi cao tuoi Viet Nam: Phuc lgi xd hgi vd cai ldn ed anh hfldng khdng td't de'n viec cham sdc cha me gia, dac biet la nhflng ngfldi nhdm tudi eao ed sflc khde ye'u Mat khae eon cai v i n g nha khdng the trflc tie'p de hd trd cha me gia nhflng hg thfldng xuyen lien lae ddng vien tinh than, gtfi t i i n v i hd trd cha me, cha me d'm dau hg thfldng trd ve nha cham sdc va ed ngfldi cdn mang cha me len t h a n h phd' ehfla bdnh vdi chit Ifldng cao hdn Mdt sd' Ifldng khdng nhd ngfldi eao tud'i khdng ed thu nhap, khdng cd kha nang lao ddng phai sd'ng dfla vao eon, chau, ngfldi t h i n Theo mdt bao d o ciia Bd Lao ddng - Thfldng binh - va Xa hdi nam 2006, ed tdi 130 ngan ngfldi eao tud'i thude dien ed ddn khdng ndi nfldng tfla, 134 ngan ngfldi tfl 90 tudi khdng ed Ifldng hflu va d c khoan trd d p xa hdi khae Trong sd' ngfldi eao tudi edn cd sflc khoe cd gan 30% tham gia lam cac cdng viec khac de kie'm sd'ng; 10% lam viee nha de eon chau di lam, dac biet ddi vdi vflng ndng thdn ty le lam viee gia dinh eao ga'p 4,5 l l n so vdi ty le d ngfldi d dd thi^° Ddi vdi nhiiu ngfldi the' he eao tudi hidn nay, tudi thg tang len eung cd nghia la hg phai chiu dflng cae v l n de ve sflc khoe va eae can benh man tinh nhiiu nam hdn Nhu elu, cham sdc sflc khoe eua ngfldi eao tud'i mdt tang dang tao nen mdt sflc ep to ldn eho ehinh phu viee eung elp ngudn lfle vd'n da eo hep eho phflc ldi xa hdi Viet Nam da ed Phap lenh ve ngfldi eao tud'i tfl nam 2000 va t h i n g 11 nam 2009 vfla thdng qua Luat ve ngfldi eao tud'i Cae van ban phap Mat quy dinh nhflng ndi dung ve vi tri, vai trd ngfldi cao tudi xa hdi va trach nhiem eua gia dinh, nha nfldc, va xa hdi dam bao cham sdc, phung dfldng va phat huy vai trd ngfldi cao tud'i Chfldng trinh hanh ddng qud'c gia ve ngfldi eao tud'i Viet nam giai doan 2005 - 2010 dfldc ehinh phu ban hanh nam 2005 vdi mue tieu chung, nhdm muc tieu cu the va ehi tieu d n dat dfldc de'n nam 2010 da can efl vao nhu c l u phat trie'n ngfldi cao tud'i Viet Nam va theo dinh hfldng eua Chfldng trinh hanh ddng qud'c te Madrid v i ngfldi cao tud'i nam 2002 Hien ed nhdm ngfldi eao tud'i dfldc hfldng hd trd theo ehinh saeh eua ehinh phu: dd la nhflng ngfldi trfldc day da tflng lam viee eho nha nfldc hoae da tflng phuc vu quin ddi, cha me liet sy hoae gia dinh ed edng vdi each mang, va ngfldi cao tud'i cd ddn khdng ndi nfldng tfla Tfl nam 2007 thi ngfldi cao tud'i tfl 85 tud'i trd len (de'n thang nam 2011 la tfl 80 tud'i trd len) vd'n khdng dfldc nhan cae khoan trd d p ke tren se dfldc nhan trd d p xa hdi Ngfldi dfldc nhan Ifldng hflu tap trung chu ye'u tai cac vflng dd thi va ehi cd rat it ngfldi d ndng thdn cd Ifldng hflu Hien ca nfldc cd khoang 1,4 trieu ngfldi dang hfldng ehe hflu tri, ma't sflc lao ddng, tai nan lao B6LDTB&XH, 2006 Be Quynh Nga 37 ddng, benh nghe nghiep (chie'm 19% td'ng sd' ngfldi eao tud'i)^^; Nhfl vay, fldc tinh cd khoang tren trieu ngfldi cao tud'i dfldc hfldng it n b l t mdt ehe trd d p , hoac Ifldng hflu Nhdm ngfldi cao tud'i dfldc hfldng ehe' bao hiem xa hdi hoae trd elp dae biet cd eugc sd'ng tfldng ddi d'n dinh Tfl Nghi dinh sd' 07/2000-ND/CP de'n Nghi dinh sd' 67/2007-ND/CP v i cac ddi tfldng bao trd xa hgi, eae nhdm dd'i tfldng thu hfldng ehinh saeh cang dfldc md rdng va mfle hfldng dfldc gia tang phfl hdp vdi mfle phat trien kinh te cua da't nfldc Chinh saeh eua Viet Nam ddi vdi ngfldi cao tudi ed hoan eanh khd khan cang dfldc bd' sung, hoan thien va diy du hdn Nam 2007, Chinh phu da ban hanh Nghi dinh sd' 67/2007/ND-CP v i chinh sach trd giup cac doi tfldng bao trd xa hdi; nghi dinh n h i m vao cac ddi tfldng ngfldi eao tudi nhfl sau: 1) Ngfldi cao tudi cd ddn, thudc hd gia dinh ngheo; ngfldi cao tfldi edn vd hoae ehdng nhflng gia ye'u, khdng ed con, chau, ngfldi than thich de nfldng tfla, thudc hd gia dinh ngheo; 2) Ngfldi tfl 85 tud'i trd len (trfldc day la 90 tud'i trd len) khdng cd Ifldng hflu hoae trd d p bao hiim xa hdi; 3) Ngfldi cao tud'i tan tat nang khdng ed kha nang tfl phue vu, thude hd gia dinh ngheo; 4) Ngfldi eao tud'i mle benh tam t h i n man tinh, sd'ng dde than khdng ndi nfldng tfla hoae gia dinh thude dien hd ngheo; 5) Ngfldi eao tud'i nhiem HIV/AIDS khdng cdn kha nang lao ddng, thude hd gia dinh ngheo Cae ehinh saeh cang thap tud'i ngfldi eao tud'i dfldc hfldng ehinh saeh, tfl 90 tud'i trd len vao nam 2000 xud'ng 85 tud'i trd len tfl nam 2007 va tfl thang nam 2010 se la tfl 80 tud'i trd len Mdt sd' dia phfldng ed diiu kien da nang mfle trd d p so vdi quy dinh cua Trung fldng va tudi ngfldi eao tudi dfldc hfldng ehinh saeh nhfl TP Hd Chi Minh, Vinh Phuc, Ha Ndi, Hai Phdng, Ble Ninh, Da Ning Mfle trd d p danh cho ngfldi eao tuoi nam 2007 cung tang len gin gip hai lln so vdi trflde (mfle ehuan 120 nghin ddng/thang) Ngfldi eao tud'i tan tat nang hfldng 180.000 ddng/thang Ne'u ngfldi eao tud'i bi HPZ/AIDS mfle hfldng la 240.000 ddng/thang Ne'u nhflng ddi tfldng tren qua dae biet khd khan thi dfldc xem xet tiep nhan vao ed sd Bdo trg Xd hdi hoae nhd xd hdi tai edng ddng; ngfldi eao tud'i dfldc hfldng mfle trd d p xa hdi neu tren diu dfldc d p the Bao hiem y te miin phi hoac dfldc kham ehfla benh miin phi tai eae ed sd y te He thong y te va van de chiia benh cua ngfldfi cao tuoi Lien quan tdi viee cham sdc sflc khde cho ngfldi eao tud'i, Nha nfldc ban hanh nhieu van ban chinh saeh, dae biet dd phai ke tdi la Lugt khdm chda benh (2009) va thong td sd 02 /2004 / TT-BYT hfldng d i n thflc Men cham sdc sflc khde " Theo Vu Bao hiem xa hoi - Bo LDTBXH, 2006 38 Ngddi cao tudi Viet Nam: Phuc lgi xd hgi vd ngfldi cao tud'i tinh hinh mdi Trong thflc te edn kha nhiiu v l n de lien quan tdi cac td chflc va dinh ehe cham sdc sflc khde ngfldi eao tud'i Bao Mem y te' Viet nam mdi ehi bao phu 26,3% dan so' Ngay ea vdi ngfldi lao ddng hfldng Ifldng- ddi tfldng eua Bao Mem y te b i t huge - ty le tham gia eung ehi dat 53%^^ Theo tai lieu eiia Vien Chien Ifldc Chinh saeh Y te tbi viee ap dung ehe Bao Mem y te b i t huge ddi vdi khu vflc kinh te tfl nhan gap nhiiu khd khan; thfldng nhflng nganh nghi cd nhieu ngfldi d'm mdi dang ky, edn nhflng nganh it ngfldi d'm thi tfl chdi Loai hinh Bao hiem y te' tfl nguyen cung khd md rdng vi ddi tfldng cfla rid phin ldn la ndng dan Ly chu ye'u ban ehe ddi tfldng tham gia bao hiem la thu nhap t h i p - khdng ed kha nang ddng gdp Cung nhfl d c nhdm ddi tfldng khle, ngfldi cao tud'i cd Ifldng hflu hoae ed trd d p xa hdi mdi dfldc d p Bao Mem y te mien phi Ngfldi cao tud'i ed nhu elu nhiiu ve cham sdc sflc khde va ed md Mnh benh tat dac thfl nhflng viec cham sdc sflc khde cho ngfldi cao tudi Men eua nganh y ti^ v l n edn mang tinh thu ddng Cac cd sd y te ehfla ehu ddng xay dflng ke' hoach td chflc kham sflc khde dinh ky mdt each thfldng xuyen n h i m phat Men benh cho ngfldi cao tudi De hieu la tinh Mnh dd, ddi vdi d'm d p tinh, hinh thflc tfl diiu tri va sxi dung dich vu y te' tfl n h l n van la hai hinh thflc phd bien Chang ban, theo tinh toan ciia mdt nghien cflu thi ehi khoang 40% ngfldi eao tud'i sxi dung dieh vu nha nfldc hi d'm Nhflng ngfldi tren 85 tud'i cd ty le sfl dung dieh vu benh vien t h i p hdn lan so vdi nhdm tud'i tfl 60 - 64 kha nang di lai ban ehe Ddi vdi benh man tinh, de'n ed sd y te nha nfldc de chan doan benh la hinh thflc phd bien Tuy nhien, ty le ngfldi cao tudi tfl chan doan benh cung tfldng ddi eao, chiem hoang 27% Kie'n thflc v i CSSK eua ngfldi eao tudi kha ban che Nhin ehung, ngfldi eao tudi it ed kie'n thflc v i phdng chd'ng mdt sd'benh thfldng gap nhfl tang huyet ap, dau khdp Khoang hdn 45% ngfldi cao tudi khdng bie't each phdng ehdng benh tang huyet ap^^ Phu nfl eao tudi cd xu hfldng sfl dung dieh vu y te' tfl nhan vdi ty le eao hdn nam gidi, nam gidi eao tud'i lai sfl dung dieh vu benh vien edng vdi ty le eao hdn Khoang each tdi ed sd y te, diiu kien kinh te va tam ly ngai lam phiin tdi eon ehiu la nhflng yeu td' cd anh hfldng den viee stt dung dieh vu y te eua ngfldi eao tud'i Tuy nhien, sfl thuan tien ve khoang each tdi cd sd y te la ly ehinh de ngfldi eao tud'i lfla chgn ed sd y te' kham ehfla benh H l u he't ngfldi eao tud'i mong mud'n dfldc kham chfla benh d nhflng cd sd y te' gin nha nhfl kham tai nha, kham d cd sd y te tfl nhan hoae kham ehfla benh tai tram y te xa Hien nay, he thd'ng cham sdc sflc khde ngfldi cao tud'i dang dan dfldc hoan thien Tuyen Trung fldng cd vien Lao khoa Trung fldng la tuye'n chuyen sau ve diiu tri eae benh lao khoa va thflc hien ehi dao v i ehuyen mdn ky thuat CSSK ngUdi cao ^^ (http://vnexpress.net /2005) " Vien Chie'n ludc va chi'nh sach y te, 2006 Be Quynh Nga 39 tud'i tren pham vi toan qud'c eung nhfl nghien cflu cae v l n de benh tat eua ngfldi eao tud'i Mdt sd'benh vien tuye'n cua 47 tinh da lap khoa Lao khoa phuc vu rieng ngfldi eao tud'i hoae ed mdt sd'gifldng diiu tri danh eho ngfldi eao tud'i n i m khoa Ndi ehfla cd diiu kien lap khoa Lao khoa Mdt so' tinh da xay dflng dfldc Vien diiu dfldng phuc hdi chflc nang, dd ed phue vu ddi tfldng la ngfldi cao tudi (tinh Ba Ria - Vung Tau) H l u het eae benh vien tuye'n huyen eung diu ed cae gifldng diiu tri danh cho ngfldi eao tud'i nam khoa Ndi Ve van de nhan lfle, h l u het eae benh vien tuye'n tinh, huyen diu thie'u d c can bd ed ehuyen nganh lao khoa Diiu ed t h i d i n de'n tinh trang nhu elu CSSK eua ngfldi eao tud'i khdng dfldc dap flng mdt each kip thdi va diy dii Cac m o h i n h c h a m sdc sijfc k h o e ngfldfi cao t u o i cae loai hinh cham sdc ngfldi cao tud'i (NCT) theo Luat NCT dfldc Qud'c hdi thdng qua 23/11/2009 bao gdm: - Cd sd bao trd xa hdi - Cd sd tfl vln, dieh vu cham sdc ngfldi eao tudi - Cd sd dieu dfldng NCT Hien d Viet Nam ed eae cd sd cham sdc NCT dang hoat ddng sau: - Md binh trung tam bao trd xa hdi - Md hinh cd sd nudi dfldng va cham sdc NCT - Md hinh trung tam tfl v l n va cham sdc sflc khde NCT - Md hinh cham sdc sflc khde NCT dfla vao edng ddng Uy ban qud'c gia v i Ngfldi cao tud'i Viet Nam hien dang thflc hien md hinh tbi diem: 1) Md hinh cham sdc ngfldi eao tudi dfla vao tinh nguyen vien d edng ddng; 2) Md hinh cham sdc sflc khde NCT dfla vao t h i y thud'c la tinh nguyen vien tai cdng ddng Muc tieu eua eae md hinh n h i m trd giup trflc tiep nhflng NCT d cdng ddng Hoat ddng cua md hinh la td chflc bien soan tai lieu, dao tao tinh nguyen vien, hfldng dan hg xay dflng ke hoach hoat ddng dfla tren nhu elu ctia ngfldi cao tud'i d dia ban cua minh va hd trd kinh phi hang thang eho boat ddng eiia hg Tai cae ddn vi nay, tinh nguyen vien tuyen truyin phd bie'n nhflng kien thflc can thiit ve cham sdc sflc khde cho ngfldi cao tudi; mat khae, hg edn van ddng tim kie'm cae ngudn trd giup eho nhflng ngfldi cao tud'i ed hoan eanh khd khan Dae biet, hg phat Men nhflng v l n di, nhu d u eu the eua ngfldi cao tudi d cdng ddng, lam elu ndi gifla ehinh quyin va ngfldi dan de ehinh quyin n i m dfldc nhu clu ngfldi cao tud'i va cd giai phap eho cae v l n de dat Md hinh ngfldi eao tud'i sd'ng ehung vdi mdt sd' nhflng ngfldi eon da trfldng dfldc eoi la he thd'ng hd trd chu ye'u mang tinh truyin thd'ng tai nhieu qude gia 40 Ngddi cao tudi Viet Nam: Phiic lgi xa hgi vd chau A dd cd Viet Nam Phan ldn ngfldi Viet Nam v l n tie'p tue lao ddng tudi da eao, eon so thd'ng ke eho tha'y r i n g ed de'n 40% ngfldi eao tudi v l n phai lam viee, va ty le d vflng ndng thdn chie chan cdn cao hdn Gia dinh la ngudn hd trd quan trgng nhat khdng gi so s i n h dfldc ddi vdi ngfldi cao tud'i, dae biet tai eae vflng ndng thdn Tuy nhien, sfl tang v i sd' Ifldng ngfldi eao tud'i, hien tfldng di dan theo mfla ciia eae vien tre gia dinh, va xu hfldng giam quy md gia dinh dang la mdt thach thflc ddi vdi vai trd cham sdc sflc khde eua the ehe gia dinh Viet Nam, dae biet la d ndng thdn Trong sud't thap nien qua, quy md gia dinh d Viet Nam eung da giam xud'ng mdt each nhanh chdng vdi td'ng ty s u i t sinh (td'ng sd' eon sud't cugc ddi sinh de cua mdt phu nfl) giam tfl eon vao nam 1980 xud'ng khoang 2,03 eon vao nam 2009^^ Quy md gia dinh giam xud'ng eung ddng nghia vdi viee se ed it cai hdn eho viec cham sdc cha me gia tfldng lai Ty sd' tiim nang hd trd^^ se giam tfl 12 ddi vao 1999 xud'ng ddi vao nam 2050^^ Khi kinh te phat trien, de giai quye't nhu elu eua eae gia dinh d thi viec cham sdc cha me gia, mdt md hinh mdi xult Men dd la nhflng ca sd chdm soc ngddi cao tudi td nhdn gin gid'ng vdi md hinh nha dfldng lao d eae nfldc phat trien Da bat dau xuat hien nhflng td chflc tfl nhan lam dieh vu cham sdc ngfldi cao tudi d cac phd' ldn nhfl Ha Ndi va phd' Hd Chi Minh Cae td' chflc la loai hinh dieh vu ldi nhuan nudi dfldng ngfldi eao tud'i vdi chit Ifldng eao bing ngudn ddng gdp ciia gia dinh hg Diiu giup giai quyet mdt p h i n nhu d u cham sdc figfldi cao tudi d dd thi Tuy nhien loai hinh edn it di va mdi x u l t Men tfl phat nen ehfla cd nhflng ehuan mfle quy dinh eu the ve chfldng trinh, ddi ngu can bd va d e ky nang d n thie't de cham sdc ngfldi cao tud'i Ket l u a n Cung nhfl cac nfldc dang phat trien khac, Viet Nam la nfldc tang nhanh ve tud'i thg trung binh cung nhfl sd' Ifldng ngfldi eao tud'i Diiu da lam cho md hinh dm dau cung thay dd'i Benh tat thfldng hay x u l t Men d lfla tud'i gia Tud'i eao la mdt yeu td nguy cd mle benh dae biet la cac benh man tinh va benh thoai boa Sfl thay dd'i ddi hdi sfl quan t l m dae biet ctia he thd'ng y te' va toan xa hdi cham sdc sflc khoe eho ngfldi eao tudi Nhflng van de ve sflc khoe va kha nang tie'p can cham sdc y te la cac van d i flu tien eua ngfldi eao tudi Mae dfl truyen thd'ng kinh trgng va phung dfldng ngfldi cao tudi edn kha manh d Viet Nam, ngheo khd', di dan va sfl thay dd'i eua cac gia tri xa hdi dang lam mai mdt kha nang cham sdc eua gia dinh ddi vdi ngfldi cao tud'i Do vay, viee xay dflng chinh http://www.un.org.vn/index.php?option=eom_eontent&view=article&id=1080:sample-results-fromeensus-show-fertility-rate-in-viet-nam-remains-below-replacement-level&eatid=88:features&Itemid=252&lang=v ^ " So'ngiidi tuoi tit 15 de'n 64 tuoi tren so'ngiidi tii 65 tuoi trcl Ien ESCAP, 1999 Bi'Quynh Nga 41 saeh cung nhu cae chfldng trinh va dich vu eho ngfldi eao tud'i la r i t d n thiet, n b l t la bdi eanh dang ed sfl thay dd'i nhanh ehdng ve nhan khau, kinh te va xa hdi nhfl hien Cflng nhfl cac nfldc dang phat trien khac, Viet Nam la nfldc tang nhanh ve tud'i thg trung binh eung nhfl sd' Ifldng ngfldi eao tud'i Diiu da lam eho md hinh d'm dau cung thay dd'i Benh tat thfldng hay xult Men d lfla tud'i gia Tud'i eao la mdt ye'u td nguy cd mle benh dae biet la cac benh man tinh va benh thoai hoa Sfl thay dd'i ddi hdi sfl quan tam dac biet cua he thd'ng y te va toan xa hdi cham sdc sflc khoe cho ngfldi cao tud'i Nhflng van d i ve sflc khoe va kha nang tie'p can cham sdc y te hien dang la cac van d i flu tien eua ngfldi eao tud'i Tai lieu t h a m k h a o Bd Lao ddng Thfldng binh va Xa hdi (MOLISA) Bao eao td'ng ke't edng tae bao trd xa hdi Vu Bao trd xa hdi MOLISA nam 2005 Bd Lao ddng Thfldng binh va Xa hdi (MOLISA) 2006 Bao cao phat trie'n he thd'ng an sinh xa hdi phfl hdp vdi bdi eanh n i n kinh te thi trfldng dinh hfldng xa hdi ehu nghia Bd Lao ddng Thfldng binh va Xa hdi (MOLISA) 2006 Bao eao phat trien he > thd'ng an sinh xa hdi phfl hdp vdi bdi eanh n i n kinh te thi trfldng, 2006 Bd Lao ddng Thfldng binh va Xa hdi (MOLISA) 2005 Diiu tra ngfldi tan tat nam 2005 MOLISA Bd Lao ddng Thfldng binh va Xa hdi (MOLISA) 2005 Khao sat hd ngheo nam 2005 Vu Bao trd xa hdi MOLISA Bg Lao dgng Thfldng binh va Xa hdi (MOLISA) 1998 Hdi thao ve Ngfldi eao tud'i Tai lieu hdi thao ehfla in Ha Ndi 04 - 05/11/1998 Bfli The Cfldng 2005 Trong mien an sinh xa hdi: Nghien cflu ve tud'i gia Viet nam, Nha xuat ban dai hge qud'c gia Hdi Ngfldi eao tud'i (2006) Ky yeu hdi nghi toan qud'c sd ke't nam boat ddng cham sdc ngfldi cao tud'i (2001 - 2005), Nha xult Ban thd'ng ke Hdi Y te edng cgng Viet Nam 2009 Bao eao nghien cflu td'ng quan ve ehinh saeh, thflc thi chinh sach va cdng trinh nghien cflu khoa hge ngfldi cao tud'i Viet Nam 10 HelpAge International 2001 Hoan canh eua ngfldi eao tud'i ngheo d Viet Nam: bio eao tfl mdt eude nghien cflu ed sfl tham gia, 59 tr 11 Martin Evans and other 2005 Older people in Viet Nam UNDP, 2005 12 Quye't dinh sd' 170/2005/QD-TTg thang nam 2005 eua Thu tfldng Chinh phu 42 Ngiidi cao tuoi Viet Nam: Phuc lgi xd hgi vd 13 Sheung-Tak Cheng, Alfred Chan, David Phillips (2007) The Ageing Situation in Asia and the Pacific: Trends and Prorities, UNESCAP 14 Td'ng cue Thd'ng ke (2004, 2006) Diiu tra mfle sd'ng dan efl, Nha xuat ban Thd'ng ke 15 Td'ng cue Thd'ng ke 2007 Dieu tra bie'n ddng dan sd' & KHHGD, Nha x u l t ban Thd'ng ke 16 Vien Chie'n Mde va ehinh saeh Y te 2006 Danh gia tinh hinh cham sdc sflc khde cho ngfldi cao tud'i d Viet Nam Ha Ndi 10/2006 17 Vien Lao khoa Dieu tra dich t i hgc v i tinh hinh benh tat, nhu elu cham sdc y te va xa hdi eua ngfldi eao tud'i Viet Nam Ha Ndi; 2002 18 World Bank 1999 Tieng ndi cua ngddi ngheo Viet Nam Ha Ndi 19 World Bank 2000 Bdo cdo phdt trien the'gidi 2000/2001: York: Dai hoe Oxford an hanh Chdng ngheo khd'New ... 9,92% nam 2004 va 10,4% nam 2006 Cung theo diiu tra nam 2006^ eho thay sd' ngfldi eao tudi ea nam va nfl diu tang so vdi nam 2004^ va ngfldi eao tudi nfl eao hdn ban nam (12,0% ngfldi cao tud'i... 11% nam 2006, 19% nam 2025 va 28% nam 2050 Ty le dan sd' ngfldi eao tudi Viet Nam dfl bao theo ket qua diiu tra mfle sd'ng hd gia dinh 2006 se nhfl sau: 10,4% nam 2006, 16,4% nam 2025 va 29,4% nam. .. ngfldi cao tud'i Ket qua eua ddt diiu tra mfle sd'ng hd gia dinh (VHLSS) vao nhflng nam 1999, 2004 va 2006 da eho thay ty le ngfldi eao tud'i tang cao Ty le ngfldi cao tud'i theo diiu tra nam 1999
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