NHIN RA THE GIOI Mdt sd kinh nghidm ve xd hdi hda gido due vd y te cua Trung Qudc I PGS TS NGUYEN MINH PHUDNG (*) C tfng vdl vlic di cich md cia trin cic ITnh vtfc kinh ti xa hdi, cdng tic xa hdi hoi[.]
NHIN RA THE GIOI Mdt sd kinh nghidm ve xd hdi hda gido due vd y te cua Trung Qudc I PGS TS NGUYEN MINH PHUDNG (*) tfng vdl vlic di cich md cia trin cic ITnh vtfc kinh ti - xa hdi, cdng tic xa hdi hoi ITnh vtfc giio due, y tidi dtftfc Ding Cdng sin vi nhi ntfdc Trung Qudc hit stfc ehu trqng Chi trtfdng xa hdi hoi giio due, y ti ttfng btfdc dtftfc cu thi hoi thinh dtfdng ldl, chlnh sich vi vin bin phip quy, din phi vd thi "ddc quyin" vi giim ginh ning bao dp cia Nhi ntfdc, gdp phin ning cao ehit itftfng dieh vq dc ITnh vtfc niy Vi xi hdl hoi giio dtfC Sau nfldc Trung Quic mdi dupe thfinh Ifip nfim 1949, cung vdi vific o i i tgo xa hfii, nhfi nudc tiln hfinh o i l cfich t h i c h l trddng hpc, x o i bd hlnh thdc trudng td thyc, chl nhit tdn tgl hlnh thfle trfldng cfing Ifip hfi thing giio dye Chlln lupc "khoa giio quic" diu nhflng nfim 1980 da dfinh d i u sp ddi cfla phong trfio xfi hfli hofi gifio dgo, vdi hing logt cfic logi hlnh trddng td thyc, c i c trung tfim dfio tgo, lifin k i t dfio tgo ngofii ofing Ifip dflpc thfinh Ifip Nfim 2000, Quic Vy vifin Trung QuIo ban hfinh thfing tfl yfiu d u "Bp Gifio dgc tflng bfldo d i y nhanh cfing tfie xa hfii hofi d l i vdl cfing tfie gifio dyo d eae d p ' Td dd, t j Ifi cfio trddng ngofii cong Ifip so vdi trudng cflng Ifip d i u tfing theo cfio nfim C Tinh d i n culi nfim 2008, Trung Quflc cd hdn 110.000 cd sfl, gifio dye ngofii cfing Ifip vdi s l hgc slnh, slnh vifin dflpc dfio tgo Ifi hOn 27 trtfiu ngfldi, chilm mfit t j trpng dfing k l nfin giio dpc D l b i o d i m oho efing tfio xa hfii hoa gifio dgc phfit triln dl vfio chilu sfiu, nfim 2002, n Vlin Khoa hQC td chtfc nhi nudc, Bd Ndl Vtf nhfi nddc da ban hfinh Lufit Gifio dye dfin doanh vfi nfim 2004, Quic Vy vifin ban hfinh Dilu Ifi hfldng d i n thyc thi Lufit nfiy nhim thdc d i y hdn nOa sg phfit triln cfla cfio t l chdc gifio dye ngoai cflng Ifip Theo dd, d l i tupng ddpc thfinh Ifip co sfl gifio dye ngofii cfing Ifip bao gflm: cfio t l ohdo sp nghifip, cfic doanh nghifip nhfi nddc, cfic dofin t h i xfi hfii, to chdo kinh t l tfip t h i , dofin t h i hpe thufit vfi ngddi dfin- V l kinh phi, efic ddn vi nfiy khflng dupc cfi'p kinh phi tfl ngfin sfich nhfi nfldc, sfl hflu cua efic t l chde nfiy nim ngoii hlnh thde sd hdu tofin dfin vfi tfip t h i Nhflng n i u chlnh quyln nhfin dfin fly quyln cho trddng dfin Ifip d i m nhfin nhifim vy giio dye nghTa vg, thi phii t r i mgl kinh phf gifio dyo tddng dng theo hpp ding fly quyln (Dilu 49 Lufit Gifio dye dfin doanh) Theo thing kS gin dfiy cfla Bfl Gifio dye Trung Quic, sp h i trp cfla nhfi nudo d l i vdi oac cd sd gifio dyo ngoai ofing Ifip nhfl sau: cd 39,9% cd sfl gifio dyo ngofii cfing Ifip ddpc huflng flu dai c i c mfit v l thufi; 17,1% ed sd dupc hddng flu dai tfl vlfio oho thufi dit; 5,7% cd sfl dflpc sg h i trg kinh phi trpc tllp tfl chinh phfl Tuy nhifin, t^ Ifi hfii Idng d l i vdi chinh sach va quin ly cua chlnh phu d l i vdl ed sd gifio due ngofii cflng Ifip Ifi tddng d l i thip, ey t h i ; tit lfi t r i Idi "rat hai Ifing" chilm 1,9%; 'tddng dfli h i i Idng" chilm 29,1%'; ty Ifi 'khfing hfii Idng lim" chilm 54,4% v i "rlt khflng hfii Idng" ohiem 8,9%"' Trii qua 30 nfim tlm tdi, thfl nghifim mfl hinh, b l sung va hoan thifin t h i c h l , cflng tae xa h l i h o i giio dye d Trung Quic da dgt mfit s l thinh tgu chlnh nhfl sau: Thtf nhit, bddc d i u hlnh thinh khung t h i T6 chlie n h * nunc 4/2012 o e h l phfip ly tddng d l i hofin chlnh Dilu nfiy da gldp oho cfic cd sd giao dyo ngoai cfing Ifip d Trung Quic od sp gia tfing dang k l v l mfit s l idpng vfi chit tflpng; nhit Ifi sau quIo gia ehlnh thdo gia nhfip T l ohdo Thddng mal t h i gidi nfim 2001, so Iflpng cfic trudng td thye 100% v i n nfldc ngofii hofic lien doanh vdi nfldc ngofii tfing len nhanh ohdng Dfiy Ifi 00 hfii t i t oho oao nhfi quin ly giao dyo fl Trung Quic cd cd hfli tiip cfin vdi phddng thdc quan ly gifio dye vfi cfio phfldng phap gifio dyo efla efic quoo gia tifin tiln tren t h i gidi Ding thdi, ngudi dfin ed nhilu ed hfli thy hddng cac dich vy gifio dye ohlt Idpng oao vdi mile chi phi hpp ly Thtf hai, odng vdl sp gia tfing eda oao cd sd giio dgc ngofii cflng Ifip, gfinh nfing giio dgc cfla nhfi nudc da bddo diu dugc "san s i " Trfin od sfl fip dyng e h l dfl p h i cfip gifio dyo nfim, vdi sp tham gia cfla cfio co sfl gifio dyo ngoii cflng Ifip, ngddi dfin ed nhilu cd hgl ddpc dfio tgo fl trinh dfi cao hdn Thtf ba, e i i cfich c h l dfi hpc phi, theo dd quy dinh td trung hgc chuyfin nghifip trfl Ifin, ngddi hgc phil ddng hpc phi nhim ehia s i hpp ly mfit phin gifi thfinh gifio dye C h l dfi hpc phi khfing ehl b l sung nguin thu d l phfit triln gifio dyo, mfi odn tfing cddng y thdo, trfich nhifim cfla hge sinh vfi phy huynh Cung vdi e h l dfi hgc phi, cfio oo quan nhfi nddo thgo hifin che dfi hgc bing, eho vay tin dyng, miln, giim hpc phi oho hpe sinh cd hofin oinh khd khfin Tuy nhifin, bfin cgnh nhOng thfinh tgu n i l bfit nfiu trfin, oflng tfie xa hfii hofi giao dye fl Trung Quic cung od nhflng hgn c h l nhit djnh Theo thing kfi cfla Bfl Gifio dye Trung QuIe, ehl cd 29,9% s l Iflpng sinh vifin, hgc sinh tfit nghifip cfio cd sd dfio tao ngoii oflng Ifip tlm dflpo vifie Ifim sau tfit nghifip; chit Iflpng eua efic cd sd dfio tao ngofii cflng Ifip cung Ifi v i n de dfing bfin, quan nifim xfi hfii v l cd sd dfio tgo ngofii cfing ifip vfin od sp phfin bifit- Nhflng hgn c h l nfiy gfiy nhilu khd khfin oho vlfio tfln tgi b i n vQng eua cac cd sfl gifio dye ngofii cfing Ifip d Trung QuIe tddng lai 2, Vi xe hdl hoi y ti Qufi trtnh xfi hfli hofi y t l fl Trung Qufic dflpc bit dau tfl cfic thfinh phfi Idn, cfic khu vpc cfi dilu kifin kinh t l phat trtin, sau dd lan d i n sang khu vpc nflng thfln Nfim 2002, Trung uong Ding Cong s i n Trung QuIo vfi QuIo Vp vifin ban hanti 'Quylt djnh v l vific tfing cfldng dSy manh hon nOa cflng tfie chfim sdo sdo khde nflng thfln' Theo dd, c i n "tflng bfldo xfiy dgng e h l dfl hpp tfio y t l nfing thfin mdi", tde Ifi xfiy dpng cac ed sd dich vy y t l fl nong thfln trfin CO sfl hpp tfie gifla nhfi nddo, doanh nghifip vfi ngufii nfing dfin, nhim d i m bio cho ngudi dfin sinh sing d khu vpe nflng thfln dupc huflng nhflng djch vy y t l t i t n h i t Ngiy 01/3/2003, 'Lufit Nflng nghifip nfldc Cflng hofi nhfin dfin Trung Hoa" sfla d l i dfi quy djnh: "Nhfi nudo c l vu, khuyin khlch, flng hfl nflng dfin odng c l va phfit trtin hinh thdo y t l hpp tfio nong thin va efie loai bio hilm y t l khfio' Cdng vdi nhflng o i i ofioh Hnh vpc y t l nhim thu hut nhilu hOn d i u td efla xa hfii vfio Hnh vpc chfim sdo sdo khfle ngddi dfin, Trung QuIo xdc djnh bfinh vifin dfin doanh Ifi mfit bfi phfin quan trpng sp nghifip y t l Hiln phfip nfldc Cfing hofi nhfin dfin Trung Hoa (nfim 1982) quy dinh: "Nhfi nfldc phit triln sp nghifip chfim sdc sflc khde, y t l , phfit triln n i n y hpe hifin dgi vfi n i n y hpc truyin thing Trung QuIo, khuyin khfch vfi flng hfi t l ohdo kinh t l tfip t h i nflng thfln, t l chflc sp nghifip, doanh nghifip nhfi nddo vfi cfio t i ohdo d khu dan ofl thfinh Ifip cfic cd sfl vfi slnh y t l , trien khai cfic hogt dfing vfi sinh mang tinh quin ohdng, bio vfi sdc khofi cho nhfin dfin"'" D l d i y nhanh vific thpc hifin xa hfii hoa efie djch vy y t l Ding Cfing s i n Trung QuIo da ehi dgo "fip dyng nhilu hinh thdc, nhilu ngufln v i n d i u tfl vfio oie dieh vy chfim sde sdo khde, y t l Nhfi nddo ban hfinh c i c chlnh sfich Uu dai vfi khuyin khfch cfio ddn vi sp nghifip, dofin t h i xfi hfli vfi c i e cfi nhfin quyfin tfing, ung hfi, dfiu td cho ngfinh chfim sdc sdc khfle, y t l " Trfin ed sd dd^ nfim 1989, Bfi Y t l Trung QuIe ban hfinh "t kiln v l mfit sfl vfin d l ed lifin quan v l vifie md rfing dich vg chfim sdc sde khde' Trong dd dfi xfie dinh efie hlnh thdc dich vg y t l khfio odng tfin tgi vfi khuyin khfch eie doanh nghifip, don vi sg nghifip thfinh ifip d e co sfl dieh vy y tfi theo hudng Ti chlie nh* nnfie 4/2012 xfi hfii hofi, khuyin khfch kinh t l d t h i thfinh Ifip bfinh vifin vfi ngfldi dfin thfinh Ifip d c eo sd khim chfla bfinh Sau chinh sach ddi, nguin vfin d i u tfl cho IFnh vge djeh vu y t l tfing Ifin dfing k l Thfing 9/1994, QuIe Vg vifin ban hfinh ' D l l u Ifi quin 1;^ od sd khfim, chfla bfinh' nhim thuc day, khuyin khlch nguin v6n xa hfit d i u tfl vfio djch vy khim ChQa bfinh vfi thang 01/1997 ban hanh 'Quyet dinh v i vifie c i i cfioh vfi phit triln ngfinh chfim sde sde khfle, y t l ' nhim c i i cich t i n g thi d l i vdi ngfinh y t l theo hfldng khuyin khlch diu tu xa hfii vfio phfit triln vfi c i i oich dich vy y t l Thfing 7/2000, liSn Bp Y t l vfi Bp K l hogch v i D i u td ban hfinh "Bien phip tgm thdi quin ly cd sd y t l hpp t i o , Hfin doanh Tnjng Quic v i nddc ngofii", md thdi ky phit triln nhanh efla eao cd sfl y t l lifin doanh glQa Trung Quic v i nddc ngofii Vdi cfio chlnh sfich khuyin khfch phfit trtin mfit cfioh phd hpp, cflng bing gifla bfinh vifin dfin doanh vfi bfinh vifin nhfi nude, bfinh vifin dfin doanh d Trung QuIo da phit triln nhanh v l s l lupng, o i nude hifin od 1.792 bfinh vifin dfin doanh, vdi tfii s i n o l dinh hon 40 ty nhfin din tfi, cd 78.051 giudng bfinh Bfinh vifin dfin doanh hifin da trfl thfinh mfit bfi phfin quan trgng hfi thing dich vg y t i cfla Trung Qulc"i Cy t h i , theo thing kfi, s l Idpng bfinh vifin dfin doanh cfla Trung Quic hifin chilm khoing 8% ting s l bfinh vifin c i nudc, dd, hai tinh Tfl XuySn vfi Trilt Giang od tjf Ifi bfinh vifin dfin doanh Idn nhfit c i nfldc: Tfl Xuyfin cd 150 bfinh vifin dfin doanh vdi 5.243 giudng bfinh, ehlim 12,9% sfi lupng bfinh vifin tofin tinh; Trifi't Giang cd 83 bfinh vifin dfin doanh vdl 4.818 giudng bfinh, chilm khoing 11,8% Tuy nhifin, b i n cgnh mfit tfch cgc, sg phfit tnln nhanh chdng cfla xa hfii hofi dich vg y t l d Trung QuIo cung d i n tdi mfit s i hgn e h l nhit dinh Cfio ohI s l sdo khfle vfi chfim sde sdc khde efla ngudi dfin khong tfing theo kip mde tfing trddng kinh t l v i dang xult hifin nhilu v i n d l ding lo nggi nhd: gia tfing tinh trgng m i t efing bing thg huflng djeh vy y t l ; tgl vdng nfing thfln, khoing g i n 40% dfin CU khfing t h i t r i dupc chi phi oho efie djch vp y t l , dd nhilu ngudi b| bfinh da khflng nhfip vifin theo chl dinh; tjf Ifi mic bfinh v i tfl vong cfic bfinh nhlem trdng od xu hudng tang; chi tifiu cfla hfi gia dinh cho dich vy y t l nam 2006 tfing g i p 18 l l n so vdi nam 1990; vifie sfl dgng nguin tfii ehlnh oho y t l kem hifiu qua, ehat Iflpng dich vy y t l glim sdt Nhieu 00 sfl y te d tuyen thfln, b i n b| bfin hoac ky hpp dong vdl oao ofl sd y t l tu nhan vfi boat dpng nhu od sd tu nhan Theo dfinh gifi efla To ehdc Y t l t h i gidi (WHO) v l k h i nfing gay quy vfi tinh cflng bing cfla efic hfi thing y t l , 'Trung Qufic Ifi qufic gia dflng thfl tfl tfl dddi ISn ting s l 191 quic gia Tfnh cflng bing v i hieu q u i thip da tilp tyc gfiy oao hfiu q u i kinh te vfi xfi hfii nghifim Irpng, vl dy, i n h hddng tifiu epe d i n sflc khofi cfla ngfldi dfin, hfing loat cae v i n d l xa hfii nhu nghfio ddi, tfing sp b i t binh cfla ngfldi dfin, vfi sp m i t cfin bing quan hfi gifla cac nhdm""' T l ehfle bfl mfiy vfi co c h l quin ly cfla c i e ed sd y t l ngoii quic doanh cdn tfldng d l i Idng lio, chUa thpc sp khoa hgc, dd, hifiu q u i hogt dfing chda cao Dgi bfi phfin cfic bfinh vifin ngofii oflng Ifip hifin chfl y l u hogt dfing Hnh vpo khfim bfinh vfi dilu tri ting hpp R l t It bfinh vifin chuyfin khoa od quy mfl Idn vfi d i u td trang thilt bi diy dfl dilu tri vfi nghifin cflu; nhilu bfinh vifin tfl nhfin dflpc thfinh Ifip vfi quin IJ theo mfl hinh gia dinh Mfit khfic, v i n d l g i i thfinh va ohlt Idpng dich vy cfla cfic cd sfl y t l ngoii eflng Ifip d Trung QuIo hifin cung dang Ifi v i n d l bdc xdo T i t c i efie y l u t l nhd: gifi thufi dit, v i n vay, gifi nhfin oflng, gifi efie ioai dieh vy thfing tin hay cfic khoin phi glao dieh efla cfio od quan quin ly d i u dupe dua vfio gifi thfinh efla cfio od sd y t l ngofii efing Ifip Chlnh vl the, gifi thfinh qufi cao, r l t khd thu hut ngudl dan d i n vdi cao djeh vp y t l ngofii eflng Ifip, sp qua t i i d efie oo sfl y t l oflng Ifip fl Trung QuIo vfin Ifi v i n d l Ifim dau d i u oao nhfi quin iy Mqt sd van de rtft ttf thtfc tiin xa hdl hoi giio dvc, y ticua Trung Qudc Thtf nhit, nfing cao nhfin thdc cfla cfio d p lanh dgo v i efic ting Idp nhfin dfin vi sp c i n thilt vfi vai trd, tfie dpng cfla xfi hfii hofi gifio dpc, y t l b l i oinh o i l cfich t h i c h l kinh t l theo hddng thi trudng, nhim phfit huy d i u tu xa hfii vfio nhflng Hnh vpo khfing nhit thilt T4l chlie n h * nn6ic 4/2012 phii nhfi nudc bao c i p hofin toan Cdng vdi ddi sing nhfin dfin cfing dflpc nfing eao, nhu d u v l chat Iflpng dich vy khflng ngflng tfing Ifin D l nfing oao chit Idpng cfic logi hlnh djch vy xa hfli, dd cd djch vg giao dgc vfi y t l , vifie d i y mgnh xa hdl hoa gifio dyo vfi y t l trd thfinh nhu oiu ngfiy cfing d p thilt Thtf hai, xfie djnh dung vai trd cfla nhfi nfldc vific d i m b i o eung dng efie djeh vg gifio dye vfi y t l cd b i n Mflt nhflng nguyfin nhfin Ifich lge c i i ofioh hfi thing y t l cfla Trung Quic Ifi, mfii trfldng thj trddng da bi khai thfic qufi mdo vfi khflng hpp ly, nhfi nudo khflng thUo hifin dflpc vai trfl efla minh, xu hudng thi trddng vfi thUdng mgl h o i rlt nghigm trpng o i i ofioh hfi thing dieh vy khfim, chfla bfinh Do dd, oln xfio dinh ro trfich nhigm cua chlnh phfl chfl y l u fl hal khfa cgnh: mtft li, tfing ngfin sfich vfi phfin b l kinh phi; hal li, oan thifip vfio vlfio xfiy dgng, phfit trtin hfi thing dich vy y t l Tuy nhifin, d l xfie dinh ro hdn trfich nhigm cfla nhfi nddc, efin phfin logi efie nhu c i u gifio dyo vfi chfim sdc sdo khoi thfinh efic d p : giio dyo p h i cfip vfi cfio dich vy y t l cflng oflng, dieh vy ohfim sdo sflc khoi ed b i n vfi efic dich vy cham sde sdo khofi khflng cd b i n Tfl dd ed chlnh sfieh vfi sg h i trp t i i ehlnh thfch hpp Thtf ba, ohd trpng xfiy dpng, hofin thifin khung phip ly d l tgo dilu kiin oho cfing tao xa hfii hofi giao dye, y t l phfit triln thufin Igi, bio d i m quyln Ipi vfi tgo tfim ly yfin tfim oho nhfi d i u td vao Hnh vpe nfiy Vdl sg phfit triln ngfiy ofing mpnh me cfla c i c cd sd gifio dyo vfi y t l ngofii efing Ifip, ddl hfli hg thing phfip lufit digu ehlnh oin ohd trgng hofin thifin theo hddng bio d i m cgnh tranh oflng bing vfi bio vg quyln sfl hflu tfii s i n cfla eic nhfi d i u tfl Tuy nhifin, y t l vfi gifio dye Ifi hai Hnh vge cd lifin quan mfit thilt tdi cufic sing efla ngddi dfin, dd, bfin oanh vific diy nhanh xa hfii hofi thflng qua khuyin khfch d i u tfl, c i n ehu trpng eflng tfie quin ly, gifim sfit boat dfing efla cfio od sd gifio dgc, y t l ngofii oflng Ifip nhim d i m b i o chit lupng cfla cfic dich vy Td dd thay d l i d i n quan nifim cfla ngfldi dfin v l y nghTa cfla xa hfii hofi gifio dyo, y t l Thd' ttf, trfin CO sd thay d l i quan nifim cflng nhic la djeh vy giao dye vfi y t l phil Ifi "phl M nhufin", efic co sfl gifio dye, dfio tgo vfi khfim chfla bfinh ngofii cflng Ifip cd t h i dupe dfing k