Hoàn thiện cơ chế thu bảo hiểm y tế ở việt nam (qua thực tiễn ở tỉnh nam định)

MUC LUC • • DANH MUC CHU VIET TAT DANH MUC BANG BIEU DANH MUC SO DO Md DAU 1: CO Sd LY LUAN VA THUC TIEN VE HOAN THIEN • • • CO CHE THU BAO HIEM Y TE CHU’ONG 1.1 Nhfirig van de co1 ban ve bao hiem y te va thu bao hiem y te •z r f 1.1.1 Bao hiem hiemy te, khai mem, chive nang va vai tro cua BHYT 1.1.2 Thu BHYT: Khai niem, nguyen tac, noi dung nguon thu va dac diem boat dong thu BHYT 10 1.2 Noi dung, nhan to anh huong, sir can thiet phai hoan thien co’ che thu bao hiem y te 14 r ■> yr 1.2.1 Quan niem ve co’ che thu bao hiemy te 14 1.2.2 Noi dung hoan thien cor che thu bao hiemy te 16 r r r r r r 1.2.3 Nhicng nhan to anh huomg den cor che thu bao hiemy te 19 21 1.2.4 Sic can thietphai hoan thien cor che thu bao hiemy te yr -r r r 13 Kinh nghiem cua mot so quoc gia va dia phuong niroc ve hoan thien co1 che thu BHYT 23 1.3.1 Kinh nghiem cua mot so quoc gia tren the gori 23 1.3.2 Kinh nghiem thu BHYT tai tinh Ninh Binh 21 r 1.3.3 Nhiing bai hoc rut co the van dung vao hoan thien cor che thu bao hiemy te 27 CHUONG 2: THUC TRANG CO CHE THU BAO HIEM Y TE TREN DIA 29 • BAN TlNH NAM DINH • 2.1 Tong quan chung ve Bao hiem y te tinh Nam Dinh 29 ■z r a 2.1.1 Dac diem ve tic nhien, kinh te xd hoi cua tinh Nam Dinh co lien quan den hoan thien cor che thu Bao hiemy te 29 * r • • r r • r 2.1.2 Qua trinh hinh va phat trien cua bao hiem y te tinh Nam Dinh 32 2.2 Hien trang co' che thu bao hiem y te tren dia ban tinh Nam Dinh 33 2.2.1 Tinh hinh van dung van ban chinh sack ve thu BHYT 33 2.2.2 Thuc trang qui trinh thu bao hiem y te 39 2.2.3 Tinh hinh tO chuc thuc hien cac qui dinh ve thu BHYT 42 2.2.4 Tinh hinh tra, kiem tra, giam sat thu BHYT tren dia ban tinh Nam Dinh 54 A r X 2.3 Danh gia thirc trang co’ che quan ly thu bao hiem y te tai Nam Dinh 55 2.3.1 Nhung tan dat duoc 55 y r y r 2.3.2 Nhh.’ng horn chh, ton tat can kkacphuc 58 CHEONG 3: PHU0NG HCONG VA GIAI PHAP cO BAN HOAN THIEN CO CHE THU BAO HIEM Y TE .65 3.1 Phuong huong hoan thien co che thu bao hiem y te 65 3.1.1 Can cu xac dinh phuong huong hoan thien co che thu bao hiem y te 65 3.1.2 Dinh huong hoan thien co che thu bao hiemy te (59 r r 3.2 Mot so giai phap nham hoan thien co che thu bao hiem y te 70 3.2.1 Nhom giaiphap ve hoan thien cac van ban phap luat, chinh sach, qui dinh ve thu BHYT 77 3.2.2 Nhom giaiphap ve to chuc thuc hien 77 3.2.3 Day mcnh cong tac cai cach hanh chinh 84 3.2.4 Ung dung cong nghe thong tin vao quan ly thu BHYT 86 3.2.5 Tang curingphap che quan ly thu bao hiemy te 88 r r a 3.2.6 Mb' rong doi tucng, loai hinh tham gia bao hiem y te nham tang v curing, phat trien ngunn thu bao hiemy te 89 y r KET LUAN - 91 TAI LIEU THAM KHAO DANH MUC CHU* VIET TAT ASXH An sinh xa hoi BHTM Bao hiem thuong mai BHTN Bao hiem that nghiep BHXH Bao hiem xa hoi BHYT Bao hiem y te BHYT BB Bao hiem y te bat buoc BHYT TN Bao hiem y te tn nguyen CSSK Cham soc suc khoe KCB Kham chua benh KT-XH Kinh te- xa hoi NLD Nguroi lao dong NSDLD Nguoi su dung lao dong UBND Uy ban nhan dan XHH Xa hoi hoa DANH MUC BANG, BIEU I BANG Bang 2.1 Tong hop ket qua thu BHYT tinh Nam Dinh giai doan 2006-2010 47 Bang 2.2 Thu BHYT bat buoc nam tir 2006 den 2010 49 Bang 2.3 Tong hop ket qua thu BHYT tu nguyen tinh Nam Dinh giai doan 2006-2010 51 Bang 2.4: Ty le hoc sinh- sinh vien tham gia BHYT tu nguyen tinh Nam Dinh 53 tir nam 2006-2010 53 Bang 2.5: Tinh hinh thuc hien ke hoach thu BHYT tir nam 2006-2010 57 Bang 2.6 So doanh nghiep tham gia BHYT tai tinh Nam Dinh 59 Bang 2.7 Ket qua thu BHYT tu nguyen nhan dan tir nam 2006-2010 59 Bang 2.8 Mire bao phu BHYT tai tinh Nam Dinh tir nam 2006-2010 61 II BIEU Bieu 2.1: Co cau nguon thu BHYT tai tinh Nam dinh 2006-2010 48 Bieu 2.2: Co cau doi tuong tham gia BHYT tai tinh Nam Dinh 2006-2010 48 III SO DO Sa 2.1 Mo hinh to churc quan ly cua BHXH tinh Nam Dinh - 45 TR JONG DAI HOC KINH TE QUOC DAN - O - NGUYEN KIM DINH HOAN THIEN CO CHE THU BAO HIEM Y TE VIET NAM (QUA THUC TltNO TINH NAM DINH) CHUYfiN NGANH: KINH t£ CHfNH TRI TOM TAT LUAN VAN THAC SI HA NOI - 2011 TOM TAT LUAN VAN Cham soc y te la mot noi dung quan cua he thong an sinh xa hoi ma bat ke quoc gia nao tu quoc gia dang phat trien va quoc gia phat trien deu coi Luat phap hau het cac nudc tren the gidi deu co cac qui pham dieu chinh cac che an sinh xa hoi BHYT la mot giai phap quan trong viec cham soc y te, mot che quan trong he thong an sinh xa hoi BHYT ddi rat sdm d cac nudc phat trien Chinh sach BHYT d Viet Nam luon duoc su quan tam cua Dang va Nha nudc ta Thu BHYT la noi dung het suc quan trong chinh sach BHYT d Viet Nam hien nay; vdi co che huy dong su dong gop cua ca nhan, tap the va cua ca cong dong xa hoi de tu hinh nen nguon qui kham chua benh, tu cho thay nguon thu BHYT de hinh nen qui BHYT la rat quan no quyet dinh den chat luong kham chua benh va quan hon nua no quyet dinh den su bai cua chinh sach Muc tieu nghien cuu luan van la khao sat co che thu BHYT dua tren co sd danh gia thuc trang tai tinh Nam Dinh de qua he thong hoa nhung van de ly luan co ban v£ co che thu BHYT, de xac dinh ro chuc nang, nhiem vu cua he thong BHYT, chi duoc phuong hudng va nhiem vu cong tac quan ly thu BHYT thdi gian tdi Dong thdi phan tich, danh gia duoc thuc trang thu BHYT tren dia ban tinh Nam Dinh nhung nam qua; nhung kho khan vudng mac qua trinh thuc hien Xac dinh cac nhan to anh hudng den chinh sach BHYT, nhung nhan to anh hudng den co che thu BHYT qua de xuat quan diem, giai phap co ban nham hoan thien co che thu BHYT tren dia ban tinh Nam Dinh va pham vi ca nudc Pham vi nghien cuu cua luan van la: Nghien cuu co che thu BHYT d Viet Nam (thong qua thuc trang co che thu BHYT d tinh Nam Dinh) de dinh hudng ve quan diem va giai phap hoan thien thdi gian tdi Ve phuong phap nghien cuu: Phan tich thuc trang co che quan ly thu BHYT qua trinh bay cac noi dung ly luan va thuc tien, ngoai luan van su dung phuong phap thong ke so sanh de phan tich, danh gia qua trinh ap dung co che thu bao hiem y te tren dia ban tinh Nam Dinh, qua de xuat giai phap hoan thien ii Chuong 1: Co- so’ ly luan va thyc tien ve hoan thien r -x a 1.1 Nhung van de co' •? co' che thu bao hiem y te V r r ban ve bao hiem y te va thu bao hiem y te Bao hiem y te trudc het la mot noi dung cua bao hiem xa hoi la mot nhung bo phan quan trong he thong dam bao xa hoi hay cdn goi la an sinh xa hoi theo tu dien bach khoa Viet Nam I xuat ban nam 1995 thi khai niem ve BHYT duoc dinh nghia nhu sau:” Bao hiem y te la loai bao hiem nha nudc to chuc, quan ly nham huy dong su dong gop cua ca nhan, tap the va cong dong xa hoi de cham lo suc khoe, kham benh va chua benh cho nhan dan” Theo Luat Bao hiem y te thi BHYT la hinh thuc bao hiem duoc ap dung linh vuc cham soc suc khoe, khong vi muc dich loi nhuan, Nha nude to chuc thuc hien” Nguon thu hiem y te duoc coi la “Xuong song” cua he thong bao hiem y te Viec toan chi phi kham chua benh co thuc hien duoc hay khong hoan toan phu thuoc vao kha nang cua thu BHYT Qui kham chua benh co doi dao hay khong, co dam bao can doi, an toan hay khong dieu phu thuoc vao hoat dong tao nguon thu qui BHYT- Thu BHYT Hoat dong thu BHYT la hoat dong khong co muc tieu loi nhuan, cac nguon thu va muc tieu su dung cac nguon thu deu thong qua viec hinh va su dung qui tien te chuyen dung, la qui BHYT Hoat dong thu BHYT co tinh da chu the dac diem xuat phat tu co so co nhieu ben tham gia dong gop de hinh qui BHYT.Hoat dong thu BHYT co su ket hop giua tinh bat buoc va tu nguyen, ve co Hoat dong thu BHYT la hoat dong rieng co cua Bao hiem xa hoi Viet Nam, Hoat dong thu BHYT luon gan chat vdi nhiem vu kinh te xa hoi cua chinh quyen dia phuong va duoc to chuc thuc hien tren co so nhung qui dinh cua Nha nudc ban hanh r r az 1.2 Noi dung, nhan to anh hudng, sir can thiet phai hoan thien co’ che thu bao hiem y te r t r f r r Co che thu bao hiem y te la phuong thuc to chuc, sap xep bo may quan ly cong tac thu bao hiem y te va cac nhiem vu thu de lam co so, dudng hudng cho bao hiem y te van hanh nham hudng tdi cac muc tieu xac dinh quan he tac dong qua lai giua cac bo phan he thong thu bao hiem y te (doi tuong tham gia BHYT, co quan thu BHYT, co quan quan ly nha nudc ve BHYT ) iii Khi dua khai niem co che thu bao hiem y te vdi doi tuong nghien cuu la thu bao hiem y te thi khai niem co che thu bao hiem y te phai bao ham nhung noi dung cua khai niem co che Co che thu bao hiem y te phai la mot phuong thuc, cach thuc nhdt dinh nao de cac bo phan he thong thu bao hiem y te phoi hop vdi nham thuc hien duoc cac muc tieu nhat dinh ve thu bao hiem y te r r r r r r Co che thu bao hiem y te phan anh moi quan he gian tiep hoac truc tiep den qua trinh van hanh he thOng thu bao hiem y te cua cac bo phan Lien quan den thu bao hiem y te co cac doi tuong nhu ngudi tham gia bao hiem y te, co quan thu bao hiem y te, co quan quan ly Nha nudc ve linh vuc bao hiem y te, cac co quan khac co r r r r lien quan day la cac bo phan he thong thu bao hiem y te Su phoi, ket hop giua cac bo phan la su phoi hop nhieu chieu va mang nhieu hinh thai khac bdi vi pham vi va ket qua phoi hop duoc thuc hien dudi nhieu goc khac Giu vai tro van hanh, hudng dan va dieu chinh qua trinh phoi hop giua cac bo phan la cac quy dinh ve thu, nop bao hiem y te Day chinh la cac muc tieu ve chinh sach bao hiem y te cua Dang, Nha nudc duoc Luat hoa la co sd de danh gia ket qua cua hoat dong bao hiem y te va qua trinh thu bao hiem y te Sau la cac quy trinh, quy che duoc hinh qua trinh phoi hop giua cac bo phan he thong thu bao hiem y te nham phuc vu cho su phoi hop Khi co su thay ddi cac qui dinh thu bao hiem y te chinh sach bao hiem y te thi cac qui trinh, r r 9 qui che phoi hop giua cac bo phan cung se duoc thay doi, dieu chinh Co the noi, chinh su phdi hop giua cac bo phan da la phuong thuc dua chinh sach bao hiem y te vao ddi song xa hoi Luan van dua bon noi dung hoan thien co che thu bao hiem y te la hoan thien he thdng cac van ban phap luat ve thu bao hiem y te; hoan thien quy trinh thu bao hiem y te; hoan thien bo may to chuc ve bao hiem y te va va tang cudng kiem tra, tra hoat dong thu bao hiem y te Dong thdi luan van cung dua cac nhan to anh hudng den co che thu bao hiem y te la:Trinh phat trien kinh te va xa hoi; he thong the che ve thu bao hiem y te va chinh sach phat trien BHYT cua Nha nudc qua cac thdi ky; ; Chu truong va cac bien phap dieu hanh quan ly thu Bao hiem y te cua Bao hiem xa hoi Viet Nam; Nang luc td chuc, quan ly, dieu hanh cua he thong thu BHYT; Quyen loi cua ngudi tham gia BHYT va chat luong kham chua benh va iv cuoi cung la nhan thuc cua cong dong ve bao hiem y te Luan van de cap den ba ly can thiet phai hoan thien co che thu BHYT la: Do yeu cau nang cao cham soc y te cho cong dong, dam bao an sinh xa hoi ben vung dieu kien kinh te thi truong dinh hudng xa hoi chu nghia; Do yeu cau giam nhe ganh nang cho ngan sach nha nudc danh cho y te; Do co che thu Bao hiem y te hien co nhung bat cap, chua phu hop vdi thuc te 1.3 Kinh nghigm cua mot so quoc gia va dia phuong niron ve hoan thien tn the itu BHYT De tao lap co so thuc tien cho viec phan tich luan van da khao sat kinh nghiem cua mot so quoc gia va dia phuong nudc ve hoan thien co che thu BHYT Luan van da gidi thieu cach thuc trien khai BHYT o Phap, Hanh quoc, Nhat ban va o tinh Ninh Binh la tinh giap ranh vdi tinh Nam Dinh tu rut mot so kinh nghiem sau: Thu- nhat la: De thu bao hiem y te dat duoc ket qua tot, chinh sach ve thu bao hiem y te phai can linh hoat, mem deo de phu hop vdi su da dang ve thu nhap, cung nhu muc song cua cac tang lop dan cu Cho du sau tat ca nguoi dan se phai tham gia bao hiem y te bat buoc, nhung ty le dong bao hiem y te cung nen chia nhieu loai phu hop vdi nhieu muc thu nhap tao dieu kien cho nguoi dan tham gia Dong thoi nen bo hinh thuc ap dung co dinh mot muc dong, ty le dong co doi vdi tung nhom ddi tuong Vi ban chat cua bao hiem y te la tuong tro giua cac vien xa hoi, giua nhung nguoi co thu nhap cao va nhung nguoi co thu nhap thap, cho nen nhung nguoi co thu nhap cao hon se dong phi cao hon la hop ly Thu hai la, day manh cai cach hanh chinh, ap dung cong nghe thong tin vao quan ly thu bao hiem y te Thu ba la, can nghien cuu quan ly doi tuong tham gia bao hiem y te va qua trinh kham chua benh cua ho bang ma ID ( ma ca nhan) co nhu vay thi viec quan ly, giam sat doi tuong tham gia bao hiem y te duoc chat che hon Thu tu la, Mo rong dich vu thu bao hiem y te thong qua cac co quan nhu: Buu dien, thue ngan hang 81 su- dung lao dong Hang thang don vi sur dung lao dong co trach nhiem dong bao cong cua nguoi lao ddng nop cung mot luc vao qui bao hiem Nhu vay cung mot doi tuong la ngudi lao ddng lam viec cac doanh nghiep, co quan, don vi doan the, td chuc kinh te, cung can cu tinh thue thu nhap ca nhan, ddng bao hiem y te la tien cong tien luong cua ngudi lao dong cung luc phai thuc hien hai nhiem vu ke khai nop thue cho co quan thue va ke khai nop bao hiem y te cho co quan bao hiem; co che vua mat thdi gian, vua ton kern ve chi phi cho cac don vi Neu co quan thue thu ho tien bao hiem y te thi cac don vi chi can thuc hien ke khai mot lan Co quan thue va co quan bao hiem su dung chung mot td khai de tien hanh theo doi viec khai nop thue va nop bao hiem y te tir se giam dupe chi phi cho cac don vi va giam chi phi chung cua ca xa hoi Ngoai vdi viec co quan thue thu ho bao hiem y te se dam bao su gan ket viec thuc thi nghiem minh cac qui tron ddng, cham ddng bao hiem y te nhu hien Ba la, Phoi hop giua co quan bao hiem vdi cac co sd kham chua benh: Thuc hien bao hiem y te la nham dam bao cong bang kham chua benh cua cac tang lop dan cu xa hoi vay can mang tinh td chuc va khong chi rieng mot co quan bao hiem cd the thuc hien De thuc hien bao hiem y te can cd su phoi hop giua co quan bao hiem va cac co sd kham chua benh vi che bao hiem y te thuc hien luon di cung vdi he thong cung cap va phan phoi dich vu y te Dam bao quyen loi cho ngudi tham gia BHYT thi co quan bao hiem y te ngoai viec ky hop ddng kham chua benh cho benh nhan cd the bao hiem y te phai phoi ket hop chat che vdi cac co sd y te viec thanh, quyet toan chi phi kham chua benh Bon la, Bao hiem xa hoi cac tinh, cung can tranh thu hon nua sir quan tarn lanh dao, chi dao cua cac cap uy, chinh quyen dia phuong doi vdi BHXH cap huyen cung nhu BHXH tinh cong tac td chuc thu bao hiem y te, tang cudng cong tac kiem tra quan ly thu bao hiem y te; Can cd hinh thuc khen thuong, dong vien kip thdi doi vdi nhung don vi lam tot cong tac nop bao hiem y te; tang cudng va tri thudng xuyen cong tac tuyen truyen ve chinh sach phap luat 82 bao hiem y te den moi ngudi dan, tu co tac dong tich cue den y thuc chap hanh phap luat ve bao hiem y te cua ngudi tham gia bao hiem y te A 3.2.2.3 Day manh cong tac thong tin tuyen truyen hoat dong thu BHYT sach bao hiem y te cua ngudi dan cdn nhieu han che Mot nhung nguyen nhan dan den hien tuong ty le ngudi tham gia bao hiem y te tu nguyen thap nhu hien ve chinh sach bao hiem y te Vi vay, ho da khong tu nguyen tham gia bao hiem y te cho ban than va gia dinh ho Vi vay thdi gian tdi Bao hiem xa hoi viet Nam tuyen truyen, ve chinh sach bao hiem y te can chu vao chieu sau, hieu qua hon la be rong va so luong Trong do, can dac biet quan tarn den viec lua chon nhung noi dung, hinh thuc phu hop nhat, hieu qua nhat Tuyen truyen lam de cap den dai da so cac ddi tuong xa hoi, hinh thuc tuyen truyen phai da dang, hap dan can chu y den nhung an pham tuyen truyen true quan sinh dong de dupe ngudi lao dong, ngudi dan quan tarn tim hieu BHXH Viet Nam cd the phoi hop vdi co quan phat truyen hinh to chuc thi tim hieu ve chinh sach bao hiem y te thong qua cac chuong trinh xa hoi hoac mot chuong trinh khac vdi chu de ve bao hiem y te; Ky hop dong hang thang md rieng mot phong su quang ba ve chinh sach bao hiem y te Ngoai cdn cd the k£t hop xay dung nhung chuyen muc, bai phong van BHXH cac tinh, va nhat la bao hiem xa hoi cap huyen can cd cac hinh thuc thong tin tuyen truyen phu hop tai phong kham, tram y te xa, y te co quan, don vi, y te nha truong, cd to chuc kham chua benh bao hiem y te de ngudi benh hieu dupe quyen loi va nghia vu viec thuc hien chinh sach bao hiem y te Tuyen truyen, hudng dan giai thich true tiep tai co sd kham chua benh nhu: phoi 83 hop vai benh vien to chuc cac buoi toa dam ve che do, chinh sach bao hiem y te giua nhan vien y te va nguoi benh; phat tai lieu, ta rai; tuyen truyen qua bang hinh tai phong chu kham chua benh Trien khai thuc hien cong tac thong tin tuyen truyen qua he thong Tuyen giao cac cap: hap tac tuyen truyen thuong xuyen thong qua ban tin thong tin sinh hoat chi bo, bao cao vien, giai thieu true tiep ve chinh sach bao hiem y te de tuyen truyen cho can bo, dang vien nam bat qua lanh dao, chi dao quan chung thuc hien tot chu chuong chinh sach bao hiem y te Hap tac chat che han vdi he thong cac co quan thong tin dai chung, xay dung doi ngu cong tac vien ngoai nganh, dong thdi cd che thu lao dong vien khuyen khich nhung cong tac vien, thdng tin vien Ddi vdi bao hiem y te tu nguyen, dac biet la bao hiem y te cho doi tuong hoc sinh - sinh vien Can cd phuong phap tuyen truyen sau xay dung song de an trien khai da duoc cac cap cd tham quyen phe duyet Tuyen truyen lam sao, tuyen truyen nhu the nao de giai thich loi ich, tinh chat nhan dao, uu viet cua bao hiem y te hoc sinh, tim su ddng tinh, ung ho cua cac bac phu huynh va du luan xa hoi, de nghi Nha nudc dua hoc sinh - sinh vien vao ddi tuong bao hiem y te bat buoc, chuyen dan, md rong cac doi tuong tham gia bao hiem y te tu nguyen sang bao hiem y te bat buoc tien tdi thuc hien bao hiem y te bat buoc toan dan Ddi vdi chu su dung lao dong: Can phai tuyen truyen thuc hien chinh sach bao hiem y te la mot chu truong ldn cua Dang va Nha nudc Vi vay, chu su dung lao dong cd trach nhiem ddng bao hiem y te bat buoc ddi vdi ngudi lao dong ma minh ky ket hop ddng lao dong tu 03 thang trd len dung theo quy dinh cua Luat Tuyen truyen chinh sach bao hiem y te bang nhieu hinh thuc de chu su dung lao dong nang cao nhan thuc tu giac chap hanh quy dinh chinh sach bao hiem y te, dan dan trd nhu cau, ddi hoi duoc tham gia bao hiem y te Ddi vdi ngudi lao dong: Day la ddi tudng hudng loi true tiep tir chinh sach bao hiem y te Can phai tuyen truyen nang cao nhan thuc cho ngudi lao dong hieu rd quyen loi va trach nhiem cua minh tham gia bao hiem y te, dac biet la tang cudng tuyen truyen den doi tuong la lao dong thdng 84 3.2.3 Day manh cong tac cai each hanh chinh Cai each thu tuc hanh chinh co tac dong to Ion den viec thuc day phat trien kinh te xa hoi Thong qua cai each hanh chinh se go bd nhung rao can ve thu tuc hanh chinh doi vdi ngudi dan Don gian hoa thu tuc hanh chinh se cat giam tdi da chi phi hanh chinh ma xa hoi phai ganh chiu La co quan thuc hien chinh sach xa hoi Bao hiem xa hoi Viet Nam can phai day manh cai each, giam bdt cac thu tuc hanh chinh cong tac quan ly thu bao hiem y te theo hudng Thu- nhat, Bao hiem xa hoi Viet Nam can tai cau true lai qui trinh nghiep vu, xay dung, thiet ke lai qui trinh nghiep vu thu bao hiem y te thong qua viec danh gia lai qui trinh mot each cd he thong nham cai thien, nang cao chat luong, thdi gian su ly va chi phi Tren co sd tai cau true lai qui trinh nghiep vu can soat he thong cac van ban phap ly lien quan den cong tac quan ly thu bao hiem y te nhat la cac van ban phap ly qui dinh ve thu tuc ho so dang ky tham gia bao hiem y te, thu tuc cap the bao hiem y te de bd sung, chinh sua theo hudng don gian hoa thu tuc, bd khau trung gian, giam thieu nhung qui dinh khong can thiet, dinh ky cong bd nhung van ban qua soat het hieu luc hoac khong phu hop de chu su dung lao dong, ngudi lao dong va can bo nghiep vu de theo doi, tranh nham lan va de thuc hien Ddng thdi chuan hoa cac quy trinh, qui dinh thu tuc quan ly thu bao hiem y te; BHXH cac tinh, BHXH cac huyen theo hudng thu gon, phan dinh rd chuc nang, nhiem vu, quyen han, trach nhiem cua tung don vi, tung ca nhan, nang cao trach nhiem cua Lanh dao don vi, cung nhu quan he phoi hop vdi cac co quan quan ly nha nudc khac viec td chuc thuc hien chinh sach bao hiem y te Viec kien toan td chuc bo may theo hudng se tao su nang dong, chu dong cho co quan BHXH thuc hien nhiem vu duoc giao Thir hai, gian don hoa cac bieu mau, thu tuc tham gia bao hiem y te; thu tuc tang giam, cung nhu thong bao nop bao hiem y te Dieu se tao dieu kien cho cac doi tuong tham gia BHYT chap hanh theo hudng dan, qui dinh cua co quan bao hiem co quan BHXH cung nen md cac chuong trinh hoac cac lop tap huan cho cac can bo, nhan vien lam cong tac td chuc, lao dong tien luong cua cac co quan, don vi, doanh nghiep nhung ngudi true tiep tham gia vao qui trinh thu bao hiem y te nhu 85 lap danh sach ngudi tham gia bao hiem y te tinh toan cac khoan phai nop, chuyen tien thu, toan cac che BHYT Thu- ba, Viec tiep don nguoi tham gia bao hiem y te den kham chua benh tai cac co so y te nen cai tien rut gon thu tuc theo each, thuan tien, kip thdi, tao su tin cua ngudi dan doi vdi co quan bao hiem y te Dong thdi phai to chuc chu dao cong tac tiep dan, giai quyet nhanh chong cac khieu nai, to cao thuoc chuc nang quyen han theo dung qui dinh Bao hiem xa hoi Viet Nam cung nen thuc hien tot cac chuong trinh tap huan nghiep vu; ddi vdi co quan Bao hiem xa hoi cap tinh, lien tuc phai cai each hanh chinh theo quy che "mot cua" Bo phan mot cua tai cac Bao hiem xa hoi huyen phai nghiem chinh chap hanh quy che tiep nhan ho so Dong thdi phai niem yet cong khai cac thu tuc, qui dinh lien quan den cac che bao hiem y te Viec trung chuyen ho so qua cac bo phan nghiep vu phai dupe thong nhat, quy dinh ro rang di chuyen va xu ly, cung nhu thdi gian tdi da dupe phep giai quyet tung bo phan, tung khau Bao hiem xa hoi cap tinh va nhat la cap huyen can phai xay dung quy che trach nhiem cho cac bo phan, cac phong nghiep vu, tu luc tiep nhan ho so den tra ho so Va qua quy trinh tien hanh xay dung phan mem quan ly cho viec, cap nhat quan ly tinh trang ho so Thu- tu-, phai thudng xuyen rut kinh nghiem cong tac chi dao va dieu hanh thong qua dd se xem xet, due rut nhung nhan to cd tac dong den ket qua cong tac chi dao dieu hanh thu bao hiem y te va cua tung bo phan he thong to chuc thuc hien chinh sach bao hiem y te Va cung thong qua rut nhung bai hoc thuc tien tu de bien cho can bo cong chuc phuc vu cho viec to chuc thuc hien Bao hiem xa hoi cac tinh cung nen xay dung cac phuong phap quan ly ddi tupng tham gia bao hiem y te mot each chi tiet, cu the, vua dam bao dap ung dupe cac yeu cau quan ly thu d dia phuong, vua dam bao qui dinh chung Phai to chuc trien khai thuc hien cong tac thu bao hiem y te mang tinh nang dong, sang tao tren co sd cac quy dinh ve thu bao hiem y te da dupe ban hanh; xay dung chuong trinh hanh dong cu the nham to chuc thuc hien muc tieu thu dung, dam bao thu du, thu kip thdi, chong that thu bao hiem y te 86 Thu- nam, Doi vdi cac dau mdi tham gia bao hiem y te, Bao hiem xa hoi cac tinh cung nen co tieu chi thdng nhat quan ly, phan loai don vi tham gia bao hiem y te theo tung ddi tuong tham gia (hanh chinh su nghiep, ngudi hudng uu dai xa hoi, ngudi ngheo, ngudi tham gia bao hiem y te tu nguyen ) de thuan tien viec quan ly Bdi vi theo Luat bao hiem y te hien dang ap dung thu bao hiem y te cho 25 ddi tuong ma mdi ddi tuong deu co nhung dac thu rieng ve each thuc cung nhu hinh thuc thu nop Chinh vi the co quan bao hiem y te nen de rieng mot quy trinh thu, phuong thuc thu, each thuc thu phu hop doi vdi mdi doi tuong tham gia bao hiem y te co dac thu khac Tir td chuc thu bao hiem y te se thuan loi hon 3.2.4 Ung dung cong nghe thdng tin vao quan ly thu BHYT Ngay viec ung dung cong nghe thdng tin vao quan ly da trd nen bien Tin hoc hoa quan ly, dieu hanh da va dang duoc cac co quan Ban, Nganh quan tarn ung dung quan ly hoat dong cua minh Ung dung cong nghe thdng tin da dua phuong thuc quan ly mdi thay the each thuc quan ly thu cong Viec ap dung cong nghe thdng tin da don gian va tdi uu hoa bai toan quan ly Ung dung cong nghe thdng tin khong chi phuc vu cho cong tac thdng ke, tong hop, du bao, luu tru ma no giup cho viec tac nghiep xu ly cong viec va thdng tin nhanh chong, chinh xac Ddi vdi viec quan ly thu bao hiem y te cac thdng tin lien quan den nhan than ddi tuong la het sue quan la co sd de cap the bao hiem y te va giai quyet-quyen loi cua ngudi co the bao hiem y te ho di kham, chua benh Trong thdi gian gan day, cong tac quan ly bao hiem y te noi chung va quan ly thu bao hiem y te noi rieng chu yeu van la bang phuong phap ban thu cong, do viec xu ly tac nghiep gap rat nhieu kho khan gay anh hudng den viec thdng ke, theo doi, bao cao, quyet toan va giai quyet nhung vudng mac cong tac quan ly ddi tuong tham gia bao hiem y te.'Trong viec ung dung cong nghe thdng tin vao quan ly d bao hiem xa hoi cac cac tinh, mdi chi d muc thdng ke, tap hop sd lieu, chua co mot phan mem xu ly du lieu tap trung tu cap tinh xuong cap huyen, trung uong tdi dia phuong Bao hiem xa hoi Viet Nam da xay dung va dua vao ung dung mot sd chuong trinh phan mem quan ly ddi tuong; song cac chuong trinh mdi chi co the khai thac va su dung d pham vi cap tinh, 87 pho, chira dap ung duoc day du cac yeu cau cong tac quan ly bao hiem y te tinh hinh mdi Viec ung dung cong nghe tin hoc vao quan ly la nham quan ly toan bo luu trinh cua ngudi tham gia bao hiem y te va qua trinh kham chua benh cua ho qua dam bao thuc hien cac qui dinh theo dung Luat bao hiem y te Quan ly nhan than, muc luong, phu cap va tinh trang sue khoe, ly lich benh tat cua tung doi tuong tham gia bao hiem y te toan bo qua trinh tham gia va ddng BHYT de lam co sd de giai quyet cac che bao hiem y te Cung cap so lieu lam can cu de giai quyet cac che bao hiem y te cung nhu cac van de khac lien quan den viec hoach dinh chinh Bao hiem xa hoi Viet Nam can xay dung, thiet ke mot phan mem chuong trinh quan ly tong the cd the dang ky tham gia bao hiem y te true tuyen ( online) Cac don vi, ca nhan tham gia bao hiem y te cd the lien he vdi co quan bao hiem thong qua truy cap true tuyen vao co sd du lieu cua co quan bao hiem tu may tinh ca nhan; truy cap true tuyen vao co sd du lieu cua co quan bao hiem thong qua the ATM cua ngan hanh cac dia phuong Phan mem ap dung cho viec thuc hien quy trinh thu, cap, quan ly the bao hiem y te Bdi vi the bao hiem y te la chung tir quan trong xac nhan qua trinh thu BHYT Bao hiem xa hoi Viet Nam cung nen nghien cuu, ung dung thay the the bao hiem y te hien bang the bao hiem y te dien tu vdi mdi ngudi cd mot ma ID ca nhan rieng tien dung cho qua trinh quan ly cung nhu qua trinh thu nop Ddng thdi vdi viec su dung the bao hiem y te dien tu se khac phuc duoc tinh trang true loi tu quy BHYT cd tinh trang lam the BHYT gia, cho muon the BHYT de di kham chua benh BHXH Viet Nam can tri va nang cap trang thong tin dien tu cua minh dd tu dd giup cho cac doi tuong tham gia bao hiem y te cd the cap nhat thong tin vd tinh hinh hoat dong cung nhu su thay doi viec thuc hien che do, chinh sach bao hiem y td Bao hiem xa hoi Viet Nam cung nen thiet lap mot mang rieng, xay dung cac trung tarn tich hop dtr lieu de td chuc thuc hien chinh sach bao hiem y td va thu BHYT, dau tu, trang cap cac thiet bi cong nghe tin hien dai nhu may doc the bao hiem y td; thiet bi kiem tra, giam sat dat tai cac co sd kham chua benh 88 Ung dung cong nghe thong tin vao quan ly hoat dong bao hiem y te noi chung va quan ly thu BHYT noi rieng cdn la dieu kien kien quyet de nganh bao hiem xa hoi day manh cai each hanh chinh cac hoat dong cua nganh, nham dam bao yeu cau quan ly ddi tuong cung nhu so luong cang dong ngudi tham gia BHYT r r •> 3.2.5 Tang cuangphap che quan ly thu bao hiemy te Bao hiem xa hoi viet Nam la co quan thuoc Chinh phu, mac du khong cd >