Xã hội hoá bảo hiểm y tế ở việt nam

11 ] - TRUONG DAI HOC KINH TE QUOC DAN *** TRAN ANH TUAN DAI HOC KTQD TT THONG TIN TH If VIEN PHONG LUAN AN-TV LIEU XA HOI HOA BAO HIEM Y TE VIET NAM > • Chuyen nganh: KINH TE CHINH TRI LUAN VAN THAC SY KINH TE • • Ngudi hudng dan khoa hoc: PGS.TS DAO THI PHUONG LIEN - A - HA NOI, NAM 2009 T+/S S 35'4 - -rE MUC LUC • • DANH MUC CHU" VIET TAT DANH MIJC BANG BIEU, SO DO TOM TAT LUAN VAN LOI NOI DAU CHUONG 1: CO SO LY LUAN VA THI/C TIEN VE XA HOI HOA BAO HlfiM YTEdVIET NAM r \ x t t r 1.1 Nhirng van de co ban ve bao hiem va bao hiem y te 1.1.1 Bao hiem va phan loai bao hiem 1.1.2 BHYT va dac didm cua BHYT 14 1.2 Sir c3n thiet khach quan, noi dung va nhirng nhan to anh hiromg tori XHH BHYT a Viet Nam 18 1.2.1 Quan niem va tinh tat yeu khach quan cua XHH BHYT o Viet Nam 18 1.2.2 Noi dung cua XHH BHYT 28 1.2.3 Nhirng nhan to anh hudmg tori XHH BHYT 35 1.3 Kinh nghiem quoc te ve XHH BHYT 40 t r r r 1.3.1 Tong quan kinh nghiem xa hoi hoa bao hiem y te dr mot so quoc gia: 40 1.3.2 Bai hoc kinh nghiem cho Viet Nam 45 CHLTONG 2: TIIUC TRANG XA HOI HOA BAO HIEM Y TE VIET NAM 47 2.1 Khai quat sir hinh va phat trien chi'nh sach BHYT VA chu tnrong xa hoi hoa BHYT cr Viet Nam 47 2.1.1 Boi canh dbi chi'nh sach BHYT dr Viet Nam 47 2.1.2 Qua trinh hinh chi'nh sach BHYT or Viet Nam 48 2.1.3 Sir phat trien cua chinh sach BHYT theo hirdng xa hoi hoa dr Viet Nam 49 2.2 Thirc trang xa hoi hoa BHYT dr Viet Nam 60 2.2.1.Ve dien bao phu cua BHYT 60 2.2.2 Quyen lgi cua nguoi tham gia BHYT 70 2.2.3 Mac phi, phuang thuc toan va kha nang dap ung tai chinh cua quy BHYT 74 2.2.4 To chuc he thong va nang lire quan li .81 2.3 Danh gia thuc trang cong tac BHYT 82 2.3.1 Ve tiru 82 2.3.2 Ve tdn tai 86 2.3.3 Nguyen nhan cua tuu va ton tai noi tren 90 CHIJONG 3: QUAN DIEM VA GIAI PHAP CO BAN NHAM THUC DAY XA HOI HOA BAO HIEM Y TE O VIET NAM 93 3.1 Mot so quan diem dinh huong cho xa hoi hoa BHYT Viet Nam 94 3.2 Mot so giai phap co ban nham thuc day xa hoi hoa BHYT Viet Nam 103 3.2.1 Mo rong va tang dan doi tuong tham gia BHYT .103 3.2.2 Phat trien nhieu loai hinh BHYT 105 3.2.3 Khuyen khich cac phan kinh te tham gia cung ung cac dich vu BHYT 106 r r 3.2.4 Xay dung co che phoi hop giua to chuc cung ung dich vu BHYT voi cac co so y te va benh nhan kham chua benh va toan cac khoan chi phi 109 3.2.5 Phat trien chuang trinh BHYT cong dong 113 3.2.6 Tang cudng vai tro cua Nha nuoc chi dao va trien khai xa hoi hoa BHYT 115 3.2.7 Dao tao nguon nhan luc dap ung yeu cau xa hoi hoa BHYT: 117 KET LUAN 119 TAI LIEU THAM KHAO 121 DANH MUC CHU VIET TAT BHTM Bao hiem thuromg 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 tu nguyen CS & BVSKND Cham soc va bao ve sure khoe nhan dan CSSK Cham soc sure khoe KCB Kham chCra benh KT- XH Kinh te- xa hoi UBND Uy ban nhan dan XHH Xa hoi hoa XHHBHYT Xa hoi hoa bao hiem y te DANH MUC BANG BIEU, SO DO Bang 2.1: Dien bao phu BHYT BB va TN nam 2005 61 Bang 2.2: So ngubi tham gia BHYT ca nude tir 2004- 2006 63 Bang 2.3: Doi tuong tham gia BHYT BB co muc dong thap hoac tuong doi thap nhirng co nguy co benh tat cao nam 2005 64 Bang 2.4: So ngubi tham gia BHYTBB thuoc khu vuc lao dong chinh quy, tinh tdi 31 /12/2005 66 Bang 2.5: Dien bao phu BHYT TN (2005) 70 Bang 2.6: So lupt ngubi kham benh ngoai tru binh quan nam_cua moi ngubi co the BHYT theo doi tuong tham gia, giai doan 2000- 2004 tren ca nude 71 Bang 2.7: So lupt dieu tri noi tru binh quan nam/100 ngubi co the BHYT theo doi tuong tham gia, giai doan 2000- 2004, ca nude 72 Bang 2.8: Muc phi dong BHYT binh quan theo cac doi tuong tham gia (Nhom bat buoc khong bao gom ngubi ngheo) 75 Bang 2.9: Gia tang chi phi KCB BHYT BB va TN dupe toan tir quy BHYT tir nam 2003- 2005 77 Bang 2.10: Muc gia tang chi phi tir quy BHYT va so ngubi tham gia BHYT qua cac nam 2003- 2005 77 Bang 2.11: So sanh chi phi binh quan dau ngubi va muc dong binh quan dau ngubi theo doi tuong tham gia BHYT tai Dong Thap qui 1/2006 78 Bang 2.12: Tan suat dieu tri noi tru cua doi tuong tham gia BHYTTN so vbi cac doi tuong BHYT khac tai Ha Noi (don vi tinh: lan) 80 Bieu 2.1: Ty cac nhom tham gia BHYT 2006 65 Bieu 2.2: Co cau lao dong phan chia theo cac khu vuc lao dong phi chinh quy, chinh quy va khu vuc khong tham gia lao dong 66 Bieu 2.3: Co cau ngubi tham gia BHYT tai Dong Thap, 2006 69 TRUONG DAI HOC KINH Tfi QUOC DAN TRAN ANH TUAN XA HOI HOA BAO HIEM Y TE d VIET NAM Chuyen nganh: KINH TE CHINH TRI TOM TAT LUAN VAN THAC SY • HA NOI, NAM 2009 • i LOI NOI DAU Tinh cap thief cua de tai BHYT la mot chinh sach xa hoi nham huy dong nguon tai chinh phuc vu cho cong tac cham soc va bao ve sue khoe nhan dan (CS & BVSKND) Viet Nam, BHYT chinh thuc ddi vao nhung nam 90 cua the ky XX Ngay 26/10/1990 Hoi dong Bq trudng (nay la Chinh phu) Thong tri so 3504/KG chi dao Uy ban nhan dan (UBND) cac tinh, pho, dac khu true thuoc trung uong, Bo Y te to chuc thi diem BHYT, tu tong ket due rut kinh nghiem de to chuc thuc hien chinh sach BHYT phu hop voi hoan canh va dieu kien nude ta Va den 15/8/1992 Hoi dong Bo truong da chinh thuc ban hanh Dieu le BHYT kem theo Nghi dinh so 299/HDBT, khai sinh chinh sach BHYT d Viet Nam, sau dupe thay the bang Nghi dinh so 58/CP 13/8/1998 cua Chinh phu ban hanh Dieu le BHYT moi Tu den nay, r ? BHYT da thu hut dupe mot khdi lupng rat ldn nguoi tham gia Qua thdi gian BHYT da khang dinh su ton tai can thiet khong the thieu dupe cua minh su nghiep CS & BVSKND Tuy nhien, nhu Van kien Dai hoi IX cua Dang cong san Viet Nam da khang dinh: “Chinh sach BHYT chi thuc su mang lai su cong bang CSSK, gop phan phat trien cac muc tieu kinh te- xa hoi (KT- XH) cua dat nude neu chung ta thuc hien dupe BHYT toan dan” hay noi each khac la xa hoi hoa BHYT Hien nay, dien bao phu BHYT moi chi chiem tren 40% dan so ca nude Thuc te xa hoi hoa BHYT chua thuc su dupe quan tarn nen khong phat huy dupe uu the cua no, r t r ' anh hudng ldn den su phat trien y te noi chung va tao su chenh lech ve hudng thu cac dich vu y te cang tang Mat khac, xa hoi hoa (XHH) BHYT it dupe de cap va chua co mot cong trinh nao nghien cuu toan dien ve cong tac XHH BHYT d Viet Nam Tir nhung ly tren, tac gia manh dan chon de tai “AT/// BHYT a Viet Nani" de viet luan van thac si chuyen nganh Kinh te chinh tri ii 2 Tong quan tinh hinh nghien cuu Hien tai, or nude ta, chua co de tai khoa hoc, cong trinh nghien cuu de cap mot each toan dien chuyen sau van de xa hoi hoa BHYT, ma chi co mot so cac bai viet co tinh chat tham luan, trao doi cua cac tac gia nhu: Bao hiemy te - Sir dori va doi mod chinh such an sinh xa hoi va Xa hoi hod BHYT de • • • dong dao nhan dan tham gia cua tac gia Tran Khac Long; Tang cirorng XHH str nghiep chain soc va bao ve sire khoe nhan dan thong qua BHYT, thirc hien tot BHYT hoc sinh cua tac gia Le Ngoc Trong; Ve during tien tod BHYT toan dan & nude ta cua tac gia Tran Van Tien; Nhirng giai phap thuc day tien trinh thirc hien BHYT toan dan cua tac gia Bo Van Sinh r r f ry\ Mac du cac cong trinh tren da co gang de cap den cac van de ve BHYT va xa hoi hoa BHYT, song xet tren khia canh ly luan va thuc tien van nhieu khoang Dac biet thuc te trien khai cua linh vuc a Viet Nam vln can r r co goc nhin toan dien, nhat la phai xem xet tu chinh ca hoat dong y te va su tac dong qua lai voi kinh te thi truong Do viec nghien cuu cua de tai nham dua cac giai phap co ban de tung budc tien hanh trien khai thuc hien BHYT toan dan vao nam 2010 theo nhu tinh than Nghi quyet lan thu IX cua Dang da de ra, cac giai phap la cap thiet va khong trung lap Muc • dich va nhiem • vu• cua luan • van Muc dich: Lam sang to ban chat cua viec XHH BHYT dieu kien phap thuc hien XHH BHYT nham thuc day su phat trien cua hoat dong BHYT giai doan moi, tien tdi BHYT toan dan thong qua Luat BHYT Nhiem • vu: • -Lam sang to ban ch£t XHH BHYT theo quan diem y te va mot so khoa hoc huu quan -Phan tich thuc trang xa hoi hoa BHYT: ket qua thuc hien, cac bien phap tien hanh XHH BHYT iii -De xuat mot so quan diem, giai phap thuc day xa hoi hoa BHYT a Viet Nam Doi tuong va pham vi nghien cuu De tai lay qua trinh XHH BHYT va viec thuc hien XHH BHYT o Viet r Nam lam doi tuong nghien cuu Giai han nghien cuu cua de tai la: thdi ky thuc hien BHYT tir dau nhung nam 1990 den nay, di sau vao giai doan BHYT tir co Dieu le BHYT moi Phuong phap nghien cuu De thuc hien de tai, tac gia lua chon cac phuang phap nghien cuu: doc _ V fl r sach, tai lieu, phan tich tong hop, phuang phap luan Mac- Lenin va tong ket a f r qua khao sat cac bao cao tong ket co lien quan den XHH BHYT Nhirng dong gop cua luan van -Gop phan lam ro hon co so ly luan ve XHH BHYT, -Danh gia thuc trang BHYT, tim nguyen nhan cua thuc trang do; -De xuat mot so giai phap tong the de thuc hien XHH BHYT co hieu qua, dua mot so khuyen nghi doi voi Du an Luat BHYT Cau true cua luan van Ngoai loi noi dau va phan ket luan, luan van chia lam chuong: Chuong 1: Co so ly luan va thuc tien ve xa hoi hoa BHYT a Viet Nam Chuong 2: Thuc trang xa hoi hoa BHYT dr Viet Nam Chuang 3: Quan diem va giai phap co ban nham thuc day xa hoi hoa BHYT a Viet Nam CHITONG 1: CO SCI LY LUAN VA THUC TIEN VE XA HOI HOA BAO HIEM Y TE O VIET NAM 1.1 X A - A a A A Nhfi'ng van de co* ban ve bao hiem va bao hiem y te 1.1.1 Bao hiem va phan logi bao hiem Bao hiem: Trong cuoc song sinh hoat cung nhu hoat dong san xuat kinh doanh hang ngay, du da luon chu y ngan ngira va de phong nhung nguoi vln cd nguy co gap phai nhung rui ro bat ngd xay ra, nhieu nguyen nhan gay De ddi vdi cac rui ro, ngudi da co nhieu bien phap khac nham kiem soat cung nhu khac phuc hau qua rui ro gay Mot / T nhung bien phap toi uu va dune su dung rong rai, la Bao hiem Co che hoat dong cua bao hiem tao mot “su dong gop cua so dong vao su bat hanh cua so it” tren co so quy tu nhieu nguoi cd cung rui ro cong dong nham phan tan hau qua tai chinh cua nhung vu ton that Cd nhieu dinh nghla ve bao hiem, song theo tac gia luan van, quan niem dSy du ve bao hiem cd the phat bieu nhu sau: “Bao hiem la mot hoat dong qua mot ca nhan cd quyen duqc hudng trq cap nhd vao mot khoan dong gop cho minh hoac cho ngudi thu ba trudng hop xay Phan logi bao hiem Hien nay, cac nude tren the gidi thudng trien khai bao hiem dudi cac hinh thuc: - Bao hiem xa hoi (BHXH) - Bao hiem that nghiep (BHTN) - Bao hiem y te (BHYT) - Bao hiem thuong mai (BHTM) Ill A nghi bira bai cua bac si (trong trudng hop benh nhan co yeu cau va mong * * o A ' muon nho rieng bac si viet giay nghi nhieu hon) Nen khuyen khich cac don vi su dung phuong thuc toan tinh chi phi hieu qua chu khong ap dat mot phuong thuc toan bat ky nao Moi don vi thuc hien toan BHYT duoc chu ddng lua chon phuong thuc toan phu hop vdi tinh hinh, dieu kien va dac trung don vi minh nhung dam bao tinh r chi phi hieu qua Cach lam vira giam tai duoc nhung vuong mac viec thuc hien toan BHYT cho benh nhan vua phat huy duoc tinh chu dong, sang tao cua moi don vi, giam duoc ganh nang quan ly va nguy co vo quy r r r quan ly chung thong nhat theo mot mdi Mot yeu to nua can de cap tbi la viec Bo Y te va cac co quan lien quan can tien hanh ban hanh danh muc thuoc, hoa chat, vat tu, thiet bi y te, dich vu ky thuat y te thuoc pham vi duoc hudng cua ngudi tham gia BHYT mot each nhanh chong, cap nhat va quy dinh phu hop vdi cac loai benh, dac biet la nhung loai thuoc cu thi lap tuc Bo can phai co nhung van ban quy dinh chat che Trong co che thi trudng, CSSK duqc cung ung dudi dang cac dich vu Tuy sue khoe khong the xem nhu hang hoa don thuan ma phai la loai hang hoa dac biet Nhung cung ung dich vu CSSK cung ddi hoi phai hoach toan, can bang thu chi Khong the nghi don gian la cu giao nhiem vu cho nganh y te r ' - r va lenh bat buoc nganh y te phai phuc vu day du va co chat luqng cao ma khong tinh den can bang thu chi Trong nen kinh te van hanh theo co che bao cap triet de va ke hoach hoa tap trung, chung ta da quen vdi viec lenh yeu cau nganh y te phai phuc vu vdi tinh than va chat luqng cao nhat r a r r nganh y te khong phai lo nguon tai chinh ma duqc nha nudc bao cap tu A den 112 Z, viec hach toan khdng duoc dat cho bat ky mot truong hop benh nao, - ■ , ’ Ngay tinh hinh da khac han: CCSK duoc cung cap dudi dang dich vu, x , f r nguon tai chinh danh cho y te khdng duoc bao cap Vi vay nganh y te gia, chi sau xac dinh gia thi mdi quy gia cho cac dich vu Hom the F f cung la can cu kinh te de so sanh va yeu cau dom vi cung ung dich vu thuc _ r f hien dung chat luong cua dich vu( khdng phai la cu chi phi cao thi chat luong mdi cao nhung da tinh dung va du gia thi don vi cung ung dich vu F phai luon cd nghia vu dam bao chat luong dich vu va ngudi benh co can cu de yeu cau dom vi cung ung dich vu phai thuc hien dich vu cd chat luong) Khdng the cd dich vu y te co chat luong ma lai khdng tinh toan du gia hoac cat xen gia hach toan Ngoai cd xac dinh duoc gia cac r 7 r r dich vu y te thi mdi co co sd de du tinh tong chi xa hoi cho y te va lap ke > f hoach cua cac nguon thu Viec dinh gia phai dam bao nguyen tac chi it cung r F thu du chi phi dau vao da bo Tai cac co sd y te cong lap va ke ca y te tu khdng vi muc dich loi nhuan , su chenh lech giua gia vdi gia khdng d muc cao Ngoai viec dinh gia phu thuoc vao quan he cung - cau F tung thdi diem Cd gia duoc xac dinh thap hon gia vdi muc dich F F F F F khuyen mai Trong chinh sach tai chinh y te, cang tien den ap dung che Oil F FF mot gia vdi mdi loai dich vu cho tat ca cac doi tuong thi cang tot ( cd nhu vay thi mdi cd dich vu vdi chat luong ngang cho cac ddi tuong khac nhau) z f f \ Khong giong vdi cac loai dich vu khac, tinh chat nhan dao cua y te, hau nhu doi vdi cac goi dich vu thuan y te va lien quan den sinh mang ( dich F F F F vu y te thiet yeu), khdng nen (va neu xet tren phuong dien dao due thi khdng the) phan chia “goi dich vu re tien” danh cho ngudi ngheo va “goi dich vu dat tien” danh cho ngudi giau Viec dat gia va viec thu theo gia lai la hai z viec khac nhung lien quan vdi chat che Tuy theo doi tuong va 113 muc tieu an sinh xa hoi, benh nhan co the chi tra trurc tiep cho don vi cung ung dich vu mot phan cua gia, tham chi khong tra chut nao (cac doi tuong hudng chinh sach xa hoi ) Trong truong hop nay, cac co quan an sinh xa hoi (nhu BHYT, quy tu thien hay nha nude thong qua mua BHYT cho ngudi dan) F ’ phai thay benh nhan bu dap chi phi cho co so cung ung de cd du gia Co kham chua benh giua ngudi giau va ngudi ngheo va cong bang ben r vung Nguyen tac cung lam cho nganh y te de thuc hien tu chu, cong t r khai, minh bach tai chinh va tranh nhung tieng tam xau co each biet r r r doi xu y te vdi cac doi tuong khac xa hoi Phat trien nhanh va vung chac BHYT va coi day la nguon thu chinh thay cho vien phi 3.2.5 Phat trien chuwng trinh BHYT cong dong Hien tai d Viet Nam, ngudi ngheo phai chi den 13% ngan r - * sach gia dinh cho y te, nhung hon 80% ho ngheo khong co bao hiem y te, va van de dat nhieu thach thuc cho vien cham soc sue khoe cho ngudi ngheo r f Mot giai phap da dupe thuc hien cong d Trung Quoc [10] va mot so dong Muc tieu cua chuong trinh BHYTCD la quat hoa bao hiem y te d binh dien cho toan quoc, bang each huy dong va su dung ngan qui tu dia t r r r phuong va ngoai dia phuong, ke ca ngoai he thong y te, dua vao nguyen tac tu nguyen Triet li cua chuong trinh la “la lanh dum la rach” (tuong trp xa hoi): ngudi giau ho trp ngudi ngheo, ngudi co viec lam ho trp ngudi khong cd viec lam, va ngudi khoe manh ho trp ngudi co benh Tuy theo quoc gia, chuong trinh BHYTCD dua vao su tu nguyen cua r r dan cac lang xa d nong thon, va nguyen tac hoat dong cung giong nhu QuT tin dung hien kha cong d nong thon Chuang trinh BHYTCD co » X f the dupe quan li bdi chinh quyen dia phuong, cong ti tu nhan (khong lay ldi), hay Sd Y te tinh hay Sd thuang binh xa hoi Mot hoi dong quan tri dupe bau de quan li qui BHYTCD, va cong khai tat ca chi thu 114 Theo chuong trinh BHYTCD, moi lang xa can van ddng khoang 60% cac ho dong gop vao quT y te nhu la mot hinh thuc dau tu cho sue khoe QuT co the hinh tu hai nguon: trich khoang 1,5 den 2% thu nhap, va Nha nuoc dong gop khoang 0,2 den 0,5% GDP (O cac nudc Phi chau, ca F Z W F nien liem 5% den 10% ngan sach gia dinh duoc xem la qua dat va rat it ngudi tham gia) Thai Lan, sau 12 nam trien khai chuong trinh, hien ti le dan F F t ~ so tham gia vao chuong BHYTCD chi 35%, nhung quT co the cung cap bao hiem cho 100% dan so Qui BHYTCD chi cho cac dich vp nhu kham thai, tiem vac-xin cho tre em dudi tuoi, dich vu cuu thuong, va chi phi mot so Ft nam benh vien mdi nam cho hoi vien Qua thuc te trien khai tai cac nudc dang phat trien d Phi chau va A chau, qui BHYTCD chang nhung tiet F F kiem ngan sach gia dinh ma cung cap mot “la chan” huu hieu cho cac ho ngheo co van de benh tat That ra, chuong trinh BHYTCD cung tung dupe gidi thieu d Viet Nam, nhung viec trien khai chuong trinh van gap nhieu khd khan Do do, X , F - ' can phai nghien cuu them ve tinh kha thi va lpi ich cua chuong trinh doi vdi cac ho ngheo va nong dan Kinh nghiem trien khai chuong trinh BHYTCD d •> F F F F F F cac nudc dang phat trien cho thay, mot sd yeu to co anh hudng den quyet dinh % i"w tham gia vao chuong trinh: tien nien liem va uy tin cua chinh quyen dia phuong viec quan li chuong trinh F Ngay nay, d nudc ta cang cang cd it ngudi chet vi nhung benh H ' w Z F F truyen nhiem, nhung phan ddng chet vi nhung benh lien quan den an uong va •J thua thai thuc pham, va viec dieu tri thudng qua kha nang tai chinh cua benh f z nhan Nhung benh thudng hay gap nhat d nong thon la: cao huyet ’ z - ap, tieu dudng, khdp xuong, tim mach va tai bien mach mau nao Chi phi cho \ r dieu tri, phan ldn la benh vien phi va thuoc, cho nhung benh da va dang lam cho nhieu gia dinh dieu dung Z Z \ Trong thdi hoa binh, giao due va y te la hai van de xa hoi dupe quan tarn nhieu nhat Tai cac nudc Tay phuong, mdi lan tranh cu la mdi lan hai 115 van de dirge dem phan tich va ban thao nhieu nhat O nude ta, thoi gian qua, van de giao due da duoc “mo xe” nhieu, nhung van de y te nhuc nhdi horn va nghiem hon thi lai chua nhan dugc quan tam dung muc cua quan chung va chinh quyen dia phuang Trong cac benh vien r r \ tinh va huyen xuong cap nghiem thi chinh quyen lai tap trung vao viec xay dung cac tru so uy ban va dang uy Thay vi tap trung dau tu vao cac co quan hanh chinh, tdi de nghi mot mat Nha nude can phai dau tu nhieu hon nua cho y te, mat khac, nong thon Viet Nam can cd mot qui bao hiem nhu BHYTCD de dam bao mgi ngudi dan hudng cac dich vu y te va nang cao chat lugng cuoc song cho mgi ngudi dan 3.2.6 Tang curing vai trd cua Nhd nirdc chi dao vd trien khai xa hoi hoa BHYT Chinh sach BHYT d Viet Nam bat dau dugc trien khai tir nam 1992 Theo Dieu le BHYT dugc ban hanh kem theo Nghi dinh 299/ND/CP cua Chinh phu, BHYT Viet Nam true thuoc Bo Y te; BHYT cac tinh va nganh true thuoc BHYT Viet Nam Den 1998, thuc hien Nghi dinh so 58/1998/ND- CP cua Chinh phu, BHYT Viet Nam dugc lap tren co sd thong nhat he thong co quan BHYT tir trung uong den dia phuang va BHYT nganh de quan ly va thuc hien chinh sach BHYT Quy BHYT dugc quan ly tap trung, thong nhat tren pham vi ca nude Tir 1-1-2003, BHYT sap nhap vao Bao hiem xa » •> hoi Viet Nam va Bao hiem Xa hoi Viet Nam la co quan to chuc thuc hien chinh sach BHYT Den 8-8-2005 Chinh phu da co Quyet dinh lap Vu BHYT thuoc Bo Y te de thuc hien chuc nang quan ly nha nude ve BHYT Trong gan 17 nam qua, Chinh phu va cac bo, nganh lien quan da ban hanh nhieu van ban phap luat ve BHYT, tao co sd phap ly cho viec trien khai chinh sach BHYT, gop phan tich cue tao nguon tai chinh cho viec bao ve, cham soc va nang cao sue khoe nhan dan Dac biet, tai ky hop thu 4, vao 14-11- 2008, Quoc hoi khoa XII da thong qua Luat BHYT va bat dau cd hieu luc tir _ r 1-7-2009 va da dugc Thu tudng Chinh phu quyet dinh la Ngay 116 BHYT Viet Nam theo QuySt dinh so 823/QD-TTg 16-6-2009 Noi dung cua Luat BHYT da co ban khac phuc duoc nhung vuong mac, ton tai r •» r viec thuc hien chinh sach tai chinh y te de tung buoc tien toi muc tieu xa hoi hoa BHYT theo dinh huong cong bang, hieu qua va phat trien X ’ De tung buoc hoan thien chinh sach ve xa hoi hoa BHYT, nang cao chat luong kham, chua benh BHYT, dap ung nhu cau cang cao va da f X dang ve kham, chua benh cua nhan dan, nhat la cua nhung nguoi tham gia x r •» BHYT thoi gian toi can day manh thuc hien mot so giai phap sau: Nang cao nhan thuc cua cap uy dang, chinh quyen, cac to chuc doan X X the va moi nguoi dan ve y nghia, tam quan cua xa hoi hoa BHYT va nghia vu cua moi nguoi dan tham gia xa hoi hoa BHYT va thuc hien chinh sach xa hoi hoa BHYT ' 2rpw * f 1 • A ♦ f F A ♦ -XT 1/1 % A f r K Tang cuong trach nhiem cua cac cap uy dang, chinh quyen cac cap viec lanh dao, chi dao va to chuc trien khai thuc hien chinh sach xa hoi hoa BHYT, trien khai thuc hien Luat BHYT voi noi dung cu the la: - Xay dung va ban hanh cac van ban duoi luat; x r - To chuc viec hoc tap bien, tuyen truyen noi dung cua Luat; - Xay dung chi tieu dan so tham gia BHYT va danh ngan sach nha •> r nuoc de mua BHYT cho nguoi ngheo, nguoi can ngheo va cac doi tuong chinh sach xa hoi ke hoach phat trien kinh te xa hoi; Tang cuong va doi moi cong tac thong tin, truyen thong ve xa hoi r x r hoa BHYT: cua cac co quan thong tan, bao chi; tuyen truyen cho tung doi tuong cu the, nhat la mot so doi tuong can duoc dac biet quan tam nhu nong dan, nguoi can ngheo, hoc sinh, sinh vien va chu su dung lao dong Cong tac r x thong tin, tuyen truyen phai tham gia tich cuc vao viec gioi thieu guong tot X thuc hien BHYT, dong thoi phat hien va phe phan nhung don vi va ca nhan khong chap hanh nghiem hay vi pham Luat BHYT r Cung co va nang cao nang luc bo may thuc hien xa hoi hoa BHYT; tang cuong dao tao nang cao chuyen mon, nghiep vu cho can bo lam cong tac 117 BHYT; tang cunng hap tac quoc te, day manh nghien cuu khoa hoc, tong ket kinh nghiem de hoan thien chinh sach xa hoi hoa BHYT Tang cuCmg nann lucquan lynha n uoc vexa ho i hoaB HYT, day ■> X manh cong tac tra, kiem tra, giam sat, xu in nghiem cac hi pham; de xuat dong hien khen thuong kip thni cac trunng hap thnc hien tot chinh sach z xa hoi hoa BHYT Xay dung va trien khai thnc hien hieu qua cac quy che phoi hap hoat dong xa hoi hoa BHYT - Nang cao chat luang kham benh, chua benh BHYT, tap trung cai cach r thu tuc hanh chinh, nang cao dao duc nghe nghiep cho can bo y te; - Su dung tot cac nguon dau tu cho mang luXi kham benh, chua benh, z dac biet la y te co so; - Thnc hanh tiet kiem kham benh, chua benh BHYT 3.2.7 Dao tao nguon nhan lire dap ting yeu cau xa hoi hoa BHYT: Chu truong xa hoi hoa BHYT sinh van de nguon nhan inc hi hay viec ke hoach hoa nguon nhan inc la yeu to quan de thuc day xa hoi hoa BHYT Can chu chat luang nguon nhan inc, so luang nguon nhan inc nguon cung ung nguon nhan inc tuong lai Nguni lao dong phai co kien thuc tong quat he dac thu cua rieng linh hnc BHYT, co trinh tin hoc su dung cac phan mem ung dung Doi hXi cac nhan hien giao dich phai co cac ky nang ban hang, ky nCng maketing, giao tiep Tao dieu kien phat huy het tiem nCng, boi duang hoan thien kien thuc, nang cao ky nCng cong tac doi hXi cac nhan hien Phoi hap hXi cac trunng chuyen nganh mo cac iXp tap huan cap nhat them kien thuc mXi he BHYT, dong thni doanh nghiep can phoi hap cong tac dao tao hXi cac chinh sach che dai ngo giu chan nhung nhan yien gioi, can tien hanh dao tao phat trien nguon nhan inc tai cho thong qua cac co so, cac trunng dao tao chuyen nganh Lna chon cac trunng dai X hoc, cao dang, trung hoc chuyen nghiep trunng co chuyen nganh phu hap gan hXi BHYT de phoi hop dao tao xa hoi hoa BHYT Cac doanh nghiep phoi hop tuyen dung, dao tao, luong, dai ngo de tri doi ngu nhan hien gioi nang cao 118 hieu qua hoat dong kinh doanh va tinh canh tranh co cac doanh nghiep nuoc ngoai tham gia vao thi truong De dat muc tieu md rong cung cap dich vu va nang cao hieu qua cung ung dich vu BHYT thi can bo sung them kien r ■> thuc tin hoc ung dung va kinh doanh Doi moi hoat dong san xuat kinh doanh theo nang cao hieu suat cua lao dong lam viec linh vuc BHYT, cd che tuyen dung hop ly tren co sd hieu qua, xay dung che sat hach, thudng ■» r r phat de khuyen khich tang nang suat lao dong r r \ Md rong quan he hop tac nuoc va quoc te dao tao nguon nhan luc BHYT, chu dao tao nguon nhan luc co trinh cao ve nghiep vu va quan ly Xay dung chuong trinh noi dung cu the va trien khai cac lop hoc bo tuc thudng xuyen, cac ldp nang cao cua can bo bo may quan ly Nha nude cung nhu cac doanh nghiep Xay dung va thuc hien cac chuong trinh dao tao nang cao trinh chuyen mon, dao tao nhan luc BHYT dat tieu chuan cao Ket luan chuong Lau nay, mdi quan he giua ngudi benh, ngudi cung cap dich vu (bac si - benh vien), ngudi quan ly quy BHYT khong cd tieng noi chung va cuoi cung trd mau thuan gay gat Mot nhung nguyen nhan la co doi xu giua ngudi cd the BHYT va ngudi tu chi tra theo gia benh vien yeu ung yeu cau khach quan cua qua trinh phat trien kinh te thi truong theo dinh r _ hudng XHCN va la buoc di quan tao da tien toi BHYT toan dan, tao dieu kien thuan loi cho viec thuc hien chinh sach XHH cong tac CSSK nhan r n dan vdi muc tieu cao ca la xay dung chinh sach y te cong bang, hieu qua va phat trien, gop phan dua chung ta tien tdi nhanh va gan vdi BHYT toan dan vao nam 2014 nhu da dinh 119 KET LUAN Cac chinh sach ve bao hiem y te (BHYT) duoc trien khai gan 17 nam qua ve co ban da dap ung duoc nhu cau kham chua benh (KCB) cua ngubi dan Tuy nhien, du doi tuong, quyen loi cua ngubi tham gia dupe mb rong, nhung thuc te BHYT hien van chua lam hai long ngubi co the da khien cho dubng tien toi muc tieu xa hoi hoa BHYT gap nhieu kho khan Xa hoi hoa BHYT la huong chinh de mb rong BHYT, tien tbi BHYT toan dan Hinh •> r thuc se dupe ap dung rong rai cho moi doi tuong, ke ca ngubi nuoc ngoai den hoc tap, du lich tai Viet Nam Ngubi co the BHYT loai nay, dupe quy BHYT chi tra cac khoan chi phi KCB phu hop vdi muc dong va loai hinh BHYT lua chon Thuc te hien ngubi dan chua man ma vdi BHYT la chu truong ' r xa hoi hoa BHYT chua dupe tuyen truyen va bien sau rong den cac tang r r r f ldp nhan dan Tai khdng it co sd y te, nhat la d pho, viec to chuc kham, chua benh BHYT chua tot, thu tuc toan vien phi vien rubm ra, ,x r \ x r mat nhieu thoi gian Ben canh do, dieu bat hop ly d cac co sb KCB ton tai su phan biet ddi xu giua ngubi KCB theo BHYT vdi ngubi KCB dich vu Luat BHYT chinh thuc co hieu luc da mb rong cho 25 nhom doi tuong, ngan sach nha nude ho trp cho ngubi ngheo, tre em, ngubi co cong, dong thoi ho trp muc dong BHYT cho cac ho can ngheo, hoc sinh, sinh vien Ngubi tham gia BHYT dupe mb rong quyen loi nhu KCB vdi ky thuat cao, i r x r ? phuc hoi chuc nang De luat thuc su di vao cuoc song, can tiep tuc thuc day xa hoi hoa BHYT Vi nhung lpi ich to ldn cua xa hoi hoa BHYT nen chung ta cang phai chu dong phat trien BHYT, dung BHYT nhu mot cong cu co ban va huu ich nhat cham soc va bao ve sue khoe cua nhan dan Toan Dang, toan dan ta dong long quyet tam thuc hien BHYT de tdi nam 2014 chung ta thang lpi vdi muc tieu BHYT toan dan Muon vay, qua trinh 120 _ •> ? X trien khai xa hoi hoa BHYT, co nhung diem tich cue can phai duoc tranh thu phat huy va co nhung ton tai, han che can phai kip thdi sua chua, bo sung va co nhung giai phap huu hieu khac phuc nhung ton tai do, de huy dong moi tang lap nhan dan tham gia mua BHYT nhu mot trach nhiem cua ca nhan voi chinh ban than minh va vdi cong ddng xa hoi; voi su nghiep cham lo va bao ve sue khoe nhan dan, cung chinh la cham lo va bao ve nguon nhan luc chat luang phuc vu cho su nghiep cong nghiep hoa, hien dai hoa dat nudc Linh vuc BHYT can day manh cai each, ddi mdi phuong thuc toan chi phi KCB BHYT theo hudng tao quyen chu dong tot han cho cac co sd y te va tang cudng dich vu y te phuc vu gan dan Ngudi benh BHYT duoc lai tir tuyen y te co sd Cac to chuc BHYT can phoi hap vdi / r r r f r nganh y te, phan dau den het nam 2010, han 80% tram y te xa ca nudc cd to chuc KCB bang BHYT, ddng thdi xay dung lo trinh de tir den 2012 thuc hien ddi mdi co ban phuong thuc toan chi phi KCB tai cac ca sd KCB BHYT De hudng tdi muc tieu BHYT toan dan can cd su thay ddi tir chinh sach quan ly den chat luang KCB Hy vong vdi nhung nd luc day manh xa hoi hoa r r BHYT, tinh trang ngudi benh cd BHYT phai lo lang chuyen sang KCB dich vu se khong va BHYT se mang day du y nghia nhan van cua nd: Mot ngudi vi moi ngudi, moi ngudi vi mot ngudi 120 _ 9 _ \ trien khai xa hoi hoa BHYT, co nhung diem tich cue can phai duoc tranh thu phat huy va co nhung ton tai, han che can phai kip thoi sua chua, bo sung va % r co nhung giai phap huu hieu khac phuc nhung ton tai do, de huy dong moi tang lap nhan dan tham gia mua BHYT nhu mot trach nhiem cua ca nhan voi chinh ban than minh va vdi cong dong xa hoi; voi su nghiep cham lo va bao ve sue khoe nhan dan, cung chinh la cham lo va bao ve nguon nhan luc chat r luong phuc vu cho su nghiep cong nghiep hoa, hien dai hoa dat nuoc Linh vuc BHYT can day manh cai each, doi mdi phuong thuc toan chi phi KCB BHYT theo hudng tao quyen chu dong tot hon cho cac co f r y sd y te va tang cudng dich vu y te phuc vu gan dan Ngudi benh BHYT dupe hudng lpi tu tuyen y te co sd Cac to chuc BHYT can phoi hop vdi nganh y te, phan dau den het nam 2010, hon 80% tram y te xa ca nude co to chuc KCB bang BHYT, dong thdi xay dung lo trinh de tir den 2012 thuc hien doi mdi co ban phuong thuc toan chi phi KCB tai cac co sd KCB BHYT Be hudng tdi muc tieu BHYT toan dan can cd su thay doi tir chinh sach quan ly den chat lupng KCB Hy vong vdi nhirng nd luc day manh xa hoi hoa BHYT, tinh trang ngudi benh cd BHYT phai lo lang chuyen sang KCB dich vu se khong va BHYT se mang day du y nghia nhan van cua no: Mot ngudi vi moi ngudi, moi ngudi vi mot ngudi 121 TAI LIEU THAM KHAO Tieng Viet Tuan Anh suu tam he thong hoa (2009), Bo luat Lao dong chinh sach mdi ve dieu chinh tien luong - tra cap bao hiem xa hoi - bao hiem y te •f r r ■? bao hiem that nghiep, bao biem tu nguyen va bat buoc nam 2009, NXB Khoa hoc xa hoi Nguyen Kim Bao (2004), He thong bao dam xa hoi a Trung Quoc hien (Tr 19-25, So 4), Nghien cuu Trung Quoc Dam Viet Cuomg (2005), Sach tham khao, NXB Chinh tri quoc gia Ngo Thanh Duomg (2006), Ban ve khai niem xa hoi hod, (Tr.57-59, So 6)- Tap chi Cong san Nguyen Van Dinh (ch.b), Ho Sy Ha, Pham Thi Dinh (2004), Giao trinh bao hiem, NXB Thong ke % Luomg Ngoc Khue (2004), Nghien cuu thuc trang va gop phan hoan _ f X r thien md hinh kham chua benh bao hiem y te tai tram y te xa Phu Linh va Due Hod, huyen Soc Som, Ha Noi, LA TS Y hoc (3.01.12) Ly Ngoc Kinh (2003), Nghien cuu thuc trang va xdy dung md hinh F kinh y te thon, ban tai Dong Hy tinh Thdi Nguyen theo co che xa hoi X Bao hiemyte, NXB Lao dong r Pham Manh Hung (2006), Xa hoi hod cong tac y te - ket qua va r nhung van de dat ra, (tr.56-59, So 10), Tap chi Cong san 10.Nguyen Thanh Long s.t va he thong (2005), He thong hod cac van ban phap luat ve bao hiem xa hoi, bao hiem y te va cac che phu cap danh cho can bo, cong chuc va ngudi lao dong, NXB Thong ke W X F 11 Tran Khac Long (2006), Bao hiem y te - su ddi va doi mdi chinh sach an sinh xa hoi, NXB Y hoc 122 12 Nguyen Van Ly (2000), Danh gid thuc trang va hieu qua dp dung v r r r r phucmg thuc chi tra bao hiem y te bat buoc tai mot so benh vien tuyen huyen thuoc tinh Thanh Hoa, Luan an TS Y hoc (3.01.12) 13 Nguyen Nguyet Nga (1997), Su phat trien cua khu vuc y te va cai r ' r * - p each kinh te mot nen kinh te dang chuyen ddi: Viet Nam 19891997 : Luan an PTS KH Kte / Manchester, 1997 14 Nguyen Hien Phuong, (2008), Co so ly luan va thuc tien cho viec xay dung va hoan thien phap luat an sinh xa hoi d Viet Nam, LATS Luat hoc (62.38.50.01) 15.Ai Phuong s.t., he thong hoa (2009), Che chinh sach mdi ve tro nam 2009 , NXB Lao dong Xa hoi 16 Ho ST Sa (chu bien), Nguyen Cao Thuong, Phan Cong Nghia (1994), Kinh te bao hiem, NXB Khoa hoc va ky thuat ** r 17 Do Van Sinh (2004), Nhung gidiphap thuc day tien trinh thuc hien bao hiemyte toan dan, (Tr 5-7, So 250), Tap chi Lao dong va Xa hoi 18 Dinh Cong Tuan, Dang Thanh Toan, Luong Van Ke (2008), He thong an sinh xa hoi cua EC va bai hoc kinh nghiem cho Viet Nam, NXB Khoa hoc xa hoi 19 Bao hiem y te va chinh sach kham chua benh mien phi, NXB Lao dong Xa hoi, 2007 % * * - 20 Cac quy dinh phap luat ve bao hiem va kinh doanh bao hiem, NXB Thong ke, 2009 bao hiem y te - 2009, NXB Lao dong 22 Hoi - dap ve Bao hiemyte va Bao hiem xa hoi (2006), NXB Lao dong 23 Luat Bao hiemyte (2008), NXB Chinh tri Quoc gia 24 Nghi dinh so 63/2005/ND-CP cua Chinh phu ban hanh dieu le Bao hiemy te 2005, (Tr.3-20, So 20), Cong bao 123 25.Nghi dinh cua chinh phu ban hanh dieu le bao hiem y te va van ban hudng dan thi hanh (1999), NXB Chinh tri Quoc gia 26/Nghi quyet so 05/2005/NQ-CP ve day manh xa hoi hod cac hoat dong giao due, y te, van hod va the due the thao (2005), (tr 17-23, So 17), Cong Bao 27 Qua trinh hinh va phat trien bao hiem y te Viet Nam (2002) Nxb Ha Noi 28 Quy dinh mdi sua doi, bo sung viec thuc hien chinh sach bao hiem y te tu nguyen (2007) NXB Chinh tri Quoc gia 29 Quyet dinh cua Bo truong Bo Y te so 6282/2003/QD-BYT 08/12/2003 ve viec ban hanh Danh muc vat tu tieu hao y te duoc bao hiem xa hoi (Bao hiem y td) toan 2003, (Tr 12982-12984, So 212), Cong bao 30 Quyet dinh cua Thu tuong chinh phu so 20/2002/QD-TTg 24/1/2002 ve viec chuyen Bao hiem y te Viet Nam sang Bao hiem xa hoi Viet Nam 2002 (Tr.614-615, So 9-10), Cong bao Lawyer dinh so 2756/2004/QD-BYT ve viec dieu chinh he so xac dinh tran toan chi phi kham chua benh noi tru cho nguoi benh co the bao hiemy te 2004, (tr 35-40,So 30), Cong bao 32 Tien luong - tien cong Bao hiem xa hoi - bao hiemy te (2008), NXB Tai chinh 33 Thong tu lien tich so 22/2005/TTLT-BYT-BTC huong dan thuc hien bao hiemy te tunguyen (2005), (tr.3-11, So 19+20), Cong Bao 34 Thong tu lien tich so 21/2005/TTLT-BYT-BTC hudng dan thuc hien bao hiemy te bat buoc (2005), (Tr.3-23, So 7+8), Cong bao 35 Thong tu lien tich so 77/2003/TTLT-BTC-BYT hudng dan thuc hien bao hiemy te tunguyen (2003), (tr.8467-8474, So 133), Cong bao 36 Van ban phap luat ve mot so loai hinh bao hiem (2002), NXB Chinh r tri Quoc gia 124 Tieng Anh Ed.: Alexander S Preker, Richard M Scheffler, Mark C Bassett (2007), Private voluntary health insurance in development' Friend or foe / - Washington, D.C : The World Bank Samuel S Lieberman, Adam Wagstaff (2009), Health financing and delivery in Vietnam : Looking forward, Washington, D.C : The World Bank Regulation of private health insurance by the private health insurance administration council (2005-2006)- Canberra : Australian National Audit Office William C Hsiao and R Paul Shaw (2007), Social health insurance for developing nations, Contributions by.- Washington, DC.: The World Bank