Hoàn thiện chính sách bảo hiểm y tế ở việt nam hiện nay theo lộ trình bảo hiểm y tế toàn dân

TRUONG DAI HOC KINH TE QUOC DAN ■ ■ 8D0O ♦ G8G8 TRU0NG THIHAI DAI HOC K.T.O.D TT THONG TIN THUVIEN HOAN THIEN CHINH SACH BAO HIEM Y TE ff VIET NAM HIEN NAY THEO LO TRINH BAO HIEM Y TE TOAN DAN ■ ■ ■ ■ CHUYEN NGANH: KINH Tfi' BAO HI^M LUAN VAN THAC SY KINH TE Ngudi htfo'ng dan khoa hoc: IS PHAM THI• DINH • • THS /10350 IIA \OI IMAM 2014 LOI CAM DOAN Toi xin cam doan toan bo noi dung luan van: “Hoan thien chink sack bao hiemy te cf Viet Nam hien theo Io trinh bao hiemy te toan dan" la cong trinh nghien cuu cua rieng toi, cac so lieu trich dan trung thuc Luan van khong trung lap vdi cac cong trinh nghien cuu tuong tu khac Ha Noi, ngay//^thang /Unam 2014 TAC GIA LUAN VAN Truong Thi Hai YEU CAU CUA HOI VAN THAC SI VE • DONG CHAM LUAN • • \ Nhtrng diem can sua chira bo sung truoc nop luan van chinh thuc cho Vien dao tao Sau dai hoc afa .J £r ■ • LX > • • £.-»■ v r Chu tich Hoi dong (Ky va ghi rd ho ten) Cam ket cua Hoc vien7 Toi cam doan se chinh sua cac noi dung y y tren Hoi dong yeu cau Hoc vien TS Nguyen Thi Chinh Trong truong hap khong chinh sira se khong dirge cong nhan ket qua bao ve Hoc vien phai dong ban yeu cau chinh sira vao truoc phan muc luc luan van chinh thirc nop cho Vien DT SDH CONG HOA XA HOI CHU NGHIA VIET NAM Doc lap - Tir - Hanh phuc oOo— NHAN XET LUAN VAN THAC SY KINH TE • • De tai: "Hoan thien chinh sack Bao hiem y te ff Viet Nam hien theo lo trinh bao hiem y te toan dan" Chuyen nganh: Kinh te Bao hiem Hoc vien: Truong Thi Hai Phan bien PGS.TS Nguyen Van Dinh Dai hoc Kinh te Quoc dan Sau doc ban luan van nay, chung toi co nhan xet Tinh cap thiet cua de tai nghien cun BHYT la mot chinh sach xa hoi duqc Dang va Nha nude ta dac biet quan tarn Bdi vay, sau nen kinh te nude ta chuyen sang co che thi trudng, Dang va Nha nude da sdm ban hanh va to chiic trien khai BHYT Tir trien khai den 91992), chinh sach BHYT da cd nhieu lan duqc chinh sua, bo sung va hoan thien Tuy nhien, de tien tdi BHYT toan dan thi chang dudng phia trudc se nhieu viec phai lam, ma trudc het la can phai tiep tuc thao gd cac vudng mac de tang dien bao phu, de nang cao chat lupng KCB, de dam bao c3n do'i quy ben vung v.v Chinh vi vay, tac gia lua chon de tai de nghien cun la rat phu hop De tai cd y nghia ly luan va thuc tien Nhung ket qua dat duqc cua luan van a Tac gia da trinh bay duqc nhung van de ly luan co ban ve BHYT, da khang dinh duqc su can thiet khach quan va ban chat cua BHYT Thanh cong cua chuong la tac gia da dua duqc khai mem chinh sach BHYT, vai tro va nhung nguyen tic co ban cua chinh sach BHYT Dac biet, la trang 16 de'n trang 23, luan van da lam rd nhung noi dung co ban cua chinh sach BHYT, bao gom: doi tupng ap dung, mure dong va phuong thuc dong BHYT; pham vi hudng BHYT va quy BHYT Dong thdi chiu kho suru tarn tai lieu ve chfnh sach BHYT cua Nhat Ban, Han Quoc, Thai Lan de nghien ciiu va rut nhung bai hoc kinh nghiem de hoan thien c BHYT cua Viet Nam Day la noi dung rat dang tran b Sau trinh bay su ddi va phat trien cua BHYT Viet Nam ttr nam 1992 den nay, tac gia da tap trung lam ro nhung noi dung co ban cua chfnh sach BHYT d Viet Nam hien Noi dung trinh bay bao gom ca quan diem cua Dang va Nha nude, loi trinh thuc hien BHYT toan dan, cac quy dinh phap luat hien hanh v6 BHYT Nhung noi dung deu dupe trinh bay co dong, xue tfch va d6 hieu Mot cong nua cua chuong II la tac gia da di sau phan tich tinh hinh thuc hien chfnh sach BHYT d Viet Nam nhung nam vira qua, tir to chuc bo may, cho den doi tuqng tham gia, so thu va chi BHYT, tinh hinh KCB va can doi thu chi quy BHYT v.v Sau rut nhung diem han che chfnh sach va to chufc thuc hien Day la mot phuong phap n c dung hudng va logic de tir co co so dua nhung giai phap hoan thien d noi dung tiep theo So lieu phan tfch cap nhat va rat dang tin cay c Hoan thien chfnh sach BHYT la mot qua trinh, vi the chung toi rat tarn dac vdi nhung quan diem hoan thien chfnh sach BHYT ma tac gia da trinh bay d chuong III, bao gom: + Xay dung chfnh sach BHYT dua tren su ket hop hai hoa giua chfnh sach phap luat BHYT vdi cac chfnh sach ASXH + Mo rong doi tuqng tham gia BHYT de tien tdi BHYT toan dan mot each sdm nhat + Nha nude giu vai tro trung tarn viec thuc hien BHYT toan dan + Hoan thien chfnh sach BHYT theo dieu kien kinh te thi trudng va xu hudng the gidi Diem noi bat cua luan van la tac gia da dua nhom giai phap de hoan thien chfnh sach BHYT theo 16 trinh BHYT toan dan d Viet Nam Trong do, nhom giai phap thu hai la: Giai phap ve phap luat dupe tap trung nhieu nhat Chung toi hoan toan dong tinh vdi cac giai phap cua luan van va co the noi day la n giai phap kha thuyet phuc, co tinh kha thi Hy vong rang, cac nha hoach dinh chinh sach co the tham khao qua trinh hoan thien chinh sach phap luat ve BHYT o nude ta Ket cau luan van: Ket cau luan van hop ly, logic va chat che Van phong ro rang, mach lac Nhung van de can trao doi a Can xem lai nguyen tac thtr nhat (trang 14): Moi vien xa hoi deu co quyen hudng BHYT b Muc 1.2.4 Noi dung co ban cua chinh sach BHYT Nhung noi dung duqc tac gia trinh bay kha he thong va logic, nhien, xet ve mat ly luan thi chua thuc su rd, vi day chi la BHYT xa hoi, BHYT tu nhan lai khac Hon nua, van de to chuc BHYT lai chua de cap c Noi dung danh gia: Thu ba (trang 73) can viet gon lai, tranh trimg lap (tiic danh gia ve noi dung chinh sach BHYT) d Giai phap: Co cau lai ngan sach y te (trang 89) viet chua rd, chua thuyet phuc e Can van mot so trang lung cung, didn dat chua rd (trang 66, 72, 102 v.v ) Ket luan Day la mot ban luan van duqc nghien cuu cong phu, nghiem tuc va co chat luqng Mac du co nhung diem can bo sung, hoan thien, song luan van v&n dap urng duqc yeu cau cua mot ban luan van thac sy kinh te Hoc vien Truong Thi Hai xumg dang duqc nhan hoc vi Thac sy kinh te - chuyen nganh Kinh te bao hiem neu bao ve cong Ha Noi, 28 thang 11 nam 2014 Phan bien PGS.TS Nguyen Van Dinh CONG HOA XA HOI CHU NGHIA VIET NAM Doc lap - Tit - Hanh phuc Ha Noi, 30 thang 11 nam 2014 NHAN XET LUAN VAN THAC SY KINH TE • • • De tai: Hoan thien chinh sach Bao hiem y te d Viet Nam hien theo lo trinh Bao hiem y te toan dan Hoc vien: Truong Thi Hai Ngudi nhan xet: TS Hoang Bich Hong- Phan bien Don vi cong tac: Khoa Bao hiem, Truong DH Lao dong- Xa hoi Sau doc toan bo ban luan van Hoan thien chinh sach Bao hiemy te ff Viet Nam hien v r ■* theo lo trinh Bao hiemy te toan dan, toi co nhan xet nhu sau; Ve sir can thiet cua van de nghien ciru Nhu cau kham chua benh la nhu cau tat yeu khach quan cua moi ngudi, bdi khong co the tranh khoi qui luat sinh ton “sinh- benh- lao- tu” De co nguon tai chinh dap ung dupe nhu cau do, ngudi da thuc hien nhieu bien phap nhu tu tiet kiem, vay mupn, xin tai trp, tham gia bao hiem Tuy nhien, tham gia bao hiem dupe xem la bien phap huu hieu hon ca, vi bat cu nao rui ro (trong pham vi bao hiem) xay ra, ngudi tham gia bao hiem deu dupe co quan bao hiem chi tra, dam bao chi phi kham chua benh Bao hiem y te (BHYT) d Viet Nam ddi nam 1992 theo Nghi dinh so 299/HDBT 15/8/1992 cua Hoi dong Bo trudng (nay la Chinh phu), ban hanh kern theo Dieu le BHYT da gop phan thuc hien kham chua benh, dam bao sue khoe ddi vdi ngudi lao dong va nhan dan, giam bdt ganh nang cho ngan sach Nha nude De thuc hien cong bang xa hoi viec tiep can vdi dich vu y te, nam 2009 Luat BHYT ddi, vdi Id trinh thuc hien BHYT toan dan vao nam 2014 Tuy nhien, den thdi diem hien nay, ti le ngudi dan tham gia BHYT mdi dat 69%, Chinh phu phai dieu chinh muc tieu BHYT toan dan den nam 2020 Co nhieu nguyen nhan de khong dat dupe muc tieu md rong ddi tupng tham gia BHYT theo lo trinh nhu thu nhap cua ngudi dan thap, ngudi dan chua nhan thuc day du ve vai tro cua BHYT, co che quan If qui chua chat che De thuc hien muc tieu BHYT toan dan - gop phan thuc hien tot an sinh xa hoi, thi can thuc hien dong bo nhieu giai phap, va co sd de thuc hien cac giai phap xuat phat tu hoan thien chinh sach BHYT Vi vay, viec chon nghien cuu de tai Hoan thien chinh sach Bao hiem y te d Viet Nam hien theo Id trinh Bao hiem y te toan dan la can thiet Nhung ket qua dat dupe - Luan van da he thong hoa cac van de ly luan ve chinh sach BHYT nhu vai tro, nguyen tac, noi dung co ban cua chinh sach BHYT; luan van cung nghien cuu ve chinh sach BHYT d mot so quoc gia co nhieu dieu kien tuong dong vdi Viet Nam de rut nhung kinh nghiem - Danh gia noi dung chinh sach va tinh hinh thuc hien chinh sach BHYT d Viet Nam - De xuat cac giai phap nham hoan thien chinh sach BHYT d Viet Nam Cac giai phap dua ve co ban la hop li - Trinh bay dep; ket cau tuong doi phu hop; so lieu co nguon goc ro rang Y kien dong gop - Ve pham vi nghien cuu: luan van chi can nghien cuu giai doan 2009-2013 (sau co Luat BHYT) la phu hop, vi Luat BHYT doi, ve co ban da giai quyet duoc nhung bat cap chinh sach BHYT truoc day, luan van chi can nghien cuu nhung han che chinh sach hien hanh de dua giai phap hoan thien - Chuong 1, muc 1.2.4 can lam ro day la noi dung cua chinh sach BHYT noi chung hay noi dung cua chinh sach BHYT d Viet Nam, vi co muc luan van neu chung chung, co muc neu noi dung cu the lam cho mot so noi dung bi trung lap giua chuong va chuong (muc a.b) - Chuong 2, luan van nen tap trung vao danh gia chinh sach va tinh hinh thuc hien chinh sach giai doan 2009- 2013, giai doan sau co Luat BHYT, khong can thiet phai danh gia giai doan truoc Muc 2.3, cac bang so lieu d mot so noi dung, luan van chia bang vdi giai doan 1993- 2007 va 2008-2013 la khong hop li (VD bang 2.1 va 2.1) bdi nam 2008 ve co ban chinh sach khong co nhieu thay ddi so vdi nam 2007 Mot so noi dung luan van sap xep khong phu hop, vi du bang 2.5 Muc dong binh quan dua vao muc 2.3.3 Tinh hinh kham benh va chi BHYT Muc 2.4.2 co nhieu ket luan chua cd du can cu, vi du noi dung Ve cong tac giam dinh BHYT (T77), k6t luan thu (T79) - Chuong 3, mot so noi dung muc 3.2 va 3.3 trung lap - Ve ket cau: chuong noi dung chua tuong xung vdi chuong va chuong Con nhieu cho van phong chua phu hop; nhieu loi chinh ta Ket luan: Luan van dap ung yeu cau cua mot luan van thac sy kinh te Ngudi nhan xet TS Hoang Bich Hong MUC LUC • • LOI CAM DOAN MUC LUC BANG CHET VIET TAT DANH MUC BANG BIEU VA H1NH VE TOM TAT LUAN VAN THAC SY i PHAN MO DAU CHUONG 1: NHUNG VAN DE LY LUAN CO BAN VE CHINH SACH BAO HIEM YTE 1.1 Su’ can thiet khach quan va ban chat cua bao hiem y te 1.1.1 Sir can thiet khach quan cua bao hiem y te 1.1.2 Ban chat cua bao hiem y te 1.2 Chinh sach bao hiem y te 10 1.2.1 Khai niem chinh sach bao hiem y te 10 1.2.2 Vai tro cua chinh sach bao hiem y te 11 1.2.3 Nhung nguyen tac co ban cua chinh sach bao hiem y te 14 1.2.4 Noi dung co ban cua chinh sach bao hiem y te 16 1.3 Chinh sach bao hiem y te d mot so quoc gia va bai hoc kinh nghiem cho Viet Nam 23 1.3.1 Chinh sach bao hiem y te d Nhat Ban 23 1.3.2 Chinh sach bao hiem y te d Han Quoc 25 1.3.3 Chinh sach bao hiem y te d Thai Lan 26 CHUONG 2: CHINH SACH VA TiNH HINH THUC HIEN CHINH SACH BAO HIEM Y TE O VIET NAM 29 2.1 Sir doi va phat trien cua bao hiem y te d Viet Nam 29 2.1.1 Giai doan trudc luat bao hiem y te co hieu luc thi hanh (tu nam 1992 d6n 01/07/2009) 29 2.1.2 Giai doan luat bao hiem y te co hieu lire thi hanh (tir 01/07/2009 den nay) 33 2.2 Noi dung co’ ban cua chinh sach bao hiem y te d Viet Nam hien 34 2.2.1 Quan diem chung cua Dang va Nha nude ve chinh sach BHYT 34 2.2.2 Lo trinh thirc hien BHYT toan dan d Viet Nam 35 93 kham chua benh Xay dung cac benh vien ve tinh de tu benh vien chinh co the chi dao tu xa cong tac kham, chua benh tai cac benh vien ve tinh co nhung ca benh nang khong giai quyet duoc Giua cac benh vien cung nen trao doi kinh nghiem cho de nang cao chat luong kham chua benh Ngoai ra, viec tang cudng dao tao doi ngu y, bac si gidi cung rat quan Chinh sach ve y te nen quy dinh ro viec luan chuyen cac bac si tdi cac vung xau, vung xa de dam bao cong bang kham, chua benh Chang han, d Thai Lan da quy dinh rd bac sy sau tot nghiep phai lam viec nam tai co sd y te nha nudc, nam dau lam viec tai tuyen tinh, nam sau lam viec tai tuyen huyen hoac tham gia yTe cong dong Sau do, bac sy cd quyen chon noi lam viec cdn neu bac sy khdng thuc hien quy dinh thi se phai nop phat Nen cd nhung chinh sach dai ngo thich dang cho doi ngu y, bac sy de tranh tinh trang phai nhan‘’phong bi”cua ngudi dan gay phien cong tac kham, chua benh 3.2.2.3 Gia tang cac bien phap de quan ly, su' dung quy BHYT mot each hieu qua va tranh true loi bao hiem Theo quy dinh hien hanh 90% sd thu BHYT duoc dung de lap quy kham, chua benh nhung viec quan ly quy BHYT lai van chua thuc su hieu qua Chinh sach BHYT chua ban hanh duoc nhung bien phap, che tai cu the de kiem soat quy BHYT mot each hieu qua nhat, co che cho co quan kiem soat quy BHYT cung chua duoc rd rang nen da tao cac khoang de nhung ngudi muon true loi quy BHYT Hach luat” Vi vay, Nha nudc can nhanh chong dua cac chinh sach mdi nham hoan thien cac quy dinh cho viec su dung va quan ly quy BHYT Cu the: - Sica ddi, bo sung ve viec quan ly va sir dung quy BHYT Sau Luat BHYT cd hieu luc, cac ddi tuong dupe ngan sach ho tro tham gia BHYT dupe md rong, muc dong bao hiem tang len tu 3% len 4,5%, luong co ban nhung nam qua cung tang len ma vien phi lai van giu nguyen hau nhu khdng thay doi, cac tinh cd dan sd tham gia BHYT tang len, nhieu tinh dat 100% Trong do, d nhung vung xau, vung xa dan cu tap trung phan tan, giao thdng di lai kho khan, xa benh vien nen viec tiep can cac dich vu y te rat it Day la nhung 94 nguyen nhan chinh lam cho sir ket du quy BHYT tang len nhanh chong, tinh den nam 2012 so ket du dat gan 13.000 ty dong Tuy nhien, van mot so tinh lai boi chi quy BHYT lien tuc tir thuc hien den va thuong xuyen nhan ho tro tir quy du phdng trung uong Dieu cho thay su khong hop ly tinh co dieu kien kinh te - xa hoi phat trien lai nhan tro cap cho viec tham hut quy BHYT cua minh tir hon Vi du: Mot so tinh lien tuc boi chi quy BHYT nam (2010-2012) la Kien Giang, An Giang, Dong Thap, Vinh Long, Can Tho; mot so tinh boi chi nam (2011-2012) la Nam Dinh, Ninh Binh, Ca Mau, Hau Giang Muc boi chi ldn nhat lai doi vao nhom nguoi tham gia BHYT tu nguyen, so tien ho su dung de kham, chua benh gap lan so vui so tien ho dong BHYT vi chi om nang ho mdi tham gia BHYT Chinh vi vay, nha nudc nen xem xet, can nhac nang muc hudng cua nhung ngudi it duoc tiep can dich vu y te d cac tinh mien nui, ho tro ho them cac chi phi an d, di lai qua trinh kham, chua benh de ho cd co hoi tiep can vdi cac dich vu y te dm dau Nhanh chong thuc day tien trinh BHYT toan dan de tang ty le ngudi tham gia BHYT, dat dupe bao phu ve chieu rong Nhu vay, BHYT mdi thuc hien dupe muc tieu ho tro lan dau dm, cung cd the hudng dupe cac dich vu y te can thiet de cham soc sue khde cho ban than minh Luat BHYT chua quy dinh cu the ve thu tuc lap quy du phong hay chia sd quy ket du trudc nen qua trinh thuc hien ddi vdi phan ket du quy cdn nhieu vudng mac Sd ket du quy BHYT van chua dupe phan bo cho cac tinh cd quy ket du nen rat nhieu dia phuong thac mac ve sd ket du BHYT cua tinh minh Quy BHYT la loai quy ngan han, chi gidi han dong va su dung nam nen viec sd ket du BHYT ldn la van de dupe quan tarn Chinh vi vay, Nha nudc nen ban hanh them cac van ban quy dinh rd ve viec su dung sd ket du cho hop ly De nang cao chat luong chung cua nganh y te va chat luong kham chua benh, sd ket du nen dau tu trd lai cho cac tinh de ho to chuc cung ung dich vu, nang cap trang thiet bi ky thuat y te, phuong tien van chuyen benh nhan phu hop cho cac vung sau, vung xa, mien nui Nhu vay ngudi dan mdi dupe hudng quyen lpi cong bang tu su cham lo 95 cua Nha nudc Viet Nam co the hoc hoi viec su dung so ket du cua cac nudc nhu Thai Lan, Trung Quoc quy dinh neu ket du pha nop vao ngan sach tdi da 10% Viec su dung quy BHYT se co hieu qua hon neu nha nudc quy dinh phan quyen cho cac cap chinh quyen, dia phuong cd so ket du Ho cd the tu su dung so ket du de dau tu cho chat luong kham, chua benh cua tinh minh Hon nua, viec phan quyen se giup cho ho cd tinh than, trach nhiem hon viec quan ly va su dung quy tranh tinh trang y lai vao co quan BHXH, khong kiem soat hoat dong su dung quy de cho viec chi dinh kham, chua benh qua muc tai cac benh vien dan den tinh trang that thoat quy, true loi bao hiem Neu quy BHYT boi chi thi ho lai r r ' cho vao ngan sach cua trung uong cap xuong ma khong chu dong cd nhung nguon kinh phi ho tro cho hoat dong ho trq kham, chua benh cua ngudi dan - Sira ddi bo sung quy dinh ve giam dinh BHYT Theo quy dinh hien hanh, BHXH la co quan thuc hien cong tac giam dinh va chiu trach nhiem trudc phap luat ve ket qua giam dinh Viec giam dinh BHYT cd vai trd rat quan trong viec thanh, quyet toan chi phi kham chua benh BHYT cua cac co sd y te vdi BHXH Viec giam dinh BHYT la co sd de danh gia chat luqng cung cap dich vu y te, bao ve quyen lqi cua nguoi thu hudng Tuy nhien, qua trinh thuc hien viec trien khai cong tac giam dinh van gap rat nhieu kho khan Do so ngudi tham gia BHYT cang tang de dat duqc muc tieu bao phu cua BHYT toan dan nen so nguoi tham gia kham, chua benh BHYT cang tang cao nen sd ho so de toan BHYT can giam dinh la qua ldn, sd luqng giam dinh vien lai qua mong va tang rat it khong du de giam dinh duqc het sd ho so tren Hien nay, BHXH mdi thuc hien giam dinh BHYT cho khoang 20% tong sd benh an kham chua benh BHYT, 80% benh an chua giam dinh van duqc toan theo quyet toan cua benh vien Vi vay, Luat BHYT can “Thi diem thuc hien phuong phap giam dinh ho so toan chi phi KCB BHYT theo ty le” theo chi dinh giam dinh mau 20% - 30% sd benh an lam co sd ap dung cho 100% sd benh an, Y te la mot nganh dac thu nen viec giam dinh se gap nhieu kho khan neu nhu giam dinh vien khong biet gi ve nghiep vu kham chua benh va cung kho phat hien 96 nhung sai sot cac ho so nen Luat cung can bo sung them cac quy dinh ve che va tieu chuan cua giam dinh vien Yeu cau giam dinh vien nhat dinh phai la cac bac sy, ngoai hieu chinh sach BHYT ho co them ca chuyen mon nghiep vu thi moi du kha nang de kiem tra, danh gia duoc viec chi dinh cua cac bac si co dung hay khong, co chi dinh qua muc lam dung cac xet nghiem de lam loi cho benh vien hay khong, viec ke don thuoc, su dung hoa chat, vat tu y te va xac dinh chi phi kham chua benh chinh xac Ngoai viec dao tao, nang cao tay nghe cho cac giam dinh vien thi cung can phai xay dung mot che uu dai phu hop cho ho de ho yen tarn cong tac, khong moac ngoac vdi cac benh vien bi kiem tra de true loi bao hiem Viec co mot co che phu hop cung giup thu hut duoc nhieu bac si chuyen sang lam cong tac giam dinh BHYT - Sua ddi, bo sung quy dinh ve phuang thuc toan chi phi kham chua benh BHYT Phuang thuc toan chi phi kham chua benh BHYT cung la mot nhan to anh hudng true tiep den viec quan ly quy BHYT Muon cho quy hoat dong hieu qua thi ddi hoi phuang thuc toan chi phi phai tdi uu, tranh lang phi Hien nay, Viet Nam van ap dung ca phuang phap toan chi phi phuang phap toan chi phi kham chua benh BHYT theo phi gia dich vu y te van dugc ap dung kha bien tdi 50% cac benh vien Day la phuang thuc tao su chu dong viec chi dinh xet nghiem, thuoc, vat tu y te nhung rat de dan den nguy co lam dung dich vu y te, thuoc va gay boi chi quy BHYT Chinh vi vay, chinh sach BHYT can nhanh chong xoa bo phuang thuc toan ma thay the bang cac phuang phap toan chi phi uu viet han nhu phuang thuc toan theo dinh suat va phuang phap toan theo trudng hap benh Phuang thuc toan theo gia dich vu y te la mot phuang phap da rat lac hau va cac nudc thuc hien BHYT toan dan da loai bo phuang phap tir lau Dich vu y te cd mot dac thu khac vdi cac dich vu xa hoi khac Ngudi benh khdng the chu dong viec dung thuoc nao de tri benh ma deu phai cac bac si chi dinh Cac loai thuoc tri benh khdng the mac ca ve gia ca nen ngudi benh cung khdng the biet 97 dirge tong chi phi can chi tra Hien nay, Cac benh vien dugc thuc hien co che tu chu tai chinh va day manh xa hoi hoa, tim mgi each de tang nguon thu tir dich vu y te da phat sinh nhieu hinh thirc lam dung BHYT tinh vi kho phat hien va kiem soat chang han nhu chi dinh cac dich vu xet nghiem, chuan doan hinh qua anh Co rat nhieu cac loai thuoc, vat tu y te ma nha nudc phai quan ly gia nen viec tinh gia va cap nhap gia ca thuong xuyen cung gap nhieu kho khan Do do, thong tin ve cac dich vu y te nguoi r i dan khong the biet va cap nhat het dugc Viec ddi mdi phuong thirc toan chi r phi kham chua benh BHYT d Viet Nam la rat can thiet Viec thay the phuong phap toan chi phi gia dich vu y te bang phuong thirc toan theo dinh suat va phuong thirc toan theo trudng hgp benh se giup cho hgat dong cua he thong y te hieu qua hon, ngudi tham gia kham chua benh BHYT tiet kiem dugc chi phi hon - Xay dimg cac quy trinh chuyen mon va phac dieu tri chuan dp dung cho cd nircrc O cac quoc gia phat trien tren the gidi thi viec xay dung mot quy trinh chuyen mon va phac dieu tri benh chuan la nhung viec dau tien kham chua benh Khi kham chua benh cac bac sy chi viec can cir vao cac phac do de chi dinh, ngudi dan cung biet viec minh se phai ap dung phac nao, dung cac xet nghiem nao de chu dong viec chua tri benh tat Tuy nhien, d Viet Nam hien van chua cd mot phac dieu tri benh chuan de ap dung cho ca nudc va phuc vu dac luc cho cong tac giam dinh BHYT Viec chua cd mot phac dieu tri benh chuan nd anh hudng true tiep den cong tac giam dinh BHYT, den quyen lgi cua ngudi hudng BHYT, den viec toan chi phi kham, chua benh BHYT Hien nay, lgi dung viec chua cd mot phac dieu tri chuan nen cac benh vien da tu y dua cac phac dieu tri khac theo chi dinh cua benh vien minh nen vdi cung mot loai benh ngudi kham chua benh BHYT khong the biet dugc chi phi chinh xac cho viec chua tri va phac nao la chuan Nd anh hudng true tiep den su cong bang kham, chua benh va quyen hudng cua ngudi tham gia BHYT Cac benh vien thuc hien xa hoi hoa va tu chu tai chinh nen gia tang cac chi dinh xet nghiem, chup chieu, dich vu khong can thiet de phuc vu lgi ich cua minh, cdn ngudi benh thi lai 98 ton tien va hai sue khde hon Chinh vi vay, nganh y te can phai co ke hoach xay dung cac phac dieu tri benh chuan de ap dung vao kham chua benh, cong bo rong rai cac phac dieu tri de cho ngudi dan duoc biet, ddng thdi giam sat luon viec kham chua benh cua cac bac si De xay dung phac dieu tri benh ngoai cac co quan quan ly nha nudc, BHXH vdi tu each giam sat quy BHYT thi can cd su tham gia cua cac bac si dau nganh ve cac chuyen mon de cd the dua dupe mot phac chuan nhat, vua hieu qua chua benh, vua tiet kiem chi phi cho ngudi dan Nhu vay, cong tac giam dinh se bdt ganh nang hon va thuc hien cong bang, khach quan hon, dat hieu qua tdi uu - Quan ly gia thuoc, vat te kham chua benh BHYT mot each hap ly Cac quy dinh ve gia thuoc va vat tu y te hien deu dupe quy dinh Luat Dupe Tuy nhien, Luat Dupe hien hanh van chua cd nhung quy dinh cu the de kiem soat viec cung ung thuoc va gia thuoc noi chung va thuoc BHYT noi rieng nen gia thuoc d Viet Nam khong on dinh va thudng cao hon vdi cac nudc khu vuc Thuoc va cac vat tu y te la mot loai hang hoa dac biet, ngudi benh bat buoc phai dung thuoc de dieu tri benh va khong cd san pham thay the thuoc nen ngudi benh la ngudi phai chap nhan gia du cao hay thap Nhieu loai thuoc danh cho nhung ngudi benh Viec ke don thuoc khong hop ly se anh hudng den sue khde cua ngudi benh, ke qua nhieu thuoc khong can thiet se anh hudng den chi quy BHYT Vi vay, viec ke don thuoc rat quan trong, can phai dupe chan chinh Can cd phac dieu tri chuan thi don thuoc mdi chuan Quy dinh gia thuoc va vat tu y te toan BHYT thong nhat tren ca nudc Tang cudng quan ly viec dau thau thuoc, nang cao trach nhiem quan ly cua BHXH, quy dinh rd rang cac danh muc thuoc BHYT 3.2.2.4 Hoan thien cac che tai dam bao tinh tuan thu chinh sach BHYT Hien nay, cac hanh vi vi pham phap luat ve BHYT van xay thudng xuyen va xay d moi chu the tham gia quan he va d tat ca cac khau cua hoat dong BHYT Chang han nhu viec nhan ban cac xet nghiem tai Benh vien Da Khoa Hoai Due, lam gia ho so kham, chua benh cd trudng hop the BHYT d tinh Ddng Nai dupe su dung 99 157 lan KCB nam, nhieu nguoi cho thue the BHYT kham, chua benh de lay tien, doi tuong phai tham gia BHYT bat buoc nhung lai khong tham gia De xay nhung hien tuong tren la chinh sach Luat BHYT thieu cac che tai nghiem khac, khong co tinh ran de nen nhieu doi tuong co tam ly coi thuong luat Vi vay, Can bo sung cac quy dinh che tai xu ly vi pham luat BHYT Luat can phai quy dinh ro cac hanh vi nhu the nao la vi pham phap luat BHYT, xay dung che tai nghiem khac de xu phat cac doi tuong vi pham Bat buoc cac doi tuong vi pham phai boi thuong thiet hai gay cho Nha nudc va nguoi thu hudng Dong thoi, tudc giay phep hanh nghe doi vdi cac-co sd y te, ca nhan co hanh vi vi pham, cham dut hoat dong doi vdi doanh nghiep tron tham gia BHYT cho nhan vien, gui thong bao ve dia phuong co cac ca nhan vi pham Tuy vao muc cua cac hanh vi gian lan, truc loi de xu ly, neu gian lan, truc loi d muc nghiem thi co the truy cuu trach nhiem,khdi to hinh su de co suc ran de cao Chinh vi vay, can phai quy dinh them nhung toi linh vuc BHYT ve hanh vi vi pham phai truy cuu trach nhiem hinh su dieu luat ve toi lua dao chiem doat tai san, toi loi dung chuc vu, quyen han thi hanh cong vu nhu: Toi tron dong BHYT, toi chiem duung tien dong BHYT, toi gia mao giay to, ho so chiem doat tien BHYT, toi chi dinh qua muc can thiet BHYT De Luat dam bao duoc vi tri cua minh xay dung nha nudc phap quyen thi viec bo sung quy dinh ve cac hanh vi pham toi va co che xu ly toi pham BHYT la vo cung can thiet 3.2.2.5 Nang cao vi tri va vai trd cua tlHXH VietNam BHXH Viet Nam la co quan dong rat nhieu vai tro chu quan: la co quan cua Chinh Phu, to chuc thuc hien BHYT, quan ly quy BHYT, bao ve quyen loi cua nguoi tham gia BHYT Chinh vi vay, BHXH Viet Nam can phai co nhung quy dinh ro rang ve quyen han va trach nhiem cua minh de phat huy duoc het cac vai trd cua minh de lam tot tat ca cac cong viec tren Quy dinh ro trach nhiem cua BHXH Viet Nam viec kiem soat chi phi va kiem soat chat luong kham, chua benh BHYT Luat BHYT can bo sung quy dinh nham nang cao nang luc cua BHXH Viet Nam kiem soat viec su dung quy 100 kham, chua benh tai cac benh vien tai tat ca cac khau: chi dinh cac xet nghiem, dich vu ky thuat, su dung thuoc, toan chi phi kham chua benh cho benh nhan BHYT Luat cung nen bo sung vai trd giam sat chat luong kham, chua benh BHYT: giam sat thai phuc vu cua nhan vien y te tir kham, chua den cham soc benh nhan BHXH cung nen tham gia vao cong tac xay dung gia, vien phi, quy trinh chuyen mon ky thuat de bao ve quyen va lgi ich cho ngudi tham gia BHYT, tranh tinh trang chi dinh tran lan cac dich vu ky thuat cd chi phi cao khong can thiet tai cac benh vien Bo sung them cac quy dinh de BHXH Viet Nam cd the bao ve quyen va lgi ich cua ngudi tham gia BHYT tot hon Chang han nhu quyen giam sat viec kham, chua benh BHYT tai cac benh vien, dugc xu ly cac vi phamj ve quyen lgi cua ngudi tham gia BHYT, thiet lap cac he thong tiep nhan thong tin phan hoi tir nguoi tham gia BHYT Luat cung can cho phep BHXH va tra y te cung tra chuyen mon nganh ve BHYT vi hien chi cd tra y te cd chuc nang kiem tra, tra nen sd cuoc tra cdn qua it, so vu vi pham dugc phat hien cung it tinh trang vi pham mot tang cao BHXH ket hgp voi Thanh tra y te de cung cd nhung phat hien sai sot, xu ly kip thdi de Luat cd tinh ran de manh hon Trao quyen tra nhung dong thdi cung phai trao quyen xir phat thi mdi phat huy dugc het nhung vai trd cua Luat phap Vi vay, Luat tra can cd co che dac biet cho hoat dong kiem tra cua BHYT viec xu ly vi pham De thuc hien dugc lo trinh BHYT toan dan thi Luat BHYT can sua ddi, bo sung cac dieu khoan thuan lgi cho viec dat dugc mat bao phu tham gia BHYT Nang cao chat lugng kham chua benh tai tat ca cac co sd y te tren ca nudc noi chung va tren cac tinh mien nui, vung sau, vung xa noi rieng de tat ca deu dugc hudng quyen lgi nhu tham gia BHYT De md rong mat bao phu nhanh chong thi nen quy dinh BHYT bat buoc theo ho gia dinh Viec quan ly sd ngudi mot ho gia dinh se de dang hon nhd 101 co su tro giup cua cac dia phuong ve quan ly nhan khau nhu vay moi khong sot duoc cac doi tuong khong tham gia, hoac tranh duoc tinh trang mot so ngudi roi vao 2-3 nhom tham gia khac Luat nen quy dinh chat che cac muc ho tro cho gia dinh tham gia BHYT day du Neu khong tham gia day du thi se khong nhan duoc su ho tro cua nha nuoc Hien nay, theo Luat BHYT hien hanh quy dinh co toi 25 nhom doi tuong tham gia BHYT la qua nhieu, nen sap xep va rut gon lai de tranh tinh trang mot ngudi co toi 2-3 the bao hiem y te, gay kho khan cho viec quan ly quy BHYT De lam duoc dieu nay, nha nuoc nen quy dinh moi cong dan co mot ma so va ap dung tien bo cua cong nghe thong tin vao de phat hien da duoc cap ma so the BHYT roi thi khong cap them nua, dam bao viec moi ngudi chi co the BHYT Ben canh viec mo rong doi tuong tham gia de dat duoc mat bao phu theo chieu rong thi cung c.an phai xay dung chinh sach phat trien theo chieu sau Nang cao quyen loi cua ngudi tham gia BHYT, giam so tien tui ma ho phai chi De the hien duoc su quan tam cua Nha nuoc toi tat ca ngudi dan thi Nha nuoc nen tang cudng ho tro muc dong BHYT cho nhom co ty le tham gia BHYT thap nhu: gia dinh can ngheo, hoc sinh, sinh vien, nong, lam, ngu nghiep co muc song trung binh Kham, chua benh mien phi tai tuyen co so cho nhung ho ngheo, gia dinh chinh sach Cdn cac doi tuong kham, chua benh co kha nang tai chinh, du dieu kien mua BHYT thi can phai co nhung quy dinh bat buoc Chang han, doi voi cac doanh nghiep co hoat dong san xuat kinh doanh tot thi bat buoc phai tham gia BHYT cho nhan vien, ngudi lao dong Quy dinh ro nhung doanh nghiep nhu the nao thi can duoc ho tro, nhung doanh nghiep nao can phai cudng che Hoan thien cac chinh sach ve BHYT, sua doi, bo sung Luat BHYT cung voi viec ban hanh du cac van ban quy dinh lien quan Trien khai, to chuc thuc hien tot ba muc tieu cu the cua De an thuc hien lo trinh tien toi BHYT toan dan: Mot la tang ty le dan so tham gia BHYT thong qua viec tiep tuc tri cac nhom doi tuong da dat ty le 100%, md rong cac nhom doi tuong de den nam 2015 dat ty le tren 75% va 102 den nam 2020 co tren 90% dan so tham gia BHYT Hai la nang cao chat luong kham chua benh BHYT, dap ung nhu cau kham chua benh cua nguoi tham gia BHYT Ba la tung buoc doi mdi co che tai chinh, phan dau den nam 2015 giam chi tieu true tiep tu tien tui cua ho gia dinh xuong dudi 40% Dong thdi, can tang cudng giam sat viec thuc hien chinh sach, phap luat, tranh su chong cheo, thieu thdng nhat giua cac van ban hudng dan thi hanh Luat va to chuc thuc hien Luat Tang cudng cong tac tuyen truyen ve BHYT toan dan tdi nhan dan, gan vai trd va trach nhiem quan ly cua cac dia phuong vao cong tac thuc hien BHYT Dong cho nhan dan, noi each khac la Nha nudc chi ho tro ngudi benh chua benh, chu khdng bao cap het cac khoan chi cho kham chua benh bang BHYT Viec mua BHYT dong nghia vdi viec ngudi dan se chac chan duoc Nha nudc ho tro, cham lo sue khde cho ban than dm dau 3.3 Kien nghi 3.3.1 Vdi Nha nuac 3.3.1.1 Vai quoc hoi - Quoc hoi tiep tuc thuc hien cac muc tieu an sinh xa hoi cd muc tieu cham soc sue khde cho ngudi dan, ung ho De an thuc hien lo trinh BHYT toan dan, ho tro cho ngudi tham gia BHYT de thuc hien dupe muc tieu dam bao cong bang cham soc sue khde Ung ho lo trinh chuyen ttr chi ngan sach cho benh vien sang chi ngan sach ho tro ngudi dan tham gia BHYT, thuc day ty le tham gia BHYT tang ca ve chieu rong lan chieu sau chat luong kham chua benh, nang cao quyen hudng BHYT thdng qua viec quy dinh lo trinh tinh dung, tinh du gia dich vu y te - Luon dat van de tang ty le tham gia BHYT hang nam noi dung phat trien kinh te xa hoi Td chuc tra, kiem tra kip thdi cong tac kham chua benh de nang cao chat luong kham chua benh cho toan dan - Can dua vao Luat dau thau ve viec dau thau thuoc BHYT mot each cong bang, hop ly: dua them nhung quy dinh cu the bang nhung van ban hudng dan chi 103 tiet hon Don vi trung thau vua phai dam bao dua muc gia thap nhung cung phai co du nang luc san xuat va cung cap thuoc dung chat luong - Xay dung co che de thuc hien BHYT bat buoc, theo ho gia dinh - Xac dinh cu the trach nhiem cua Thanh tra y te, BHXH, cac co sd y te trudc Dang va Nha nudc - Nen de cac dia phuong tu quan ly va su dung quy BHYT cua minh de ho chu dong viec phat trien he thong y te Gan trach nhiem chi dao vdi tirng dia phuong tu chiu trach nhiem ve ty le tham gia BHYT d dia phuong minh - Nang cao vai trd cua cong tac giam dinh BHYT, len ke hoach chi dao dua cac phac dieu tri benh BHYT, thong nhat chung ve gia thuoc, dich vu y te tren toan quoc - Ban hanh Nghi quyet ve day manh thuc hien chinh sach BHYT, tien tdi BHYT toan dan tren co sd ket qua cua Bao cao giam sat 3.3.1.2 Vai Chinh Phu - Chinh phu hudng dan thuc hien cac quy dinh chinh sach BHYT Thirc hien lo trinh chuyen ddi tir cap ngan sach true tiep cho benh vien sang ho tro kinh phi cho nguoi tham gia BHYT - Chinh Phu chi dao cac dia phuong md rong ddi tuong tham gia BHYT theo tien trinh lo trinh BHYT toan dan Yeu cau cac dia phuong cd ty le ddi tuong tham gia BHYT thap nghiem chinh thuc hien Chi dao viec su dung phan ket du quy BHYT hop ly de bao dam quyen lgi cho nhung tinh cd sd ket du quy BHYT - Chinh phu chi dao nganh y te sir dung cac ung dung cua cong nghe thong tin vao quan ly BHYT de tranh tinh trang cap trung cho mot ngudi 2-3 the BHYT mot nam - Chi dao Bo Y te, BHXH Viet Nam, UBND cac cap, co quan thong tin dai chung phoi hop thuong xuyen, chat che hoat dong thong tin, giao due, truyen thong vd BHYT - Thuong xuyen tong ket va danh gia ket qua thuc hien BHYT tai cac dia phuong de cd phuong an xu ly kip thdi 104 - Chinh phu chi dao cac can bo, cong chuc, vien chuc nha nuoc thuc hien viec tham gia BHYT bat buoc nghiem chinh - Phan cong, tuyen truyen, van dong ve BHYT giua Bo y te va BHXH cho hop ly Can giao kinh phi de chu tri tuyen truyen ve BHYT cho Bo y te vi Bo y te la co quan chu tri 3.3J.3 VaiBo YT - Bo Y Te can nhanh chong ban hanh cac quy dinh ve viec su dung quy BHYT cho hop ly Som ban hanh cac phac dieu tri ap dung chung cho tat ca cac benh vien Som thay the cac phuong thuc toan' chi phi lac hau bang cac phuong phap toan chi phi toi uu - Ket hop voi cac bo, ban nganh co lien quan de quan ly ve tran kham, chua benh BHYT tuyen cho cac benh vien cho phu hop Xay dung mot he thong gia thuoc tap trung duoc cong bo rong rai tren ca nuoc - Trien khai cac giai phap dau thau thuoc, vat tu y te de lua chon duoc cac loai thuoc hop ly de nang cao chat luong KCB BHYT - Chan chinh y duc, tang cudng tra va don doc cac dia phuong thuc hien nang cao y duc, chat luong hoat dong chuyen mon nganh y te 3.3.2 YiiBHXH Viet Nam - BHXH Viet Nam nen dua cac quy dinh cu the viec thu, chi va su dung quy BHYT cho hop ly - BHXH Viet Nam can to chuc phat hanh va quan ly the BHYT khoa hoc hon de tao dieu kien thuan loi de ngudi dan tham gia BHYT; - Nang cao nang luc cua cac can bo giam dinh BHYT de co the phat hien nhung vi pham toan chi phi kham chua benh BHYT, tao dieu kien thuan loi cho cong tac quan ly quy BHYT - BHXH Viet Nam nen phoi hop voi cac bo ban nganh lien quan de soat lai cac quy dinh chinh sach BHYT de dieu chinh cho hop ly lam gia tang quyen loi cho ngudi tham gia BHYT, dong thdi cung co nhung che tai xu ly nhung 105 vi pham nganh mot each nghiem minh Phoi hop de soat lai cac doi tuong sot lai chua tham gia BHYT de co nhung giai phap ho tro kip thdi 3.3.3 Vdi cac co’ so’ kham chua benh BHYT - Nghiem chinh thuc hien cac chinh sach BIIYT dupe quy dinh Luat BHYT hien hanh - Kham, chua benh BHYT theo cac phac dieu tri chuan, tranh tinh trang chi dinh qua muc khong can thiet lam tieu ton them tien cua ngudi dan de true loi ve cho benh vien minh - Luon luon nang cao tinh than hoc hoi toan nganh de chat luong kham, chua benh dupe tot hon Thudng xuyen cap nhap nhung chinh sach BHYT de thuc hien va tuyen truyen cho ngudi dan tham gia BHYT - Dua cac y kien de xay dung mot chinh sach BHYT cong bang, hieu qua 106 KET LUAN Chinh sach BHYT la mot tru cot cua he thdng an sinh xa hoi Vdi y nghia cao ca cua minh, chinh sach BHYT dem den cho ngudi dan su cdng bang cham soc sue khde, nang cao chat luong cuoc song, the hien ro duoc tinh than tuong tro giua ngudi vdi ngudi luc dm dau, benh tat Dang va Nha nudc luon luon quan tarn den sue khde cua ngudi dan nen cac chinh sach nham phat trien BHYT, dua BHYT vao toan dan luon duoc chi dao sau sac va kip thdi Vdi de tai” Hoan thien chinh sach BHYT Viet Nam hien theo lo trinh BHYT toan dan” tac gia da the hien dupe nhung quyet tarn cua Dang va Nha nudc de thuc hien BHYT toan dan thdi gian tdi bang viec tirng buoc hoan thien cac chinh sach BHYT cua Viet Nam De tai da nghien cuu, danh gia khach quan thuc trang cua chinh sach BHYT ap dung ddi song Chinh sach BHYT cang di vao ddi song cua nhan dan vdi nhung y nghia nhan van sau sac Chinh sach BHYT cua Viet Nam da tiem can ngang vdi nhung chinh sach BHYT cua nhung nudc da thuc hien cong BHYT toan dan Nhung qua trinh trien khai chinh sach BHYT van gap mot so vudng mac chua quy dinh ro rang trach nhiem cua tirng chu the, quyen lpi cua ngudi dan d mot so dia phuong van chua duoc cong bang nen de tai da dua nhung giai phap va kien nghi de cho chinh sach BHYT Viet Nam dupe hoan thien hon Trong qua trinh nghien cuu de tai, tac gia da nhan dupe rat nhieu su giup do, gop y tir cac thay, co va cac ban khoa bao hiem, dac biet la giang vien hudng dan de tai TS.Pham Thi Dinh - giang vien khoa Bao Hiem, trudng Dai hoc Kinh Te Quoc Dan de cd the hoan thien dupe de tai nghien cuu Mot lan nua, tac gia xin cam on thay, co va cac ban da nhiet tinh giup Tac gia rat mong nhan dupe nhung y kien, gop y cua moi ngudi de de tai dupe hoan thien hon Tran Trong! Ha Noi, thang 10 nam 2014 107 TAI LIE• U THAM KHAO Ban Chap hanh Trung nang Dang Cong san Viet Nam(2009), chi thi 38- CT/TW cua Ban Bi thu 7/9/2009 ve day manh cong tac BHYT tinh hinh mdi, Ha Noi Bao hiem xa hoi Viet Nam (2010) ,Bao Cao tinh hinh boi chi quy BHYT va de xuat giai phap gui Chinh Phu, Ha Noi Bo Y te Viet Nam va Nhom doi tac y te (2008), Bao cao chung tOng quan nganh y te nam 2008 - Tai chinh Y Te d Viet Nam, Ha Noi Bo Y Te (9/2007), Bao cao tdng ket 15 nam thuc hien chinh sach BHYT, Ha Noi Dao Van Dung, Thuc hien chinh sach bao hiem y te d nudc ta: Thanh tuu, thach thuc va giaiphap, Tap chi Tuyen giao so nam 2009, Ha Noi Nguyen Thi Thanh Huong (2012), Ca sd ly luan va thuc tien hoan thien phap luat BHYT d Viet Nam, Luan an tien sy, Hoc vien Chinh Tri - Hanh Chinh Quoc Gia Ho Chi Minh LnatB HHYn am 2008 Phan Van Toan (27-28/8/2013), Lo trinh/Chien luac tien tdi BHYT toan dan giai doan 2012-2015 va 2020, Tai lieu hoi thao tap huan ’’Tim hieu cac chien luac tang cudng tiep can thuoc cuu mang”, Trung tam ho tro sang kien phat trien cong dong (SCDI) Thu tiroTh Chinn Phh(2006), (20_y^ZI dink so 153/2006/QD-TTg 30/6/2006 ve phe duyet Quy hoach tdng the phat trien he thOng y te Viet Nam giai doan den 2010 va tam nhin den nam 2020, Ha Noi 10 Uy Ban Thudng Vu Quoc Hoi, Doan Giam sat, Bao cao Ket qua giam sat viec thuc hien chinh sach, phap luat ve BHYTgiai doan 2009-2012, Ha noi 11 Uy ban thudng vu quoc hoi, Vien nghien cuu lap phap( 10/2013), Bao hiem y te toan dan, Thuc trang va kien nghi, Ha Noi