Phát triển bảo hiểm y tế tự nguyện nhân dân ở việt nam

TRUdNG DAI HOC KINH T< QuOc DAN • • *** NGUYEN THI HONG CHI da/ hqc ktqd TT THdNG* TIN THU V/EN PHONG LUAN AN - TV LIEU PHAT TRifN BAO HlfM Y TE TT NGUYEN NHAN DAN d VIET NAM Chuyen nganh: KINH TE BAO HIEM LUAN VAN THAC SY KINH tE • • Ngitdi hito’ng dan khoa hoc : PGS.TS NGUYEN VAN D|NH THS 59 90 HA NOI - 2009 Il MUC LUC • • Trang DANH MUC CAC CHU VIET TAT DANH MUC BANG, BIEU DO TOM TAT LUAN VAN MO DAU CHUONG I: LY LUAN CHUNG VE BAO HIEM Y TE TU • • NGUYEN NHAN DAN 1.1 KHAI NIEM BAO HIEM Y TE TU NGUYEN NHAN DAN 1.1.1 Lich su ddi cua BHYT 1.1.2 Khai niem ve BHYT tu nguyen nhan dan 1.2 SU • CAN THIET VA VAI TRO CUA BAO HIEM Y TE TU • NGUYEN NHAN DAN 1.2.1 Su can thiet khach quan r 11 11 1.2.2 Vai tro cua BHYT tu nguyen nhan dan 1.3 NHUNG NOI • DUNG NGUYEN NHAN DAN co BAN CUA 13 BAO HIEM Y TE TU • 18 •> 1.3.1 Doi tuqng va pham vi bao hiem 18 1.3.2 Phuong thuc dong BHYT tu nguyen nhan dan 19 1.3.3 Quy BHYT tu nguyen nhan dan 19 1.3.4 To chuc BHYT tu nguyen nhan dan 1.4 KINH NGHIEM TRIEN KHAI BAO HIEM Y 22 tE TU 24 NGUYEN O MOT • • SO NUOC TREN THE GIOI VA BAI HOC • CHO VIET NAM 1.4.1 Kinh nghiem thuc hien BHYT tu nguyen d cac nudc 24 phat trien 1.4.2 Kinh nghiem thuc hien BHYT tu nguyen d cac nudc dang phat trien 26 1.4.3 Nhung bai hoc kinh nghiem thuc hien BHYT tir nguyen cho Viet Nam CHlTONG II: THIJC TRANG TRIEN KHAI BAO HIEM Y TE TU NGUYEN • NHAN DAN Q VIET • NAM 2.1 CHINH SACH BAO HIEM Y TE TU* NGUYEN NHAN DAN O VIET NAM 2.1.1 Giai doan 1993-2002 2.1.2 Giai doan 2003 - 2008 2.2 PHAN TICH THLC TRANG TRIEN KHAI BAO HIEM Y 32 41 55 TE TU • NGUYEN • NHAN DAN O VIET • NAM 2.2.1 Giai doan 1993-2002 2.2.2 Giai doan 2003 - 2008 CHlTONG III: GIAI PHAP PHAT TRIEN BAO HIEM Y TE 55 61 71 IL• NGUYEN • NHAN DAN VIET • NAM 3.1 QUAN DIEM CHUNG 3.1.1 Lo trinh thirc hien BHYT toan dan Viet Nam 3.1.2 Quan diem phat trien BHYT tir nguyen nhan dan den 71 71 74 nam 2014 3.2 GIAI PHAP PHAT TRIEN BAO HIEM Y TE NHAN DAN O 78 NIOC TA 3.2.1 Cac giai phap vT mo 3.2.2 Cac giai phap vi mo KET LUAN DANH MUC • TAI LIEU • THAM KHAO 78 82 88 89 DANH MUC CAC CHU' VIET TAT BHXH Bao hiem xa hoi BHYT Bao hiem y te KCB Kham chua benh DANH MUC C AC BANG BIEU Trang Bang 1.1: So ngubi tham gia BHYT giai doan 1993 - 2008 12 Bang 2.1: So ngubi tham gia BHYT tu nguyen nhan dan (1993 - 2002) 55 Bang 2.2: So thu BHYT tu nguyen nhan dan (1993 - 2002) 56 Bang 2.3: Chi phi KCB BHYT tu nguyen nhan dan (1993 - 2002) 57 Bang 2.4: Can doi quy KCB BHYT tu nguyen nhan dan (1993 - 2002) 58 Bang 2.5: So ngubi tham gia BHYT tu nguyen nhan dan (2003 - 2008) 61 Bang 2.6: So thu BHYT tu nguyen nhan dan (2003 - 2008) 64 Bang 2.7: Ty le tang (giam) so thu va muc dong BHYT tu nguyen nhan 65 dan (2004 - 2008) Bang 2.8: Phan bo quy BHYT tur nguyen nhan dan (2003 -2008) 66 Bang 2.9: Chi phi KCB BHYT tur nguyen nhan dan (2003 - 2008) 67 Bang 2.10: Can doi quy KCB BHYT tu nguyen nhan dan 68 (2003-2008) Bang 3.1: Lo trinh thuc hien BHYT toan dan theo Luat BHYT 71 Bang 3.2: Ty le dan so tham gia BHYT nam 2008 73 =it 11 TRUdNG DAI HpC KINH Te" QUd’c DAN NGUYEN TH| HONG CHI phat tri6'n bao hiem y te tv nam ■ nguyE ■ n nhan dan viet ■ Chuyen nganh: KINH te bAo hiem TOM TAT LUAN VAN THAC SY • • HA NOI - 2009 i MO DAU Ti'nh cap thiet cua de tai Ti'nh den het nam 2008, nude ta co 44,75% dan so co the BHYT, nhu vay hon 50% dan so chua co BHYT Trong so co 30,57% dan so chua co the la nhung ngudi nong dan, lao dong tu do, co thu nhap khong on dinh Vi vay tac gia chon de tai “Phat trien BHYT tu nguyen nhan dan a Viet Nam ” de nghien cuu Muc tieu nghien cuu r y y Lam ro nhirng van de ly luan ve BHYT tir nguyen nhan dan va danh gia yr tinh hinh trien khai BHYT tu nguyen nhan dan d Viet Nam De xuat cac giai phap de phat trien BHYT tu nguyen nhan dan d Viet Nam mot each ben vung r Doi tuong, pham vi nghien cuu y r a Doi tuomg nghien ciru: Cac van ban phap quy, cac bao cao ve BHYT r tu nguyen nhan dan Doi tuong tham gia BHYT tu nguyen nhan dan b Pham vi va giai han nghien cuu: Cac loai hinh BHYT tu nguyen nhan dan da va dang trien khai d Viet Nam Phuong phap nghien cuu Ngoai cac phuong phap tu logic, phuong phap vat bien chung e a r va vat lich su, de tai su dung tong hop cac phuong phap thong ke phuong phap so sanh, danh gia, phuong phap phan tow Ket cau de tai a a yr a a Ngoai phan md dau va phan ket luan, de tai dupe gom chuong: Chuong I: Ly luan chung ve BHYT va BHYT tu nguyen nhan dan Chuong II: Phan tich tinh hinh thuc hien BHYT tir nguyen nhan dan d Viet Nam Chuong III: Phuong hudng va giai phap phat trien BHYT tu nguyen nhan dan d Viet Nam ii CHtfONG I LY LUAN CHUNG VE BAO HIEM Y TE TV • • NGUYEN • NHAN DAN ~ r A A I.I KHAI NIEM BHYT TV NHAN DAN • • NGUYEN • 1.1.1 Lich sw doi cua BHYT l.l.l.l Tre n the giffi Quy BHYT dau tien da doi d Due Nam 1883, nude Due co luat r a BHYT va nhieu nude khae tren the gidi eung thuc hien BHYT eho ngudi lao dong nhu d Due Tai Hoi nghi toan the eua To ehue lao dong quoe te (ILO) da thong qua Cong ude so 102 (1952) da dat ehe eham soe y te len hang dau eua he thong an sinh xa hoi Su ddi eua BHYT xuat phat tu su bao ve r •> sue khoe eho ngudi lao dong ehang may ho bi om dau benh tat Vdi tinh ehat xa hoi rong rai do, BHYT da dupe trien khai d rat nhieu nude tren the r a gidi va eang khang dinh dupe vi tri quan trong van de dam bao an sinh xa hoi O Viet Nam Ngay 15/8/1992 Hoi dong Bo trudng (nay la Chinh phu) ban hanh Nghi dinh so 299/HDBT ban hanh dieu le BHYT Sau hon nam thue hien, tu thue r A tien va trude yeu eau nhiem vu mdi Chinh phu da ban hanh Nghi dinh so 58/1998/ND-CP ban hanh ve Dieu le BHYT Ngay 16/5/2005 Chinh phu ban r a _ _ r hanh Nghi dinh so 63/2005/ND-CP ban hanh Dieu le BHYT thay the Nghi dinh so 58/1998/ND-CP Ngay 14/11/2008 Quoe hoi ban hanh Luat BHYT I.I.2 Khai niem ve BHYT tur nguyen nhan dan BHYT tu nguyen nhan dan d Viet Nam la hinh thue BHYT tu nguyen Nha nude to ehue thue hien eho ngudi dan ehua eo the BHYT bat buoe de KCB eho ngudi tham gia bi om dau, benh tat va khong vi mue dieh lpi nhuan 1.2 SU* CAN THIET VA VAI TRO CUA BHYT TU" NGUYEN • • • NHAN DAN 1.2.1 Sy can thiet khach quan r x x r Van de cham soc sue khoe cho ngudi dan luon luon la van de dat len r x r •> r hang dau cac chien luge phat trien kinh te - xa hoi cua cac quoc gia Boi vi, neu khong co suc khoe ngudi se khong lam dugc bat cu viec gi va neu xet tren pham vi mot quoc gia thi no se anh huong den kinh te - chinh tri cua quoc gia 1.2.2 Vai tro cua BHYT, BHYT tu nguyen ? r xx BHYT dam bao quyen lgi ve cham soc y te va nang cao chat lugng KCB cho ngudi tham gia BHYT bi om dau, benh tat BHYT gop phan giam ganh nang cho ngan sach nha nudc va thuc hien cong bang xa hoi cham soc suc khoe va tai phan phoi thu nhap BHYT lam song lai he thong y r r te co so va gan bo mgi vien xa hoi 1.3 NHLTNN NOI • DNNG CO B AIN CUA BHYT TIT • T GUYNN • NHAN DAN 1.3.1 Doi twang va pham vi BHYT tu nguyen nhan dan Doi tugng tham gia BHYT tu nguyen la nhung ngudi lao dong tu do, nong dan, thg thu cong nhung ngudi co thu nhap khong on dinh hoac thu nhap theo mua vu 1.3.2 Phuong thuc dong BHYT tu nguyen nhan dan Ngudi tham gia BHYT tu nguyen co the dong phi theo thang hoac a ax nam va dugc cap the co thdi gian tuong duong vdi so tien da dong 1.3.3 Quy BHYT tu nguyen nhan dan A X Quy dugc hinh chu yeu tu tien dong gop cua nhung ngudi tham gia va su ho trg cua Ngan sach Nha nudc 1.3.4 To chuc BHYT tu nguyen nhan dan nude ta, viec to chuc thuc hien BHYT BHXH Viet Nam quan ly 1.4 KINH NGHIEM THlTC HIEN BHYT TtT NGUYEN O MOT • x r x • z x • • • • ~ x SO NVOC TREN THE GIOI VA BAI HOC • CHO VIET • NAM 1.4.1 Kinh nghiem thuc hien BHYT tu nguyen d cac nudc phat trien BHYT tu nguyen o cac nudc phat trien duqc trien khai dudi hinh thuc BHYT tu nguyen bo sung Bao hiem y te tu nguyen bo sung la viec ngudi dan da co the BHYT nhung muon tham gia BHYT tu nguyen bo sung de duoc huong quyen loi cao hon 1.4.2 Kinh nghiem thuc hien BHYT tu nguyen d cac nudc dang phat trien X BHYT tu nguyen dua tren cong dong duoc cac nudc dang phat trien Z X duoc ap dung cho ngudi ngheo hoac ngudi co thu nhap thap khong du dieu kien tham gia BHYT bat buoc hoac BHYT tu nhan 1.4.3 Nhung bai hoc kinh nghiem ve BHYT tu nguyen cho Viet Nam Kinh nghiem thuc hien BHYT dua tren cong dong cua nhung nudc dang phat trien la bai hoc cho Viet Nam qua trinh phat trien BHYT tu nguyen nhan dan, tien tdi thuc hien BHYT toan dan 76 A phuong tien thong tin dai chung da lam cho cong tac tuyen truyen co sue thuyet phuc va mang lai hieu qua Nhieu dia phuong khong chi can bo lam r r BHYT tu nguyen u tinh, huyen, ma can bo lanh dao cung true tiep xuong cu su du cac cuoc hop bien cho dan; Doi ngu dai ly duuc cac dia phuong thuong xuyen quan tam khong chi viec cung cap tai lieu kip thui, ma tri duuc cac cuoc hop giao ban dinh ky vui doi ngu dai ly, nham thong tin, bien va uon nan kip A ' thui nhung diem dai ly lam chua duuc Nhieu dia phuong da lam tot viec soat thuong xuyen, kien quyet cham durt hup dong vui nhung dai ly yeu kern, hoat dong khong hieu qua, do chat luong cua doi ngu dai ly da dan duuc nang cao, di vao on dinh; A Co su quan tam dau tu va su dung hieu qua nguon tai chinh phuc vu cho cong tac trien khai BHYT tu nguyen; r Lanh dao BHXH tinh, thuc su quan tam; doi ngu can bo lam BHYT tu nguyen luon no luc, the hien trach nhien cao cong viec duuc giao 3.1.2.2 Kho khan - BHYT tu nguyen nhan dan tru van de “nong” cong luan, r r r du luan xa hoi va duuc dua chat van tai dien dan Quoc hoi; - Trong mot nam, che va viec to chuc thuc hien BHYT tu nguyen nhan dan duuc dieu chinh bui 03 Thong tu khac nhau: + Truuc thang 5/2007, BHYT ty nguyen duuc thuc hien theo Thong tu so 22/2005/TTLT-BYT-BTC 24/8/2005 cua lien Bop Y te - Tai chinh; 77 + Ngay 30/3/2007, lien Bo Y te - Tai chinh ban hanh Thong tir so 06/2007/TTLT-BYT-BTC hudng dan thuc hien BHYT tu nguyen de thay the Thong tu lien tich so 22/2005/TTLT-BYT-BTC, 24/8/2005; + Ngay 10/12/2007, lien Bo Y te - Tai chinh tiep tuc co Thong tu so 14/2007/TTLT-BYT-BTC bo sung, sua doi mot so diem cua thong tu lien tich so 06/2007/TTLT-BYT-BTC; - Nguoi dan chua man ma voi BHYT tu nguyen - Gia thuoc, vat tu y te tang cao da lam cho chi phi KCB BHYT cang cang gia tang; - Thieu ddng bo, cham doi moi linh vuc cong nghe thong tin da lam anh hudng den viec dieu hanh, quan ly va chua dap ung duoc yeu cau nghiep vu - Khd khan lon nhat, ddng thoi cung la thach thuc chung cua quy r BHYT tu nguyen nhan dan la tinh trang boi chi quy tir nam 2005 va tiep tuc gia tang tir nam 2006 - 2008 voi muc nghiem hon; - Nhieu bo, nganh d Trung uong chua quan triet quan diem, chu truong A A _ < cua Dang ve yeu cau to chuc trien khai chinh sach BHYT tu nguyen; cap uy r dang, chinh quyen d mot so dia phuong chua thuc su quan tam; a r a r - He thong co so kham chua benh khong phat trien kip ca ve so luong va chat luong Tinh trang qua tai d cac co so KCB cang gay gat; tinh a r rv than thai cua mot bo phan can bo, nhan vien y te van mang nang tinh cira quyen, phien nhieu, 78 - Sir chi dao, dieu hanh cua BHXH Viet Nam co nhung luc chua kip r x r r t thoi, thieu nhat quan; Noi dung ve cai each co cau, to chuc duqc dua thao luan mot so cuoc hop, hoi thao da phan nao tac dong va anh hudng den viec chi dao, tam tu cua nhung nguoi lam BHYT tu nguyen; - Mau thuan giua yeu cau mo rong doi tuqng de thuc hien 16 trinh tien toi BHYT toan dan voi viec dam bao can doi quy; giua so nguoi co nhu cau KCB muon tham gia voi nhung nguoi khoe manh chua muon tham gia, luon la nhung mau thuan kho giai quyet dieu kien hien nay; - Tinh trang vi pham cac quy dinh ve chuyen mon, nghiep vu xay r r a nhieu dia phuong; Nang luc cua mot so can bo, dac biet tuyen huyen • A A AAA , han che ve nhieu mat chua dap ung duqc yeu cau nhiem vu Nhieu dai ly thu BHYT tu nguyen nhan dan cac dia phuong duqc ky hop dong va lam viec kha hieu qua, ben canh cung co khong it dai ly lam viec rat han che, chua dam bao yeu cau; nhung dai ly chua duqc ky hop dong 3.2 GIAI PHAP PHAT TRIEN BAO HIEM Y TE NHAN DAN MOC TA 3.2.1 Cac giai phap vi mo 3.1.1.1 Ve chinh sach BHYT tu' nguyen nhan dan - Thuc hien nhat quan chinh sach BHYT tu nguyen nhan dan, A A tranh su thay doi thubng xuyen nhu nhung nam qua lam mat long tin doi voi nhan dan A r A e - Can co quy dinh ty le toi thieu mot cong dong dan cu tham gia r hoac 100% vien ho gia dinh tham gia, dam bao nguyen tac cong dong chia se, so dong bu so it bao hiem 79 r r - Xay dung lo trinh thuc hien tang muc dong de nguoi dan nam bat r duoc, tranh tinh trang thuong xuyen tang muc dong va nam sau tang gap doi so voi nam trudc nhu nhung nam qua Viec xay dung muc phi phai dua ngubi dan - Viec thuc hien ho tro muc dong ngubi dan tham gia BHYT can phai < cu the, ro rang, tranh chung chung tren van ban, co dia phuong bo tri Ngan r _ r r sach, co dia phuong khong bo tri Ngan sach Thuc te trien khai cho doi tuong can ngheo theo Thong tu so 10/2008/TTLT-BYT-BTC mac du quy dinh Ngan sach Nha nuoc ho tro 50% nhung viec trien khai cham phu thuoc vao can doi Ngan sach cua dia phuong - Theo lo trinh BHYT toan dan Luat BHYT, den nam 2014 se thuc hien BHYT bat buoc toan dan Tuy nhien, nhieu nhom doi tuong tham gia BHYT van phai thuc hien cung chi tra tu 80 - 95% di KCB va nhieu dich vu ky thuat cao van bi gibi han chi phi Do do, tu bay gib, can phai nghien cuu, xay dung chinh sach de thiet ke cac chuong trinh BHYT tu nguyen bo sung de ngubi dan co the tham gia de huong quyen loi cao hon nhu b cac nuoc phat trien Viec xay dung chinh sach phai dam bao duoc can doi quy BHYT, nen dua nhieu muc dong va mure huong khac de ngubi dan lua chon 3.2.1.2 Ve cong tac to chuc a) Hoan thien cong tac to chuc, nang cao vai tro trach nhiem cua nganh y te, nganh BHXH - Cong tac to churc phai di trudc mot bubc Phai bo tri can bo lam cong tac thu BHYT tu nguyen b cac phong thuoc BHXH tinh, va cac chi 80 nhanh BHXH quan, huyen Viec bo trf can bo chuyen theo doi cong tac thu BHYT tu nguyen se tao thuan loi cho ngudi dan tham gia BHYT tu nguyen va giai quyet vudng mac kip thcri cho ngudi dan tham gia BHYT tu nguyen - Tai cac benh vien can bo tri giam dinh vien thudng true tai cac benh vien nham dam bao quyen led cho ngudi co the BHYT va giam sat viec su dung quy BHYT tai benh vien - Thudng xuyen dao tao, nang cao nghiep vu cho can bo thu BHYT tu nguyen va giam dinh vien tai co so KCB BHYT, hinh mot doi ngu du nang luc thuc hien chinh sach BHYT - Xay dung doi ngu dai ly thu BHYT tu nguyen nhan dan tai cac xa, phudng du manh ve so' luong va chat luong Day la yeu to' quan trong trien khai BHYT tu nguyen nhan dan vi tir doi ngu cong tac vien nay, chinh sach BHYT tu nguyen nhan dan se dan den duoc vdi ngudi dan, lan toa cong ddng dan cu Dai ly thu la nhung ngudi true tiep tiep xue vdi ngudi dan, tuyen truyen giai thich de ngudi dan hieu ro ve chinh sach, che BHYT ~ r Hien nay, moi xa phudng chi cd dai ly, de thuc hien dupe tot chuong trinh BHYT tu nguyen nhan dan can tang cudng hon nua doi ngu dai ly, moi xa, phudng can cd 2-3 dai ly thu BHYT - Tang cudng co so vat chat, dieu kien lam viec, sdm ung dung cong nghe thong tin quan ly do'i tuong tham gia BHYT va quan ly cong tac KCB cua doi tuong tham gia BHYT cho co quan BHXH va co so KCB - Cai each thu tuc hanh chinh tao thuan loi tdi da cho do'i tuong tham gia BHYT, khong ngimg nang cao chat luong KCB tai cac co sd y te, nhanh chong md rong mang ldi KCB BHYT tai cac xa, phudng 81 - Tang cudng six phoi hop giira cac nganh to chiic thuc hien chinh sach BHYT, nhat la moi quan he giua co quan BHXH va co sd KCB nham dam bao toi da quyen loi cho ngudi tham gia BHYT - Nganh BHXH sdm chuyen doi tac phong lam viec hanh chinh sang tac phong phuc vu doi tuong tham gia BHYT Chi nao ngudi benh BHYT duoc cham soc tan tinh, chu dao, day du tai cac co sd KCB BHYT thi ngudi dan mdi thuc su tin tuong vao chinh sach BHYT va tu nguyen tham gia b) Nang cao track nhiem cua cac Bo, nganh va chinh quyen dia phucmg r e e •> Cac cap, cac nganh co vai trd quan trong viec phat trien BHYT tu nguyen, quyet dinh viec co dua duoc chinh sach BHYT tu nguyen den vdi ngudi dan hay khong - Quan triet Nghi quyet Dai hoi Dang toan quoc lan thu” X; Nghi quyet so' 46-NQ/TW 23/02/2005 cua Bo chinh tri ve cong tac bao ve, cham soc strc khoe nhan dan tinh hinh mdi den cac chi bo, dang vien ca nudc Day nhanh viec thuc hien Nghi quyet so' 05/2005/NQ-CP 18/04/2005 cua Chinh phu ve day manh xa hoi hoa cac hoat dong giao due, y te, van hoa va the due the thao; Quyet dinh so 243/2005/QD-TTG 05/10/2005 cua Thu tudng ban hanh chuong trinh hanh dong cua Chinh phu thuc hien Nghi quyet so' 46-NQ/TW 23/02/2005 cua BO chinh tri, tdi cac cap, cac nganh nh^m lam chuyen bien manh me ve nhan thtre va hanh dong thuc hien chinh sach BHYT, dam bao cho moi ngudi dan duoc KCB theo che BHYT; - Thuc hien nhanh tien trinh doi mdi co cau, co che ngan sach Nha nudc gianh cho y te da duoc Chinh phu dinh hudng Nghi quyet so 82 05/2005/NQ-CP 18/04/2005 ve day manh xa hoi hoa cac hoat dong giao due, y te, van hoa va the due the thao: "Doi mdi che vien phi tren co so tifrig budc tmh dung, tinh du cac chi phi true tiep phuc vu benh nhan Tung budc chuyen doi viec cap kinh phi hoat dong thuong xuyen cho cac co sd KCB sang cap true tiep cho do'i tuong hudng thu dich vu y te Nha nudc cung cap thong qua hinh thurc BHYT" Day la giai phap co ban cd tac dong manh den viec phat trien doi tuong tham gia BHYT, quyet dinh viec sdm tien tdi BHYT toan dan Tuy nhien den Nghi quyet da ban hanh duoc hon nam nhung qua trinh trien khai thuc hien van cham, chua dong bo - Luat BHYT quy dinh rat cu the trach nhiem cua tung Bo, nganh, cua Uy ban nhan dan cac dia phuong ve trach nhiem thuc hien Luat BHYT nen phai co su phoi hop chat che theo Luat de thuc hien Trong qua trinh xay ~ X dung cac van ban phap quy hudng dan thuc hien Luat can quy dinh, giao r r trach nhiem cho Uy ban nhan dan cac cap phoi hop vdi co quan BHXH cac cap thuc hien viec trien khai BHYT tu nguyen nhan dan nham thuc day nhanh muc bao phu BHYT 3.2.2 Cac giai phap vi mo X 3.2.2.1 Day manh cong tac thong tin tuyen truyen Tuyen truyen la mot nhung noi dung quan trong viec van dong ngubi dan tham gia BHYT tu nguyen, viec van dong, tuyen truyen phai tap trung vao nhung noi dung sau: - Tuyen truyen cho ngubi dan hieu duoc ro muc dong, quyen loi, cac thu tuc can thiet di kham chua benh BHYT Cong tac tuyen truyen van x r r dong can duoc chu trong: viec in an to roi phat true tiep cho ngubi dan, phat X tren dai truyen 83 x r x \ - Trong hoat dong truyen thong can xac dinh dung doi tuong truyen thong, tu xay dung noi dung va phuong phap tuyen truyen van dong phu viec tuyen truyen van dong nguai dan tham gia BHYT Xay dung chuong trinh phoi hop voi Hoi Nong dan, Hoi phu nu de day manh cong tac thong tin, tuyen truyen den nguoi dan Nam 2006, BHXH Viet Nam da ky Nghi quyet lien tich va Chuong trinh phoi hop voi Hoi Nong dan, nhung r Chuong trinh moi chi dung lai tren cac van ban, viec trien khai thuc te chua co su chi dao nhat quan va su phoi hop dong bo De trien khai Luat co o r \ r hieu qua, viec phoi hop vdi cac to chuc la can thiet - Day manh cong tac thong tin tuyen truyen ve chinh sach BHYT dac biet la BHYT tu nguyen, day la yeu to quan giup thay doi nhan thuc cho moi ngudi de hieu dung ban chat, su can thiet cua BHYT, qua tu giac va tao thoi quen tham gia BHYT tu nguyen 3.2.2.2 Day manh cdng tac trien khai o’ cac co' so' Luat BHYT co hieu luc tu 01/7/2009 nhung de Luat di vao cuoc song thi cong tac to chuc thuc hien phai duoc trien khai sdm va ddng bo - BHXH Viet Nam can xay dung van ban hudng dan cu the de BHXH r i cac tinh, to chuc thuc hien - BHXH cac tinh, tren co so hudng dan cua BHXH Viet Nam, tranh thu su chi dao cua UBND tinh, su giup cua cac cap, cac nganh tai dia phuong, cac hoi doan the de trien khai BHYT tu nguyen den cac xa, phudng 84 - BHXH Viet Nam can to chuc tot viec cap the BHYT tu nguyen nhan dan Khi ngudi dan da nop tien vao quy BHYT, co quan BHXH can nhanh chong cap the cho ngudi tham gia, tranh tinh trang de lau, keo dai lam ngudi X X dan phai chd dcri hoac di lai nhieu lan - Phat hanh the BHYT dien tu la yeu to quan trong giai doan hien va tuong lai - Can tang cudng chat luong y te co sd, dac biet la chat luong KCB tai tram y te xa, phudng, bao dam cho nhan dan tham gia BHYT tu nguyen duoc cham soc sue khoe theo che BHYT tu y te co sd, tung budc cai thien chat luong KCB tai cac tuyen chuyen mon ky thuat - Xem xet phuong thuc toan chi phi KCB giua co quan BHXH va cac benh vien, tranh viec ldi va hieu khong dung cac quy dinh cua cac co quan co tham quyen, anh hudng den quyen loi cua ngudi tham gia, tac dong khong tot den viec van dong tham gia BHYT cua ngudi dan 3.2.2.3 Doi moi cong tac phuc vu nguoi co the BHYT Day la mot nhung van de cot loi cua BHYT noi chung va BHYT tu nguyen noi rieng Thuc te la co quan BHXH cap the BHYT cho ngudi dan viec KCB cho ngudi co the BHYT lai cac co sd KCB thuc hien Do vay co quan BHXH can phoi hop vdi Sd Y te va co sd KCB, tang cudng cong tac dam bao quyen loi theo quy dinh doi vdi ngudi dan di KCB BHYT: - Co quan BHXH khong ngung cai each thu tuc hanh chinh, phoi hop cung co sd KCB tao thuan loi cho ngudi dan di KCB, tranh phien ha, thu tuc rudm Co quan BHXH can bo tri can bo giam dinh thudng true tai cac X A benh vien de hudng dan cho ngudi benh co the BHYT cac thu tuc can thiet 85 a ax Cai tien thu tuc KCB BHYT tai cac ca sa y te bang each luac bo nhung thu tuc ' r \ khong can thiet lam vua hai long ngudi benh vua dap ung duoc yeu cau y y f quan ly KCB tot Dau tu xay dung mang cong nghe thong tin va phan men quan ly tu khau tiep don den ket thuc qua trinh kham benh Luu tru va quan ly du lieu cua benh nhan BHYT de lam can cu cho nhung lan kham sau - Nghien cuu, trien khai thi diem quy trinh KCB chuan tai cac ca sa r r r KCB va ban hanh thong nhat tren pham vi ca nuoc Cai tien, luac bo nhung r i khau trung gian nhu dong dau kiem tra, nop phi A - Quy dinh cong khai, minh bach nhung chi phi ngoai che BHYT A A cho benh nhan biet truoc nhap vien nhu chi phi dich vu, vat tu y te ngoai quy dinh, chi phi thuoc ngoai danh muc, chi phi thu them tien giudng, tien y r>u phau thuat theo yeu cau A A 9 - Quy dinh cong khai cho benh nhan biet thdi gian toi thieu de kham benh nhan, so benh nhan toi da bac sy duac kham ngay, tranh tinh trang de benh nhan BHYT phai chd dai lau X A A 9 * - Ca quan BHXH can phoi hap voi nganh y te to chuc cac buoi toa A A ' dam, doi thoai truc tiep voi can bo tai cac ca sa KCB nham thao go nhung A AX vuong mac, giai dap chinh sach cho doi ngu can bo y te, tao su dong thuan vi X X muc dich chung la dam bao quyen lai ngudi tham gia BHYT, gop phan can doi quy BHYT 3.2.2.4 Tang ctrd’ng cong tac kiem tra, giam sat - Can tang cudng cong tac kiem tra giam sat nham dam bao dung quy dinh ve dieu kien phat hanh the BHYT, viec di KCB co dung doi tuang tren the hay khong 86 •> r x - Kiem tra, giam sat chi phi KCB tai cac co so y te thong qua cac ho so, benh an tranh tinh trang lam gia ho so de rut tien BHYT X X - Giam sat chat che viec kham va dieu tri benh, dam bao quyen loi KCB va toan chi phi KCB BHYT cho nguoi co the BHYT - Co quan BHXH cung can co bien phap kiem tra, giam sat thai cua y bac sy doi voi benh nhan BHYT doi tuong BHYT tu nguyen nhan dan dam bao nguoi dan duoc phuc vu tan tinh di kham chua benh Viec thuc hien kiem tra giam sat mot mat thong qua viec nang cao trinh cua X doi ngu giam dinh vien tai cac benh vien Mat khac, lanh dao BHXH tinh can co su gap go, trao doi voi lanh dao benh vien de quan triet thai phuc vu cua y bac sy doi voi benh nhan BHYT 3.2.2.5 rong kha nang cung u'ng dich vu y te, thuoc men ca nang cao chat luoun KCB cho unudi tham gia BHYT - Md rong mang ludi y te th xa phudng, huyen, tinh den tuyen trung uong va dam bao du nguon luc can thiet cho mang ludi y te - Hoan thien he thong BHXH, co so KCB BHYT cac cap nhat la tuyen xa, phudng de dam bao quyen loi KCB cho ngudi tham gia BHYT - Mo rong mang ludi KCB BHYT cho co so KCB dan lap du dieu kien, tao dieu kien cho nguoi dan co the BHYT duoc lua chon nhung co so KCB z co thai phuc vu tan tinh, chu dao va chat luong tot r - De thuc hien duoc BHYT toan dan thi viec dau tu md rong mang ludi cung ting dich vu y te ca nudc cung phai tien hanh dong bo, kip thdi va khan truong hon nua mdi dam bao cac dieu kien cung ting y te can thiet cho ngudi benh tham gia BHYT 87 3.2.2.6 Doi mffi phiuongthuc toan chi ph h KCB BHYT vH cac r iff say te Hien viec thuc hien toan chi phi KCB BHYT giua co quan BHXH voi cac co so KCB chu yeu van theo phuong thuc phi dich vu Mot so dia phuong thi diem phuong thuc toan theo dinh suat nhung van nhieu bat cap Phuong thuc duoc nhieu nuoc tren the gioi thuc hien la toan theo chan doan (DRG) can duoc nghien cuu va dua vao thuc hien thi diem o Viet Nam Tien tOi BHYT toan dan vua la muc tieu cua hoat dong BHXH vua la bien phap tai chinh tich cuc gop phan thuc hien cong bang xa hoi he thong cham soc suc khoe cong dong, dam bao cho moi vien xa hoi deu duoc bao ve suc khoe bang mang luOi BHYT quoc gia Phat trien BHYT tu nguyen nhan dan, tung buoc tien toi BHYT toan dan nham dat tOi cong bang, hieu qua cham soc suc khoe, thuc hien chia se giua ngudi khoe vOi ngudi om, ngudi giau vOi ngudi ngheo, ngudi tuoi lao dong vOi tre em, ngudi gia, the hien tinh uu viet cua xa hoi ta.Tuy nhien, de thuc hien duoc r muc tieu BHYT toan dan viec phat trien va mo rong doi tuong tham gia r BHYT tu nguyen la vo cung quan nhung cung het suc kho khan Cac nhom doi tuong va hinh thuc tham gia co the khac qua moi giai doan nhung viec tuyen truyen, nang cao nhan thuc de ngudi dan tu nguyen tham r y r t r gia BHYT la van de cot loi Ngudi dan phai thuc su hieu va thay duoc viec tham gia BHYT la su can thiet cuoc song cua ho Muon vay, ngoai cong tac thong tin tuyen truyen thudng xuyen, lien tuc thi viec dam bao quyen loi r r y cho ngudi tham gia, cai tien thu tuc KCB tai cac co so KCB la van de then chot viec nang cao hinh anh cua to chuc thuc hien BHYT vOi ngudi dan, tao niem tin cua ngudi dan vao chinh sach BHYT noi chung, chinh sach BHYT tu nguyen nhan dan noi rieng 88 KET LUAN Phat trien BHYT tir nguyen nhan dan la mot buoc dem quan tien tdi BHYT toan dan Muc tieu BHYT toan dan co dat duoc hay khong phu thuoc vao doi tuong Theo Luat BHYT, doi tuong chi chiem khoang 12% dan so nhung la doi tuong kho thuc hien nhat vi sau nam co Thong tu hudng dan thuc hien BHYT tu nguyen nhan dan, muc dat duoc cao nhat chi la hon trieu doi tuong tham gia Hien nay, doi tuong can ngheo mac du se dupe thuc hien bat buoc tu 1/7/2009 nhung viec trien khai van rat kho khan vi ngudi dan van phai nop 50% muc dong, do, de tren Theo Luat BHYT, den nam 2014 se thuc hien BHYT bat budc toan dan, doi tuong BHYT tu nguyen se chuyen dan vao cac nhom doi tuong khac theo quy dinh Luat Tuy nhien, de thuc hien dupe muc tieu BHYT toan dan, tu den nam 2014 viec trien khai BHYT tu nguyen van phai dupe tuyen truyen, bien de tang so ngudi tham gia BHYT va tao thoi quen di kham chua benh bang the BHYT cua ngudi dan Trong qua trinh nghien cuu luan van, tac gia da cd gang nghien cuu tai lieu, tu lieu, nhien, de tai chac chan nhieu han che Tac gia rat mong nhan dupe su chi dan, gop y cua cac nha khoa hoc, cac thay cd giao va cac dong nghiep de de tai dupe hoan thien hon Tac gia xin chan cam on su hudng dan tan tinh cua PGS.TS Nguyen Van Dinh va cac thay cd giao Khoa Kinh te Bao hiem, cac ddng nghiep Ban BHXH tu nguyen, Ban Thuc hien chinh sach BHYT - BHXH Viet Nam da cung cap sd lieu, tai lieu de tac gia hoan thien luan van nay./ 89 DANH MUC TAI LIEU THAM KHAO • • Tieng Viet BHYT Viet Nam (2003), Nien giam thong ke BHYT giai doan 1992 2003, Nha xuat ban Thong ke, Ha Noi Bo Y te - Ban khoa giao trung nong (2003), Vien phi, Bao hiem y te va su dung dich vu y te, Ha Noi Chinh phu (1998), Nghi dinh so 58/1998/ND-CP 13/8/1998 Ban hanh Dieu le BHYT, Ha Noi Chinh phu (2005), Nghi dinh so 63/2005/ND-CP 24/8/2005 Ban hanh Dieu le BHYT, Ha Noi Chinh phu (2009), Nghi dinh so 62/2009/ND-CP 27/7/2009 Quy dinh chi tiet va hudng dan thi hanh mot so dieu cua Luat BHYT, Ha Noi Bo Tai chinh - Y te (2003), ThOng tu so 77/2003/TTLT-BTC-BYT 7/8/2003 hudng dan thuc hien BHYT tu nguyen, Ha Noi Bo Y te - Tai chinh (2005), Thong tu so 21/2005/TTLT-BYT-BTC 27/7/2005 hudng dan thuc hien BHYT bat buoc, Ha Noi Bo Y te - Tai chinh (2005), Thong tu so 22/2005/TTLT-BYT-BTC 24/8/2005 hudng dan thuc hien BHYT tu nguyen, Ha Noi Bo Y te - Tai chinh (2007), Thong tu so 06/2007/TTLT-BYT-BTC 30/3/2005 hudng dan thuc hien BHYT tu nguyen, Ha Noi 90 Bo Y te - 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