Thực trạng giám định bảo hiểm y tế tại bệnh viện đa khoa tỉnh bắc ninh

r — - - ■ TRUONG DAI HOC KINH TE QUOC DAN ■ ■ - r^r^wQJ 'KA'XA - NGUYEN thi ngoc dung THtfC TRANG GIAM DINH BAO HIEM Y TE TAI BENH VIEN DA KHOA TINH BAC NINH CH UYEN NGANH: KINH if BAO HJ^M LU AN VAN THAC SI KINH TE • • Ngtfo'i htfo’ng dan khoa hoc: PGS.TS PHAM THI DINH DAI HOC K.T.Q.D TT THONG TIN THU'VIFN PHONG LIAN AN-TU LIEU ~\c-I? •? HA NOI, NAM 2016 L - -^1 LOI CAM DOAN Toi da doc va hieu ve cac hanh vi vi pham su trung thuc hoc r x x ■ thuat Toi cam ket bang danh dir ca nhan rang nghien cuu toi tir thuc A N hien va khong vi pham yeu cau ve sir trung thuc hoc thuat Cac so lieu, ket qua neu luan van la trung thuc va co nguon goc ro rang dudi su dinh hudng va chi dan cua PGS.TS Pham Thi Dinh, trudng Dai hoc Kinh te Qudc dan Cong trinh nghien cuu duqc thuc hien qua trinh hoc tap tai Trudng Dai hoc Kinh te Qudc dan XAC NHAN CUA GIAO VIEN HOC VIEN HUONG DAN Nguyen Thi Ngoc Dung LO’I CAM ON Luan van chrnc thuc hien dudi sir huong dan tan tinh cua PGS.TS Pham Thi Dinh Hoc vien tran cam on co giao da dinh htrong va chi dan mau muc suot qua trinh thuc hien nghien cun Hoc vien xin gui ldi cam on sau sac tod cac thay, co giao khoa Kinh te Bao hiem - Truong Dai hoc Kinh te Quoc dan da dao tao va giup khoa hoc qua trinh hoan thien nghien cuu Hoc vien xin gui loi cam on tran den Benh vien da khoa tinh Bac Ninh, cac ban va anh chi em dong nghiep da nhiet tinh ho tro thoi gian, thong tin, dong gop y va phan tich sau sac nhung noi dung lien quan den de tai nghien cuu./ Tran HOC VIEN Nguyen Thi Ngoc Dung YEU CAU CUA HOI DONG CHAM LUAN VAN THAC SI VE Nhung diem cdn sua chua b6 sung trubc nop luan van chinh thuc cho Vien dao tao SDH r Chu tich Hoi dong (Ky va ghi ro ho ten) Cam ket cua Hoc vien7 Hoc vien (Ky va ghy rd he Neu hoc vien c6 trach nhiem chinh sura theo yeu c&u cua Hoi d6ng chim luan vSn Trong trudng hop khong chinh ' sira se khong duoc cong nhan ket qua bao ve Hoc vien phai dong ban yeu cau chinh sua nhy vao truoc phan muc luc luan vSn chinh thuc nop cho Vien DT SDH CONG HOA XA HOl CHU NGHIA VI$T NAM Doc lap - Tu - Hanh phuc _ *** _ NHAN XET LUAN VAN THAC SY KINH TE • • • De tai: Thuc trang giam dinh BHYT tai Benh vien Da khoa tinh Bac Ninh Chuyen nganh: Kinh te Bao hiem Hoc vien: Nguyen Thi Ngoc Dung Phan bien I PGS.TS Nguyen Van Dinh Dai hoc KTQD Sau doc ban luan van, chung toi co nhan xet Tinh cap thiet cua de tai nghien cuu Giam dinh BHYT la mot nhung khau quan nhat, phuc tap nhat toan bo qua trinh trien khai BHYT d Viet Nam Bdi khau giam dinh lien quan true tiep den quyen loi cua ngudi co the BHYT, nhung dong thdi lai lien quan den cha't luong KCB BHYT, den y thuc trach nhiem va dao duc cua ngudi thay thuoc v.v Thuc te' d Viet Nam nhung nam vua qua cho thay, day la khau kho quan ly nhat va de phat sinh tieu cuc nhat Chinh vi vay, d tai luan van co y nghia thuc te' rat ldn, ben canh y nghia ly luan De tai la cdng trinh nghien cuu doc lap, khong co su trung lap va dung chuyen nganh Ket qua dat duoc cua de tai nghien cuu a Luan van da he thong hoa va lam ro co sd khoa hoc cua BHYT va giam dinh BHYT Da trinh bay co he thong noi dung cua cong tac giam dinh, cac yeu td anh huong den cOng tac giam dinh BHYT tai cac co so KCB BHYT Dac biet, da trinh bay duoc kinh nghiem giam dinh BHYT mOt sd dia phuong nhu Thanh Hoa, Thua Thien Hue, sau rut mot so bai hoc cho Bac Ninh Cach tiep can nghien cuu day rat dang tran b luan van da trinh bay duoc thuc trang cong tac giam dinh BHYT tai Benh vien Da khoa tinh Bac Ninh theo cac trinh tu: + Quy trinh giam dinh + Tinh hinh KCB BHYT + Thuc trang giam dinh Bang nguon tai lieu kha phong phu va cap nhat, nhung noi dung tren duoc trinh bay va phan tfch kha sau sac, vi vay da giup nguci doc tha'y rat ro thuc trang cua cong tac o mot co sd KCB cap tinh cua Viet Nam Sau phan tfch, tac gia da co nhung danh gia sat thuc ve nhung ket qua dat duoc cung nhu nhung van de han che' ba't cap can phai hoan thien Chung toi hoan toan dong tinh ve nhung danh gia va nhan xet cua tac gia, nha't la ve mat han che' (trang 55): "Giam dinh chua dung, chua du, dan toi nhieu truing hop quyen loi cua benh nhan khong duoc dam bao hoac that thoat chi phi " c TU nhung han che' rut qua phan tfch chuong 2, luan van da de xuat nhom giai phap nham hoan thien khau giam dinh BHYT Chung toi phap duoc lap luan va trinh bay co co so thuc te va co nhieu tfnh kha thi Ket cau luan van: chat che va logic, trinh bay ro rang, mach lac va dung quy che', van phong sang sua, de hieu Nhung van de can trao d6i de tiep tuc hoan thien MOt la, nen dat ten chuong la: Co so khoa hoc ve cong tac giam dinh BHYT Ten cac muc noi dung luan van phai thong nha't voi ten muc tieu (vf du: Nii dung cong tac giam dinh BHYT) vOi (Noi dung giam dinh BHYT) (trang 9) Hai la, tai bang 2.3 (trang 37): Chi tieu so lugt KCB khong dung, nhat la don vi tfnh Ten bang 2.4 (trang 41) la so lugt ngudi Ba la, giai phap d 3.2.2.I (trang 64) trinh bay so sai, chua co suc thuyet phuc (vi tieu dd cua giai phap la hoan thien cong tac to chuc can bo, giam dinh vien) v.v Ket luan: Macdu m6t so diem thieu sot can tiep tu c hp an thion, song chung toi cho rang day la ban luCn van dugc nghien cUu kha cOng phu, nghiem tuc va co cha't lugng LuCn van dap ung yeu cttu cua mot lucn van thac sy kinh th va tac gia xUng dang dugc cOng nhcn hoc vi thac sy kinh th - chuyen nganh bao hihm Ha Noi, 17 thang 12 nam 2016 Ngudi viet nhan xet PGS.TS Nguyhn Van Dinh NHAN SY KINH TE • XET LUAN • VAN THAC • rw-izy X -x zy \ • Ten ae tai: “Thuc trang giam dinh bao hiem y te tai Benh vien Ba khoa tinh Bac Ninh” Hoc vien: Nguyen Thi Ngoc Dung Chuyen nganh: Kinh te bao hiem Phan bien TS Nguyen Van Thanh r i Sau doc noi dung ban chinh, tom tat luan van, toi co mot so y kien nhan xet sau day: Tinh cap thiet, y nghia khoa hoc cua de tai luan van Bao hiem y te toan dan la mot chinh sach dung dan, dam bao muc tieu cong bang xa hoi cham soc va nang cao sue khoe nguai dan vi vay tai nhieu nude tren the giai da va dang trien khai a muc khac Tai Viet Nam hoat dong bao hiem y te (BHYT) da dat dugc nhung cong nhat dinh, nhien can tiep tuc hoan thien chinh sach BHYT co cong tac giam dinh BHYT de BHYT phat trien hieu qua han thai gian tai De co the hoan thien chinh chinh sach BHYT thi can nghien cuu trien khai tai cac dia phuong, chinh vi vay nghien cuu thuc trang giam dinh BHYT tai mot tinh benh vien da khoa hang dau tinh Bac Ninh la can thiet va co y nghia thuc tien Nhung ket qua dat duoc Luan van Nhung ket qua dat dugc til' nghien cuu cua hoc vien co the ghi nhan nhu sau: \ f Thu- nhat, hoc vien da giai thieu dugc ly luan chung ve cong tac giam dinh BHYT, neu mot so kinh nghiem trien khai giam dinh BHYT tai r _ / mot so dia phuong nhu Thua Thien Hue va Thanh Hoa / •> Thu hai, hoc vien da tom tat lich su hinh va phat trien Benh vien Da khoa tinh Bac Ninh va neu len thuc trang cong tac giam dinh BHYT tai Benh vien nay, danh gia mat dugc, mat han che cua cong tac giam dinh BHYT Thu ba, tren co so danh gia thuc trang trien khai thoi gian qua, hoc vien da manh dan de xuat cac nhom giai phap va kien nghi nham hoan thien cong tac giam dinh BHYT tai Benh vien Da khoa tinh Bac Ninh ■X w Ve hinh thuc, phuong phap va tin cay cua luan van Luan van cung cap he thong tu lieu phong phu Ve noi dung, day la cong trinh doc lap cua hoc vien, phu hop voi / •> chuyen nganh kinh te bao hiem Nhung diem han che cua luan van Luan van se hoan chinh hon neu hoc vien lam ro mot so diem nhu sau: - Thu nhat, tai Phan ma dau hoc vien chua dua neu duoc tong quan cac nghien cuu da co lien quan true tiep den cong tac giam dinh BHYT nhu Luan van thac sy cua cao hoc vien Van Qudc Huy ve Tang cudng Kiem soat chi phi toan BHYT tai BHXH tinh Binh Dinh - Dai hoc Da Nang nam 2013; Luan van thac sy cua cao hoc vien Bui Thi Lan Phuong ve Giai phap ve quan ly cong tac giam dinh BHYT tren dia ban thi xa Phuc Yen, tinh VTnh Phuc Hoc vien can bo sung cac tai lieu tham khao vao Luan van cua minh X - Thu hai, tai trang 17 den trang 20 chuong hoc vien neu kinh nghiem trien khai cong tac giam dinh tai tinh Thira Thien Hue va Thanh Hoa nhung khong neu nguon tai lieu tham khao De nghi hoc vien bo sung noi dung XI X - Thu ba, tai trang 59 va 60 chuong Bang so 3.1 va 3.2 ve ke tra don vi tinh la trieu dong hay nghin dong cho phu hop - Thu tu, tu trang 62 den 64 Chuang 3, tieu de 3.2 hoc vien ghi la giai phap hoan thien cong tac giam dinh BHYT tai Benh vien Da khoa tinh Bac Ninh nhien sau phan tich cong tac giam dinh BHYT tai ca cac co so KCB nhu cac benh vien va phdng kham, tram y te phuong, y te trudng hoc la chua phu hop Neu pham vi nghien cuu la cong tac giam dinh / BHYT thuoc BHXH tinh Bac Ninh se phu hop va co tinh khai quat cao hon Cau hoi: A i • • z De nghi hoc vien phan tich so sanh nhung mat noi troi va han che cua cong tac giam dinh BHYT tai Benh vien Da khoa tinh Bac Ninh so vdi cac benh vien Da khoa cap tinh khac, neu hudng khac phuc hoan thien Ket loan Luan van Thac sy vdi de tai “Thye trang giam dinh bao hiem y te tai Benh vien Da khoa tinh Bac Ninh” cua hoc vien Nguyen Thi Ngoc Dung la mot cong trinh nghien cuu doc lap, hoi du cac yeu cau va dieu kien theo quy dinh cua Nha nude Vdi luan van nay, hoc vien xung dang nhan bang thac sy chuyen nganh kinh te bao hiem Ha Noi, 21/12/2016 Ngud’i nhan xet Nguyen Van Thanh 70 dupe di doi, mot phan cu cua khoa tham chuc nang sat khoa Chan doan hinh anh se duoc danh cho viec cai tao phdng dat may Citi 64 lat cat, phan lai se quy hoach bd tri lai khu vuc lam viec va vi tri cac ban kham de thuan tien phuc vu nhan dan toi KCB Tang them phdng kham benh nham dap ung kham 50 benh nhan/ban kham, tang them ban huong dan giup giai dap thac mac va ho trp cho benh nhan Ky hop dong vdi cac Cdng ty Tu van xay dung de thiet ke cac hang muc: Xay nha dat may chup mach xoa nen ky thuat sd de chuan bi tiep nhan may tu du an ODA; Cai tao nha de o xy de tang nang luc phuc vu benh nhan; Mo rong nha dieu tri khoa Ung budu, giam ty le BN/giudng; Sua chua he thong phdng chay chua chay bao dam cdng tac phdng chay chua chay da dupe dau tu tren 10 nam va chua dupe bao duong, cai tao lan nao; Sua chua cai tao khoa Nhi de dam bao dieu kien ve sinh moi trudng, tong muc dau tu 9.250.000.000 dong, ngan sach tinh ho trp 1.500.000.000 dong, phan cdn lai quy phat trien hoat dong su nghiep don vi thuc hien, tat ca cac cdng trinh tren nham muc dich giai quyet yeu cau buc xue qua tai cua cdng tac kham dieu tri benh, dam bao dieu kien kham dieu tri cua nhan dan, nang cao chat lupng dich vu kham dieu tri va dam bao ve sinh moi trudng, chong xuong cap cdng trinh b Ve trang thiet bi y te Trang thiet bi y te dong vai trd quan trong viec KCB Chinh vi vay dau tu va su dung co hieu qua cac trang thiet bi y te se gop phan nang cao chat lupng dich vu KCB cua benh vien Chinh vi vay, de viec KCB dat hieu qua cao, benh vien > r r \ can trang bi them cac loai thiet bi y te nhu dinh hudng danh muc da de Thuc day nhanh tien trinh thuc hien nguon von Du an ODA de tung budc thuc hien chuong trinh hien dai hoa trang thiet bi y te Uu tien thuc hien trudc cac thiet bi cua cac khoa can lam sang: Xet nghiem, Chan doan hinh anh va Tham dd chuc nang de tang chat lupng, giam thoi gian cho dpi qua trinh kham dieu tri cua benh nhan Viec day manh dau tu trang thiet bi cho cdng tac KCB, ngudi benh den vdi benh vien se dupe tiep can cac phuong tien may moc chan doan hien dai Nhd do, 71 cong tac chan doan va dieu tri dat hieu qua cao, nang cao chat luqng KCB cua benh vien Viec dau tu trang thiet bi phai di song hanh vdi viec dau tu ngudi, vi vay r r r r cd ke hoach trien khai mua sam cac thiet bi tren phai kern theo ke hoach dao tao ngudi de su dung thiet bi do, khai thac triet de va khong lang phi viec dau tu CNTT cung la mot phan cua trang bi cd sd vat chat cho benh vien CNTT la phuong tien trq giup dac luc va cd hieu qua cao quan ly benh vien Dua ung dung CNTT vao viec quan ly benh vien la mot phuang thuc rat tot de gop phan thuc day benh vien phat trien toan dien, tirng budc dap ung duqc yeu cau ve KCB va cham soc sue khoe cho nhan dan Nhanh chong xay dung he thong phan mem, cac chuong trinh quan ly, dieu hanh benh vien, ho so benh an dien tu thuan tien phu hqp vdi quy md giudng benh Thiet lap he thong phan mem thong toan benh vien giup cho cac khoa, cac cac sy cd the tim kiem thong tin benh nhan nhu : tien su enh, thudc da va dang su dung mot each de dang va nhanh chong Tu bac sy cd the a a r dua cac phac dieu tri nhanh va chinh xac hon ddi vdi ngudi benh CNTT giup giam sat tu xa viec ke toa thudc cua bac sy kham dieu tri ngoai tru, giup cho nha quan ly phat hien nhung bat thuong va can thiep vao nhung toa thudc chua hqp ly, cd nhu vay bac sy mdi can nhac, than ke toa cho ngudi benh, giup cho ngudi benh chong hoi phuc, vdi chi phi hqp ly Doi ngu nhan vien phong cong nghe thong tin can phai duqc dao tao de cd thd su dung, va quan tri mang LAN tot cho benh vien Viec ung dung cong nghe thong tin quan ly benh vien se nang cao chat luqng va hieu qua cong tac dieu hanh, quan ly kinh te, quan ly KCB, hoat dong chuyen mon cua benh vien; cung cap thong tin phuc vu cac yeu cau cua lanh dao, can bo quan ly, can bo chuyen mon mot each chinh xac, day du, kip thdi 3.2.3.2 Giai phap ve nguon luc y te Nguon nhan luc y te la mot nhung yeu to cau quan trong chat luqng dich vu KCB cua benh vien Mot nguon nhan luc tot, se rat cd y nghia viec trien khai cd hieu qua cac hoat dong va do nd quyet dinh su cong cua benh vien Nguqc lai nguon nhan luc kern, du co sd tang, may moc 72 thiet bi co hien dai den dau di nua thi hieu qua hoat dong cung van han che Cho nen benh vien phai co chien luoc hoach dinh nguon nhan luc, hoach dinh nguon nhan luc la qua trinh nghien cuu, xac dinh nhu cau nguon nhan luc, dua cac chinh sach va thuc hien cac chuong trinh, hoat dong bao dam cho benh vien co du nguon nhan luc voi cac phdm chat, ky nang phu hop de thuc hien cong viec cd nang suat, chat luong va hieu qua cao Qua trinh hoach dinh nguon nhan luc can dupe thuc hien mdi lien he mat thiet vdi qua trinh hoach dinh va thuc hien chien luoc va chinh sach KCB cua benh vien - Khuyen khich can bo y te tai benh vien di hoc tap Tuyen dung du va phu hop vdi nhu cau ve ngudn nhan luc, dac biet la bac si cd trinh cao - Viec tuyen dung vien chuc y te Sd Y te va Sd Noi vu td chuc tuydn dung tren cd sd bien che giao nam va cac vi tri, tieu chi don vi su dung dd nghi ldn Chung ta can ddi mdi tieu chuan vd tuydn dung, danh gia viec thuc hien nhiem vu tren ca mat chuyen mon va mat dao due chu khdng chi dua vao bang cdp Cong tac dao tao sau tuydn dung cung can dupe chu Can bo y td dupe tuydn dung can dupe cu di hoc tap, dao tao chuyen mon phu hop vdi vi tri minh dupe tuydn Ben canh do, cac can bo y td benh vien can phai dupe cu di hoc tap, tiep can vdi nhung kidn thuc, chuyen mon mdi; cd nhung cong nghe mdi dua vd benh vien, nhung nhan vien phu trach lam viec vdi khoa hoc ky thuat mdi nen dupe di dao tao dd cd the cd kha nang ung dung cong nghe mdi mot each tot nhat Tu nang cao chat luong dich vu cham soc sue khde cho nhan dan Hang nam, benh vien to chuc cac buoi tap huan vdi cac chuyen gia y khoa nudc de tang them kinh nghiem cho can bo y td Ngoai ra, benh vien can td chuc kiem tra dinh ky, danh gia xep loai can bo y td, nhan vien lam tot nhiem vu, sieng nang, can cu thi can cd bien phap khen thudng, khuyen khich ; nhan vien chua dat yeu cau can phai tap trung huan luyen ; nhan vien yeu kern, chua cd trach nhiem can phai phe binh, cd hinh thuc phat khac nhu giam thu nhap tang them Tir mdi kich thich dupe y thuc phan dau, tinh than tu giac nang cao trach nhiem va nang luc cua mdi can bo y td 73 Nhin chung, benh vien can tap trung phat trien doi ngu nhan vien y te cd chat luong cao khong chi ve hoc ham, hoc vi ma dong gop viec phat trien nhung khoa hoc ky thuat, ngoai phai co tinh than, thai trach nhiem cao cdng viec Nhu vay, hieu qua cdng tac kham va dieu tri mdi duoc nang ao,dap ung duoc nhu cau cua nguoi dan Ngoai ra, benh vien cung can tang cuong moi quan he hop tac vdi cac benh vien trung uong tren dia ban TP Ha Noi de tranh thu su ho trq chuyen mon ky thuat, ho trp dao tao theo de an 1816 de ap dung duoc nhieu tien bo khoa hoc ky thuat mdi gop phan nang cao chat luong phdng benh, chua benh cho nhan dan Dong thoi, benh vien can tap trung cdng tac giao due chinh tri tu tuong, thuc hien tot 12 dieu y due, chong moi bieu hien, nhung thai khong tot gay phien cho ngudi benh Nang cao tinh than trach nhiem doi vdi tung can bo, vien chuc; thuc hien tot quy tac ung xu va quy dinh ve giao tiep Phan dau xay dung benh vien da khoa tinh Bac Ninh dat danh hieu benh vien xuat sac toan dien dua theo cac tieu chuan cua Bo y te cua benh vien” Viec nang cao hieu qua KCB la mot yeu cau buc thiet cua nganh y te Day la the hien muc dich dap ung quyen loi duoc KCB cang cao cua nhan dan Doi mat vdi nhu cau KCB cua ngudi dan hien dang mot tang len, nganh y te hien dang doi mat vdi nhieu thach thuc phai vuot qua Viec nang cao chat luong luong benh vien luon la van de duoc Nha nudc va xa hoi dac biet quan tarn Vi vay, thach thuc duoc dat la lam de giam duoc tinh trang benh nhan qua tai, lam de giam thieu duoc nhung thu tuc hanh chinh cdn rudm va dac biet chan benh ke don lam cho chinh xac va co hieu qua Ben canh do, viec ' r \ r nang cao tinh than thai phuc vu chuyen nghiep cung dang la van de nhuc nhdi doi vdi toan bo he thong y te noi chung va doi vdi mdi can bo y te noi rieng 74 De nang cao chat luong dich vu KCB cung nhu hoan thien cong tac giam dinh BHYT tai Benh vien hien tai khoa Kham benh va cac khoa dieu tri benh vien da khoa tinh Bac Ninh vdi yeu to “con ngudi”, “co sd vat chat” da dua ra, nhom cac giai phap vdi yeu to “quy dinh che do” can thuc hien de nang cao chat luong dich vu kham dieu tri ngoai tru cua benh vien nhu sau: r r \ r \ r a Thiet lap moi quan he truyen thong “thay thudc - ngudi benh ” Nhung yeu to tang cuong moi quan he thay thuoc-ngudi benh bao gom: Thay thuoc chu ddng gidi thieu ve minh vdi ngudi benh va gia dinh ho tu benh nhan dupe goi vao Neu tu luc dau, ho dupe don iep, san soc can than thi moi quan he thay thudc - ngudi benh se rat tot va tao tien de cho viec kham chua benh sau nay, nhung cau noi nhu “benh vien se cd gang tao dieu kien de ngudi benh dupe dieu tri va cham soc tot nhat, ddng thdi khuyen khich ngudi benh neu cd ban khoan thi manh dan hoi thay thudc va nhan vien y te” nhu la lieu “ thudc chua benh” va la budc dau tien cong viec KCB cua thay thudc moi tiep nhan ngudi benh Bac si va dieu duong true tiep kham cho ngudi benh chu y den van de xung hd vdi ngudi benh cho phu hpp Trong thuc hanh lam sang khong the nao luong trudc dupe nhung bien chung cd the xay Cd nhung trudng hpp xay bien chung sai sot ve mat chuyen mon cua can bo y te tai benh vien nhien trudc can bo y te cd thai an can, vui ve, hoa nha va quan tam cham soc den ngudi benh va can bo y te cung da thong bao va giai thich can ke rd rang vdi benh nhan va ngudi nha benh nhan ve bien chung va each xu ly nen ho khong he bi kien cao hay lam kho de b Nang cao ky nang giao tiep cho ddi ngu nhan vien y te tai Benh vien Muc tieu: Nham nang cao ky nang giao tiep cho nhan vien y te tai benh vien Khi danh gia ve chat luong cua dich vu thi khong chi danh gia ve cac dich vu ky thuat y te ma danh gia chat luong dich vu y te thong qua viec tiep xue va qua trinh cham soc cua nhan vien y te vdi benh nhan va ngudi nha benh nhan Vay de benh 75 nhan va ngudi nha benh nhan danh gia tot ve chat luong dich vu y te thi can bo y te can cd cac ky nang sau: - Nhung van de nhu : cho doi den luot kham, benh nhan phai nam ghep giuong, co trudng hop benh nhan khoi benh, trudng hop benh nhan khdng qua khoi luon luon la nhung van de cd kha nang xay Vi vay, phat sinh nhung van Ar r r de day viec can bo y te phai lam la giao tiep vdi benh nhan va ngudi nahf benh nhan that nhe nhang va hop ly de ho cd the thdng cam - Khi giao tiep vdi nguoi benh can phai an noi nhe nhang, dung muc ; net mat phai hai hoa, cu chi, hanh vi phai hop ly An tuong dau tien cua ngudi benh den kham benh rat quan trong, ho phai cam thay dupe quan tarn, dupe chain soc thi mdi cd the yen tarn va tin tuong giao tinh mang cua ho cho dpi ngu nhan vien y te cua benh vien dupe - Trong viec kham va dieu tri nhieu cd nhung bien chung xay ra, vi vay, can bo y te phai thudng xuyen lam viec vdi benh nhan va ngudi nha benh nhan de giai thich va bien truoc Cach thuc giai thich va su dong cam cua can bo y te ve nhtrng bien chung se lam cho benh nhan va ngudi nha benh nhan cd the hieu va thdng cam hon c Cai each thu tuc hanh chinh-giam thdi gian cha dai cua ngirai benh Muc tieu cua cai each cac thu tuc hanh chinh can dua tren nguyen tac dat loi ich cua ngudi benh len tren, lay ngudi benh lam trung tarn Cac bien phap cai each thu tuc hanh chinh, tap trung cai tien khu vuc kham benh, giam thoi gian cho dpi cua ngudi benh, giam sd luot kham/bac si/ngay, bdi cac sang kien duoi day: - Ap dung che hanh chinh mot cua day truyen kham benh Ung dung CNTT vao cong KCB tir khau dau tien la don tiep den khau cuoi cung, lap bang dien tu lay sd kham tu dong, may doc ma vach de han che sai sot va giam thoi gian nhap ma the Tai khoa kham benh va cac khu nha cua benh vien can bo tri ngudi hudng dan 76 - Bo tri nhan luc hoac cai each quy trinh cho thoi gian phai cho dqi cua ngudi benh giam xuong d mot so khau nhu: kham benh, lam cac xet nghiem, toan vien phi - Tang sd phong kham, tang ca, tang gid lam viec Yeu cau can bo y te tai khoa kham benh di lam sdm 30 phut va chi tan ca giai quyet xong viec kham chua benh cho ngudi benh; thu bay kham benh nhu tuan; Can bo y te phdng kham thong bao sd dien thoai ca nhan de ngudi benh nhan tu van qua dien thoai - Day manh ung dung CNTT, phan mem quan ly benh vien phai duoc ket noi toan vien, nhung thong tin ve benh tat cua ngudi benh phai duoc cap nhat lien tuc, thudng xuyen qua mang noi bo cua benh vien Thong tin cua ngudi benh phai duoc chuyen sang giai doan tiep theo mot each tu dong de giam bdt thdi gian chd doi - Dat camera theo doi tai khu cap cuu va kham benh de dam bao an ninh trat tu cho benh nhan, than nhan va khach hang tdi benh vien - Bo tri cac ban hudng dan de hudng dan ngudi benh den noi ho can den A ' ' Dong thdi cac benh vien cung co cac bien phap nhac nhd ngudi dan den kham benh thi khong nen co hanh vi chen lan, xd day de giu trat tu va mdi trudng lam viec an toan, van minh cua benh vien e Thong tin cho ngudi benh day du, dung muc va kip thdi - Trong qua trinh kham va dieu tri, ngudi benh can duoc biet nhung thong tin ve benh tat cua minh nhu: muc nang nhe, phac dieu tri, cac xet nghiem can thiet; cd nhung thu thuat, phau thuat nao; su dung loai thuoc nao; tien trien den dau hay cd the xay nhung trudng hop nao; chi phi KCB va quyen loi, nghia vu cua ho Nhung thong tin phai dam bao day du va dung su that - Trudc ngudi benh vien va bac si va dieu dudng can hudng dan ngudi benh ve theo doi nhung trieu chung sau kham va dieu tri; dong thdi ngudi benh can duoc hudng dan ve che an uong nghi ngoi, luyen tap su dung thuoc va 77 kham lai; duqc dan ndu co nhung bien chumg nao nang hon thi phai lien he voi bac si de cd bien phap can thiep kip thdi > > f Khong de ngudi benh mac cam vdi nhimg khac biet ve sy cong bang Khi nguoi benh den kham va dieu tri, ho chi mong duoc su quan tam cam soc cua cac nhan vien y te, vi vay moi nhan vien y te can phai bo tri thdi gian va nhan luc hop ly de giai quyet cho benh nhan each nhanh chong va dung thu tu de dam bao nguyen tac “ngudi den trudc duqc phuc vu trudc” tru co cap cuu Tranh trudng hop benh nhan cam thay bi phan biet bdi viec chi tra cua ngudi benh Ddi vdi nhung ngudi benh cd bao hiem, can bo y te can giai thich cong khai cho ngudi benh nhung dich vu BHYT han che chi tra de ngudi benh lua chon; dac biet la nhung dich vu ky thuat cao nhu chup MRI, thay khdp hang, thay thuy tinh the, ., nhung han che ve dich vu duqc chi tra BHYT neu nhu khong duqc giai thich ro rang va cu the se khien ngudi benh hieu nham ve viec ho bi phan biet ddi xu 3.2.3.4 Chu dong phong ngura su co y khoa va dam bao an toan ngudi benh Trong qua trinh kham chua benh cd rat nhieu nguy co cd the xay vdi ngudi benh nguyen nhan benh tat co nhung dien bien kha phuc tap Nhung van de an toan ngudi benh luon duqc dat len hang dau, la yeu to quang de ngudi benh danh gia chat luqng cua benh vien Vi vay, qua trinh dieu tri, cac can bo y te cua benh vien luon phai de phong va canh giac cao Nhu vay se khien cho ngudi benh cam thay yen tam va tin tudng doi vdi doi ngu nhan vien y te noi rieng va benh vien noi chung Khi phat sinh su co vdi ngudi benh thi thdng thudng benh nhan va ngudi nha benh nhan khong du binh tinh de phan biet duqc nguyen nhan cua cac bien chung la trinh bac si hay tinh chat cua benh tat hay vi nguyen nhan nao khac Vi vay, benh vien can cd doi ngu danh gia, kiem diem nguyen nhan xay cac tai bien Ddng thdi benh vien cann nghiem tuc giai thich va xin loi ngudi benh nhung han che ve mat chuyen mon cung nhu la nhung tai bien khong chu y ma su co khach quan ngoai y muon Viec xin loi khong chi co nghia la thtra nhan sai sot ma 78 the hien str cam thong voi ton that cua nguoi benh Tu nhan duoc su thong cam cua nguoi benh ve nhung han che cua CSYT r r 3.2.3.5 Ap dung md hinh quan ly chat luong theo ISO tai Benh vien Da khoa r tinh Bac Ninh Trong chien luoc nang cao chat luong dich vu y te cua cac nudc dang phat trien, theo khuyen cao cua cac chuyen gia chat luong y te quoc te, ben canh viec dau tu them nguon luc tai chinh, co so tang, trang thiet bi, nhan luc, tang cubng ky nang quan ly, viec thiet lap he thdng chat luong, ap dung cac phuong phap chat luong la rat quan Nhung nudc dang phat trien cd nguon luc han che, viec dau tu them nguon lire la rat kho khan, vi vay, viec ap dung cac phuong phap chat luong se mang lai hieu qua Quan ly chat luong la tap hop cac hoat dong cd phoi hop de dinh hudng va kiem soat mot to chuc (ISO 9000: 2000) Day la mot nhung giai phap quan nham dap ung nhu cau, su hai long cua khach hang va ngudi su dung dich vu Quan ly chat luong da va dang duoc ap dung rong rai tat ca cac nganh cong nghiep, dich vu va dupe ap dung he thdng kham benh, chua benh Trude yeu cau ve nang cao chat luong dich vu nham tang cudng sue thu hut ngudi benh, mot sd benh vien da chu dong ap dung cac md hinh quan ly chat luong r r nhu: ISO, quan ly chat luong toan dien (TQM), danh gia va cong nhan chat luong Xay dung tieu chuan ISO tai khoa kham benh va nhieu don vi khac Tu quy trinh ISO nay, benh vien chi rd mdi can bo, mdi vi tri phai lam nhung gi va bao dam thdi gian cu the, benh vien cung thuc hien gan trach nhiem cu the tirng vi tri de moi ngudi deu cd gang va hoan chuc trach, nhiem vu dupe giao Cac hoat dong dieu hanh va quan ly cua benh vien nham kiem soat hoat dong cung cap dich vu KCB dupe md ta cu the cac tai lieu lien quan thuoc He thdng quan ly chat luong benh vien xay dung phu hop vdi cac yeu cau cua tieu chuan TCVN ISO Moi can bo, nhan vien benh vien deu phai thau hieu va tuan thu tien hanh theo dung cac quy dinh cua he thdng tai lieu dupe ban hanh 79 Viec ap dung tieu chuan luong quan ly chat luong ISO giup benh vien thiet lap he thong van ban cac qua trinh quan ly va tac nghiep, nham dam bao viec thuc hien, kiem soat, tri va cai tien thudng xuyen cac hoat dong cua benh vien Day la nen tang quan de benh vien tiep can vdi xu the quan tri benh vien hien dai va khoa hoc hon tuong lai 3.3 Mot so kien nghi r yr Ddi vai ca quan quan ly nha nuac ve y te Phoi hop vdi cac Bo nganh thong nhat danh muc, trinh Chinh phu phe duyet du an ODA nham ho tro cac co sd y te dau tu trang thiet bi Tang cudng chi dao thuc hien de an 1816 tuyen tren tang cudng ve tuyen dudi hudng dan chuyen mon, tuyen dudi len tuyen tren nang cao nghiep vu chuyen mon Hudng dan chuyen mon, phac dieu tri chuan, hudng dan chan doan va dieu tri benh vdi su dien bien phuc tap cua mo hinh benh tat Xay dung va thudng xuyen cap nhat hudng dan dieu tri cho cac benh dua tren bang chung ve an toan va hieu luc cua cac can thiep y hoc Sdm trinh phe duyet ke hoach tuyen dung nhan vien y te theo chi tieu guong benh duoc giao Doi vai UBND tinh Bac Ninh Chi dao cac Sd ban nganh phoi hop vdi Benh vien da khoa tinh Bac Ninh nhanh chong hoan thien cac budc cua du an ODA trinh Chinh phu phe duyet Can ddi bo tri von doi ung cua DA Bo tri ngan sach de ung dung CNTT quan ly benh vien va dau tu phat trien nguon nhan luc co chat luong cao Chi dao cac co quan chu quan len ke hoach tuyen dung nhan luc bo sung theo chi tieu guong benh dupe giao r r Ddi vai ca quan Bao hiem xa hoi tinh Bac Ninh Thanh quyet toan kip thdi nhanh chong 80 Quy dinh ve chinh sach chuyen vien tu benh vien da khoa tuy£n huyen len benh vien da khoa tinh de giup nguoi benh co BHYT ti£p can dich vu y te co chat lupng da duoc dau tu thiet bi hien dai, chuyen mon duoc nang cao, phat huy hieu qua dau tu cua du an Cung cap danh sach doi tuong dang ky KCB ban dau tai benh vien, co quan BHXH chi thong bao so lupng the dang ky tai benh vien ma khong co danh sach kem theo lam benh vien kho kiem soat dau vao 81 KET LUAN • Moi truong hoat dong cua benh vien nhung nam gan day da co nhieu thay doi, the hien qua viec thuc thi chinh sach xa hoi hoa y te, he thong benh vien tu da doi va cang phat trien, dong thoi benh vien cong duoc lien doanh vdi cac don vi tu nhan de to chuc khoa kham chua benh theo yeu cau va khoa dieu tri ky thuat cao; benh vien tu nhan cung duoc kham bao hiem y te, dieu da md rong quyen lua chon cua ngudi tham gia bao hiem y te; cam ket cua Viet Nam gia nhap To chuc Thuong mai The gidi da tao co hoi cho nudc ngoai dau tu vao linh vuc benh vien Ba su thay doi tren da lam da dang loai hinh cham soc sue khoe, lam tang so luong benh vien, ddng thdi tao thuan loi cho ngudi dan tiep can dich vu cham soc sue khoe Dieu dan den su canh tranh giua cac nha cung cap dich vu, dac biet kham chua benh ngoai tru Dieu dat thach thuc ddi vdi co quan BHXH tai cac tinh, tren ca nudc ve cdng tac giam dinh BHYT Nhan thuc duoc thach thuc dat cung nhu nhung kho khan trudc mat ddi vdi cdng tac giam dinh BHYT, hoc vien nghien cuu de tai Thuc trang giam dinh Bao hiem y te tai Benh vien Da khoa tinh Bac Ninh tren co sd he thong hoa mot sd van de co ban ve giam dinh BHYT tai co sd kham chua benh, danh gia thuc trang cdng tac KCB tai Benh vien Da khoa tinh Bac Ninh; de xuat mot sd giai phap va kien nghi nham hoan thien cdng tac giam dinh BHYT tai Benh vien Da khoa tinh Bac Ninh DANH MUC TAI LIEU THAM KHAO • • Bao hiem xa hoi tien trinh hoi nhap quoc te (2007), Nxb Lao dong - xa hoi, Ha Noi Bao hiem xa hoi Viet Nam (2011), Quyet dinh so 466/QD-BHXH ban hanh quy trinh giam dinh bao hiem y te Benh vien Da khoa tinh Bac Ninh (2011 - 2015), Bao cao tong ket cong tac benh vien nam Bo tai chinh (1998), Thong tu so 66/2001/TT - BTC 22/8 hudng dan sua doi mot so dieu cua Thdng tu so 85/1998/TT - BTC 25/6/1998 cua Bo Tai chinh hudng dan quy che quan ly tai chinh doi vdi bao hiem xa hoi Viet Nam Bo Y te (2009), ve chuong trinh nang cao chat luong kham, chua benh tai cac co sd kham chua benh vi muc tieu dap ung su hai long cua ngudi benh Bao hiem Y te, Cong van so 527/CTr-BYT, 18 thang nam 2009 Chinh phu nudc Cong hda xa hoi chu nghia Viet Nam (2006), Nghi dinh so 152/2006/ ND - CP 22/12 hudng dan mot so dieu cua Luat bao hiem xa x r hoi ve bao hiem xa hoi bat buoc Do Van Sinh (2005), “Hoan thien quan ly quy bao hiem xa hoi d Viet Nam”, Luan an Tien si kinh te, Hoc vien Chinh tri Quoc gia Ho Chi Minh Ngo Kim Thanh (2010), Giao trinh quan tri chien luoc, Nxb Dai hoc Kinh te quoc dan Nguyen Thi Chinh (2012), “Hoan thien he thdng td chuc va hoat dong chi tra cac che bao hiem xa hoi d Viet Nam”, Luan an Tien sy chuyen nganh Kinh te Bao hiem, Dai hoc Kinh te Quoc dan 10 Nguyen Van Dinh (2009), Giao trinh Quan tri kinh doanh bao hiem, Nxb Dai hoc Kinh te Quoc dan 11 Pham Thi Dinh (2015), Giao trinh Kinh te Bao hiem, Nxb Dai hoc Kinh te Quoc dan 12 Pham Truong Giang (2012), “Hoan thien co che thu bao hiem xa hoi o Viet Nam”, Luan an Tien sy chuyen nganh Kinh te Bao hiem, Dai hoc Kinh te Quoc dan 13 Phong giam dinh chi bao hiem y te, co quan bao hiem xa hoi tinh Bac Ninh r •> (2011 -2015), Bao cao tong ket nam 14 Quoc hoi (2006), Luat so 71/2006/QH11 cua Quoc hoi: Luat Bao hiem Xa hoi 15 Quoc hoi (2008), Luat so 25/2008/QH12 cua Quoc hoi: luat bao hiem y te 16 Quoc hoi (2009), Luat Bao hiem y te so 46/2014/QH13 13/6/2014 17 Tir dien Bach khoa (2003), Nxb Chinh tri quoc gia, Ha Noi 18 Tran Due Nghieu (2005), Hoan thien quy che chi BHXH, De tai nghien cuu r r r ? r khoa hoc cua BHXH Viet Nam 19 Trang Web: www.baothuathienhue.vn 20 Trang Web: www.baothanhhoa.vn 21 Vien Chien luge va Chinh sach y te (2010J, Nghien cuu thuc trang qua tai, r r \ r r dudi tai cua he thong benh vien cac tuyen va de xuat giai phap khac phuc 22 Vien nghien cuu lap phap, Uy ban thuong vu Quoc Hoi (2013), Bao hiemy te toan ddn - Thuc Pang va giaiphap, Chuyen de nghien cuu vao thang 10 nam 2013 Turnitin 12/2016 preferences Processed on: 30-Dec-201c 00:07 ICT ID: 702523743 Originality Report Word Count: 33903 thuc trang giam dinh bao hicmyte tai benh v Submitted: By Thi Ngoc Dung Nguyen Similarity by Source Similarity Index 18% Internet Sources: Publications: Student Papers: 17% 1% 8% Document Viewer include Quoted include bibliography exclud-ng matches < 30 worosv -????? NguyOn thP ngac dung Thuc tr’ng gi,m ®Pnh B"flo hiOm y td t xi BOnh viQn §a mode: \ show highest matches together ▼ ‘ < 1% match (student papers from 08-Dec-2016) Submitted to National Economics University do$£ next match khoa tOrih B3/4C Ninh chuyan ngpnh: kinh td blio hiOm Ngei hing dEn khoa hac: Pgs ts phxm tht> ®Pnh Hp nei, n’m 2016 LOT CAM DOAN Toi da doc va hieu ve cac hanh vi vi Because submitted papers remain the intellectual property of their authors, instructors, and respective institutions, we are unable to show you the content of this paper at this time If you would still like to view this paper, your instructor may be able to request permission to view the paper from the instructor to whom the paper was originally submitted pham su1 trung thi/c hoc thuat Toi cam ket bang danh dp* ca nhan rang nghien cl/u toi ty1 thu"c hien va khong vi pham yeu cau vie su* trung thy"c hoc thuat Cac soilieu, ketique neu luanivan la trungithuc va co nguonigoc ro rang dudi su’ dinh hudng va chi dan cua PGS.TS Pham Thi Dinh, tri/dng Daiihoc Kinhite Quocidan Cdng trinh nghien cifu di/oc thuc hien qua trinh hoc tap tai Trudng Daiihoc Kinhite Quocidan XAC NHAN CUA GIAO VIEN HOC VIEN HUONG DAN Nguyen Thi Ngoc Dung LOT CAM ON Luan van duoc thuc hien du'di is://turnitin.com/newreport.asp?eq= &eb= &esm=30&oid=702523743&sid= 749815158&n= &m=0&dsc= &tn=98042&svr=02&lang=en_us&bypass_cv= 1/1