Tình hình thực hiện bảo hiểm y tế tự nguyện tại việt nam

BO GI AO DU C VA DAO TAO TRUONG DAI HOC KINH TE QUOC DAN ■ ■ *** L^g^UANAN TULieu Nguyen Thi Thu Trang TINH HINH THUC HIEN BAO HIEM Y TE TV NGUYEN TAI VIET NAM Chuyen nganh: Kinh te Bao hiem LU AN VAN THAC SY KINH TE NGLTOI HlTONG DAN KHOA HOC: TS Pham Thi Dinh THS 3t>25'9 Ha Noi, Nam 2009 MUC LUC r r Trang Danh muc cac chu viet tat Danh muc cac bang, bieu, so do, hinh ve Tom tat luan van MO DAU Chiro’ng 1- Nhfrng van de ly luan chung ve BHYT tu nguyen 1.1 Khai quat chung ve BHYT 1.1.1 Su c4n thi6t cua BHYT 1.1.2 Ban chat va tac dung cua BHYT 1.1.3 Cac hinh thuc BHYT 1.2 Noi dung co ban cua BHYT tu nguyen 11 1.2.1 Doi tuqng BHYT va doi tuong tham gia BHYT tu nguyen 11 1.2.2 Pham vi BHYT tu nguyen 12 1.2.3 Phuong thuc BHYT tu nguyen 13 1.2.4 Quy BHYT tu nguyen 14 1.2.4.1 Khai niem 14 1.2.4.2 Nguon hinh 14 1.2.4.3 Muc dich su dung 14 1.2.5 Quyen va nghia vu cua cac ben tham gia BHYT 15 1.3 Kinh nghiem to chare, tharc hiain BHYT bhrnghuy^n o mot so nude va bai ioc cio Vieh Nam 19 3.1TryghQyoc 20 TiCi Lag 21 3.3 Piilippig 22 1.3.4 Bai ioc kini ghiiem 22 Ciuogh 2- Tiiuc hragg hrieg kiai BHYT hw gguyng hai Vint Nam 25 2.1 Sr doi va piCh hrieg caa BHYT hc ghuyeg o Vieh Nam 25 2.1.1 Giai dong 1992-2002 25 2.1.2 Giai doag 2003 -2007 29 2.2 CCc yey ho agi iuonh hoi viec hicc iieg BHYT hu ghuyeg hai Vieh Nam 32 2.2.1 Yey ho kmi he 32 2.2.2 Yey ho xa ioi 34 2.2.3 Yey ho cimi hri, piCp lyat 35 2.2.4 Yey ho vah ciah ky hiyah hai cCc co so y he 38 2.3 Co so ppiC ly thic hien BHYT th gg^yen taiViet Nam (gha^i ddon 2003 - 2007) 39 2.3.1 Dieu be BIHYT beg hanh kem theo Nghi dinli so 58/1998/NH-CP ’ ’ 39 2.3.2 Thong tu lien tich s6 77/2003/TTLT-BTC-BYT 40 2.3.3 Dieu le BHYT moi kem theo Nghi dinh so 63/2005/ND-CP 40 2.3.4 Thong tu lien tich so 22/2005/TTLT-BYT-BTC 40 2.3.5 Thong tu 06/2007/TTLT-BYT-BTC 41 2.3.6 Thong tu 14/2007/TTLY-BYT-BTC 44 2.4 Phan tich thuc trang trien khai BHYT tir nguyen tai Viet Nam (giai doan 2003 - 2007) 46 2.4.1 Doi tuqng tham gia BHYT tir nguyen 46 2.4.2 Tinh hinh thu quy BHYT tir nguyen 50 2.4.3 Tinh hinh chi quy BHYT tir nguyen 54 2.4.4 Can doi quy BHYT tir nguyen 59 2.5 Danh gia chung ve tinh hinh thuc hien BHYTTN o Viet Nam 62 2.5.1 Ket qua dat duqc 62 2.5.2 Nhtrng ton tai va nguyen nhan 63 2.5.2.1 Doi tuong tham gia BHYT tir nguyen van thap so voi tiem nang 63 2.5.2.2 Quy BHYT tir nguyen co xu huong boi chi mot gia tang 64 2.5.2.3 To churc KCB chua dap ung duqc yeu cau KCB 67 2.5.2.4 Cong tac tuyen truyen chua duqc chu 68 Chuong3 - Giai phap phat trien BHYT tu nguyen tien toi BHYT toan dan 69 3.1 Muc tieu thuc hien BHYT tu nguyen 69 3.2 Mot so giai phap phat trien BHYT tu nguyen d Viet Nam 72 3.2.1 Hoan thien he thong phap luat ve BHYT noi chung va BHYT tu nguyen noi rieng 72 3.2.2 Khong ngung hoan thien to chuc bo may, nang cao nang luc cua he thong BHXH Viet Nam 74 3.2.3 Huy dong cac nguon luc de thuc hien bao hiem y te 76 3.2.4 Tang cudng thong tin tuyen truyen nham nang cao nhan thuc ve BHYTTN cho cac doi tuong tham gia BHYTTN 77 3.3 Dieu kien thuc hien cac giai phap 80 3.3.1 Vdi Chinh phu, Bo Y Te va Bo Tai Chinh 80 3.3.2 Doi vdi cap uy dang, chinh quyen va ban nganh lien quan 81 3.3.3 Vdi he thong kham chua benh 82 3.3.4 Vdi BHXH Viet Nam 84 3.3.4.1 Xac dinh rd nhiem vu chinh tri duoc Dang va Nha nudc giao 84 3.3.4.2 Quan tam den cong tac can bo va hinh mang ludi Dai ly thu BHYT tu nguyen 85 3.3.4.3 Mot so che do, quy dinh hien tai can duoc nghien cuu, dieu chinh cho phu hop vdi tinh hinh va dieu kien mdi 86 KETLUAN 88 Danh muc tai lieu tham khao 90 Phu luc 93 DANH MUC CAC TlT VIET TAT Bao hiem y te BHYT Bao hiem xa hoi BHXH Bao hiem y te tu nguyen BHYTTN Bao hiem y te bat buoc BHYTBB Cham soc sue khoe ban dau CSSKBD Kham chua benh KCB Hoc sinh, sinh vien HSSV Ho gia dinh HGD Ngudi lao dong NLD Ngan sach nha nude NSNN Xa hoi chu nghia XHCN DANH MUC CAC BANG BIEU, SO DO, HINH VE Bang 2.1 So ngudi tham gia BHYT (giai doan 1993-2002) 26 Bang 2.2 So tien thu BHYT (giai doan 1993-2002) 27 So 2.1 Co cau to chuc he thong BHXH Viet Nam theo Nghi dinh 100/2002/ND-CP 31 Bang 2.3 Ty le tang truong GDP va GDP binh quan dau ngudi 33 Bang Dan so va toe tang dan so cua Viet Nam 34 Bang 2.5 Tinh hinh tham gia BHYT tu nguyen (giai doan 2003 - 2007) 48 Bang 2.6 Muc dong BHYT tu nguyen (Giai doan 2003 - 2007) 51 Bang 2.7 So tien thu BHYT tu nguyen (giai doan 2003 - 2007) 53 Bang 2.8 Tinh hinh chi quy BHYT tu nguyen (giai doan 2003 - 2007) 55 Bang 2.9 Can d6i quy BHYTTN (tu 2003-2007) 60 BO GIAO DUC VA DAO TAO TRUONG DAI HOC KINH TE QUOC DAN * * * Nguyen Thi Thu Trang TINH HINH THUC HIEN BAO HIEM Y TE TV NGUYEN TAI VIET NAM Chuyen nganh: Kinh te Bao hiem TOM TAT LUAN VAN THAC SY • Ha Noi, Nam 2009 • Sue khde ngudi la von quy nhat, la dong luc quan trong phat trien kinh te - xa hoi cua dat nude Cho nen, nhieu nam qua cong tac chain soc sue khde cho nhan dan luon dupe Dang va Nha nude ta quan tam Qua 15 nam trien khai va to chuc thuc hien, tu nam 1992 chinh sach r r BHYT da thu dupe nhung ket qua quan Ngoai doi tupng lam cong an luemg, cac doi tupng khac nhu hoc sinh, sinh vien (HSSV), nong dan va dan cu tren ca nude noi chung cung cd the tham gia neu cd nhu cau dudi hinh thuc BHYT tu nguyen (BHYTTN) Tinh den het nam 2007, ca nude da cd 36,8 trieu 43,3% dan so ca nude, doi tupng tham ngudi tham gia BHYT, chiem gia BHYTTN la gan 9,38 trieu ngudi vdi tong thu 831,89 ty dong, chi kham chua benh (KCB) la 2.190 ty dong de dam bao quyen lpi cho nhung ngudi tham gia BHYTTN Ngoai ra, BHYTTN hoc sinh, sinh vien nhung nam qua da gop phan tich cue khoi phuc lai he thong y te trudng hoc, sau mot thoi gian dai gan nhu bi bo trang Nhd cd kinh phi tu quy BHYT HSSV trich lai cho cac nha trudng, nen y te trudng hoc dupe hinh va hoat dong trd lai d nhieu trudng, gop phan tich cue vao viec giao due the chat va chain soc sue khoe ban dau (CSSKBD) cho HSSV, ho trp cho muc tieu giao due toan dien hoc sinh cac nha trudng BHYTTN cho dan cu da dupe trien khai vdi nhieu loai hinh khac nhu: BHYT cho vien ho gia dinh (HGD) theo dia gidi hanh chinh; BHYT cho cac doi tupng: vien, hoi vien cac Hoi, Doan the, cho than nhan ngudi lao dong (NLD) dang thu hut su quan tam cua nhieu tang ldp dan cu, cung nhu cap uy Dang va chinh quyen cac cap Tuy da dat dupe nhung ket qua dang khich le, song so ngudi tham gia BHYTTN van chua nhieu, ty le so ngudi tham gia BHYTTN rat thap so vdi r r \ r r so doi tupng tiem nang Cac doi tupng tham gia BHYTTN hien mdi chu yeu 85 r r a \ r bo lam cong tac vua yeu ve nang luc vira thieu ve so luong, lai thudng xuyen thay doi Chua quan tarn den viec tranh thu su lanh dao, chi dao cua cac cap uy dang va chinh quyen dia phuong, cung nhu su phoi hop vdi cac A A nganh d dia phuong; chua chu y dau tu kinh phi cho cong tac truyen thong; che ddi vdi can bo lam BHYTTN chua thoa dang, da lam cho hoat dong BHYTTN d dia phuong khd phat trien va dat ket qua thap 33.4.2 Quan tarn den cong tac can bo va hinh mang ludi Bai ly thu BHYT tu- nguyen: Viec thuc hien trien khai BHYTTN tren ca nudc la nhiem vu khd, bdi Z A A _ vay he thong BHXH can quan tarn dau tien la cong tac can bo: - Can bo lam cong tac BHYTTN phai cd du nang luc va kinh nghiem, z a z z z co kha nang lam viec doc lap, tiep xuc vdi cong dong Vua nam chac che Z A chinh sach ve BHYTTN, vira cd kha nang thuyet trinh, giai thich, tuyen truyen; cd kien thuc xa hoi va gan gui vdi dan Do vay, trudc mat viec sap r _ xep can bo lam BHYTTN phai duoc uu tien lira chon, sau phai chu y quan Z A tarn thudng xuyen den cong tac dao tao, bdi dudng nghiep vu, khong ngimg nang cao trinh cho doi ngu can bo d khu vuc nay; z - Khong chi chu y den nang luc, trinh do, can bo lam cong tac BHYTTN phai dam bao du ve sd luong de thuc hien nhiem vu Can thiet phai cd nghien cuu xac dinh nhu cau va dinh bien can bo lam viec d khu vuc A A nay, tranh tinh trang noi qua it, noi qua nhieu nhu hien Can sdm xem xet ap dung nguyen tac: can bo lam BHYTTN tang tuong ung vdi viec phat trien ddi tupng BHYTTN - Cung vdi cong tac dao tao, nang cao nang luc cho can bo, can thuc hien thudng xuyen cong tac giao due tu tuong cho doi ngu can bo BHXH noi chung va can bo lam viec d linh vuc BHYTTN noi rieng Mdi can bo phai quan triet va nhan thuc sau sac nhiem vu cua minh la phuc vu ddi tupng, 86 phuc vu nhan dan Nhung can bo co thai lam viec quan lieu, phien ha, - Di doi vdi cong tac can bo, phai nhanh chong hinh doi ngu Dai ly lam BHYT Vi thuc te cho thay, can bo du co dong may cung khong the dai den het cac thon, xom, to dan cu Hien nay, ca nude cd 14.000 dai ly, du BHYTTN: day la nhung ngudi dan sd tai, hon het ho cd dieu kien de thuc hien nhiem vu cua ngudi di van dong, tuyen truyen, giai thich, hudng dan va thu tien cua ngudi tham gia, Thuc te trien khai BHYTTN thdi gian qua cho thay, neu khong cd he thong Dai ly, viec thuc hien BHYTTN se khong the A md rong dupe Vi vay, viec lua chon, boi dudng, dao tao mang ludi Dai ly BHYT can duoc quan tarn va md rong den tat ca cac vung mien 3.3.4.3 Mot so che do, quy dinh hien tai can dirge nghien ciru, dieu chinh cho phu hgp vdi tinh hinh va dieu kien mdi: BHXH Viet Nam dugc Chinh phu giao cho nhiem vu true tiep to chuc trien khai BHYTTN ca nude Trong qua trinh thuc hien, BHXH nen A A dua nhung dieu chinh cho phu hgp vdi dieu kien mdi A - Ve muc dong va ap dung muc dong: Lien bo ban hanh khung muc dong, viec quyet dinh muc dong cu the nen giao cho Tong Giam doc BHXH Viet Nam tren co sd de nghi cua BHXH tinh, se thuan lgi hon Nen linh hoat cho ap dung muc dong cua khu vuc nong thon mot thdi gian ddi vdi cac dia ban nong thon mdi dugc thi hoa Trudng hgp hgc sinh neu khong tham gia BHYT theo trudng hgc, tham gia theo HGD cung nen cho thuc hien muc dong theo HGD, de tao thuan lgi cho hoc sinh tham gia - Dieu kien tham gia BHYTTN: Vdi ddi tugng la HGD, can nghien cuu de dua dieu kien phu hgp, tham gia khong bi qua rang buoc vao ngudi 87 A A khac: dieu kien chi can 100% vien ho tham gia la duoc, thay cho ty le cua mot khu dan cu nhu hien Dac biet luu y den dieu kien cho khu vuc mien nui, vung kho khan cho mem deo de ngudi dan va ca hoc sinh A co dieu kien tham gia - Viec chuyen kinh phi 20% CSSKBD cho cac truong hoc cung can thay doi: truong co hoc sinh tham gia BHYT deu dupe nhan nguon kinh phi Viec su dung va quyet toan khoan kinh phi cung nen theo A A hudng: don gian, tao dieu kien cho nha trudng su dung phan kinh phi r dung muc dich va thuc hien quyet toan theo nam hoc a r r a - Dieu kien de chi tra mot so noi dung: Viec chi tra tro cap tu vong can thuc hien ngudi tham gia BHYTTN chang may bi chet, khong nen dat dieu kien ve thdi gian f r r y Mot so bat hop ly neu tren khong phai la nhung van de ldn, nhung no lai co tac dong khong nhd den tam tu, suy nghi cua ngudi dan, cung nhu anh r r hudng den su nhiet tinh cua cac nha trudng vdi doi tupng BHYT HSSV 88 KET LUAN BHYT tir nguyen la mot chinh sach xa hoi van moi me va khong it ' nhung kho khan doi voi nude ta Vi vay, qua trinh thuc hien trien khai ~ •> ' BHYTTN van han che nhan thuc, lung tung to chuc thuc hien Nhung vdi ban chat nhan dao, phat huy dupe truyen thong dao ly “la ngan ddi nen BHYTTN da nhanh chong nhan dupe su hudng ung nhiet X tinh cua dong dao quan chung nhan dan Su ddi va phat trien manh me cua —— ' BHYTTN da chung minh tinh dung dan chinh sach xa hoi cua Nha nude Viet Nam Sau 15 nam hinh thanh, xay dung va phat trien, BHYTTN giai doan nho le thi cho den doi tupng BHYTTN dupe md rong cho ca dan cu, lao dong tu do, cac hoi doan the, tren pham vi 64 tinh ca nude BHYTTN da dat dupe nhung tuu quan trong, gop phan dac luc vao cong cua cong cuoc doi mdi dat nude noi chung cung nhu su nghiep cham soc va bao ve sue khoe nhan dan noi rieng Dieu dang chu y la hien da co tren 11 trieu ngudi tham gia nhieu chuong trinh BHYTTN , dap ung yeu X X cau cham soc sue khde cua cac tang ldp nhan dan nhu: BHYT nhan dan theo HGD, BHYT HSSV Ngay nay, vdi su quan tarn cua Dang va Nha nude, BHYTTN cang the hien dupe tinh uu viet, phu hop va bao dam tot nhat cho cong tac KCB cho ngudi dan; phuong thuc toan cang don gian va linh hoat; quyen lpi cua ngudi co BHYTTN cang dupe tang cudng va dam bao; nguon tai chinh tir quy BHYTTN gop phan cho su phuc hoi va phat trien y te co sd, cua mot so chuyen nganh y hoc ky thuat cao, chi phi ldn BHYT dupe xac 89 dinh la mot co che tai chinh y te chu yeu tuong lai, thuc hien muc tieu A •> z cong bang, hieu qua va phat trien cua nganh y te Tu thuc tien trien khai BHYTTN, chung ta dang no luc khac phuc nhung khd khan, vudng mac va rut bai hoc kinh nghiem de phat trien BHYTTN va buoc tung buoc vung chac tren lo trinh tien tdi BHYT toan dan r r \ t theo Nghi quyet Dai hoi Dang toan quoc lan thu X “Phat trien va nang cao chat luong BHYT, thuc hien BHYT ddi vdi toan dan” co, cac chuyen gia linh vuc BHYTTN de hoan chinh bai viet, dam bao tinh ung dung cao thuc te Z Z Ldi ket xin dupe danh de bay to loi cam on chan nhat cua tac gia den TS Pham Thi Dinh da true tiep hudng dan tac gia hoan bai luan van Xin cam on nhung nhan xet quy bau cua cac chuyen gia linh vuc BHYT va cac thay co giao dang cong tac tai Khoa Kinh te Bao hiem z z trudng Dai hoc Kinh te Quoc dan 90 DANH MUC CAC TAI LIEU THAM KHAO Bao hiem xa hoi Viet Nam (2005), Bao hiem xa hoi Viet Nam 10 nam xay r •> r dimg vaphat trien, Nha xuat ban Thong ke, Ha Noi Bao hiem xa hoi Viet Nam (2006), Kinh nghiem thuc hien BHXH cua cac r r f r nudc khu vuc va mot so nudc tren the gidi, Nha xuat ban Thong ke, Ha Noi Bao hiem y te Viet Nam (1992), Nhung van ban quy dinh ve BHYT Viet Nam, Nha xuat ban Thong ke, Ha Noi Bao hiem y te Viet Nam (1994), Nhung van ban quy dinh ve BHYT Viet Nam, Nha xuat ban Thong ke, Ha Noi Bao hiem y te Viet Nam (2001), Nhung van ban hudng dan ve BHYT, Nha xuat ban Thong ke, Ha Noi Bao hiem y te Viet Nam (2002), Nien giam thong ke BHYT nam 1993 - 2002 Nha xuat ban Thong ke, Ha Noi Bao hiem y te Viet Nam (2002), Qua trinh hinh va phat trien Bao hiemy te Viet Nam, Nha xuat ban Thong ke, Ha Noi Bo Y te, Nien giam thong ke y te Ha Noi 1994-2006, Nha xuat ban Thong ke, Ha Noi Chinh phu (1992), Nghi dinh so 299/HDBT 15/8/1992 cua Hoi dong Bo trudng (nay la Chinh phu) ban hanh Dieu le BHYT, Ha Noi 10 Chinh phu (1993), Nghi dinh so 100/CP 18/12/1993 cua Chinh phu \ •> ve kinh doanh bao hiem, Ha Noi 11 Chinh phu (1998), Nghi dinh so 58/1998/ND-CP 13/8/1998 cua Chinh phu ban hanh Dieu le BHYT, Ha Noi 91 12 Chinh phu (2003), Nghi dinh so 100/2003/ND-CP cua Chinh phu Quy dinh chuc nang, nhiem vu, quyen han va ca cau to chicc cua BHXH Viet Nam, Ha Noi 13 Chinh phu (2005), Nghi dinh so 63/2005/ND-CP 16/5/2005 cua Chinh phu ban hanh Dieu le BHYT, Ha Noi 14 Chinh phu (2001), Quydt dinh sd 35/2001/QD-TTg 19/3/2001 cua Thu tuong Chinh phu phe duyet chien luoc cham soc va bao ve sue khoe nhan dan giai doan 2001-2010, Ha Noi 15 Dang cong san Viet Nam (1986), Van kien Dai hoi dai bieu Dang toan r > quoc Ian thu VI, Bao dien tu Dang cong san Viet Nam, Ha Noi 16 Dang cong san Viet Nam (2001), Van kien Dai hoi dai bieu Dang toan r > quoc Ian thu IX, Bao dien tu Dang cong san Viet Nam, Ha Noi 17 Lien Bo Y te - Tai chinh - Lao dong thuong binh xa hoi (1995), Thong tu lien bo so 14/TTLB 30/9/1995 cua lien bo Y te — Tdi chinh — Lao dong TBXH - Ban Vat gid chinh phu hudng dan viec thu mot phan vien phi, Ha Noi 18 Lien Bo Y te - Tai chinh (2003), Thong tu lien bo so 77/2003/TTLT- BYT-BTC 07/8/2003 cua lien bo Y te - Tdi chinh hudng dan thuc hien BHYT tu nguyen, Ha Noi 19 Lien Bo Y te - Tai chinh (2005), Thong tu lien bo so 22/2005/TTLT- BYT-BTC 24/8/2005 cua lien bo Y te - Tdi chinh hudng dan thuc hien BHYT tu nguyen, Ha Noi 20 Lien Bo Y te - Tai chinh (2007), Thong tu lien bo so 06/2007/TTLTBYT-BTC 30/3/2007 cua lien bo Y te - Tdi chinh hudng dan thuc hien BHYT tu nguyen, Ha Noi 92 21 Lien Bo Y te - Tai chinh (2007), Thong tu lien bo so 14/2007/TTLTBYT-BTC 10/12/2007 cua lien bo Y te - Tai chinh hucrng dan thuc 22 hien BHYT tu nguyen, Ha Noi TS Nguyen Van Dinh (2004), Giao trinh Kinh te Bao hiem, Nha xuat ban thong ke, Ha Noi 93 PHV LUC 1: PHAN LOAI CAC NHOM DOI TlTONG THAM GIA BAO HIEM Y TE Viec phan loai de xac dinh ddi tirong tham gia BHYT duoc dat r x r y \ nham xac dinh so ngudi, tinh chat nganh nghe lao dong, nguon tai chinh thuc hien BHYT, dong thdi lam co sd de du bao ve kha nang tham gia, to chuc thuc hien va du bao tai chinh dap ung de co bien phap can thiep md r r rong ddi tuong ke hoach phat trien BHYT A Phan loai theo cu cau dan so r Tren co sd cac doi tuong tham gia BHYT hien cd the phan nhom nhu sau: • Nhom 1: Ngudi lam cong hudng luong; ngudi lao dong va chu su dung lao dong cung dong BHYT; • Nhom 2: Ddi tuong chinh sach xa hoi duoc ngan sach nha nude mua the BHYT; • Nhom 3: Ngudi ngheo duoc ngan sach nha nude dong BHYT; • Nhom 4: Ddi tuong tre em dudi tuoi (duoc ngan sach nha nude bao r cap chi phi kham chua benh, chua thuc hien BHYT); • Nhom 5: Hoc sinh, sinh vien; (tu dong phi tham gia BHYT); • Nhom 6: Cac ddi tuong lai khac (tu dong phi tham gia BHYT) r X (Cac ddi tuong tren chua bao gom luc luong vu trang, cong an, nhimg nguoi dang bi giam giu cac trai cai tao) Cac doi tuong cu the tung nhom nhu sau: Nhom Lao dong lam cong an luong Doi tuong nhom thuoc pham vi BHYT bat buoc, bao gom: 94 - Ngubi lam cong an luong cac don vi hanh chinh su nghiep, cac doanh nghiep nha nudc, doanh nghiep co phan hoa, doanh nghiep tu nhan, doanh nghiep cac luc luong vu trang, doanh nghiep lien doanh, doanh nghiep 100% von nudc ngoai va cac hop tac xa duoc lap va hoat dong theo luat hop tac xa - Ngudi lao dong cac co sd ban cong, dan lap, tu nhan thuoc r •> cac nganh van hoa, giao due, y te, the due the thao va cac nganh su nghiep r khac, so lao dong cac to chuc cd su dung lao dong duoc lap va hoat dong hop phap khac muc phi mua the BHYT bang 3% luong va phu r cap luong r r Tong so doi tuong nhom hien cd khoang 13.5 trieu ngudi Day la nhom cd muc dong BHYT cao nhat va cd kha nang chia se doi vdi cac nhom ddi tuong tham gia BHYT khac Nhom ddi tuong du bao se cang tang qua trinh phat trien cong nghiep hoa va hien dai hoa dat nudc Tuy nhien, hien ty le tham gia BHYT d nhom dang thap, chi dat 46% vdi khoang 6.2 trieu ngubi tham gia Trong do, doi tuqng tham gia BHYT khoi Nha nudc quan ly chiem 75%, Ddi tuqng lao dong tham gia BHYT pham vi doanh nghiep tu nhan, doanh nghiep lien doanh vdi nudc ngoai, Lao dong Viet Nam lam viec doanh nghiep 100% von dau tu nudc ngoai, ho kinh doanh ca the chiem 32% r Nhom Ddi tuqng chinh sach xa hoi duqc ngan sach nha nudc mua the BHYT, bao gom: - Ngubi cd cong vdi each mang: Hien dang co 3,156 trieu ngubi, r r r r du kien so doi tuqng se giam % hang nam va den nam 2010 khoang trieu ngubi, sb doi tuqng co the BHYT la 1.256 ngan ngubi, dat khoang 40% tong so doi tuqng (do nam 2006 mdi thuc hien BHYT cho doi tuqng la 95 thircmg binh, ngudi hudng chinh sach nhu thuong binh nhan che tro cap lan) z e < - Doi tugng Bao trg xa hoi hien co 465 ngan nguai, du kien nam 2010 se co 1,1 trieu nguai dugc mua the BHYT theo dinh hudng cua Chinh A phu ve chinh sach Bao trg xa hoi a r - Dai bieu hoi dong nhan dan cac cap khong hudng luong tir ngan sach, can bo xa phuong hudng trg cap hang thang theo Nghi dinh 130/NDCP; - Cuu chien binh thdi ki chong Phap, chong My - Than nhan cua sy quan quan doi, cong an, quan nhan chuyen nghiep thuoc quan doi nhan dan dang tai ngu Nhom Ngudi ngheo: dugc xac dinh theo chuan qua cac thdi ki Chuan ngheo giai doan 2006-2010: khu vuc nong thdn la 200.000 A dong/ngudi/thang va khu vuc thi la 260.000 d/ngudi/thang r Theo chuan ngheo mdi, ca nudc co khoang 3,9 trieu ho ngheo, chiem 22% so ho toan quoc; ty le ho ngheo cao nhat la vung Tay Bac (42%) va Tay Nguyen (38%), thap nhat la vimg Dong Nam Bo (9%) Tuy nhien, thien tai thudng xuyen xay ra, anh hudng ldn den san xuat va ddi song, keo theo Z A Z A su thieu ben vung cua ket qua XDGN, nguy ca toi ngheo van tiem an 96 Nhung no luc cong tac XDGN da gop phan giam nhanh ty le ngheo doi cua ca nude, tu 30% nam 1992 xuong 8,2% nam 2004; dudi 7% nam 2005 Can cu muc tieu giam ngheo, du bao so ngudi ngheo giai doan 2007-2010 la: 2010 Nam 2007 2008 2009 Ho 2.954.801 2.564.438 2.220.000 1.850.000 14.774.000 12.821.900 11.100.000 9.250.000 ngheo Nguoi ngheo Nhom Tre em dudi tuoi: Cd khoang 9,5 trieu chau va mdi nam tang khoang 1,5 trieu; nhom hien dang thuc hien theo co che thuc thuc chi ngan sach nha nude r r r bao cap; ngan sach dupe cap true tiep cho cac co sd KCB Nhom Hoc sinh, sinh vien: Do tuoi tu den 24, thuoc tat ca cac loai hinh dao tao; hien cd khoang z z ? 19 trieu va tang hang nam theo muc gia tang sd tre den tuoi di hoc Nhom z z HSSV hien dang tham gia BHYT tu nguyen la chu yeu, cd mot sd tham gia BHYT bat buoc theo dien chinh sach va ngudi ngheo, dupe ngan sach nha nude ho trp z Nhom Cac doi tupng lai khac: Chu yeu la nong dan, lam nghiep, ngu nghiep, ngudi lao dong tu do: khoang 23,7 trieu ngudi Nhom thuoc doi tupng tham gia BHYT tu Z Z e A nguyen nhung ty le tham gia rat thap Nhom se giam dan theo su phat trien cong nghiep hoa 97 B Phan loai theo tinh chat lao dong Co the chia nhom nhu sau: A Nhom 1: Lao dong chinh quy va than nhan, gom: Nhom se bao gom: - Can bo, cong chuc vien chuc nha nudc; r Ar - Tat ca nhung ngudi lao dong co hop dong (ngan han, dai han) cac doanh nghiep, ca nha nudc va tu nhan; r a - Than nhan hay nhung ngudi an theo (gom.- cha, me (het tuoi lao r a dong, gid, yeu hay khong co cong an viec lam), vo hoac chong (khong co cong an viec lam), dudi 18 tudi( hoac dudi 25 tuoi neu dang la hoc sinh, sinh vien) hoac khong gidi han tuoi neu bi tan tat, khong cd kha nang lao dong) cua ngudi lao dong r r a Day la nhom co tiem nang cao nhat tham gia BHYT bat buoc vi cd thu A 9 A nhap on dinh (theo tien cong, tien luong), duoc to chuc, quan ly chat che (cd A A !>/ e hop dong lao dong) nen de quan ly, dam bao duuc nguon thu cung nhu kiem soat doi tuong tham gia Nhung ngudi nghi huu cd the thuc hien rieng hoac theo dien than nhan cua ngudi lao dong Hien nay, nhom da tham gia BHYT bat buoc nhung than nhan/ A r ngudi an theo cua nhom chua duoc bao gom ddi tuorng tham gia r hoac thuc hien theo co che khac (vdi tre em dudi tuoi) Nhom Lao dong khong chinh quy va than nhan: a r a Bao gom tat ca cac nhom lao dong thuoc cac nganh nghe khac thuoc moi phan kinh te, nong dan chiem ty ldn, nhung ngudi A buon ban nho va than nhan, cac phan ton giao v.v Dac trung cua nhom la kho kiem soat, thu nhap khong on dinh va rat khac 98 r •> \ Trong nhom co the tach rieng nhom doi tugng can duoc nha nunc A bao trg, bao gom: nguai thuoc dien chinh sach xa hoi, ngudi thuoc dien ngheo Day la nhung nguai co thu nhap thap hay khong co kha nang lao dong can dugc ho trg ve mgi mat, co ho trg ve cham soc sue khoe cua ca nha nude va xa hoi Ngan sach nha nudc se dong BHYT cho nhom Nhom Nhom dac thu khac Nhom bao gom: nhung ngudi dang tham gia luc lugng vu trang va nhung ngudi bi giam giu cac trai cai tao Nhom (bao gom ca than nhan cua ngudi tham gia luc lugng vu trang) co the thuc hien qua co che BHYT hoac bang hinh thuc tai chinh khac (nhu cap kinh phi true tiep cho Bo Quoc phong, Bo Cong an hay cho cac ca sd kham chua benh) r Theo each phan loai nay, tinh chat, quy mo cua cac nhom se khac Nhom lao dong chinh quy cang tang theo toe cong nghiep hoa, hien dai hoa dat nudc 99 PHU IXC 2: LO TRINH BAO PHU BHYT THEO NHOM DOI TUONG Tong so ddi tupng Doi tupng lam cong Sn luong N8m 2006 Tham gia BHYT Tyl? bao phu Tongsd ddi tupng N8m 2007 Tham gia Tyl? BHYT bao phu Tongsd ddi tupng N3m 2008 Tham gia BHYT Nam 2009 Tyl? bao phu Tongsd ddi tupng Tham gia BHYT 13537 6367 47 13838 7264 59 14164 8191 57.83 14512 10185 Ddi tupng chinh sach xa h$i 6829 40100 60 6962 5980 85.9 7019 6435 93.52 7132 7019 Ddi tupng ngudi nghdo 1834 15283 83.3 14774 13297 90 12821 11539 90 11100 10500 0 0 Tre em ducri tuoi 9500 9500 6650 70 9500 7125 N8m 2010 Tyl? bao phu 70.2 Tongsd ddi tupng Tham gia BUY! 14640 12482 104 7502 6984 94.6 9250 9250 75 9500 9500 Tyl? bao phu Tongsd ddi tupng N8m 2015 Tham gia BHYT Tyl? bao phu 16964 16964 100 93.09 7607 7607 100 100 9000 9000 100 89.89 100 10000 10000 100 Hqc sinh, sinh vi&i 1900 8019 42.2 19190 10555 55 19382 11629 60 19576 14682 735 19771 17794 90 20900 20900 100 Ddi tupng khac 1705 3101 18.2 30646 6129 20 23685 5921 25 25928 7778 30 28192 9021 34.88 30686 18043 57.6 Cpng 8426 36870 43.8 85410 43224 50.6 86571 50366 54.6 87748 57289 65.3 88941 65032 73.12 94989 82514 86.9