Chênh lệch xã hội trong thụ hưởng bảo hiểm y tế

-I7' t lta nol I ^ Oa, l W ChGnh lech bao hidfu trongthg hudng ' ytd Ho ngheo co tfr6 b6o fridm y td rt hon so voi ho kha gi6, va thu hudng muc chi tr6 cria co quan bao nidm y td c0ng rt hon Tinh hlnh ch6nh lech cho tna'y vi6c cdi td fre tfrdng b6o nidm y td hi6n hanh la mot y€u cdu xd trOi hdt suc khdn thidt rnAru nUu eUANG (.) hu chirng ta tld thdy bii chlu chi phi v6i ty nlng hon ngAn s6ch gia dinh I(dt quA cuQc tli6u tra cria chring t6i vd phric loi xi hQi d dAn crr TPHCM vdo th6ng 9-2008 cho thdy c6c tdng lop lao tlQng nghdo cdn ph6i chiu th6m nhidu thi6t thdi chinh s6ch bio hidm y td, phdn l6n chrra tlugc bao phri bdi chd d6 phirc lgi niy DiQn iil{Ec bao phfr bdi chd d0 y td beb Trong tdng sd 4.471 nhAn khdu hiifi m6u tli6u tra (1.000 h6) vio thdi itidm th6ng 9-2008(2), c6 54% c6 thd bdo hidm y td, cdn lai 46% kh6ng c6 th6 bio hidm y td Trong sd nhfrng ngrrdi c6 th6 b6o hidm y t6, 35% thu6c di6n b6t bu6c, 12% thu6c di6n trt nguy6n (phdn l6n ld hoc sinh, sinh vi6n), vd 7% th6 bio hidm y td di6n kh6c (di6n gia dinh nghdo, gia dinh chinh s6ch, ngudi cao tudi ) DAn crr d n6i thinh c6 54% c6 th6, vring ven 52%o, vd d ngoai thinh 57o/o PhAn td theo tudi t6c, rf lQ c6 th6 b6o hidm y td noi hia 0-5 tudi la 77%,\rta 6-10 tudi 82%, trta Ll-17 tudi BO%, nhung hia tudi ho cl6ng tr) 18 tdi 60 tudi thi thdp hon, chi khoing tr6n drt6i 40-50%, cdn d hla tudi tr6n 60 53% Trong hdu hdt nhfrng ngudi lao cl6ng dang ldm vi6c khu 46 dai da sd nhfrng ngudi t6 (gIy"), thi t'ji khu wc kh6ng chinh thfc thudng c6 mrlc thu nhap thdp hon vi bdp b6nh hdn so v6i nhfrng ngdnh nghd thu6 khu vuc chinh thrlc (nhu cd quan ve nrt6c ddu c6 th6 b6o hidm y 16 drroc bao phri bdi chinh s6ch bio hidm y td chi chidm tnidc(r), ry le ngrrdi bi b6nh nh6m hQ gia tlinh nghdo cflng trldng duong nhrr nh6m h0 kh6 gi6, nhtrng hq l4i phii g6nh t wc nhi 50% lao clQng d khu vgc kinh td tu nhAn (doanh nghiOp trt nhAn, c6ng ty tr6ch nhi6m hfru h4n ) vd chi c618% d khu vuc kinh td ci thd @u6n g6nh b6n brrng,lao d6ng tU ) Phdn ldn lao d6ng thu6c khu wc kh6ng chinh thtc (hay cdn goi ld phi chinh quy) ddu kh6ng c6 th6 bio hidm y td, nhu lao clQng tidu thri c6ng nghiOp vi lao dQng trr (84% khdng c6 th6), bu6n b6n nh6 (79%), n6ng din (71%), hay kd cA n6i tro (74%) vi thdt nghiOp (80%) Trong d6, cfrng bidt rXng bio hiim y td c0a Ciic loqi th6 ciic c6 nh6n thirnh vi6n c0a c6c hQ m6u tfiiu tra, phAn theo c6c nh6m hg dqra tr€n mritc thu nh6p (ng0 phin), 2008 (dvt: TPHCM o/o) lim vi6c doanh nghiOp nhd ntt6c, doanh nghiOp trr nhAn c6 tr6n 10 lao dQng, c6ng ty li6n doanh ) PhAn td theo di6n b6o hidm y td, tli6u cl6ng chri j'h bi 19 phAi tli tli6u tri ndi nhfrng ngrrdi c6 th6 bio hidm y td dien trt nguy6n (3O%) vd di6n kh6c (33%) d6ng hon gdp d6i so vdi nhfrng ngudi c6 th6 bAo hidm y td di6n b6t buQc (16%) Trong mAu cli6u tra, chi c6 25% hd gia tlinh c6 iIAy dri th6 b6o hidm y td cho tdt ch cic thinh vi6n cria minh, cdn lai 59% gia dinh chi c6 m6t sd ngudi c6 th6, vit 16% gia tlinh hoin toin kh6ng c6 c6 th6 bAo hidm y td Sd h0 gia dinh dd c6 tIAy cln th6 bio hidm y td cho tdt chc6c thdnh vi6n cria minh chidm ty 16 cao nhdt noi c6c hd nh6m trlc nh6m kh6 gii nhdt(49%), noi nh6m (nghdo nhdt) qi 16 niychi dat L9%,noinh6m 2ldI7%, vd nh6m 3ld,l6%- Noi c6c h0 khe giA nhdt, ty 16 nhAn khdu c6 th6 b6o hidm y tdl6n tdi7O%, ty lQ ndy noi nh6m h6 nghdo nhdt chi dat 47% Iinh hinh phin bd nqin s6ch "r ' cua' co q uanbiohiim qr^Jra yre N|6m1 Nt6m2 Nlfrn3 Nl$m4 Ntfrns trltrto*lU $irilrf$ Kdt qui Ngu6n : CuQc di6u tra cdc hO gia dinh TP H Thdi b60 rinh CM vd o th tdsii Gdn dn g 9-2008 23-7-2009 9-2008 tri m6t n5m cu6c khiio s6t th6ng cho bidt chi phi rlidu cria tdt ch cic h6 gia dinh m6u di6u tra tdng c6ng l6n tdi 2,68 tiddng, d6 tdng sd tidn cd quan bAo hidm y td chi trA cho c6c b6nh nhAn tdli 522 tri6u ddng (chidm L9,5% tdng chi phi clidu tri cria c6c hd gia dinh) Mrlc chi tri cria cd quan bio hidm y td tinh binh quAn tr6n tdng sd nhfing ngudi c6 th6 bio hidm y tdld 218.000 ddng/ngudi/ndm, d6 ri6ng di6n bio hidm y td bft bu6c le 240.000, c6 th6 b6o hidm y di6n trr nguy6n 253.000, vi rQng Tinh hinh ph6n bd kinh phi blo hiim y td chi trl cho ciic bQnh nhin thuQc cdc nh6m h9 gia dinh, ph6n theo mf'c thu nhip (ng0 phAn), TPHCM 2008 ilh6m I (ngh6o nh{t}: 69,1 ti€u ddng 'l3o/o di6n kh6c 33.000 ddng/ngrrdi/n[m Trong tdng sd tidn chi tri cria co quan bio hidm ytdcho c6c h6 gia dinh m6u didu tra, phAn ldn nhdt li Nh6m 23,8 2: ti€u ddng 5o/o tri cho nhfrng ngudi hrru tri vi mdt sric lao dQng (chidm 3B%), kd d6 le gioi lao tlQng tri 6c (2O%), nhAn vi6n (L2%o), hoc sinh vd sinh vi6n (5%), tri bio hidm y td la tlidu cfing clugc ghi nhAn m6t b6o c6o cria Ngdn hing Thdgidi nlm 2007 phAn tich c6c sd li6u cfia cd quan 86o hidm X6 Viet Nam(3) Kdt qui clidu tra th6ng 9-2008 cho bidt kh6ng phii c6 th6 bio hidm y td cffng ddu srt dqng the tli tli6u hQi tri: !i lQ c6 srl dung th6 chi l6n t6i (nghdo nhdt) Ld.S3"/o,cdn noi nh6m (gidu nhdt) 5t%; ri6ng noi nh6m li 59% d dAy c6 16 kh6ng cdn phii nhXc l4i nhfrng phidn to6i viQc di6u tri bio hidm y td cho bQnh nhAn di6n cfing nhrt thri tuc to6n bAo hidm y td mA b6o chi lAu dd phin 6nh nhi6u vd khidn nhi6u ngudi Ngu6n : CuQc di€u tra aic hQ gia dinh 6TPHCM vdo thdng 9-2008 nghdo: 4,6 tri6u cldng/ngrrbi noi nh6m (gidu nhdt) vi 5,5 tri6u noi nh6m 4, ndi nh6m (ngh6o nhdt) chi 2,0 triQu tl6ng/ngrrdivi nh6m ld 0,9 tri6u i Cdn ndu chi tinh sd b6nh nhAn bi bQnh n{ng phii di6u'tri n6i trir tai bQnh vi6n thi ri6ng c6c bQnh nhAn thuQc hai nh6m h0 vd (kh6 gii nhdt) chidm tdng cQng tli 64% tdng sd tidn chi tri cria co quan bio hidm y td, vd c6c bQnh nhAn thuQc hai nh6m hQ (ngh6o nhdt) chi tluoc hrrdng tdng cQng L4o/o sd tidn chi tri niy N6i c6ch kh6c, phdn ldn khodn chi trd cfia cd quanbdo hidmy td ddu d6n ud aic nh6m gia dinh trung htu ud khti sid ngai sfi dqng th6 Ndu tinh tdng cdng sd tidn co quan bio hidm y td chi tri MOt vii Th6ng 11-2008 vila qua, Qudc hQi dinh m6u didu tra, chring ta c6 dd thdng qua LuAt 86o hidm y t5, tt4o luQt ddu ti6n linh vgc ndy hudng ddn mgc ti6u phd c{p chd tIQ (nh6m vA 2) (vdn chidm tdi 4Oo/o tdi m6t phAn n[m tdng kinh phi bio hidm y t6 (l8o/o), ngugc l4i hai nh6m kh6 gii nhdt (nh6m vd 5) thi l4i hudng sd frO) nhAn dugc chrra bio hidm y td vd muc ti6u c6ng bing xd h6i; il4o luQt nAy dI dinh muc ti6u thuc hi6n bcio hidmy tdtodn ddn vdo ndm 2OL4 y tdbinh qudn cho m6t bQnh f chring t6i, TPHCM tl[t mqc ti6u xdy dqng m6t hO thdng bio hidm y td todn dAn s6m nhAn thu6c nhfrng nh6m h6 kh6 gii cao hdn hin so v6i nhfrng nh6m h6 hon cdc tlia phuong kh6c, bXng c6ch tinh to6n d6 th4c hiQn sdm uiQc md hon m6t nr?a tdng kinh phi ndy (57%) Mrlc to6n cria co quan bio hidm lu{t mdi n6i tr6n, itac biQt ddi vdi nhfing ngdnh nghd thuQc khu vuc phi chinh thrlc nhu tidu thri c6ng nghiQp, lao dQng tg do, n6ng dAn nhim b&o tlim cho nhfrng tAng l6p lao d6ng nghdo niy c6 cd h6i ttrrgc tidp cAn v6i dfch vU chdm s6c srlc kh6e mQt c6ch xrlng d6ng, vd ttng budc giAm b6t hiQn tr4ng ch6nh l6ch x5 hdi srr m{t nhim vQn clQng drrgc srr tl6ng g6p vd tidp srlc cria c6c td chrlc til thi6n tu nhAn vi t6n gi6o, mdt khdc dAy cf,ng ld mdt khu6n rurd ainfr chd mi nhfrng tdng ldp kh6 gii c6 thd mong mudn nhim tl4t clrroc y6u cdu chdm s6c srlc kh6e cao hon MIt khdc, thinh phd cfing c6 thd nghiOn c(tu kinh nghiQm c6c nudc ttd tidn hdnh xAy dqrng nhfrng loai hinh td chric mdi nhrr hop ttic xd y td chhng h?n DAy li d4ng td chrlc tr/ nguyQn cria c6c gia dinh nguiri dAn, g6p ti6n dd trd thdnh x5 vi6n, cring vdi m6t sd b6c si, y td vi dudc si, cfing ld x5 vi6n, dd xAy dqng co sd y td t4i dia phrrong, v6i quan tlidm chinh ld mgi ngudi ctng tham gia ho4t tIQnS y tddg phdng cld tg ch[m s6c vd bio vQ srlc kh6e t.r (4) ViQn Phdt tridn Bdn v0ng virng Nam bQ ChIthich: (1) Xem biil'Cdng nghdo, chi phiy td cdng ld gdnh nQng",TBK|SG s6 ngiy 16-7,trang 45 itd nghi cho c6c gia thd thdy ring hai nh6m h6 nghdo nhdt sd diAn bdo hidm y td, sdm 16 trinh tI6 d4o thg hudng phirc loi y td Ngodi ra, TPHCM n6n chri truong khuydn khich c6c lo4i hinh bcio hidm y td ru nhdn dd bd sung cho hQ thdng bAo hidm y tddo NhA nrr6c chri tri, mQt chi nQi tro (S%),lao tlQng tidu thri c6ng nghiQp vi lao cIQnS tu (4%), bu6n b6n nh6 (3%), c6ng nhdn (2%o), n6ng dAn (chrra t6rl%) Vi6c nh6m huu tri vd di6n bAo hidm ytdtg nguy6n chidm qi ldn nhdt ngAn s6ch chi m|t hon so vdi Theo thidn n6n Thbitrio Kinh tdsii Gdn 23-7-2009 (2)Xin xem dac didm m6u ttidu tra c0a cudc tinh hinh thu hudng phrlc lgi xa hQi cfra cdc hQ gia dinh dAn cLTTPHCM cfidu tra vd tidn hinh vio thSng 9-2008, biivtra d5n Clrrgc (3) Xem World Bank, Vietnam Development Report 2008 Social Protection, Joint Donor Report to the Vietnam Consultative Group Meeting, Hanoi, December -7, 2007, tr 92 (4) Ngey 2-3-2009 vila qua taiTPHCM, Li6n minh Hgp tdc xd ViQt Nam de ph6i hop vdi Hi6p h6i Hgp tdc xa Y td Nhdt B6n (JHCA) td chfc cuQc h6i th6o mang t€n li "Hop tdc xa y td - md hinh chim s6c sric kh6e cQng oong" 47 ... bio hidm y td tinh binh quAn tr6n tdng sd nhfing ngudi c6 th6 bio hidm y tdld 218.000 ddng/ngudi/ndm, d6 ri6ng di6n bio hidm y td bft bu6c le 240.000, c6 th6 b6o hidm y di6n trr nguy6n 253.000,... xAy dqrng nhfrng loai hinh td chric mdi nhrr hop ttic xd y td chhng h?n DAy li d4ng td chrlc tr/ nguyQn cria c6c gia dinh nguiri dAn, g6p ti6n dd trd thdnh x5 vi6n, cring vdi m6t sd b6c si, y. .. nghdo, chi phiy td cdng ld gdnh nQng",TBK|SG s6 ngiy 16-7,trang 45 itd nghi cho c6c gia thd thdy ring hai nh6m h6 nghdo nhdt sd diAn bdo hidm y td, sdm 16 trinh tI6 d4o thg hudng phirc loi y td Ngodi