Governments role in health care development in vietnam

U UPPSALA UNIVERSITET Students: Bui Tien Phong Nguyen Viet Cuong Pham Thi Binh GOVERNMENT'S ROLE IN HEALTHCARE DEVELOPMENT IN VIETNAM Supenisors: Prof Dr Ven-Erik Svard Dr Dana Khac Anh Hanoi-May 2011 ABSTRACT Thesis title: Government's roles in health care development in Vietnam Master of Public Management Program Authors: Bui Tien Phong, Nguyen Viet Cuong, Pham Thi Binh Supervisors: Prof Sven-Erik Svard, Dr Dang Khac Anh Date of defense: May/2011 Objectives: Reviewing and evaluating government's role in heath sector in Vietnam in renovation process; Analyzing the actual situation of Govemment's role in heath care development of Vietnam and proposing some solutions to enhance government's role in heath sector in the future Methodologies: • Documents studies • Comparision method • Statisitical method • Social survey Outcomes and Conclusions: In the renovation process since 1986, there has been dramatic changes in Government's role: in stead of taking over every activities in the society centrally planned economy under Soviet Union model, our Govemment has gradually shifted to social management in the macro-management tools such as legislation, policies and other tools, ie moving from the role of the " boat sailing rowing" to the role of "boat controller Health care is a major sector of reform because it influences people's health and the stable development of society During renovation process, the health sector in Vietnam has gained many important achievements, but still exists some shortcomings and weakness Healthcare service is a special activity and is different with other goods consuming activities in which people, despite of being rich or poor has the right to get equal minimum benefit of healthcare service quality Only Govemment with its integrated power is able to ensure the equity of providing healthcare service quality to everyone Govemment plays an important role in the development of health; ensure the right to access health care of every citizen Government's role in health development in Vietnam is first shown in the following key aspects: the role of govemment in fonning the legal framework in providing administrative support for private sector in health services to develop and control the provision of health services which can meet the requirements of the Govemment and the society Besides the development of govemment health sector, the implementation of "health socialization" has led to positive results In the future, it is necessary to consider "health socialization" to be one of the main direction for the development of health sector in Vietnam to mobilize more resources for development Complete legal system on health care, increase resources for the development of health facilities, improving the quality of staffs working in healthcare, implementation the orientation to ensure healthcare access to every people, strengthening the inspection and examination of the state in the health sector will contribute to the improvement of people's health care, ensuring that every people have equal access to primary health care at minimum level Recommendations/ Suggestion for deeper study: It is necessary to study and complete govemment's institution in health sector, determining specific roles of the Govemment in health sector Contribution of the thesis: In theory: Systematizing all flindamental theories on Govemment's roles in health service supply In practice: • Analyze and identity the Govemment's roles in health development in Vietnam ( from the actual situations in Lao cai province and Haiphong city) • Propose solutions to improve Govemment's roles in health sector in Vietnam in general and in Hai Phong and Lao Cai in particular Key words: Health; Administration Refonn; Socialization; Govemment's role Contents INTRODUCTION CHAPTER 1: THE GOVERNMENT' ROLES FN HEALTH SECTOR 1.1 Health care and its roles in the society 1.2 Government's management roles in healthcare sector 1.2.1 Govemment's role in ensuring the equity in medical service 1.2.2 Government's role in ensuring the effectiveness of healthcare service supply CHAPTER 2: GOVERNMENT'S VIETNAM ROLES IN HEALTHCARE 2.1 Awareness of the Government's roles in health care DEVELOPMENT IN 10 10 2.1.1 Vietnam Healthcare situation and reasons for renovation 10 2.1.2 Government's roles in health care sector in the past years 18 2.2 "Socializing" health care supply in Vietnam 21 2.2.1 Basis for "socializing" health care service in Vietnam 21 2.2.2 Actual situation of socialization in health care in Vietnam: 22 CHAPTER 3: ENHANCING THE GOVERNMENT'S ROLES IN VIETNAM HEALTHCARE DEVELOPMENT IN THE FUTURE 28 3.1 Vietnam healthcare development orientation in the future 28 3.2 The govemment's roles in health development 30 3.2.1 Improvement of health laws and policy systems 30 3.2.2 Build the development plan for health/medical center systems 31 3.2.3 Complete the socialization for health sector 32 3.2.4 Develop plans for health mechanism renovations and effective usage of health resources 33 3.2.5 Strengthen health inspection and control 33 3.2.6 Policies of training and education of medical/health moral 34 3.2.7 Building and implementing suitable compensation policy to the medical officers and statT 36 3.3 Recommendations 36 3.3.1 To the National Assembly 36 3.3.2 To the Govemment 37 3.3.3 To the judicial organs/orhanizations 37 3.3.4 To Ministry of Health and Departments of Health 37 3.3.5 To the municipal people's committee 37 CONCLUSIONS 38 REFERENCE 39 APPENDIX 41 ABBREVIATION In short In full Description in English ATVSTP An toan ve sinh thuc pham Food hygiene and safety ATTP An toan thuc pham Food safety KGB Kham chCra benh Medical examination and treatment BVSKND Bao ve sue khoe nhan dan People's health protection QLNN Quan ly nha nuac Govemment's management QPPL Quy pham phap luat Legal principles UBND Uy ban nhan dan People's Committee XHCN Xa hoi chu nghTa Socialist VBQPPL Van ban quy pham phap luat Document of legal principles VSATTP Ve sinh an toan thuc pham Food safety and hygiene INTRODUCTION I The necessity of the research Recently, the Govemment of Vietnam has paid attention to health development to provide better healthcare service to its people Its health network, especially local health centers, has been enhanced and developed; many epidemic diseases have been controlled; the health service is more diversified; health insurance has initially been developed effectively The results show that better health service has been provided to many regions in the country Most general health index of Vietnam people have higher than that of other countries with the same income per capita However, Vietnam, together with the achievements, there still exists some problems in health service such as: organizational structure is not appropriate; legal system for healthcare service is limited; healthcare systems have not meet the new requirements of the market economy and changes in diseases structures; health service quality has not met the new increasing and diversified requirement of the people; health service conditions for the poor, and the minorities at remote and mountainous areas are not good; medicine production capacities is limited; the medicines prices arc getting high compared to the income of average person; health service inspection and control is not good enough: some people are not aware of protecting health for themselves; environment hygiene and food hygiene and safety have not strictly controlled Besides limited resources, there are shortage in quantity and inappropriate in organizational structure It is necessary to enhance socialization activities - the participations of private sectors in health service - in reform/renovation process in health service It is obvious for the change in the Govemment's role in health service management Both public and private sectors can participate in this service The Govemment's role will change from the sole management entity to those whose provide directions for the health service activities Enhancing the quality of the Govemment's management and direction/orientation activities, separating management activities with health service provision will increase the effectiveness of the Government's management This results in the Government's roles as minimum and the private's roles as maximum in health service activities as possible The study of the Govemment' orientation roles in health service are an objective requirement during renovation process Therefore, the group has chosen the thesis: Government's roles in health ser> ice development in Vietnam today Research objectives and research questions The research ohjecfives are • to evaluate the role of Govemment in health service provision and • to enhance socialization activities in health ser\ ice in order to improve health ser\ ice quality in Vietnam Research questions • How the Govemment's roles change in public service provision during the renovation process? • What are the roles of Govemment in health service in Vietnam today? • What should the Govemment in order to successfully implement their jobs in health service provision? Research target and scope • Research target: Government's roles in health sector in Vietnam today • Research scope: the research group investigate the practical health service situations in Lao Cai province and Haiphong city to understand the actual health service situations in Vietnam Research methodologies • Documents studies • Comparison method • Statistical method • Social survey Research contributions The results of the research will help In terms • oftlieory: Systematizing all fundamental theories on the Govemment's roles in health service provision //; ternts of practices • Analyze and identity the Govemment's roles in health development in Vietnam ( from the actual situations in Lao Cai province and Haiphong city) • Propose solutions to improving the Government's roles in health service in Vietnam, today (\)nclusions Apart from introduction, and conclusion, the research has chapters Chapter I Rationale of Govemment's roles in healthcare sector Chapter Real situation of Government's roles in the development of health sector of Vietnam Chapter Improving Govemment's roles in the development of health sector of Vietnam in the future CHAPTER 1: THE GOVERNMENT' ROLES IN HEALTH SECTOR 1.1 Health care and its roles in the society Health care involves with the caring and protecting people's health People's health is affected by the nature, environment, and society Therefore, health care and protection sector also has to change together with social development and people's awareness According to the decree issued by the Vietnam Government on functions, responsibilities, accountabilities, and organizational structure for the Ministry of Health, the healthcare service areas include preventive health, medical care, health recovery, traditional/herbal medicine, people treatment, harmful cosmetics control, food hygiene and safety, and medical equipment" The healthcare, hence, is viewed as specific and direct activities of people and society in applying sciences in disease prevention, and treatment and protecting people's health The Government is an entity both managing healthcare activities, and carr>ing out its Govemment management roles in this sector.^ Health investments are related to human resource development Therefore, every nation in the world considers healthcare service is an indispensible pari of its national economy structure The product of health service are caring and protecting people's health The Govemment management in healthcare sector is belonged to entities of the Govemment mechanism (executive bodies), adjusting behaviors of individuals and organizations in healthcare service provision (disease prevention, treatment, and people health care and protection) in order to meet the people's legitimate requirement for healthcare and protection 1.2 Government's management roles in healthcare sector Healthcare service has great impact on people's health and social development It is a public service provided by the Government Government's roles in healthcare sector are detailed as below: 1.2.1 Government's role in ensuring the equity in medical service i luman beings are born with the rights of living healthy and pursuing happiness They can use healthcare service and health protection to ensure their living activities Therefore, the Government should ensure that every person in the society basically use minimum healthcare service ' Decree No 49/2003/ ND - CP on 15.5.2003 by the Government on functions, responsibilities, aaccountabilities for the Ministry of Health (Article 1) ' Prof Do Nguyen Phuong, Strategic orientation in people's healthcare protection activities from 2000 to 2020, Hospital Management, Medical Publishing Mouse Ha Noi 2001 Implementation the equity by ensuring faimess for all people to health care, consistent with the economic capacity of society and Govemment policies on free health care and reduce costs for the poor, living in areas with difficult people and ethnic minorities According to the current statistics, there are 350 health service centers in Vietnam Healthcare service is a special activity and is different with other goods consuming activities in which people, despite of being rich or poor has the right to get equal minimum benefit of healthcare service quality Only Government w ith its integrated power is able to ensure the equity of providing healthcare service quality to everjone Nowadays, the process of economic renovation in Vietnam has led to the increase of income gap between the rich and the poor, social stratification is becoming bigger and bigger among social classes According to specialists' calculation, the imbalance between high income individuals and low income individuals is at times The number of people living under poverty line in our country accounts for 6% of the population and is allocated in all provinces and districts all over the country but mainly gather in rural and mountainous area Those groups of people mainly take medical service at grass root levels because they can not afford medical services in hospitals at upper level Nearly 80 per cent of Vietnam populations who are living in rural area not buy healthcare insurance and they are not capable of paying for their treatment when they get diseases In order to deal with this issue, the Government has issued and performed a wide range of regime and policy on medical examination and treatment for poor people, but because of limited Government budget and limited contribution of social resources, there should be effective solutions to mobilize more social resources for healthcare development 1.2.2 Government's role in ensuring the effectiveness of healthcare service supply 7.2.2./ The Government should apply unified criteria to ensure quality of healthcare service supply Criteria of the quality standard in providing healthcare service consists of a system of laws and regulations set by the Government and Government bodies in healthcare sector It is stated in the Constitution, Law and regulations, Resolution and other legal documents Legal documents that are directly regulating and managing health performances including: Law on Protection of People's Health (1989); Pharmacy Law (2005); Law on Food Hygiene and Safety (2011); Ordinance on Medical and Pharmaceutical Practice (2003) Other legal documents have many articles relating to heath sector such as: Law on Children Protection, Care and Hducation (2004); Marriage and Family Law (2000); Population Ordinance (2003) With the purpose of efficiently developing healthcare service, Govemment's regulation should not rely solely on regulations stated in standard legal documents which directly infiuence dung, tinh du cac chi phi true tilp phuc vu benh nhan Nha nuoc co chinh sach trg giup dii vai nhirng ngudi co thu nhap thdp vd co hodn canh dac biet kho khan Cong khai minh bach vi?c thu, chi vien phi cho nguai ddn bilt 3.2.5 Tang cu-trng cong tac tra, kilm tra y te Tang cuong cong tac tra, kilm tra vd sir ly nghiem minh cdc hdnh vi vi pham phap luat ve y te Id mot nhirng nhiem vu quan trgng cua Nha nuoc dl ddm bdo cdc ca sa cung cdp djch vu y tl dap img dugc cac tieu chudn yeu cau ciia Nha nuac phuc \ u tot nhat cac nhu cau ciia cdng dan va td chuc xa hdi theo diing djnh hucrng cua Nha nude Ddi mdi cdng tac kiem tra ddi vdi ITnh vuc y td cAn tap trung vao nhung ndi dung chii ydu sau day: Thu nhdt, lang cudng ccmg lac hau kidm Mc)l nhirng didm ndi bat ciia cac vi pham phap luat vua qua la vide Chinh phii da bac bd mot sd giay phep dd co cac giay phdp lidn quan ddn y Id Nhung ITnh vuc bj bai bo giay phep nhu hanh ngbd xoa bdp, hang nghe trang ibidt bj y td, quang cao ITnh vuc y td thi tan sd vi pham ddu tang Do do, can thidt phai tang cudng cdng tac kidm tra tra ddi \ di ITnh vuc na\ dac biet la cdng tac hau kidm Cdng tac hau kidm can phai dupe tidn hanh tren co sd sap xdp lai, bd sung dpi ngu tra chuydn nganh vd y td Thu hai, ddi mcVi phucmg thuc Ira kidm tra Tang cucmg phoi hcrp lidn nganh cdng tac tra, kidm tra; kdt hcrp chat che giija cdng tac tra y td, cdng tac kiem tra ciia cac co quan QLNN \c y te ddi vdi tra ciia thii trudng tra nhan dan va cdng tac kidm tra ciia Dang Cd nhu vay, mdi phat huy dupe sue manh ciia ca he thdng tra, giam sat, ciia ca he thdng chinh trj vide ran de, phdng ngira cac \ i pham phap luat, phat hidn kjp thdi va xu ly nghidm cac hanh vi vi pham phap luat ve y td Thi'f ba chii trpng tra, kidm tra khu \uc y td nha nude Dd tao su binh dane giua khu vuc y td nha nude va y td tu nhan, cdng tac tra chuydn nganh \ d y td can chii trpng tra cac co sd y te cua nha nude ban nua thay vi chi chii trpng ddn khu v\rc tu nhan Thu tir xu ly hanh \ i vi pham phap luat vd y td 38 Viec xu phat cdc vi pham hanh chinh ITnh vuc y tl ddm bdo cong bdng giira khu vuc y tl nhd nuoc vd khu vuc y tl tu nhdn Trong qud trinh tra khu vuc y tl nha nuac, neu phdt hien cdc hdnh vi vi pham phap luat vl y tl thi phdi kip thai xir ly nghiem minh, tranh nl nang xir phat nhe, xu phat mang tinh chdt hinh thirc Viec xir ly ky luat phdi bdo ddm hdnh vi vi pham tuang img vdi hinh thirc ky luat theo quy djnh cua phap luat Khi xu ly ky luat phdi ddm bdo binh ddng cong bdng giira cong chirc lanh dao vai cong chirc binh thuong, trdnh tinh trang cong lanh dao thi xir ly nhe cong chirc binh thuong thi xir ly nang Viec xu ly ky luat cung nhu xir ly bli thucmg trach nhiem vat chat phdi ddm bdo tuan thii triet de cac quy djnh cua phdp luat vc trinh tu thu tuc, tham quyin xir ly vi pham tranh de tinh trang "tam khong phuc khdu khong phuc"' Thu nam, cung co to chirc tra chuyen ngdnh vl y tl He thong to chirc tra nha nuac vl y tl ngoai Thanh tra Bo Y tl va Thanh tra Sa Y tc nhu hien phai ma rong them cd Ihanh tra y tl quan hu>en thi xa dl tao mang luai tra, kiem tra thiet thuc vd hieu qud luon gan vai ca sd di sdt co so Mudn thuc hidn tdt cdng tac tra, kidm tra y td, mot nhung nhiem \u trpng tam la phai nang cao chat lucmg dc)i ngii tra \ idn y id: Xay dung dpi ngu tra vidn cd pham chat chinh tri \ a dao due chi cdng vd tu co trinh dp chuydn mdn nghiep vu vung vang, bao dam cho td chuc tra y td sach, \ ijng manh Bdn canh dd phai tang cudng sd lupng \ a chat lupng dpi ngu tra vidn d tuydn tinh, dam bao moi ScV y te phai cd it nhat tir 20-30 tra vidn tu\ theo sd dan va didu kien dia ly nh^m thuc hidn tot cac chuc nang, nhiem \ u tra chuydn nganh vd y td Tang cudng cdng tac dao tao, bcM duong kidn thuc phap luat, kien thuc QLNN kidn thuc vd chu\dn mem y tC\ ky nang tra nh5m nang cao trinh \ a nang lire cho dpi ngu tra vidn Bdn canh vide nang cao nang lire cho dc)i ngu can bd, cdng chuc tra y td, can tang cucma co sd vat chiil, phucmg tidn boat dc>ng phuc \ u cho cdng tac tra, kidm tra nhu dau tu them kinh phi dd trang bj d td xe may may anh, may ghi am dac biet 39 cac phdng xet nghiem, phuong tidn xet nghidm bao dam phat hidn nhanh va chinh xac vi pham chat lupmg vd an toan thuc pham, thuoc, my ph4m anh hudng true tiep den sue khoe ngudi 3.2.6 Co chinh sach dao tao, sir dung, giao due y due Nha nude can xay dung quy hoach tdng thd cac co sd dao tao vd y te mpi cap: S4p xdp lai mang ludi,md rdng va nang cap cac co sd dao tao,dap ung nhu cAu vd can bd y te phu hpp vdi quy hoach phat tridn nganh; xay dung mot sd trung tam dao tao can bd y te ngang tam cac nude tidn tidn khu vuc De nang cao nang lire cho y td tuydn huyen va tuydn ca sd, dac biet la d cac vung sau, viing xa, vung dac bidt khd khan, can tang cucmg dao tao can bd y td theo hinh thuc cu tuydn Chii trpng dao tao can bd quan ly y td, nhat la can bd quan ly bdnh vidn Coi trpng vide dao tao, sir dung va dai ngc) nhan tai vd y td Md rdng vide dua can bd cd trinh dc) cao di dao tao d nude ngoai bang ngudn kinh phi nha nucVc, khuydn khich du hpc tu tiic theo cac chuydn nganh dang cd nhu cau Dd cdng tac dao tao cd y nghTa quydt djnh vide nang cao nang lire ciia can bd y te, xuat phat lir nhirng ydu cau, nhiem vu nuVi \ a nhijng han chd > du kem ciia dc>i ngu nay, cdng tac dao tao, bdi dudng can tap trung vao mot sd giai phap sau: Vk hinh thirc, noi dung, phuong phdp ddo tgo Vd hinh thuc dao tao: Tap huan; hc)i nghj chuydn dd; lidn kdt, phoi hcrp bd nganh lien quan .Ve ndi dung, chucmg trinh dao tao, bc\i dudng ap dung cho tung ddi tupng: - Doi vdi can be) lanh dao, quan ly dirc;c quy hoach la ccmg chuc cap cao, can dupe dua di dao tao cd bai ban, tap trung - Cac y bac sT khac, dugc tu>ln dung cdc benh vien da qua dao tao ve chuyen mdn thi cdn boi dudng them kiln thirc NI tam ly NI phap luat mot chuang trinh vao thdi gian thich hcrp Ve kien thirc chuyen mon: 40 - Nang cao nang lire thuc thi cdng vu ciia dpi ngu can bd y te de thuc hidn tot cdng viec, nhiem vu dupe giao - Trau ddi kha nang giao tiep, kha nang quan he cua bac sT doi vdi nhan dan, vdi cac ddng nghiep Doi mai chucmg trinh Can xac djnh chuang trinh dao tao, bdi dudng bac sT mot each phu hpp vdi cdng vi?c Vide dao, bdi dudng bac sT phai theo nhdm nganh, ITnh vuc cdng vide - Tridn khai cdng tac didu tra co ban dd khao sat, vd so lucmg danh gia ch^t lupng toan bd dpi ngu CBCC hidn cd Kdt qua didu tra co ban phai dua dupe cac so lieu cu the va danh gia chinh xac vd trinh dp, nang lire va cac didu kidn hien cd ciia CBCC dd xay dung kd hoach dao tao lai ddi vdi dpi ngu Vide ddi mcVi chucmg trinh can phai xuat phat tu nhu cau ngudi hpc, can trang bj kidn thuc gi dd dap ung dupe nhidm \ u cua thuc tien ddi hdi va kha nang xay dung, ddi mdi noi dung, chuong trinh ciia cac co sd dao tao, bdi dudng didu kidn thuc td cho phep Chucmg trinh dao tao kidn thuc phai vua rc)ng, vua sau, vua kdt hpp kidn thuc ccr ban va kidn thuc chuydn nganli 3.2.7 Xay dung va thuc hien chinh sach dai ngo hop li doi voi can bp, nhan vien y te hue te hidn cho thay muc dc) dai ngd ddi vdi dpi ngu can bd, cdng chuc ndi chung va can be), cdng chuc nganh y td ndi ridng, nhat la dc)i ngu \ bac sT cdn rat thap Day la mot nhung nguydn nhan dan tdi su sdi mdn vd y due, tang muc dp tham nhung nganh y td, Dd giai quyet vSn dd elm cd chinh sach tang lucmg thich hcrp, can ddi vdi cac nganh ngbd khac bao dam muc sc^ng cho can bd, cdng chuc Can cd che dc) bao hidm xa bc)i va bao hidm y tc ddi vdi nhung ngudi cdng tac tai tram y td xa Hurc hidn vide luan chuydn can be): khii>cn khich thay thuoc vd cdng tac d mien niii, vumi sau, viing xa, viing cd nhidu klid khan 41 Ben canh do, viec cung co ddi ngu can bd y tl can phdi thuc hien triet dl tren ca sd ; dinh co cdu sd lugng, chat lugng cua ddi ngii cdn bd, cdng chirc theo he thdng ngach :, chirc danh, tieu chudn nghiep vu hgp ly, hodn thien chi tuyIn dung, bo nhiem, dao ), tinh gian bien chd Tien luong cac chd dp ciia can bd, cdng chuc y te dupe cai each co n, trd ddng lire cua ndn cdng vu, bao dam cude sdng ciia can bd, cdng chuc va gia lb nham nang cao tinh than trach nhidm va dao due ngbd nghiep ciia can bd, cdng chuc y Muc dich ciia vide ddi mdi su dung tai chinh cdng la tao quydn chii dpng, tu quyet, • chju trach nhidm cho don vi sir nghiep cd thu ma trudc hdt la Thu trudng don vj va ng cudng trach nhidm QLNN va dau tu cho cac boat ddng su nghiep Sap xdp bd may ) chuc va lanh dao hop ly, tang thu nhap, tang phiic Icri khen ihucmg cho ngudi lao ddng Chd dp dai ngd ddi vdi y, bac sT cac bdnh vidn can thay ddi cho phu hpp Vi u van dd khcn thucmg, ky luat, bdi ducTnig tidn lam tbdm gid Co sd vat chat, trang thidt bj giiip y bac sT hoan cdng \ ice dupe giao Cac rang thidt bi su dung cac benh vidn la cac thidt bi y td Cac thidt bj dd ddi hdi v^an phdng va cac Phdng ban chuc nang phai thudng xuydn bao dudng, thay thd dam bao :6ng vide ciia y bac sT hieu qua 3.3 Mot so kien nghi, de nghj 3.3.L Voi Quoc hoi - Ra soat he thdng van ban Luat va van ban dudi luat vd y td nham timg budc hoan thidn va nang cao chat lirprng phuc vu y td - Tans cudng cdng tac giam sat vide thuc hien cac van ban phap luat \ d y td va xu ly cac kidn nghj giam sat - Tronu phan bc^ kd hoach ngan sach hang nam, cd danh mc)t khoan kinh phi hpp ly ban chi thudng xuydn cho dich vu y td dd cac hoat dc)ng y te dam bao hidu qua thidt thuc 3.3.2 Doi voi Chinh phii 42 - Xay dung chidn lupc y td giai doan tu 2011 ddn nam 2020 lam dinh huomg cho cong tac xay dung kd hoach quan ly chat lupng y td - Xay dung mot muc chi ngan sach ridng cho quan ly cac djch vu y td trdn co sd tinh diing, tinh dii ngudn ngan sach da chi lam co sd dd Qudc hdi quydt djnh phan bd ngan sach hang nam - Tdng kdt, nit kinh nghidm vide thuc hidn chinh sach phap luat vd quan ly y td thdi gian qua va tang cudng chi dao vide thuc hidn chinh sach phap luat vd quan ly chat lugng y te - Day manh xa hdi hda djch vu y te 3.3.3 Doi v6"i cac ctr quan tu- phap - Tang cudng nang luc dilu tra khdi td cac hanh vi vi pham phap luat ITnh vuc y tl; xir ly nghiem cdc hanh \ i \ i pham phap luat vc y te 3.3.4 Doi voi B9 Y te va cac Sff y te - Ra soat, sua doi, bd sung, ban hanh van bdn theo thdm qu> en ITnh \ irc dugc phdn cdng quan ly - Kien toan td chirc tra chuyen ngdnh vl y tl tai cac co so y te: cd co che phoi hgp giira tra chuyen nganh y tl N di luc lugng qudn ly thi trudng: tang cudng cdng tdc kilm tra, tra, xir ly nghiem ddi ^ di cac hanh vi ^\ pham phap luat ve quan ly chat lugng y te 3.3.5 Kien nghj doi voi UBND tinh, phd - Ban hanh kjp thdi van ban QPPL phii hgp vdi dilu kien dia phuang va td chirc tdt viec triCMi khai thuc hiC-n cac van ban ciia co quan cdp tren: xdc dinh rd nhiem N u quan ly y tl kl hoach hoat ddng hang nam - Quan ly chat che cac benh N ien, ca sd y tl ddng tren dja ban - Td chirc tdt cdng tac tra, kilm tra, xu ly nghiC-m vd kjp thdi cac vi pham phap luat ve y tl trC-n dja ban quan ly 43 - Bd tri hop ly ngudn ngan sach chi thudng xuydn hang nam danh cho cdng tac quan ly y te, dac bidt la y td d cap xa, phudng - Huy ddng cac ngudn lire ciia dia phuang tham gia vao boat ddng phat tridn cac djch vu y te; phat huy vai trd ciia co quan thdng tin dai chiing, ciia cac td chuc doan the xa hdi tham gia giam sat va phat hidn kip thdi cac vi pham phap luat vd y te 44 KET LUAN Cdng cude ddi mdi d Viet Nam dupe khdi xudng va thuc hien tu nam 1986 da mang lai nbijng thay ddi to Idn trdn mpi mat ciia ddi sdng xa hdi Hidn nay, cdng cude doi mdi dang di vao chidu sau, cung vdi qua trinh cdng nghiep boa, hidn dai boa boi canh Viet Nam dang cang hdi nhap sau ban vao ddi sdng qudc te LTnh vuc y te cd vai trd quan trpng vide bao dam cho xa hpi phat tridn mot each lanh manh, vi vay la mot nhung ITnh vuc gianh dupe su quan tam ciia Nha nude Nang cao vai trd quan ly ciia nha nude ITnh vuc y te la rat c4n thiet Vai trd cua nha nude ITnh vuc y te the hidn trudc het trdn cac mat: Xay dung hanh lang phap ly cho hoat dong ciia cac don vj cung cap djch vu y te, xay dirng he thong chinh sach thich hop khuyen khich su tham gia cua mpi doi tuong xa h9i vao cung cap dich vu y te; sir dung cac cong cu, ddn bay kinh te ho trp cho cac dan vj cung cap djch vu va tang cudng hoat dpng kiem tra, giam sat cac don vj thuc hien cac tieu chuan, yeu cau cua nha nude, giir vung djnh hudng cua Nha nuoc, Ddi mdi va hoan thien he thdng y td theo hudng cdng bang, hidu qua va phat tridn, nham tao co bdi thuan Ic^i cho mpi ngudi dan dupe bao vd, cham sdc \ a nang cao sue khoe vdi chat lupng cang cao, phu hpp vdi sir phat tridn kinh td - xa hdi ciia dat nude Ben canh dd, phat tridn bao hidm y td toan dan nham timg budc dat tdi cdng bang cham sdc sue khde, thuc hidn su chia se giija ngudi khde vdi ngudi dm, ngudi giSu vdi ngudi ngheo, ngudi dc) tudi lao ddng vdi tre em ngudi gia; cdng bang dai ngd ddi vdi can bd y td Nha nude cd bien phap dd nhijng ngudi ngheo cung ducrc hucrng cac djch vu cham sdc sue khoe ban dau, cd didu kien tidp can va su dung cac dich vu y te cd chat lupng, mpi ngudi ddu dupe sdng cdng ddng an toan phat Iridn tdt ve thd chat va tinh thAn, giam t> Id mac bdnh, nang cao thd lire \ a phat tridn ^idng ndi Can thiic ddy qua trinh xa hc)i hda cac djch vu cdng ITnh \ uc Y td Nha nuc7c tap trunR vao lai thu> en", dc'ing thdi giai quydt van dd ban chd ngudn luc, \ ira giai quydt 45 nhu cau nang cao chat lupng djch vu va quan trpng ban ca chinh la muc dich cai thidn :hat lugng Y td dam bao sue khde nhan dan Bdn canh dd, vide phat tridn kinh td y te la boat ddng rat cAn thidt, bdi vi qua dd ndi cd nhirng bang chung khoa hpc thuydt phuc dd xay dung chinh sach y te phu hop va icay dung cdng cu giam sat, danh gia hidu qua vd nhirng tac ddng ciia vide thuc hidn chinh >ach Kinh td Y te tap trung vao cac ndi dung lidn quan ddn cac pham trii cong bang, hidu qua va phat tridn ciia y td, bao gdm Tai chinh bdnh vidn; Chat lupng djch \ u y td; Y td du phdng; Nang cao sue khde; Cham sdc sue khde cho ngudi ngheo va Bao hidm Y td Cdng tac y td dam bao phuc vu sue khoe cho ngudi dan d Viet Nam la mot nhiem vu quan trpng va can thidt vi an sinh xa hdi 46 TAI LIEU T H A M KHAO Ban chap hdnh Trung uang - Nghj quylt so 46/NQ- TW ngdy 23/2/2005 ciia Bd Chinh trj ve cdng tdc bdo ve, cham sdc vd ndng cao sire khde nhan dan tinh hinh mdi Ha Ndi, 2005 Bd Y te (1995), Sa luge lich sir y tl Viet Nam Nxb Y hgc Hd Ndi Bd Y te (2001) Bdo cdo ddnh gid nam thuc hien Phdp lenh Hdnh nghi y, dugc tu nhdn Bd Y te (2002), Cdc chinh sach vd gidi phap thuc hien cham sdc sire khoe ban dau, Hd Ndi Bd Y te: Bdo cao danh gid 01 nam thuc hien quylt djnh so 139/2004'QD-TT ciia Thii tudng Chinh phu vl KCB cho ngudi ngheo Ha Ndi-2004 Bd y te: Bdo cao danh gid 10 nam thuc hien Luat bdo v? sire khde nhdn ddn Ha Ndi-2004 Bui Thd VTnh, Thiet ke To chirc cdc ca quan hdnh chinh Nhd nude, Nxb Chinh tri Quoc gia Ha Ndi, 1999 Chinh phii, Nghj djnh sc^ 30/2003/ND-CP 1/4/2003 quy djnh chuc nang, nhidm vu, quydn ban va co cau td chuc cua ecr quan thuc)c Chinh phii Chinh phu, Nghi djnh sd 41/2005/ND-CP ban hanh 25 thang nam 2005 quy dinh chi tidt ^ a hucrng dan thi hanh mot sd didu ciia Luat Thanh tra Chinh phu, Nghj dinh sd 49/2003/ND-CP 15/5/2003 quy djnh chuc nang, nhidm vu, quydn ban va co cau td chuc ciia Bd Y td Chinh phu, Nghj djnh so 77/2006>^D-CP 03/08/2006 vd td chuc va boat ddng ciia Thanh tra y td Dc) Nguydn Phucmg (1998), Mc)t sd van dd xay dimg nganh Y td phat tridn d Viet Nam, Nxb Y hpc , Ha Ndi Dc^ Nsuvdn Phircme, Dinh hirc'mg chidn \uac cdng tac cham sdc va bao vd sue khoe nhan dan tir nam 2000 dC-n 2020 Quan ly benh vien Nxb Y hoc Hd Ndi 2001 GS TS Vu Huy Tir, PTS Le Chi Mai PCiS Vd Kim Son Quan ly khu \uc cdng NXB Su That, 1998 I loc \ iC-n lanh chinh Quoc gia, Hdnh chinh phdi trien vd cai cdch hdnh chinh Ha Ngi 1999 47 Hgc vien Hdnh chinh Qudc gia, Nhung vdn di ca bdn vi qudn ly hdnh chinh Nhd wM-d'c, Ha Ndi 1999 Luat Bao ve sire khde nhdn dan ngdy 30/06/1989 Luat Thanh tra ngdy 15/06/2004 Thanh tra y te (2001), Chuyen dl tra y tl, quyIn 3/2001 Nxb Y hpc Hd Ndi Thanh tra nhd nude vl y tl (2002) Mot sd van bdn quy pham phdp luat vl tra hanh nghi y, dugc tu nhdn , Ha ndi Ths Nguyen Huy Quang qudn ly nhd nude bdng phap luat ITnh vuc y tl d nude ta hien (ludn van thac sy hdnh chinh cdng khoa 5, 2003) Thu tudng Chinh phu - Quylt djnh so 35/2001/QD-TTg ngdy 19/3/2001 phe duyet Chien luge Cham sdc vd bdo ve sire khoe nhan ddn giai doan 2001-2010 Thu tudng Chinh phu, Quylt dinh sd 153/2006/QD-TTg ngdy 30/6/2006 vl viec quy hoach tdng the phdt trien he thong y tl Vict Nam giai doan din nam 2010 vd tam nhin den nam 2020; Thu tudng Chinh phu Quylt djnh sd 243/2005/QD-TTg ngdy 05/10/2005 Ban hanh Chuang trinh hdnh ddng cua Chinh phii thuc hien Nghj quylt so 46/NQ-TW ngdy 23/02/2005 ciia Bd chinh trj ve cdng tdc bdo ve, cham sdc vd nang cao sire khoe nhan dan tinh hinh mdi Total Food Safety and Hazardous Substance Control, Republic of Indonesia, 2001, Tr.lO Truang Thj Thuy Thu, Qudn ly Nhd nuac vi chdt hrang ve sinh ATTP a Viet Nam tu gdc nhin cdi cdch hdnh chinh Luan \ an thac sT qudn ly Nha nude Hoc vien Hanh chinh qudc gia Ha Ndi 2003 WHO- 10 pomt Regional Stategy for food safety in the South - East Region (Rome- 1999) Wl lO and FAO (1995), Codex Alimentarius Italy WHO Western Pacific Region Viet Nam December 2002 Food Bom Disease Surveillance Document No: 1A - WHO, Western Pacific Region Viet Nam, Jenuary 2002, Food Bom Disease Sur\eillance Report, Document No: FA - World Health Organization Westem Pacific Region, Viet Nam, December 2002, Food Born Disease Surveillance Document No: FA - 48 PHU LUC BIEU T N G H Q P D I T U Q N G PHONG VAN Doi tiTQ^ng So phieu phat Ket qua thu ve 50 48 ran bp lam ITnh vuc y te tai Hai 'hong 15 15 in bp lam ITnh vuc y te tai Lao Cai 15 15 ^guai dan thu huang y te (Hai ^hong, Lao Cai) MIIEU PHONG VAN TT Phan n9i dung chinh Phu*ang an tra loi — ' f Ong (Ba) da dupe huong nhung chinh sach 1- Bao hiem y te cho nguai ngheo trp giup nao? 2-Mien giam hpc phi 3- Con em dupe di hpc 4-1 lo trp tien (tien, sach va) - Giam tien kham, chua benh 6- Khac Ncu phat hi(;n thay minh hoac cac phan 1- Khong lam gi? gia dinh bj 6m dau thi ong (ba) lam gi? 2-T^i mua thu6c ve u6ng 3- Den tram y te kham 4- Den bac sT tu 5-Den b^nh vi^n 6- Khac Trong truong hop bj 6m tai 6ng (ba) 1- Bi benh nhe nen khong can den kh6ng den cac co so y te? 2- Kh6ng CO du tien de tra va nhung khoan ngoai bao hiem 3- Thu tyc hanh chinh diing the bao hiem phuc tap 4- Thai dp phuc vu cua bac sT chua t6t 5- Khac Khi ong (ba) di khdm chi^a b?nh, 6ng (ba) hai 1- S\[ phyc vu cua y, bac sT long nhat vc ITnh v^rc gi? 2- Trang thiet bj y te 3- Kinh phi phu hpp kha nSng nguai dan 4- Khac 1- Mua dan gian Ong (bd) suy nghTa gi ve vi?c mua BI IVT? 2- Mua rat kho khSn 3- Mua bao hiem binh thuong 49 ^ i heo Ong(ba) vi?c mua B H Y T tu nguyen c i n 1- Mua theo timg xa phuang tien hanh theo hinh thuc nao? 2- Mua c6 60% dan s6 dang ky 3-Mua tu 4- Khac — • u n g (ba) nghla gi ve x5 hpi hoa y te? 1- La hinh thirc phat huy dupe hieu qua y te 2- Dam bao cho nguai dan huong cac djch vu y te 3- Dam bao su cong bang y te Theo 6ng (ba) Nha nuoc can lam gi de nang I- Dau tu kinh phi cao hi?u qua hoat dpng y te? 2- Dau tu trang thiet bi 3- Dao tao, boi duong dpi ngu y, bac sy 4- Xa hpi hoa y te 5- Don gian hoa thu tuc hanh chinh De nang cao hoat dpng y te nha nuoc can: 1- Dau tu cho cac benh vien c6ng 2- Dau lu b^nh vi^n tu 3- Phat trien mang luai kham chira benh co so Theo 6ng (bk) di mpi ngudi dan dupe huong 1- Huy dpng cac nguon luc kinh te cdc djch vy y tc thi Nha nuac can lam gi? 2-Tien tai HBYT toan dan 3- Giam kinh phi y te 4- Xa hpi hoa cac djch vy y te 5- Khac HILU PHONG VAN: Ve linh vyc y te Tinh Lao Cai TT Phan n^i dung chinh Phuong an tra loi 1- Y te benh vi^n c6ng Theo Ong (Ba) cac djch vu y te nao t6t han? 2- Y te benh vi^n tu 3- Trung tam kham chirc benh da khoa 4- Trung tam y le xa phuang - Tu nhan Theo ong (bd) yeu to nao thuc day y te phat I- Quan ly cua nha nuoc tri^n? 2- Kinh phi dau tu 3- Cac trang thiet bj 4- Chuyen mon ciia y, bac sT Hien co can thiet phai tien hanh xd hpi 1- Rat can thiet hoa y te -thua ong (ba)? 2- Kh6ng can thiet Idm 3- Binh ihuong Theo ong (bd) cac thii tyc hanh chinh y le 1- Phien ha, kham chCia benh lau con? 2- Dd dan gian hoa thu tuc hanh chinh 3- Can cai each thii tge hanh chinh 50 [) Ong (bd) nghT gi ve each phuc vu cua cac y 1- Chua nhiet tinh bdc sT b?nh vien e6ng? 2-Nhi?i tinh 3- Binh thuong — • ^ iNeu Dl b?nh ong (ba) co di benh vien? I-C6 2- Kh6ng 3- Tu di mua thuoc 4- Khac Ngoai tien vi^n phi, ong (ba) phai tra cac I-Co loai tien gi nira? 2- Kh6ng 3- Khac Ong (ba) nghT gi ve khuong vien cua benh l-Chat vien tren dja ban ph6? 2- Rpng 3- Binh thuong 4- Qua chat Theo ong (ba) nha nu6c can day manh dich vy 1- Kham chira b^nh cho nguai gid y te nao? 2- Kham va dau tu kinh phi cho nguai ngheo Tre em duai thang tu6i Theo ong (ba) cdc djch vy y te tren dia ban 1- Chua dap ung dupe nhu cau da dap irng dupe nhu cau chua 2- Dap irng dupe nhu cau cho nguai dan 3- Can phat huy cdc djch vu y te i l l K U P H O N G V A N : \ e linh v^rc y te Thanh Hai Phong r Phhn nOi dung chinh Phuang an tra lai Theo C)ng (Ba) cac djch v\i y te ndo t6t hon? 1- Y te b^nh vien e6ng 2- \ ' te benh vien tu 3- Trung lam kham chuc benh da khoa 4- Trung lam y te xa, phuang - Tu nhan Theo ong (ba) yeu to nao thuc day y te phat - Qudn ly eiia nha nuac tri