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Dd'i vdi BHYT, tie'p tuc ra soat nham eat giam, loai bd cae khau trung gian, cac bffdc giai quye't cdng viee chdng cheo, trung lap cac hd sd, bieu mlu khdng can thie't khi thffe hien[r]
(1)Kinh to ^a Uirbao
E)am bao an sinh xa hoi
cho nong dan - Thu'c trang va mot so ham y chmh sach
DINH THI NGA* BUI V A N HOYEN**
Tom tat
Dd'i vdi ngudi nong ddn, chinh sdch ddm bdo an sinh xd hgi dugc the hien tren cdc tru cot chinh Id: bdo hiem y te'(BHYT) tyt nguyen, bdo hiem xd hgi (BHXH) tyt nguyen, trg gidp xd hdi, xda ddi gidm ngheo, cung vtng dich vu xd hgi ca bdn Bdi vie't ddnh gid thytc trqng ddm bdo an sinh xd hgi cho ngudi ndng ddn dUa tren cdc tru cot ndy, qua dd dua mgt sd khuye'n nghi de hodn thien chinh sdch an sinh xd hdi cho ndng ddn d nUdc ta thdi gian tdi
Tff khoa: an sinh xd hgi, ndng ddn, ndng thdn Summary
To farmers, policies on social security are presented in some main pillars including voluntary health insurance, voluntary social insurance, social assistance, hunger eradication and poverty reduction, supply of basic social services This paper reviews the status of social security for farmers based on these pillars, and then provides some recommendations to improve policies
on social security for farmers in our country in the coming time Keyvt'ords: social security, farmers, rural area
GlOfI THIEU PHL/aNG PHAP NGHIEN CLfU
-M
Theo Tdng cue Thd'ng ke (2018), tinh de'n het nam 2017 (sd bo), dan sd Viet Nam dat 93,672 trieu ngffdi, dd gan 2/3 sinh sd'ng d ndng thdn (60,858 trieu ngffdi) Trong so' 53,703 trieu lao ddng tren ca nffdc, thi cd de'n 36,587 trieu lao ddng d khu vffc ndng thon (chie'm hdn 68%) Trong bd'i canh ngffdi dan va lao ddng khu vffc ndng thon chie'm ty le rat cao, tff lau viec dam bao an sinh xa hdi cho ngffdi ndng dan da la chu trffdng ldn cua Dang va Nha nffdc Thffc te nhffng nam qua, nhieu chinh sach an sinh xa bdi da dffdc ban hanh hffdng tdi muc tieu dam bao mffe td'i thieu ve sffc khde va cac phue ldi xa hdi cho dd'i tffdng nay, nhffng hieu qua chffa dat mong ddi Vi vay, viec danh gia de nhin nhan thffc trang, tff dd dffa giai phap tang cffdng an sinh xa hoi cho ndng dan d Viet Nam la ra't can thie't
De danh gia thffc trang dam bao an sinh xa hdi cho ngffdi ndng dan, nhdm tac gia tie'n hanh khao sat trffc tie'p 770 ho ndng dan tren dia ban 15 tinh, phd' nam 2017 Thdng tin chi tie't m l u theo dia phffdng dffdc trinh bay cu the tai Bang
BANG 1: THONG TIN MAO THEO TINH/THANH PHO Tinh /thanh phd'
Ben Tre Binh Du'dng Binh Phu'dc Da Nang Dak Lak Dak Nong Ddng Nai Ha Giang Ha Noi Long An Phu Tho Thanh Hoa TP Hd Chi Minh Tuyen Quang VTnh Long Total
Sd'Weft 19
1 1 29 48 120 26 56 102 69 1 52 96 50 100 770
Tv Id f %i 2.4 0.1 0.1 3.8 6.2 15.6 3.4 7.3 13.2 9.0 0,1 6,8 12,5 6 n o
inn^n Nguon: Khao sat cua nhonn tac gia •PGS, TS., ** PGS, TS., Hoc vien Chinh trj Quoc gia Ho Chi Minh I Email: nga79qlkt@yahoo.com.vn Ngdy nhdn bdi: 01/11/2018; Ngdy phdn bien: 16/11/2018; Ngdy duyet ddng: 20/11/2018
(2)KET QUA NGHIEN CLfU Xda ddi gidm ngheo Mgt Id, hd trg vay vd'n
Theo khao sat cua nhdm tac gia, 34,3% sd ho vay vd'n de san xua't, kinh doanh va ngudn vdn vay nhieu nha't van la tff cac ngan hang (57,3% Iffa chon) Binh quan mdi ho vay 51,92 trieu ddng/thang, dd hg vay nhieu nha't la 300 trieu ddng/thang, ho vay it nha't la trieu ddng/thang Thdi ban vay trung binh khoang 36 thang, dd ho vay dai nha't la 10 nam, hd vay ngan nha't la thang Lai sua't binh quan phai tra la 0,75 trieu ddng/thang
Ve mffe dap ffng cua vd'n vay vdi nhu cau vay, 91,1% cho rang dap ffng tam dffdc va td't Chi cd 8,9% cho rang, vd'n vay chffa dap ffng dffdc nhu cau vay vd'n, mffe vay tha'p (73% Iffa ebon), thdi gian vay ngan (27%), thu tuc vay phffc tap (15,9%) va lai sua't cao (11,1%)
Ngoai ra, 48,1% nhffng ngffdi dffdc hdi mud'n tie'p tuc dffdc vay vd'n, 51,9% cdn lai khdng cd nhu cau vay vd'n hoac tie'p tuc vay vd'n
Hai Id, hd trg tiin hgc nghi
Trong nam gan day, chi cd 8,1% sd' ho cd vien gia dinh dffdc hd trd tien hoc nghe Ngudn tien hd trd hoc nghe dffdc cung cap bdi Hdi ndng dan, Ngan hang Chinh sach Xa hoi, hoc bdng, ngan sach xa, trung tam giao due hffdng nghiep, UBND huyen, trung tam day nghe cua huyen Muc dich hoc nghe la de nang cao tay nghe (56,6% Iffa ebon) va chuyen nghe mdi (43,4%) Sau hoc nghe, 69,2% hoc vien cd thu nhap tang them, cdn lai thu nhap khdng thay ddi Ly giai thich viec thu nhap khdng tang them sau hoc nghe la ndng dan khdng cd viee lam, hoac chffa tim dffdc cdng viee dn dinh; chffdng trinh hoc khdng dap ffng yeu cau cua doanh nghiep ly thuye't nhieu va ngffdi hgc xong khdng lam dffdc viec
Khao sat nhu cau hgc nghe cho tha'y, chi cd 24,1% nhffng ngffdi dffdc hdi cd vien gia dinh mong mud'n dffdc tie'p tuc hd trd hgc nghe, 75,9% edn lai khdng cd nhu cau
Ba Id, hd trg tim viec ldm
Ciing nam gan day, so hd cd ngffdi dffdc Nha nffdc hd trd tim viec lam chi dat 14% Nha nffdc hd trd tim viec lam chu ye'u qua gidi thieu viee lam miSn phi va tff van, dinh hffdng nghe nghiep Ngoai ra, cdn cd them hinh thffc dao tao nghe, cho vay tien dao tao de di xua't khau, eho vay vd'n lai sua't tha'p, hffdng din ky thuat de tff tao viec lam
Tuy nhien, 88,1% y kie'n cho rang, nhffng hd trd tren chffa dap ffng dffdc nhu cau cua ngffdi dan, bdi hg cho rang viec lam khdng phu hdp (52% Iffa chgn), viec lam khdng dn dinh (24%), khdng tim dffdc viec lam (20%), hay viec lam thu nhap tha'p (18,7%) Do vay, 67,2% cho rang, khdng cd vien nao gia dinh mong mud'n dffdc tie'p tuc hd trd tim viec lam
Bdo hiem ddnh cho ndng ddn
Dd'i vdi BHXH tu nguyen, 69,1% ddi tffdng tra ldi
trong ba nam gan day, khdng gia dinh tham
gia BHXH ttf nguyen Dd'i vdi vien chffa tffng tham gia, 71,8% khang dinh khdng cd nhu cau tham gia, ehi 28,2% co nhu cau mua BHXH tif nguyen
Chi cd 30,9% so hg ed vien gia dinh tham gia Tuy nhi6n, so nhffng vien dang tham gia BHXH tff nguyen, 48,8% cd nhu cau tiep tuc tham gia, cdn lai 51,2% khdng cd nhu cau tie'p tuc tham gia nffa
Dd'i vdi BHYT, 12,3% dd'i tffdng chifa
tham gia BHYT, khdng cd tien (49%), tha'y khdng can thie't (39,1%), khong cd thdng tin va khdng bie't mua d dau (5,7%) Dd'i vdi nhffng ngffdi chffa tham gia BHYT tff nguyen, 68,5% cd nhu cau tham gia bao hiem
87,7% nhffng ngffdi dffdc hdi tra ldi co the BHYT Trong dd, 68,1% da sff dung BHYT de kham, chffa benh va 31,9% chffa sd dung lan nao
Ve thu' tuc toan BHYT, 64,1% dd'i tffdng nhan xet thu tuc nhanh gon, thuan tien, 31,4% cho bie't thu tuc rffdm ra, mat thdi gian, 4,3% danh gia toan rat khd khan, hoac cd nhiing nhidu 60,6% ngffdi dffdc hdi cho rang, hp dffdc hffdng dan tan tinh, de hieu qua tnnh sff dung BHYT, 23,8% danh gia hffdng dSn qua loa va 15,6% ddi tffdng phai tff tim hieu gan nhff hoan toan
Ve" mffe chi tra cua BHYT, 61,7% danh gia mffe chi tra trung binh, mot sd chi phi khdng dffdc bao hiem chi tra; 32,0% danh gia mffe chi tra cao, giam chi phi kham, chffa benh eua gia dinh; 6,4% khang dinh mffe ehi tra tha'p, hau het gia dinh phai tff toan
Cung theo khao sat, nam qua, trung binh mdt hg gia dinh mlu dieu tra cd 5,79 Iffdt di kham, chffa benh Chi phi trung binh eho boat ddng kham, chifa benh la 12,5 trieu ddng/nam, chu yeu gia dinh tff ehi tra 54,2% sd ngffdi tham gia khao sat tra ldi, gia dinh cd kha nang chi tra sdtien nay, 26,5% "tffdng dd'i chat vat de xoay xd tien chi tra", 13,5% "rat khd cd kha nang chi tra" va 4,3% "hoan toan khdng cd kha nang toan, phai xin vien hoac xin tai trd"
Khi dffdc hdi ve sff phan biet ffong kham, chffa benh giffa benh nhan siJf dung BHYT va benh nhan khdng su" dung, 60,8% khang dinh khdng cd sif phan biet nao, 35,3% Iffa chgn "benh nhan khdng sff dung bao hiem dffdc phue vu td't hdn" va 3,9% cho rang benh nhan sff dung bao hiem dffdc phue vu tdt hdn
(3)Kinhte va Dirha
Dd'i vdi viee dung BHYT de di kham, chffa cac loai benh khdng nghiem trgng va chi phi kham, chffa benh tha'p so vdi mffe thu nhap cua gia dinh, thi 51,4% lifa chgn cd sur dung BHYT, 26,1% Iffa chgn khdng su* dung BHYT, 22,3% xem xet tiiy thifc te thu tuc va dich vu cua tffng benh vien, tram y te, ma se quye't dinh CO dung BHYT hay khdng
Trg giiip xd hgi ddnh cho ndng ddn
Dd'i vdi hd trg thudng xuyen,
nam gan day, 84,7% sd' hd khdng dffdc hffdng cac che trd giup, nhff: hd trd tien mat hang thang, cham sdc tai cac ed sd bao trd xa hdi Chi khoang 9,4% sd' ho dffdc nhan hd trd tien mat hang thang, 0,5% dffdc nhan cham sdc tai cac cd sd bao trd xa hdi, nha xa hdi
Trong so' hd dffdc trd giup tien mat hang thang, cac vien chu yeu thugc nhdm sau: ngffdi thudc hd ngheo (50,8%); ngffdi cao tudi (24,6%); ngffdi ldn khuyet tat (20%); tre em khuyet tat (13,8%) Ngoai ra, cdn cd mdt sd'it vien thudc cac nhdm, nhff: tre em nhiem HIV thudc hg ngheo va ngffdi bi nhiem HIV thudc hd ngheo Mac du dffdc hffdng hd trd, song 43,2% dd'i tffdng nhan trd cap cho rang, tien trd cap hang thang it, khdng dap ffng dffdc nhu cau cua hg 45,6% cho rang tien trd cap d mffe binh thffdng
Mdt diem tieh cffc la, tien trd cap phat thffdng xuyen dung ban (76,9% ddng y), chi cd 6,4% cho la cham
Trong so cac hg cd vien dang dffdc cham sdc tai cac trung tam bao trd xa hdi, nha xa hdi, hau het cac hd deu danh gia chat Iffdng cham sdc va sinh hoat tai cac cd sd la trung binh va tdt, kha tren cac mat ddi sd'ng vat chat, tinh than, hd trd giao due, dao tao nghe Rieng cham sdc y te' tai cac trung tam vin nhan dffdc danh gia kem
Dd'i vdi hd trg dot xudt, ket qua Bang
2 cho thay, hinh thffc chu ye'u la hd trd Iffdng thffc dip Tet am lich (76,5%) Cac hinh thffc hd trd khac, nhff: hd trd sau thien tai, hda hoan, tai nan lao ddng cd dffdc thffc hien, nhffng ty le rat ban che' Dd'i vdi cac khoan trd cap dot xua't nay, 58,9% cho rang la khdng du dap iJng nhu cau cua ngffdi/hd gia dinh nhan trd cap, 31,1% danh gia tffdng ddi du va du so vdi nhu cau, cdn lai 10% khdng rd Ve viec ca'p phat cac khoan trd cap, 83,1% nhan xet cac khoan dffdc cap phat binh thffdng va kip thdi Chi cd 4,8% cho rang cap phat cham
BANG 2: cAC HINH THCfC H TR0 DOT XOAT Hinh thii'c hd tr^
H6 trd lifdng thtfc dip Tet am lich
H trd Itfdng thtfc sau thien tai, hoa hoan, mat miia
Ngifdi bi thifdng nang thien tai, hoa hoan, tai nan giao thong, tai nan lao dong
H S trd chi phi mai tang thien tai, hoa hoan, tai nan giao thong, tai nan lao dong
Ho trd lam nha d, sila chifa nha d theo quy dinh
Ho trd khan cap tre em cha, me de bi chet, mat tich thien tai, hoa hoan hoac ly bat kha khang
Ho trd tao viec lam, phat trien san xuat theo quy dinh
Ty 1§ dtfcfc nhSn (%) 76,5 13,6 6,2 3,7 14,8 1,2 16,0 BANG 3: CAC LOAI H TRd HOC SINH DtfdC HC/dNG
Lo^i hd tr(;r Difdc mien, giam hoc phi
Du'dc ho trd trang phue, sach vd, diing hoc tap Du'dc cap hoc bdng
Difdc ho trd lu'dng thifc, thu'c an Dufdc ho trd cho d
Ho trd khac
Ty le dvKfc nh§n (%) 25,9
7,2 2,6 11,0 5,3 4,6 BANG 4: KHO KHAN CUA DICH Va Y TE TAI DIA PHCTdNG
Kho khan Thie'u cd sd y te phil hdp
Thie'u can bp y te Trinh bac sy ye'u Trang thie't bi thie'u, lac hau
Chi phi kham, chUa benh cao khong difdc su" dung the BHYT, hoac mu'c toan cho ngu'di benh co the qua tha'p Cong tac tuyen truyen kem
Con hien tu'dng tieu cifc kham, chiTa benh
Ty le danh gia (%) 39,7 22,4 37,9 47,2 8,1 22,8 10,7 Mguon: Khao sat cua nhom tac gia
Mgt so'dich vu xd hgi eg bdn ddnh cho ndng ddn Ket qua khao sat cho bie't, 68,7% sd hd mSu khao sat cd tre em dang di hgc Idp miu giao tudi tai cae cd sd cdng lap va dffdc miSn hgc phi
Dd'i vdi hgc sinh di hgc, theo Bang 3, cac loai hd trd phan ldn dffdi hinh thffc miin, giam hgc phi (25,9%), hd trd Iffdng thifc, thffc an (11%) va trang phue, sach vd, dd dung hgc tap (7,2%) Ngudn kinh phi cho boat dgng hd trd la ca tff ngan sach nha nffdc (83,8%) va cac td chffc ngoai nha nffdc, nhff: hdi phu huynh cua trffdng, Idp
Danh gia ve khd khan cua dich vu y te tai dia phffdng Bang cho tha'y, khd khan ldn nha't la trang thie't bi thie'u, lac hau (47,2% ddng y), thie'u cd sd y te phu hdp (39,7%) va trinh bac sy yeu (37,9%)
Ve nha d, hien chi cd 11,9% sd'hd dang sd'ng nha tam, dot nat, cdn lai deu sdng nha ban kien cd, kien cd', nha xay 89,6% sd'hd tff xay nha, 5,8% so' hd dffdc Nha nffdc hd trd tien xay, 1,8% dffdc lang xdm hd trd, 1,3% vay tien lai sua't tha'p de xay dffng, 1,8% la nha thue de d Trong sd'cac hd nay, chi 23,4% sd'hd cd nhu cau hd trd ve nha d Cac dd'i tffdng cdn lai khdng cd nhu cau hd trd nha d chu ye'u la khdng thugc dien hffdng hd trd va tff lo dffdc/khdng cd nhu cau sufa chffa
(4)xay nha mdi Ngoai ra, nguyen nhan cdn khoan hd trd tha'p, khdng dap ffng nhu eau, thu tuc vay phffc tap, tieu cffc qua tiinh xet duyet
Lien quan de'n viec sff dung nffdc sach, 67,1 % sd hd da lap ddng hd nffdc Cac hd cdn lai su" dung ngudn nffdc khac tff dffdng dng, nffdc gieng khoan, nffdc tff nhien tff sdng, sudi
Danh gia chat Iffdng ngudn nffdc, 56,8% sd hd cho rang, hg dung nffdc sach, hdp ve sinh theo cam nhan ca nhan; 29,3% danh gia nffdc sach theo chuan qud'c gia; 5,8% cho rang nffdc hg dung khdng hgp ve sinh Nguyen nhan cac hd gia dinh chffa dffdc tiep can dffdc ngudn nffdc hdp ve sinh la dia phffdng chffa cd hg thd'ng nffdc hdp ve sinh (78,1%); khdng cd tien de lap dat dffdng dng din nffdc vao nha (23%); gia dinh khdng cd tien tra tien nffdc hang thang (10,9%) Hdn nffa, cd tdi 72,6% sd hg khdng nhan dffdc bat cff hd trd nao viec xay dffng, lap dat, trd gia sff dung nffdc Ve van de cung cap thdng tin, khao sat cho tha'y, trff thdng tin ve sffc khde va thdi sif chinh tri, giai tri dffdc chinh quyen dia phffdng cung cap tffdng dd'i thffdng xuyen, cdn cac loai thdng tin khac thi cung cap it hoac chi cd chffdng trinh, dff an
Trong dd, khao sat cho tha'y, nhu cau cua ngffdi dan dffdc cung cap thdng tin tff chinh quyen dia phffdng la rat ldn Da so nhffng ngffdi tham gia khao sat cd nhu cau dffdc cung cap ta't ca cac loai thdng tin tren, dac biet la ve cham sdc sffc khde (95,6%), giao due (89,2%), hffdng din san xua't, kinh doanh (87,9%)
MOT SO HAM Y CHINH SACH
Thdng qua ke't qua khao sat, nhdm tac gia de xua't mdt so kien nghi chinh sach nham dam bao an sinh xa hdi cho ngffdi ndng dan thdi gian tdi, nhff sau:
Mgt Id, hodn thien chinh sdch hd trg viec ldm vd gidm ngheo theo hudng:
Nang ty le vay vdn de phat trien san xua't ndng nghiep dd'i vdi hd ngheo, hd vffa thoat ngheo
- Hd trd dao tao nghe gan vdi nhu cau cua thi trffdng lao ddng d tifng viing ndng thdn
Dd'i vdi ndng dan phai chuyen ddi nghe nghiep, dao tao nghe can gan vdi hd trd tim kiem viec lam phii hdp vdi nganh nghe dao tao, vdi nang life lam viec Cd chinh sach hd trd dao tao nghe dai ban vdi nhffng nganh nghe ma xa hgi cd nhu cau nhieu
Hai Id, hodn thien chinh sdch bdo hiem
Dd'i vdi BHXH, can da dang hda cac mffe ddng gdp cho phd hdp vdi dieu kien kinh te, thu nhap, tam ly, thdi quen cua ngffdi dan; day manh tuyen truyen nang cao y thffc, trach nhiem cua ngffdi ndng dan dd'i vdi viec tu" dam bao an sinh cho ban than
Dd'i vdi BHYT, tie'p tuc soat nham eat giam, loai bd cae khau trung gian, cac bffdc giai quye't cdng viee chdng cheo, trung lap cac hd sd, bieu mlu khdng can thie't thffe hien cac thu tuc hanh chinh ve BHYT, dac biet la viec dang ky tham gia, thu nop, cap, ddi the BHYT va toan chi phi kham chffa benh BHYT cho ngffdi dan
Ba Id, md rgng dd'i tugng, tdng mdc hd trg vd da dqng hda cdc hinh thdc hd tra ddi vdi chinh sdch trg gidp xd hdi
Tffng bffdc dam bao cho mgi ngffdi ndng dan cd thu nhap dffdi mffe sdng td'i thieu deu nhan dffdc trd giup xa hpi; hoan chinh he thd'ng chinh sach trd giup xa hdi theo hffdng tiep tuc md rdng ddi tffdng thu hffdng, nang dan mffe trd cap xa hdi thffdng xuyen phu hdp vdi kha nang ngan sach nha nffdc
Ben canh Nha nffdc ddng vai tro chu dao, can md rdng sff tham gia cua khu vifc tff nhan vao trien khai cac mo hinh cham sdc ngffdi cao tudi, tre md coi, ngffdi khuye^t tat, dac biet la md hinh nha dffdng lao; dam bao hd trd kip thdi, hieu qua cho ngffdi ndng dan gap rui ro dot xua't (hoa hoan, tai nan, thien tai ) cd the khac phue va vffdt qua khd khan, sdm dn dinh san xua't va ddi sd'ng, dam bao thu nhap, khdng bi rdi xud'ng ngheo khd
Bdn Id, ndng cao chdt lugng cung cdp dich vu xd hgi ca bdn:
Tang cffdng cung cap cho ndng dan thdng tin hffdng dan san xua't, kinh doanh, thi trffdng tieu thu san pham, thdng tin ve viee lam, giao due, cham sdc sffc khoe, dae biet la thdng tin ve cac che do, chinh sach cua Nha nffdc dd'i vdi ngffdi dan
Day manh cdng tac quan ly chat Iffdng benh vien, xay dffng bd tieu chuan chat Iffdng benh vien lam cd sd kiem tra, danh gia chat Iffdng dich vu kham, chu'a benh Hang nam, Bd Y te nen bd sung danh mue cac dich vu, thudc, vat tff y te kip thdi de dap ffng nhu eau cua ngffdi bdnh cd the BHYT
Day manh xa hdi boa cdng tac y te, da dang cac hinh thffc td chffc kham, chSa benh de dap ffng nhu cau va chat Iffdng kham, chffa benh BHYT cang cao cua ngffdi ndng dan.Q
TAI LIEU THAM KHAO
1 Qudc hgi (2013) Hien phdp nude Cdng hda Xd hgi Chd nghia Viet Nam, 28/11/2013 2 Tdng cue Thd'ng ke (2018) Nien gidm Thd'ng ke ndm 2017, Nxb Thd'ng ke