TiNH HlNH K H A M C H C A BENH B A O H I ^ M Y T t TAI TRAM Y T^ XA THEO LUAT B A O H I ^ M Y T ^ TAI lirtOT S6 T I N H
Nguyin Ho^ng Long*, Nguyin Thanh Long BpYte
TOM TAT
Nghi6n cuu vi#c tri^n khai khdm chOa b^nh bSo hilm y ik (KCB BHYT) tgi tram y te (TYT) xa theo Lu|t BHYT dupc li6n h&nh nhSm phSl hi$n nhO'ng kh6 khan, t6n lgi trong qud trinh tn4n khai chinh sdch. Nghifin cir\i khdo sdt tgi 16 TYT xa thuOc 8 huy$n cda 4 tlnh, thu thdP th6ng tin qua phu-ong phdp dieu Ira co sd y t^. phdng viin sdu vd thdo lu$n nh6m. Kki qud nghiSn cdu cho th^y: Ty l# cdc TYT xd tham gia KCB BHYT tgi 4 linh nghidn CLPU chi6m ty i$ 83-94% Phuong thiPC thanh todn cho KCB BHYT tgi TYT xa khong c6 sy thay a6i giu'a trirbc vi sau khi cd Ludt BHYT. KCB BHYT tgi TYT xd cua 2 tinh bj khong ct\k mirc trin thanh todn, d 2 tinh khdc khdng b[ kh6ng ch^ muc tr^n thanh todn. Vi§c KCB BHYT tai TYT xa hi§n tai gap r^t nhilu khd khdn do dieu ki§n co sd v|t chit, TTB y t i vd nhdn iyc it cdc TYT xa chua dam bdo chit iugng 6k ddp irng nhu ciu KCB.
Til' khda: Khdm ch&a b^nh, TYT xd, iudt BHYT L DAT VAN DE
Bao hi6m y te la mgt nguon lai chinh y te quan trpng gop phan thuc hien muc lieu cong bSng trong cham soc sire khoe. Sau han 15 nam trien khai BHYT, chinh sach BHYT da thu dugc nhihig k6t qua nhat dinh. S6 ngudi tham gia BHYT lien tuc lang qua cac nam, tinh den cuoi nam 2010, dat ty le bao phu khoang 62%
dan so. Quyen lpi cua ngudi tham gia BHYT ngay cang dugc ma rgng va dam bao. Viec ngudl benh dugc tiep can cac dich vu kham chiia benh BHYT ngay tai tuyen xa, phudng da gop phan giam bdt chi phi kham chixa benh, Khoang 70% trong tong so 10.303 tram y te xa phudng tham gia kham chira benh BHYT [1].
De tirng buoc hoan chinh he thong chinh sach ve BHYT, Luat BHYT dugc ban hanh ngay 14/11/2008 va co hieu Iuc thgc lhi ttr 1/7/2009, trong do, neu ro viec tri^n khai KCB BHYT tai tuyen xa. Nghien ciru danh gia viec trien khai kham chiia benh BHYT tai luyen xa dugc thuc hien nham phat hien nhiing khd khan, ton tai trong qua trinh trien khai chinh sach BHYT. Nghien cim nay tap trung vao 2 muc tieu sau: (i) Mo ta viec triSn khai kham chira benh BHYT tai Tram y te xa Iheo quy dinh
cua Luat BHYT d mot so dja phuang; (ii) Xac dinh nhiing kho khan, tdn lai trong trien khai kham chiia benh BHYT tai TYT xa theo quy dinh cua Luat BHYT.
IL PHlTONG PHAP NGHIEN ClTU Phuang phap dugc sir dung trong nghien cuu nay la mo la cat ngang c6 phan tich, ket hgp hai phuang phap thu thap so lieu dinh tinh va dinh Iupng. Nghien ciiu tien hanh tai 4 linh dugc lua chgn CO chu dich bao gom: Ha Nam, Khanh Hoa, Kien Giang va Gia Lai. Tai m6i tinh, lua chgn ngau nhien 2 huyen va mdi huyen lira chon 2 xa CO trien khai kham chiia benh BHYT.
Trong nghien cuu dinh Iugng, dieu tra co sd y le thong qua bieu mSu dupc ap dung de thu thap thong lin lien quan den boat dpng kham chiia benh BHYT cua cac ca so y te dugc khao sat trong khoang thai gian tir nam 2009 den 6 thang dSu nam 2011. Phong van can bp y te bang bp cau hoi dugc thiet kk sim ciing dugc ap dung nham tim hieu danh muc cac trang Ihiet bi tai tram y te xa so vai qui dinh tai Quyel dinh 1020/QD-BYT va tinh hinh tu danh gia cua can bp tram y tk ve kha nang thuc hien thanh thao cac dich vu y te theo danh muc ky thuat tai TYT
* Ten tac gia: Nguyen Hoang Long Dia chi: Bg Y t6. Ha Ngi Dien thoai, 0913503255 Email: [email protected].
122 Tap chi Y hpc dir phong. Tap XXIII, s6 2 (137) Ngay nhan bai: 26/11/2012 Ngay giri phan bien: 29/11/2012 Ngay dang bai: 28/4/2013
xa so vdi quy dinh t^i QD 23/2005/QD-BYT.
Trong nghien cihi dinh linh, lidn hanh phong vkn sau va thao Iuan nhom dugc thgc hien vdi nhom doi tupng vdi Ianh dao Sd Y le, co quan BHXH tmh/huyen, lanh dao TTYT huyen, ti-am Irudng TYT xa va b?nh nhan co the BHYT dk tim hi6u nhiing thu&n Igi, kho khan, bat cap frong kham chiia b8nh BHYT.
So lieu tii nghien ciiu dinh lupng dugc phan lich bang phan mem Stala.Thong tin djnh linb dugc dugc xii ly theo phuang phap ma hoa md vdi tiing nhom chii de.
IIL KET QUA
3.L Tinh hinh trien khai kham chira benh
BHYT taii TYT xa theo quy dinh ciia Lu?t BHYT & mpt s6 dia phuong
TYT xa CO thuc hi?n KCB BHYT chifim mpt ty le tuang doi cao tai 8 huyen thugc 4 tinh nghien ciiu, chicm khoang 95% (trir mgt huyen thugc tinh Khanh Hda co ly le TYT xa tham gia KCB BHYT lh4p nhat, chi chiem 22%). Khong CO su thay ddi ve ty I? TYT xa KCB BHYT qua ba nam 2009, 2010 va 6 thang 2011. Cac xa chua trien khai chu yeu la do chua dii dieu kien ve CSVC va chua c6 bac si.
Vg hinh thuc ky hgp d6ng ti'ong KCB BHYT tai TYT xa, co quan BHXH huyen khong ky hgp ddng hire h6p vdi TYT xa tiong KCB BHYT ma ky hgp dong KCB BHYT vdi benh vien huyen, trong do bao gdm ca KCB BHYT lai TYT xa.
Bdng 1. Phuo'ng thifc thanh toan KCB BHYT tai cdc huyen va xa khdo sat tru'dc vd sau khi trien khai Luat BHYT
Dja dilm Tnrac khi cd L u | t (<2009) Sau khi co Luat (>2010)
Hd Nam Kien Giang Khdnh Hda Gia Lai
Tuyen huyen Phi dich vu Phi dich vu Phi djch vu Phi dich vu
Tuyen xa Cd muc tran Cd muc tran Thuc thanh thuc chi Thgc thanh thyc chi
Tuyen huyfn Djnh suit Djnh suit Dinh suit Oinh suit
Tuyen xa Cd mtrc tran Cd mi>c trin Thuc thanh thuc chl Thuc thanh thuc chi Phuong thiic thanh toan cho KCB BHYT tai
TYT xa khong co su thay doi trudc va sau khi CO Luat BHYT, cho du phuang thiic thanh toan BHYT cho cac benh vien huyen c6 thay doi tii hinh thiic phi dich vu sang khoan dinh suit.
Viec KCB BHYT tai TYT xa bi quy dinh miirc frln thanh toan a 2 huyen khao sat thupc tinh
Ha Nam (khong qua 30.000d/l don thuoc) va Kien Giang (khong qua 35.000d/l don thuoc).
Cl Khanh Hda va Gia Lai, KCB BHYT tai TYT xa khong bi khong che muc Iran thanh loan.
Viec quy dinh phucmg thiic thanh loan va miic trin thanh toan KCB BHYT lai TYT xa nay phu thugc vao timg benh vien huyen.
Bang 2. Hoat dong KCB BHYT tai cac xa duxrc khao sat cua 4 tinh
Chi so
Ty 10 ]irat b^nh nhan c6 the BHYT/t6ng s6 luqrt benh nhan KCB tai TYT xa (%)
-2009 -2010 - 6 thang 2011 So lan KCB binh quan nam tai TYT xa cOa benh nhan BHYT
-2009 -2010 - 6 thang 2011
Ha Nam
66,1 75.1 62,0
3,1 1.7 0,8
Kien Giang
37,6 28,2 33,4
2,3 1,4 1,2
Khanh Hoa
47,6 46,5 51,0
2,8 1,5 1.4
Gia Lai
46.4 48.2 43,9
2,6 1,6 1,3
Tap chi Y hoc du phong, Tap XXIII, so 2 (137) 123
Ty I? b?nh nhan co the BHYT den KCB lai TYT xa so voi ldng so lugt b?nh nhan ddn KCB tai TYT xa co sy dao dpng ldn giua cac tinh. CJ linh Kien Giang, chi khoang 1/3 so hrpi b?nh nhan dan KCB tai TYT xa co the BHYT. Gia Lai la tinh co ty le bao phii BHYT cao do da so dan la dong bao dan tpc thieu so nhung ty I?
ngudi CO the BHYT den KCB tgi TYT xa l?i chifim ty I? tuang doi thap (chua den 50%). Kel qua thao luan nhom vai TYT xa cua tinh Gia Lai cho lhay nguyen nhan chii yeu la do the bi sai thong tin nen benh nhan khong dugc KCB bang BHYT.
"Nhi&u ngudi c6 the BHYT d6n kham tai tram nhung khong cSp thuoc dugc lir nguon BHYT do the bj sai thong tin. Da phSn la sai hp ten do chil yeu la ngudi dan lgc. Neu minh cir cap thuoc thi a huyen ciing khong thanh toan do quy dinh chat ISm" - Phong van sau tram trudng TYT xa.
Ty le benh nhan dSn KCB tai TYT xa c6 the BHYT d linh Khanh Hoa chiem khoang 50%
va cao hon d tinh Ha Nam (hem 60%). Phan tich so lan KCB binh quan nam tai TYT xa cda b?nh nhan c6 the BHYT cua 8 huyen khao sat d 4 tinh qua cac nam, ket qua cho thay ngudi c6 the BHYT di kham chiia benh vdi tan suit tuong doi cao. Tuy nhien, tan suat nay c6 xu hudng giam theo thdi gian khi thuc hien phuang thiic KCB BITYT theo dinh suit. Cu thS la d tinh Ha Nam, nam 2009, trung binh 1 ngudi co the BHYT KCB tai TYT xa 3,1 l k , nhung tii sau nam 2010 khi ap dung phucmg thuc thanh loan khoan theo djnh xuat, chi so nay giam xuong chi con 1,7 Ian nam 2010 va 0,8 lan trong 6 thang dau nam 2011. Tuong tu nhu vay, d cac linh con Iai (Kien Giang, Khanh Hoa va Gia Lai), chi s6 nay cung giam tu khoang 2,3-2,8 lin/l the BHYT xudng con 1.2-1,4 lin/l the BHYT ti-ong 6 thang diu nam 2011 (Bang 2).
Ty le benh nhan co the BHYT chuyen luy6n tir TYT xa len BV huyen vdi ty le tuang doi cao d mpt so dia phuong. Tuy nhien thuc td lai TYT xa khong thong ke so lieu chuygn tuyen. Ly do benh nhan cd the BHYT khong KCB BHYT tai TYT xa ma xin chuyen vien da dugc tim hi6u qua thao luan nhom vdi TYT xa va benh vien huyen, chii yeu la do cac dich vu y 18 cung iing
tgi TYT xa chi la c^c dich vy ca ban, tham chi thieu thudc thidt yfiu so vai danh myc quy dinh, nhan lyc vira thifiu vira yfiu khong dap ung dugc nhu chu KCB cua ngudi b?nh nen TYT xa phdi chuyfin b?nh nhan Ifin BV huy?n. Vi du nhu b?nh nhan bj b?nh mgn tinh nhu tifiu dudng, tang huyet ap da cd bifin chung... nhung danh myc thudc ctia TYT xa khong co hoac b?nh nhan can phai lam xet nghicm nhung TYT xa lai khong co nhimg dich vu cgn lam sang.
••Danh muc thuoc KCB BHYT tgi TYTxa Id khdng hpp ly. Chu truang vdn ndi Id dua KCB BHYT vi xd nhung bpnh nhdn bi tdng huyit dp len bpnh vipn khdm bpnh vd du^rc cho thudc theo danh muc thuoc cua luyin huypn, ldn sau bpnh nhdn den TYTxa khdm cdng vi tdng huyil dp nhu-ng lgi chi cdp du(Tc thudc theo danh mi^c thuoc luyen xd nin bpnh nhdn thdc mdc vd xin chuyin di do muon dugrc diiu tri cimg thuoc vdi ldn tru&c " - Phdng van sau tram trudng TYT xa.
Mgt ly do nira ciia vi^c chuyen myen la benh nhan tu de nghj dugc chuyfin tuyfin do khong tin tiidng vao chit lugng KCB lai TYT xa. Nhu d huyen Chu Se tinh Gia Lai, hku hfit cac TYT chua trien khai do de tai TYT xa, thyc tfi chi co 3 TYT xa da de mac dii ca 15 TYT xa trong huyen dfiu c6 nir ho sinh va dupc trang hi du dung cu da de. O Kifin Giang. kfit qua thao luan nhom vdi cac trudng tram y te xa cho lhay "mpt ty le rdt cao benh nhdn din TYTxa chi de xin gidy chuyen vien chir khdng phdi de KCB. Ho khdng tin tu&ng vdo chdt luang diiu tri cua chiing toi vd xin di. Khdng cho khdng dirac".
3.2. Nhihig kho khan, ton tai trong trien khai kham chua b^nh BHYT tai TYT xa theo quy dinh cua Luat BHYT
Viec tiifin khai KCB BHYT lai TYT xa theo Lual BHYT da lam lang dugc kha nang tifip can ciia nguai dan ti-ong KCB BHYT ngay lai tuyfin xa, dac bigt cho doi tugng la ngudi cao luoi, ngudi ngheo va mgl so nhdm doi tugng tdn thuang khac. Tuy nhifin, trong boi canh hien nay, viec KCB BHYT tai TYT xa con ggprSt nhieu khd khan. Kfit qua dieu tra ca so y tfi ve tinh trang ca sa vat chat, trang thifit bi, kha nang thuc hien danh myc phan tuyfin ky thugt cimg nhu kel qua thu dugc lir phong van sau va thao
124 Tap chi Y hoc dir phong, Tap XXIII, so 2 (137)
luin nhom vdi nhom doi tugng la tram truang tdng s6 co 175 trang thifit bi dugc quy dinh d irgm y te xa cho thay nhiing bat cap sau day: tuyfin xa nhung tren thyc te d ca 4 linh khao sat, - Cac TYT xa dupc khao sal con thifiu nhifiu trung binh mpt TYT xa chi c6 77 trang thiet hi trang thiet bi y tfi tiieo quy djnh cua Bg Y lfi: (chifim dudi 50%) (Bang 3).
Bang 3. Tlnh hinh sin cd mgt s6 trang thiet bj t^i tr^m y te xa so vd-i qui djnh tgi Quylt djnh 1020/QO-BYT ngdy 22/3/2004 Trung binh s6 logl trang thilt bj tgi TYT du
theo qui djnh H^ Nam Kien Giang Khdnh Hda Gia Lai Chung
Kh^m vS dlki trj {69 ioai) Y hoc CO truyan (24 loai) Chuyen khoa TMH-RHM-M4t (17 loai) Kh^m di^u trj sin phy khoa - dff (J6 (35 loal) TTB xet nghi§m
Dgng eg di$t khuan (9 loai) Chung (175 ioai)
30 4 6 24 0 4 73
29 5 2 25 0 5 72
50 4 3 27 0 4 97
33 3
»
18 0 3 67
34 4 4 24 0 4 77 - Kel qua tu danh gia ciia can bd tram y
le xa ve kha nang thyc hifin thanh thgo cac dich vu y le theo danh myc ky thuat tgi TYT
xa so vdi quy dinh tai QD 23/2005/QD-BYT ngay 30/8/2005 cho thiy con rlt han che (Bang 4).
Bang 4. Ty ddnh gia ve khd nang thyc hdnh thanh thao m$t so cdc danh muc ky thuat thu&ng gap tai tram y te xa theo qui djnh tai QD 23/2005/QD-BYT ngay30/8/2005)
Phan nhom ky thugt Hd Nam Kien Giang Khanh Hoa Gia Lai Hoi sue cap ci>u, ch6ng ddc va npi
khoa (18 ky thuat) Nhi khoa (12 ky thuat) Ngoai khoa (13 ky thuat) Phg san (13 ky thuat)
10
5
- Nhan lyc y tfi thifiu ve so lupng, yeu ve chat Iugng va bat hgp ly ve ca cau, tinh trang TYT xa chua cd bac si Iam vi?c tai tram vln cdn pho bifin (44% TYT xa dugc khao sat c6 bac sT va hau hfit dfiu la bac sT he chuyen tu), danh myc thuoc KCB BHYT a TYT xa hgn chfi; kinh phi chi cho hogt dgng thudng xuyen ciia TYT xa khong dii.
- Quy dinh kfi dan thudc khong phii hpp: doi vdi nhihng TYT xa co bac sT tang cudng hi BV huyen, viec ke don thudc vln phai theo danh myc thuoc danh cho TYT xa da dan dfin tinh tr^ng bac si tir BV huyfin khdng mudn tang
cudng ve xa do dich vu ky thuat qua hgn che, bfinh nhan den TYT xa dugc bac sT myfin trfin vfi KCB nhung quyen Igi dich vu dugc hudng cung vln khong co gi khac biel.
- Mirc Ihu phi KCB d TYT xa con qua thap va khong co cac nguon kinh phi khac de bu dap cac khoan chi phi khac (in in hd so, bieu mSu, chi phi di Iai dfi giao dich, nhgn thuoc tir BV/TTYT huyen...) nfin da gay rdt nhifiu khd khan cho TYT xa trong KCB BHYT.
- Viec cap phat the BHYT d mgt so dia phuang con chua kip thai va nhifiu sai sot, anh hudng tai quyen lpi cua ngudi c6 the BHYT.
Tap chi Y hoc du phong, Tap XXIII, so 2 (137) 125
IV. BAN L U ^ N
Vi?c KCB BHYT tgi TYT xa khong c6 sy thay ddi giira trudc va sau khi cd Lugt BHYT vfi so lugng cac TYT xa tham gia KCB BHYT ciing nhu ve phuang thirc thanh toan cho KCB BHYT lai TYT xa. So iugng cdc TYT xa tham gia KCB BHYT khong co sy thay doi nay la do vi?c dhu lu cho cdc TYT xa dugc Ihyc hi?n tir trudc khi c6 Lugt BHYT dfi cdc xa dupc cong nhan Chuan quoc gia y tfi xa [2].
Hau hfit cdc TYT xa chua tnen khai KCB BHYT dfiu la cdc xa chua dgt chuan quoc gia vfi y te xa, nguyen nhan chii yfiu do chua dii dieu kifin vc ca sd vat chat va chua c6 bac sT.
Vific KCB BHYT a 2 tinh Khanh Hoa va Gia Lai khong bi khoan miic Iran thanh loan.
D6i voi tinh Khanh Hda, ly do chu yfiu Id do tinh CO chii truang trong md rgng quyfin Igi KCB cho bfinh nhan BHYT ngay tai luyen xa.
D6i vdi linh Gia Lai, do ly le chi tifiu quy a tinh nay rdt thap do vay viec KCB cho bfinh nhan BHYT tai TYT xa khong hi han chfi mirc tran thanh toan. Cdc tinh nhu Hd Nam va Kifin Giang bj han che miic tran thanh todn tai TYT xa do hdu hfit cac BV huyen dfiu trong linh trang bi dm quy do linh trang thanh loan da tuyen. Ket qud vfi so Idn KCB binh quan nam lai TYT xa cua benh nhan BHYT d 2 linh Ha Nam va Kien Giang da cho thdy ro chi so nay CO xu hudng giam theo thdi gian khi thyc hifin phuang thirc KCB BHYT theo dinh xudt. Dfi han chfi tinh trgng hi am quy, cdc BV huyfin da phdi co cdc quy dinh chat che ban trong KCB BHYT tgi luyfin xa.
Ty le benh nhan chuyfin tuyfin cao phan ndo phan anh dupc linh san co va chat lupng djch vu y le tai TYT xa. Kel qua cua mgl nghifin ciiu khdc ve "Danh gia tinh hinh thyc hicn KCB BHYT lai TYT xa" cung cho thay xd CO ty le chuyfin luyen cao thudng d nhirng xa khong c6 bac sy lam vific vd chi co khoang 5-10% Id benh nhdn dugc chuyfin do vugl khd nang cua TYT xa, con chu yfiu Id do benh nhan de nghi dupc chuyen Ifin bfinh vi$n dfi ldm them xet nghiem hoac do benh nhan
khong hai long voi cac dich vy y tfi tai TYT xa [3].
Kfit qud nghifin cuu da chi ra mgt so kho khan, ton tgi trong KCB BHYT lai TYT xa.
Tuy nhifin, co nhifiu van de l6n lai c6 lien quan den chat lugng khdm chira b?nh t?ii TYT xa, cy th^ Id: nhdn Iyc khong dam bao do thifiu ve s6 lugng va trinh dp han chfi; thifiu trang thiet hi; kha nang thyc hien thdnh thao cac dich vy y le theo danh muc phan tuyfin ky thuat han chfi... Ket qua nghifin ciiu "Danh gid vi?c thyc hi?n chirc nang nhiem vy cua TYT xa tai 10 tinh" lien hanh nam 2010 cung cho nhan dmh chdt lugng kham chiia benh ciia TYT xa hifin tgi chua ddm bdo do nhiing bat cgp vfi van dfi s6 lugng va trinh dp nhan Iuc y te, thieu trang thifit hi va thuoc [4], Vific dua BHYT vfi xa de thyc hifin myc tifiu cham soc siic khoe toan dan se con gap nhifiu kho khan trong thdl gian tdi nfiu nhu TYT xa khdng dugc kien todn mot each tich cyc va loan difin.
V. K E T LUAN
Ty lfi cdc TYT xa Iham gia KCB BHYT tai 4 tinh nghien ciiu chiem ty Ifi tuang doi cao (83-94%), thdp nhdt la tinh Khdnh Hda (chi CO 22% so xa thugc 1 huyfin nghifin ciiu tham gia KCB BHYT). Khong co su khac bifit vfi s6 TYT xa tham gia KCB BHYT truoc va sau khi ihyc hifin Lual BHYT. Phuomg thiic thanh loan cho KCB BHYT lai TYT xd khong cd sy lhay doi trudc vd sau khi co Luat BHYT. Trong 4 Iinh nghifin cim, KCB BHYT tai TYT xa 6 hai linh Hd Nam va Kifin Giang la co hi khong chfi muc Iran thanh toan, trong khi do vdi hai tinh Id Khdnh Hoa va Gia Lai khong hi khong chfi miic trdn thanh toan.
- Viec KCB BHYT hien lai gap rdt nhifiu kho khan do dieu kien ca sd vat chdt, TTB va nhdn lyc 6 cdc TYT xa chua ddm bdo chat lugng dfi dap irng nhu cdu KCB; su lin tudng ciia ngudi dan vao TYT xa chua cao; vi?c cap phat the BHYT d nhieu dia phuong chua kip thoi va con sai sot.
126 Tap chi Y hoc du phong, Tap XXIII, s6 2 (137)
TAI LIEU THAM KHAO
1. Bp Y tfi - Vu Bdo hiem y tfi. Bao cao linh hinh thyc hifin BHYT nam 2010.
2. Vifin Chifin luge va Chinh sach Y tfi. Bdo cao danh gia viec thyc hifin Chudn quoc giay lfi xa giai doan 2001-2010. HaNgi.
2010.
3. Dy an tang cucmg nang lyc he thong y te ca sa mpt so tinh trpng difim. Ddnh gia tinh hinh thuc hi?n khdm chira benh bao hifim y te lgi trgm y tfi xa. Ha Ngi, thdng 6/2011.
4. Vifin Chifin luge vd Chinh sdch Y te. Ddnh gid vice thyc hifin chiic nang nhiem vy cua TYTxa ciia lOtinh. Ha Ngi, 2010.
HEALTH SERVICE DELIVERY FOR INSURED PATIENTS AT COMMUNE HEALTH STATIONS ACCORDING TO THE LAW ON HEALTH INSURANCE IN SOME PROVINCES
Nguyen Hoang Long, Nguyen Thanh Long Ministry of Health
A survey lo assess the implementation of heallh service delivery for insured patients al commune health stations according to the Law on Health Insurance is conducted to identify its difficulties and constraints. The survey is done in 16 commune heallh stations (CHSs) of 8 districts of 4 provinces. Data is collected through facility survey, in-depth in- terviews and focus group discussions. Find- ings show that: The percentage of CHSs providing heallh services for insured patients in 4 study provinces is high. There is no dif-
ferent in applying provider payment methods before and after implementing the Law on Health Insurance. Two provinces apply treal- menl ceiling to insured patients in health serv- ice delivery at CHSs and other two provinces do not. CHSs have many difficulties in imple- menting health service delivery for insured patients because of poor infrastructure, lack- ing of equipment and shortage of medical doctors.
Key words: health service delivery, com- mune health station. Law on Health Insurance
Tap chi Y hoc du phong, Tap XXIII, so 2 (137) 127
