vd phiu thudt tai Benh vien HiJU Nghi ehiing t6i nhan tha'y benh gap ehu ye'u d nam, BN eao tudi ehiem tdi 77,2% kem theo nhieu benh phdi hdp. BN de'n vien ehu ye'u Id dau bung, rdi loan tieu hda, la mau. Ty le de'n vien cdn mudn vdi bieu hien cua tae rudt ehiem 12,3%), giai doan HI va IV la 54,4%. ThUdng ton u sui ehiem 62,3%, va chu ye'u la UTBM tuye'n (85,9%). Md cap Clfu 13,1%); md phien 86,9%,. U chu ye'u d dai trdng trai va trUe trang (32,5%) va 37,7%). ThUdng tdn ' xam lan tang lan can 14,9%, di can hach 30,7%, di can phiie mac 7%, di can xa 23,7%. Phlu thuat eat u nd'i ngay thi dau 63,1%, cat u HMNT 17,5%), phlu thuat Hartmann 14%, kh6ng eat u chi lam HMNT 4,4%. Ty le bie'n ehUng 12,3%), ty le tif vong 1,7%,, ke't qua tdt sau md 86%).
Vdi dae thu cua Benh Vien HUu Nghi BN la ngUdi eao tudi, nhieu benh phdi hdp, mac dii ehan doan edn mudn, ehiing t6i nhan tha'y phlu thuat UTOTT va phoi hdp hda chat sau md cho ke't qua ban dau la kha quan, tuy nhien can cd sU kham xet, danh gia t^ m^
de lUa chpn phUdng phap md thich hdp.
TAI LIEU THAM KHAO
1. Nguyen Xudn Hung vd cpngsu (1999). "Nhan xit dieu tri ung thu true trang tai B$nh vi&n Vi§t DUc trong 8 nim (1989-1996)". Tap chi thdng tin y dUdc - Sd ddc biet chuyen de ung thu, trang 79-82.
2. Ha Vdn Quyet vd cdng sU (2005). "Nghien cifu chan doin vi diiu tri phiu thuat tic rudt do ung thu dai tring". Ngoai khoa sd 3/2005, trang 28-36.
3. Nguyin Quang Thdi, Doan HUu Nghj (1999).
"Chin doin vi dieu trj phiu thuat ung thu dai trang qua 324 benh nhan tai benh vien K (1992-1998)". Tap chi thdng tin y dUdc - Sd ddc biet chuyen de ung thU, trang 70-76.
4. Anand Govindarajan et al (2006). "Population- Based Assessment of the Surgical Management of Locally Advanced Colorectal Cancer". Journal of the National Cancer Institute 98:1474-1481.
5. Bruce G. Wolff et al (2007). The ASCRS Textbook of Colon and Rectal Surgery, p. 335-481. ,
6. David E. Beck (2002). "Surgical Management of Colon and Rectal Cancer". The Oehsner Journal 4;p.156-162.
7. Kiyotaka Okuno (2007). "Surgical Treatment for Digestive Cancer". Digestive Surgery;24:108-114.
8. Leonard B. Saltz (2002). "Surgery of colorectal cancer". Colorectal Cancer Multimodality Management, p. 247-456.
9. Michael J. O'Connell (2004). "Current Status of Adjuvant Therapy for Colorectal Cancer". Oncology
18(6): p. 1201-1208.
XAY DUNG BO CHI SO DANH GIA GANH NANG KINH TE CUA UNG THlT TAI VIET NAM
N G U Y I N Q U Y N H ANH, BUI NGOC LINH, TRl/ONG O A N G K H O A , DLfONG VIET TUAN, N G U Y I N T H ! TRANG NHUNG, N G U Y I N THANH HUONG
Trudng Dai hoc Y teCong cong
TOM T A T
0 Viet Nam, ung thw dang cd xu hw&ng tang len va da so cac trwong hop mac dwoc phat hi$n khi da mudn . din din ganh nang benh tat va kinh ti lan cho ngwai
benh, he thong cham sdc sire khde va toan xa hgi. Do lwang ganh nang benh tat (bao gim ganh nang djeh te va kinh ti) ciia ung thw la mgt trong nhOng diiu kien Co ban de xay dgng chwang trinh phdng chong ung thw cd hieu qua. Nghien ciru "Xay dung ch! so va chuan bi cho viec khao sat, danh gia ginh nang cua ung thw doi vdi CQng ding", dwgc thgc hien nhim dap irng yeu cau dd.
Bai viet nay nham giai thieu mgt phan kit qua cua nghien ciru ndi tren, vai 2 ngi dung chinh (1) xaypwng bd chi so danh gia ganh nang kinh ti ciia ung thw va (2) ban luan mgt so diim can Iwu y khi tiin hanh woe tinh ganh nang kinh ti ciia ung thw trong bii canh Viet Nam.
Tong quan tai lieu va nghien ciru djnh tinh dwoc sir dung di xay dung bq chi so. Nghien ciru da dwa ra 13 chi so danh gia ganh nang vi mat kinh te cua ung thw dwac phan thanh 3 nhdm: (1) Chi phi true tiip, (2) Chi phi gian tiip va (3) Chi phi vd hinh.
Kit qua nay bwdc md diu gdp phan tim kiim cac giai phap phii hgp va hieu qua di han chi ganh nang ciia ung thw. Trong qui trinh xay dung, nhdm nghien ciru da can nhic toi da din cac yep to vi van hoa va
chon Igc cac chi so cd tinh kha thi, cd do tin cay trong viec thu thap so lieu. Tuy nhien, viecirng dung bq chi so vao diiu kien thwc ti ciia Viet Nam se ddi hdi sw kheo leo va linh dgng di cac chi so nay cd the phan anh tot nhiiu khia canh cua ganh nang ung thw.
Tir khoa: chi si dinh gia, ganh nang benh tat, ganh ning kinh ti, ung thw
SUMMARY
Cancer incidence has increased in Vietnam and that most of the cases are detected in the late stages results in high disease burden and'economics burden for not only the patients but also the health system and society.
The estimation of burden of cancer including epidemiology burden and economic burden, is one of the fundamental conditions to develop an effective cancer prevention program. The study on "The development of indicators and preparation for estimation of burden of cancers for community" was conducted to meet that demand.
This article introduces some results of this study including 2 main parts: (1) indicators for estimation of economics burden of cancer and (2) discussion on some issues when estimating economics burden of cancer in the context of Vietnam. Systematic review and qualitative method were used to develop the indicators.
13 indicators for estimation of economics burden of cancer were developed and classified into 3 groups including (1) direct costs (2) indirect costs and (3) intangible costs.
These results initially contribute to the finding of appropriate and effective interventions in order to reduce burden of cancer When conducting the research, the researchers also considered cultural characteristics to choose the indicators which are confident and feasible to collect data. However those indicators should be applied in a flexible way to reflect different aspects of burden of cancer in Vietnam.
Keywords: indicators, burden of diseases, economics burden, cancer .
OAT VAN 0 6
0 cdc nude dang phat trien, trong liie benh truyin nhiem van tiep tue Id nguyen nhdn chinh cua gdnh nang benh tat thi cdc loai benh khdng truyen nhiem dang gia tdng vd chiem mpt ty trpng tang dan trong co cau benh tdt. Ung thu Id mpt trong sd cdc loai benh khdng truyin nhiim vdi he luy nghiem trpng. Tuong tu nhu tinh hinh thay doi md hinh benh tdt d cdc nude dang phdt trien, cdc benh khdng truyin nhiem, trong dd ed ung thu, dang cd xu hudng tang len d Viet Nam. Theo thdng ke vd udc tinh CLia benh vien K, tdng sd ca mdi mac ung thu d nam gidi Id 36.024 vd d nu gidi Id 32.786 vao ndm 2000. Ty le mdi mac chuan theo tudi cua tat ca eae loai ung thu (kiidng tinh ung thu da) Id 141,6/100.000 d nam gidi vd 101,6/100.000 d nu' gidi (1). Sd lieu eua he thdng ghi nhdn quan the tai 6 tinh Hd Ndi, Hai Phdng, Thai Nguyen, Hue, Thdnh phd Hd Chi Minh vd Can The, cho thay trudng hpp mdi mac cua tdt ea cdc loai ung thu tdng len ddng ke qua cdc ndm.
Vdi xu thi Chung nhu vdy, bang chifng khoa hpe ve su chuyen biln benh tat d Viet Nam hipn nay van edn rat han ehe. Cho den nay, da sd cdc nghien eicu eua Viet Nam deu dp dung phuong phdp cdt ngang vd ehi dua ra dupe cdc chi sd djeh te hpe, vi du nhu ty le mac benh, ty le tLf vong, v.v.. Trong dieu kien ngudn lue han che, chi phi cae djeh vu y te tdng cao, su gid hda ddn sd vd nhu eau cham sdc sire khde tdng len khdng ngimg, cdc nhd hoach dinh chinh sdeh phai cdn nhdc lua chpn cdc can thiep mang lai hieu qua tdi uu ddng thdi cdn ddi vdi su cdng bdng trong tiep can djeh vu. Thdng tin djeh
• te ve cdc van d l sire khde ddng vai trd rat quan trpng trong qud trinh xdy dung chinh sdeh, tuy nhien thdng tin v l gdnh ndng kinh t l gay ra do mdc benh eung ddng vai trd khdng kem phan quan trpng, ddc biet trong viee ddnh gia cdc chuong trinh can thiep y te. Tuy nhien d nude ta cho den nay chua cd nhieu nghien ciru d l cap den viee ddnh gid gdnh ndng kinh te ciia ung thu.
Vdi muc tieu bude dau chuan bj eho viee ddnh gid ganh nang benh tdt cua ung thu ddi vdi xd hpi vd cd nhdn, gdp phan eung cap bang chirng eho eae nhd hoach djnh chinh sdeh lua chpn cdc can thiep phii hpp vd hieu qua nhdm kiem sodt ung thu d nude ta, bdi bdo ndy nham 2 mgc tieu :
(1) Xdy dung bd chi sd do ludng gdnh ndng kinh t l cua ung thu.
(2) Bdn ludn mdt sd diem cdn luu y khi tien hdnh udc tinh gdnh ndng kinh t l eiia ung thu trong bdi eanh Viet Nam.
T 6 N G Q U A N
ve PHU'ONG
PHAP00 LU'ONG
G A N H
NANG KINH Tl
Khdi nipm "gdnh ndng" thudng xuat hien trong ore nghien ciru ve ung thu vd ed the dupe hieu theo nhilu khia canh, bao gdm tir vong (2), sd ndm sdng mat di (3, 4), tdc dung phu cua chu'a tri (5, 6), benh kem theo (7), stress vd cdc anh hudng tdm ly (6), tdc dpng ciia ung thu ddi vdi CO sd y t l (8), mire dp sir dung djeh vg (2), chi phi benh tdt (9-12), vd DALYs (Disability Adjusted Life Years - sd ndm sdng dieu chinh theo mire dp tdn tat) (2). Bdi vi ed nhiiu cdch hilu v l gdnh nang ciia ung thu vd khdng cd mpt djnh nghTa thdng nhat vd bao quat, viec udc tinh gdnh ndng eua ung thu da gap nhilu khd khan (13). ^ .
Gdnh ndng kinh te khdng chi bao gdm ehi phi dieu tri hien tai vd trong tuong lai d cdc co sd y t l ma con bao gdm viee ehdm sdc ngudi bpnh d gia dinh, su giam siit ve kha ndng lao ddng vd cdc ehi phi vd hinh. Hodgson vd Meiners (14, 15) eung nhu Drummond vd cdc cpng sir (16) da dua ra khung phdn tich d l udc tinh chi phi kinh te CLia bpnh tdt dua vdo ty le mdc bpnh vd chi phi chO'a tri.
Cdc tdc gia ndy de nghj can nhae 3 nhdrn ehi phi:
(1) Chi phi tryc tilp lien quan din chan dodn vdc
dilu tri benh; _ ^ (2) Chi phi gian t i l p do mat nang sudt lao dpng vi
tam thdi ngirng lao dpng, mat sire khde vd tir vong sdm;
(3) Chi phi vd hinh bao gdm cae ylu td khd do ludng nhu su dau ddn v l the xdc vd tinh than md benh nhdn vd ngudi than phai gdnh chju.
Tinh todn chi phi kinh t l bao gdm 3 budc chinh: xdc djnh (Identification), do ludng (Measurement) vd djnh gid (Valuation). Bude "xdc djnh" bao gdm vipe liet ke toan bp ngudn lire sir dung trong qua trinh dilu tri eho ngudi benh vdi yeu edu diing, dii, trdnh triing lap.
Drummond vd cpng su gidi thieu cdch phdn nhdm cdc ngudn lue sir dung thdnh 3 nhdm: (1) ngudn lue cua he thdng y te; (2) ngudn lue eua ngudi benh vd gia dinh; (3) ngudn lue cua cdc khu vuc khde (vi du nhu phiic Ipi xd hpi). Budc tiep theo, bude "do ludng" chinh Id viec lua chpn dan vj tu nhien thich hpp de xdc djnh sd luo-ng ngudn lue/ddu vdo dd sir dung. Cudi cung, bude "djnh gid" vdi nhiem vu chinh Id xdc djnh chi phi don vj (don gid) cho moi khoan mgc ngudn lue hay ddu vdo d l xae dinh tdng gid tri ngudn lue.
PHU'ONG P H A P
Nghien ciru dupe thue hien trong 6 thdng (8/2008 - 2/2009), sir dung 2 phuong phdp sau:
(1) Tong quan tai lieu: (a) Tham khao cdc bdo edo, nghien ciru, hudng dan vd cae tai lieu khde lien quan din ddnh gid gdnh ndng benh tdt cua ung thu dupc thuc hien trong vd ngodi nude d l xdy dung cdc ehi sd do ludng gdnh ndng benh tdt cua ung thu vd hudng dan tinh todn cdc chi sd. (b) Hdi ciru, tham khao cdc bdo edo, nghien ciru, sd lieu v l djeh t l hpe (dae biet Id sd lipu cua he thdng ghi nhdn ung thu) vd v l ehi phi eua ung thu, vd quy trinh thu thap sd lieu v l ung thu tai Viet Nam d l dua ra cdc khuyin nghj v l he thdng thu thap sd lipu phue vg cho ddnh gid gdnh ndng eua benh ung thu, ddng thdi budc dau dua ra nhQ'ng djnh hudng edn thiet phue vu tinh todn cae chi sd
(2) Nghien cuu djnh tinh: thue hien cdc cupc phdng van sau hay thao ludn nhdm vdi cae ddi tupng khde nhau, eg the:
Y HOC THl/C HANH (727) - SO 7/2010 35
• 07 ddi tupng Id cdc nhd quan ly benh vien K de tim hilu cdc thdng tin sdu v l hp thdng thu thpp thdng tin lien quan din benh ung thu, tinh sin cd vd dp tin eay CLia thdng tin, cung nhu nhdn xet, gdp y d tam quan ly v l tinh kha thi eiia bd ehi sd.
• 05 cdn bd y t l true tilp tham gia dilu trj de tim hilu cdc thdng tin sau v l benh ung thu eung nhu qud trinh dilu tri vi dg nhu ddc dilm, phdn loai, phde dd dilu tri, thdi gian dilu tri, ehi phi dilu tri, v.v..,
• 05 chuyen gia v l kinh t l y t l tai Vipt Nam vd trudng dai hpe Johns Hopkins - Bloomberg (My), dai hpe Sydney, Queensland (Uc) d l thdng nhat v l cdc ehi sd, ddnh gid, nhdn xet tinh khd thi trong cdng tdc thu thap sd lieu vd each tinh eae ehi sd lien quan den gdnh ndng kinh te tai Viet Nam.
• 65 benh nhdn vd ngudi nhd cham sdc benh nhdn dang dilu tri ung thu tai Hai Duong, Bae Giang vd Cdn Tho d l tim hilu cdc thdng tin v l qud trinh chua tri, thdi gian vd chi phi dilu tri, v..v..
Cdc cupc phong van dupc tiln hdnh dua tren bang hudng ddn phdng vdn sdu cho tirng nhdm chi sd vd cho tirng ddi tupng dupc phdng vdn. Npi dung eupe ptidng van dupe ghi chep, tdm tat vd phdn tich theo chii d l sii' dgng phuong phdp ma trdn thdng tin, tir dd tdng hpp thdng tin cho bp ehi sd cudi ciing vdi nhu'ng khoan mgc cd t h i thu thap dupe thdng tin cd dp tin cay eao tgi Viet
N a m . •, -
K^TQUA
1. 86 chi s6 do lu'O'ng ganh nang kinh t l cua ung thu-
Cdc chi sd do ludng gdnh ndng kinh t l cua ung thu dupc xdy dung dua tren cae nhdm ehi phi dd dupc de cap trong phan tdng quan. Phdn tach cdc nhdm vd hang mue chi phi giup chiing ta cd the udc tinh dung, dii va trdnh triing lap tdng ehi phi kinh t l cua ung thu. Dudi ddy Id danh sdeh cdc chi sd dupc sap xep theo nhdm ehi phi.
Bang 1: Danh mue chi sd do luo'ng ganh ndng kinh te cua ung thu
STT TEN CHl SO DIENGIAI CONG THU'C TiNH/KV
HIEU I Ganh nang Kinh te = A + TPL + C
1.
al a2 a3
a4 a5 a6 a7 2.
bl
b2
Chi phi true tiep: Chi phi kiem tra, ehan dodn, dieu tri vd cham sdc benh nhdn Chi phi ciia cac chuung trinh kham sang loc ung thu dien rong
Chi phi kiim tra chin doan/kham sang loc cho doi twang co nguy ca cao va nghi nga mSc ung thw
Chi phi trong qui trinh dieu tri tai ca sa dieu tri chinh
Ci Id chi phi chua tri thep hda don thanh toan vdi benh vien. Ci bae gdm 2 phan: phan tu chi tra cua benh nhan
C11 va phan bap hiem thanh toan C12;
C2 la trp cap eua nha nude danh che hpat dpng kham chua benh cua co sd y te. Neu p la % trp gia cua nha
nude danh ehe hoat dpng kham chua benh danh chp eae eo sd y te d Viet Nam thi
C2 = Ci[p/(1-pj](")
C3 la ehi phi di lai, an a va eac chi phi khac phdt sinh chp bpnh nhan trong qua trinh dieu tri tai co sd dieu tri
chinh.
Chi phi dieu tri va phue hoi chirc nang ben ngoai ca sa dieu tri chinh Chi phi tii l<ham
Chi phi "dieu tri theo phuang phap khac"
Chi phi phat sinh cho ngwai nha benh nhan
Chi phi gian tiep: Cac ehi so lien quan den nang suat lao dong mat di TPL (Total Productivity Lost) la tong nang suat lao dpng mat di do ung thu;
k Id tong so cac loai ung thu duge udc tinh;
i la dai dien cho^cap loai ung thu, 1 = 1,2 , k E[l|ung thu=i] la ky vpng thu rrtnap eua cac benh nhan ung thu loai i.
TPL (Total Productivity Lost) fe tpng nang suat lao dpng mat di dp ung thu;
' -^ ILi (Income Lost 1) la thu'nhap mdt di trong thdi gian dieu tri;
IL2 (Ipcpme Lost;2) la thu nhap gi§m di khi trd la* thittrupng lap dpng; -j- ,*. • - IL3 (Incpme Lest 3) la thu nhap mat di dp khdng t h i trd lai thj trudng lap ddng;
IL4 (Incpme Lpst 4) la thu nhap mat di dp t u vpnq vi unq thu ; Thu nhap mat di trong thai
gian dieu tri
Thu nhap giam di khi trd lai thi trwong lao dong
i, , E[LOS|ung thu=i] la ky vpng thdi gian n§m vien cua - * ' ung thu Icai i (LOS= Lengh of Stay);
E[l|ung thu=i] la^ky vpng thu nh|p ciia cae benh nhdn , ung thu i;
ni la teng SP ea dieu ,tri eiia Icai unq thu i EjTjung thu=i] la ky vpng thdf gian lam viec cdn lai sau
J) (khi chu'a trfung thu i;
q la phan trarfi thu nhap trung binh cdn lai sau khi chua tri
A = a1 + a2 + a3 + a4 + a5 + a6 + a7
a1 a2 a3 = C = C1+C2+C3
a4 a5 a6 a7 TPL Phuong phap 1:
TP-L> = Z,''[T6ng DALysJfE[l|ung thu=i]
Phuong phap 2:
TPL.f |'LI + IL2 + IL3 + IL4
IL1 = I i * E[LOS|ung thu=i]*E[l|ung thu=i]*ni
IL2 = I,''E[T|ungthu=i]*(1- 5 (7)*E[l|ung thu=i]*ni
bS
b4
b5
3.
cl
Thu nhap mat di do khong thi tra lai thi trwang lao dgng
Thu nhap mat di do tw vong
Thu nhap mat di cua ngwai than de cham sdc benh nhan
trong va sau l<hi nam vien
Ii*E[T|ung thu=i] Id ky vpng ve thdi gian le ra ed the Idm viec nhung tren thuc te khdng lam vipe vi sire
khoe kem sau khi chO'a tri ung thu Icai i;
h la sac xuat cd the trd lai thj trudng lap dpng sau khi chu'a tri i;
EjTLjung thu=i] la ky vpng thdi gian sdng mat di dp tu vong sdm, bang tupi thp ky vpng a nam benh nhan
chet (TL: Time Lost)
E[OCf|ung thu=i] la ky vpng chi phi ca hdi eua ngudi than de cham sdc benh nhan) ung thu Icai i (OCf=
Oppprtunity Cpst/Family Members);
E[lf|ung thu=i] la ky vpng thu nhap eiia ngudi thdn benh nhan ung thu jpgi i;
ni la tpng sp ca dieu tri cua loai ung thu i.
Chi phi vd hlnh
Dau dan ve thi xac va tinh than cua benh nhan va ngwdi nha
IL3=Z,"E[T|ungthu=ir(1- /?)*E[l|ung thu=i]*ni
IL4 = L''E[TL|ung thu=i]*E[l|ung thu=i]*ni
IL5 = I," E[OC,|ung thu=i]*E[l,|ung thu=i]*n,
C el Trong 3 nhdm ehi phi neu tren, ehi phi true tiep chi
tra cho chan dodn vd dieu tri la cu the nhat nhung viee tinh todn tren thue te khdng hoan toan don gian. Dudi gde dp kinh te, do luo'ng gdnh nang cua benh tat ddi hdi phai tinh todn du cae "ehi phi kinh te". Chi phi kinh t l bao gdm tat ea eae khoan xa hpi chi tra cho mot hoat dpng ndo dd, vi vay Idn hon chi phi dupe luu tru trong sd sdeh ke todn. O Viet Nam, gia thanh cua cac djeh vu y t l tai cdc co sd cong lap kh6ng bao gdm eau phan ehi phi v l dat dai sir dung de xay dyng cdc co sd khdm chua benh. Vi vay tinh toan ehi phi kinh te eua ung thu ddi hdi phai ude tinh mirc dp trg gia cua nhd nude cho cdc co so y te va phan bd cua khoan trp cap eho eac loai hinh khdm chO'a benh khac nhau trong dd cd ung thu.
Nhdm chi phi thir hai the hien ganh nang eua ung thu ddi vdi xa hpi khi kha nang lao dpng eua ngud'i benh giam siit hode khong edn kha nang tham gia vdo qua trinh san xuat tao ra eua cai vat chat. Khi tinh todn chi phi ndy, quan diem phan tich se tao ra su khac biet rat Id'n. Xet dud'l gde dp cd nhan, gia du nlu mdt benh nhan cham dirt lam viee hodn todn sau khi mac benh vd vdn tiep tue cd thu nhap mpt phan thdng qua bao hiem xa hpi, thi ehi phi eua ung thu la mire giam sut thu nhap cua ed nhan dd (bang thu nhap khi edn lam viee trii' di thu nhap tir bao hiem xa hpi). Tuy nhien, dudi gde dp xa hpi, ung thu da lay di toan bp ddng gdp lao dpng cCia ca nhan nay vao qua trinh san xuat. Chinh vi vay ma khi xet theo quan diem xd hpi, ehi phi eua ung thu Id rat cao ddi vdi nhdm ngudi tre tudi bdi vi thd'i gian lao dpng cua hp edn dai vd cong tdc phdng ngua ung thu cd the mang lai hieu qua eao.
Nhdm chi phi vo hinh rat quan trpng, dae biet ddi vdJ benh nhdn ung thu. Benh tat gay ra dau ddn ve the xdc vd tinh than cho benh nhan va ngud'i than. Day Id nhij'ng "ehi phi" khdng d l de do ludng nhung gdnh nang eua ehiing la ddng ke ma cdc ed nhan phai ganh chju do he qua nghiem trong cua phan Idn cdc trud'ng hpp mac benh.
2. Mot s6 vdn d l cdn lu-u y khi tiln hanh u'O'c tinh gdnh nang kinh t§ ciia ung thu" trong bdi canh Viet Nam
Bp cong eu gdm 13 chi sd cd the giiip do ludng
ganh nang kinh te cua ung thu m6t each toan dien.
Neu dieu kien eho phep, mpt nghien ciru vd'i qui m6 Idn cd the sir dung ca 13 chi sd de danh gid todn dien 3 nhom chi phi cua ung thu. Bdi vl tinh chat phirc tap va ddi hdi Id'n ve kinh phi, dO' lieu vd tho'i gian, cdc nghien ciru tren the gidi thud'ng tap trung vao mpt vai khia canh cua benh tat khi thuc hien danh gia kinh te y te (16). Tiiy theo dieu kien thuc te, chung ta ed the phan chia nghien ciru ddnh gia ganh nang kinh te cua ung thu thanh eac nghien ciru nhd de d l thuc hien hon. Co mpt sd van de can luu y khi thue hien cac nghien ciru danh gia ganh nang kinh te eua ung thu.
Co" SO" dir lieu va thdng tin
Ddi vd'i nghien ciru djnh lupng, co sd thdng tin va dii' lieu la dieu kien tien quyet. Phuong phap nghien cuu dii tdt bao nhiSu cung khdng the bii dap cho nhCrng khiem khuyet cd tinh he thdng cua dCe lieu.
Mpt sd ddc tinh quan trpng ma dO' lieu can phai cd Id:
dp chinh xac cao, ed the kiem ehirng dup-e, mang tinh dai dien, thong tin khach quan, cho phep k i t ndi, cap nhdt lien tue, cd the phien giai dupe, du thdng tin de tra IdJ cau hdi ma nghien ciru dat ra.
Trong nhdm chi phi thu nhat (chi phi true tilp), du' lieu CO ban nhat la chi phi dieu trj cho eac loai ung thu.
Yeu cau dat ra la phai tinh toan dup'c chi phi kinh te chir khdng ehi la chi phi ke toan, vi vay, ehung ta can du' lieu ve chi phi dugc thiet lap mpt each co he thdng.
DO' lieu de phan tich nhom chi phi ve mat nang suat lao dpng khdng lien quan nhieu den y te ndi ehung va chCi-a trj ung thu noi rieng. Theo tim hieu cua nh6m nghien ciru, d Viet Nam, nhu'ng thong tin de phue vu eho nghien euu uo'c tinh nhdm chi phi ve mat nang suat lao dpng la het sue han che. Chiing ta can phai thuc hien cdc cupc dieu tra cd quy mo de tao dung co sd du' lieu. Cac nuoc tren the gidi da thue hien rat nhieu nghien euu ma trong dd benh nhan ung thu dugc theo doi trong thd'i gian dai (cohort studies), khi dd, cac su kien quan trong ve sue khde, cdng an viec lam, mdi quan he xa hpi... cCia benh nhan deu dugc ghi chep mpt each c6 he thdng de tim hieu tac dpng eua ung thu den do'i sdng cua ho.
LiFa chon phuio-ng phap u'O'c tinh ganh nang benh tat v§ kinh t l
Y HOC THl/C HANH (727) - SO 7/2010 37
Cd 3 phuong phap djnh lugng chinh dugc sir dung de udc tinh ganh nang benh tat ve kinh te cho mpt quan the dan sd: uo'c tinh chi phi vT m6 (macro- costing), udc tinh chi phi vi mo (micro-costing), va m6 hinh ehi phi (modeling) (17, 18). Phuong ptidp udc tinh vT m6 sir dung du lieu gpp lai (aggregate data).
Diem manh cua phuong phap nay cho phep sir dung nhieu ngudn dU lieu va khong ddi hdi qua nhieu chi tilt tu ngudn sd lieu. Tuy nhien nhuge diem cua phuong phap la dp chinh xac khong eao, d l d i n den mot buc tranh tdng the ve chi phi khong sat vd'i thuc t l .
Phuong phdp uo'c tinh chi phi vi mo lam ngugc lai, sir dung dir lieu d mUe dd ea nhan va ,theo doi dpc eiing mpt nhom bpnh nhan theo thdi gian (longitudinal data) de tranh nhiiu trong mdi quan he tuong tae giira cac cau phan ganh nang benh tat. Tinh chinh xdc cua cae kit qua khi sir dung phuong phdp udc tinh chi phi vi mo eao hon nhung quy mo va dp sau cua phan tich phu thupc rat 16'n vao su s i n ed cua dO' lieu cho cac loai benh tat, dae biet Id 6w lieu d cap dp benh nhan.
O cae nude cong nghiep, chinh phu cd ngudn kinh phi thudng xuyen cho cae trudng dai hpe vd vien nghien euu thuc hien eac cupc dieu tra va xay dung co sd du lieu de sir dung rpng rai eho eac nghien cuu. Ddi vd'i eac nude dang phat triln nhu Viet Nam, viec thu thap day du du' lieu cho mpt phan tich nhu vay la rat tdn kem va mat thdi gian.
Phuong phdp m6 hinh chi phi duge xay dung nham han c h i nhirng ddi hdi khat khe ve dU lieu eua phuong phap ude tinh ehi phi vi m6 va tinh thilu chinh xae eua phuong phap ude tinh chi phi vT mo.
Phuong phdp mo hinh chi phi dp dung cdc ky thuat thdng ke vd phan tich quyet djnh (decision analysis) de giai quylt mpt loat cac van d l lien quan d i n trudng hgp du' lieu bj thieu. Cac ky thuat thdng ke thudng dugc sir dung, vi du ngoai suy cdc gia trj ben ngoai khoang quan sat, thay the dO' lieu bj thieu, va lap md hinh cho dir lieu khdng c6 phan bd chuan...
Lua chon quan d i l m tinh toan
Kill danh gid ganh nang kinh te, "quan diem phan tich" phai dugc neu ro. Phan tich kinh te ed the duge xem xet dud'l goc dp cua benh nhan, don vj chi tra (vi du CO quan/edng ty bao hiem), co sd y te hoac xa hpi. Vi du chi phi de chii'a trj cho mpt ca ung thu dugc phat hien sdm la 5 trieu ddng, co quan/c6ng ty bao hilm se thanh toan 4 trieu ddng va benh nhan se thanh toan 1 trieu ddng cho co sd y te. Dudi goc dp ca nhan, ehi phi dieu trj cho ca ung thu nay Id 1 trieu ddng nhung dudi goc dp cua co quan/eong ty bao hiem va xa hpi thi chi phi dieu trj la 4 trieu ddng va 5 trieu ddng. Trong trud'ng hgp phUc tap hon, gia djnh rang benh nhan khong du kha nang ddng gdp 1 trieu ddng, quyet djnh khong tham gia ehua trj, d i n den hau qua la benh nang hon va chi phi chO'a trj tdn kem hon va cudi eiing la tu vong sdm. Ciing mpt ca benh nhung ganh nang cCia ung thu do tri hoan chO'a trj Idn hon rdt nhieu so vd'i ehUa trj som.
U'oc tinh va phan tich ganh nang benh tat noi ehung vd ung thu noi rieng doi hdi phai hieu dung mpt
sd khai niem kinh t l co ban va sir dung hgp 1 3C phuong phdp djnh lugng. Mpt trong nhQ'ng thach lirc khi do ludng gdnh ndng kinh t l cua ung thu la jenh nhan co t h i cd cac loai benh khac. Viec bde tdch tdc dpng ve mat chi phi cua ung thu tu cdc benh tat vd yeu td khde thudng khong d l dang. Khi ddi ^mat vdi dieu kien thong tin kh6ng hodn hao vd tinh chat kh6ng chae chan cua ehan dodn vd du bdo, viec tinh todn se eang khd khan hon.
K^T LUAN
Bp ehi sd ddnh gid gdnh nang kinh te cua ung thu bao gdm 13 chi sd, ehia thdnh 3 nhdm chinh (1) chi phi true tilp, (2) ehi phi gidn tilp va (3) chi phi vd hinh. Bp chi sd dugc xdy dung tren co sd tham khao nhieu cdng trinh khoa hpe qudc t l va can nhdc tdi da den cdc y l u td ve van hod d l chon Ipc eae ehi sd ed tinh kha thi va dp tin eay trong viec thu thap s6 lieu cung nhu dam bao nguyen tac tinh dung, du vd trdnh triing lap. Chiing tdi cung da nhan dugc nhieu ldi khuydn cua cdc chuyen gia Viet Nam vd cd glng sir dung kit qua cua cac nghien cuu qudc t l mpt each hgp ly nhat. Tuy nhien, viec ung dung bp chi sd vdo dieu kien thuc te cua Viet Nam se ddi hdi su kheo leo vd linh dpng de cac chi sd c6 the phan anh day du cac khia eanh khac nhau cua ung thu.
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