JOURNAL OF COMMUNITY MEDICINE
YHOC
CONGDONG 2018
MOT SO YEU TO LIEN QUAN DEN NHAN THIJIC, THUC HANH VE THONG TUYEN BAO HIEM Y TE CUA NGUdi CAO TUOI TAI 4 XA THUOC HUYEN KIEN XUONG TJNH THAI BINH NAM 2017
TOM TAT
Mgc tiiu: Xac dinh mpt sd yeu td liSn quan din nhdn thdc, thgc hanh vi thdng tuyln bao hiSm y le cua ngudi cao tudi (NCT) tgi 4 xa thupc huyen KiSn Xuong tinh Thai Binh nam 2017. Ddi tugng nghiin cdu: Ngudi cao tudi dang sinh sdng tgi dia ban nghien cuu. Phinmg phap nghien ciru: Phuong phap dich te hpc md ta qua cupe dieu tta cat ngang. Kit qua nghien cihi: NCT trinh dp hpc van Id THCS ttd xudng cd xu hudng khdng bill vl quy dinh thdng tuyln nhieu han NCT cd trinh dp tten THCS 0,2 Ian. NCT tu 75 ttd ISn cd xu hudng khdng biSl vi quy djnh thdng tuyen nhilu hem 1,9 Idn nhdm NCT dudi 75 tudi. NCT biSt quy dinh thdng tuyen cd xu hudng khdm, chua binh thdng tuyln Bdo hilm y tl cao gap 4,1 lan so vdi nhdm khdng biSt vS quy dinh nay.
Td khda: Ngudi cao tudi; bdo hiem y ti; thdng tuySn, Thai Binh.
SUMMARY:
SEVERAL FACTORS RELATED TO AWARENESS, PRACTICE ABOUT MEDICAL EXAMINATION, TREATMENT AT THE MEDICAL ESTABLISHMENT OF THE SAME LEVEL OF THE ELDERLY IN 4 COMMUNES, KIEN XUONG DISTRIC, THAI BINH PROVINCE IN 2017
Objective; Identify some factors related to awareness, practice of medical examination, treatment at the medical estabUshment of the same level of the elderly in 4 communes of Kien Xuong district, Thai Binh province in 2017. Subject: The elderly in the research region Method: The cross-sectional descriptive study with a combination of quantitative and qualitative Results: Elderly people with lower secondary school education tend to be less aware of medical examination.
Nguyen H6 My'; Nguyin Out Thanh^; Phqm Tnidng Sdn' Nguyen Van llS'n'; Phan Thu Nga'; Ngo Van Ddng' treatment at tiie medical establishment of the same level than older adults with upper secondary education of 0.2 times; Elderly people aged 75 and older tended to be unaware of medical examination, treatment at the medical establishment of the same level than older people under 75 years of age 1,9 tunes; Older people who know the this regulation tend to have healthier access to medical care by 4.1 times than those who do not know about this regulation.
Keywords: Elderly; health Insurance; tteatment at the medical establishment of the same level. Thai Binh.
L DATVANDE
Sg thay ddi vl cdu true ddn sd dan din biln doi ve md hinh benh tdt, ttong dd cd md hinh benh lat cua NCT, dac bilt la cua NCT sdng d cdc vung ndng thon Vipt Nam, theo dd cung dnh hudng dSn hanh vi khdm chda benh ciia NCT. Hien nay phdn ldn ngudi cao tudi chua co th6i quen di kilm tta siic khoe djnh k^, nhilu ngudi khing biSt minh cd benh hoac biSl cd benh nhung khdng tuan thu theo dung hudng ddn diiu tri. Vile sd dyng dich vy y tl cda ngudi cao tudi thudng bi hgn chl, dgc bipt la doi vdi ngudi cao tudi d nhijng vung ndng thdn khdng co thi baohiSmy te [6].
Trong khi cac nude phat ttien cd ty lp ngudi dan tham gia bao hiim y ti la 99% -100% thi d Viet Nam mdi d?t cd 76%. nam 2015. Dang luu y la ty IS ngudi cao tuoi cd the bao hiim y ti chi dat 60% la cgc ky dang lo ng?i cho edng tac chdm sdc sdc khde. Ngudi cao tudi thara gia BHYT khdng chi di chua benh ma quan ttpng hcmli dugc khdm benh thudng xuyen de kip thdi phat hiln, diSu tri bpnh ngay td giai dogn ban ddu [3]. Trong khi d6, Lu?l Bao hiim y tS cd r4l nhilu quy dinh chi dp uu dai mi vdi ngudi dan ndi chung va ngudi cao tudi ndi riing, nhu 1. TVudng Dai hoc Y Dugc Thai Binh.
2. TVudiig Cao D3ng Y ti Thdi Binh.
Ngay nhdn bai: 01/03/2018 |
^r\f: I S63(44)-Thang05-06/20ia I Websile: yhoccongdong.vn
Ngay phan bien: 08/03/2018 | » Ngdy duyet dang: 15/03/2018
1 \M\ H I E N cufu KHOA HOC
mpt so doi tugng ngudi cao tuii dugc thanh todn phi vgn chuySn khi ehuySn tuyin hay nhu viec quy dinh "thdng tuyen" kham chua benh ttong Luat sda ddi bd sung nam 2014 tgo diSu kien thudn lgi tdi da cho ngudi tham gia BHYT ndi chung vd ngudi cao tudi ndi rieng ttong vi|c tiSp cdn cae 'iich vu y tl [1], [5]. Nham tim hieu nhung yiu to liSn quan den nhdn thdc, thgc hdnh thdng tuyin ctia ngudi cao tudi, chung tdi lien hdnh nghiin cdu vdi muc tieu:
Xdc dfnh mot so yeu to lien quan din nhgn thuc, thuc hanh ve thing tuyin bdo hiim y ti cda ngu&i cao tuoi tgi 4 xa thugc huyen KiSn Xuang tinh Thdi Binh ndm 2017.
n. DOI TU'gfNG VA PHU'ONG PHAP NGHlfeN Ctru
2.1. Dja dilm, thdi gian, d6i tirong nghien cuu - Dja diem nghien cuu: 4 xa thudc huyen Kiin Xuong, tmh Thai Binh, bao gdm: tin Iran Thanh Nl, xa Binh Minh; xa Binh Nguyln, xa Vu Tdy.
- Doi tugng nghien cuu: Ngudi cao tudi hipn dang smh sing tai dia bdn nghien cdu.
- Thdi gian nghiin cuu: Nghien cuu dugc thgc hipn tii 1/2017-12/2017
1 2.2. Phmmg phdp nghiin cihi 2.2.1. Thiet ke nghien cthi
Nghien cuu dugc ttin hdnh theo phuang phdp djch te hpc mo td thdng qua eudc dilu tra cat ngang cd phan tich.
2.2.2. C&mdu vdphuffngphdp chgn mdu al Cd man
Thay vao cdng thdc, linh dugc co mau cho nghiin cuu la 465 NCT.
b/ Phuang phdp chpn mau:
+ Chpn xd; Chpn chu dich 4 xa theo lieu chuan sau:
- 2 xa dgi dien cho khu vgc thi ttan, ven thj ttan: Thi trdn Thanh Nl, xa Binh Minh.
- 2 xa dai difn cho khu vgc xa thi ttdn: xa Bmh NguySn vd xa Vii Tdy
-I- Chpn ngudi cao tudi: Tgi mSi xa dugc chpn, chung tdi ldp danh sdch tat ca cdc thdn, sau dd tiin hanh bde tham ngau nhien 1 thdn di bdt ddu diiu tra.
Sau dd lap danh sach NCT trong dp tudi 60 trd lln lai thdn dd. Chpn ngau nhien theo hinh thdc bde tham dl phdng vdn ddi tugng ddu tiSn cua xa. Ap dung phuang phdp "cdng lien cdng" di chpn ddi tugng tiSp theo eho din khi phdng van dd sd ddi tugng cho mdi xa.
2.3. Phuang ph jp thu thap thong tin - Thdng tin dugc thu thap bang phuang phap phdng van thdng qua bd phiiu diiu tra. Xdy dgng bd phiiu diiu tta phd hgp vdi mgc lieu nghien cuu. Bd cau hdi nay dugc xay dung dga vao muc lilu nghiin cdu vd dua ttln nhiing ndi dung qui dinh vS cham sdc sdc khoe ngudi cao tudi dugc ban hanh ttong Lugt Ngudi cao tudi sd 39/2009/QH12 va Ludt Bao hiim Y ti sda ddi, bd sung nam 2014 [2], [3].
2.4. Cac phuong phdp han chi sai si Han che bang cdch td chuc tap huan ky ludng, thdng nhdt cdch ghi nhgn sd lipu cho todn bp dilu tta viln trudc khi tiSn hdnh nghien cdu. Gidm sdt qua trinh diSu tta nghiin cdu. Cac phiiu dieu tra dugc lam sgch trudc khi nhap vao may vi tinh.
2.5. Xir 1^ si lieu
Sd lieu sau khi diiu tta dugc ldm sgch thd va nhgp vdo mdy vi tinh bang phdn mSm EPI-DATA, sau dd chuySn sang phdn mim SPSS 22.0 de xd ly vdi cac test tiidng kl y hgc, gia tri p< 0,05 dugc coi la cd y nghia thdng ke. KSt qua thu dugc sau khi xd ly sd Ii|u dugc trinh bay dudi dang cdc bang, biiu do va hop phdng van slu.
m . KET QUA NGHlfcN COtJ Bang 3.1. MSi liin quan giiea trinh dg hgc vin, nhdm tuii vd hiiu biit vi quy dinh thong tuyin
ir
TDHV
Nhom tuoi
THCS tro xu6ng Tren THCS
>75
<75
(n=46S) Solircmg 279
57 128 337
Khong bi^t Tylf(%)
160 20 98 211
57,3 35,1 76,6 62,6
P
<0,05
<0,05 OR (CI,,,)
0,2 (0,2-0,5)
1,9 (1,2-3,1)
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JOURNAL OF COMMUNITY MEDICINE
YHOC
CONGDONG 2018
Ty 11 NCT cd trinh dd hpc vdn td THCS trd xudng 0,2 Idn. TJ lp NCT tii 75 tudi ttd ISn khdng biit ve khdng blit vi quy dinh thdng tuyln khdm, chda b|nh quy dinh thdng tuySn khdm, chua benh bao hiim y tg bao hiim y le chiim 57,3% va chiim 35,1% d nhdm chiim 76,6% vd chiim 62,6% d nhdm NCT dudi 75 NCT CO trinh dp trln THCS, NCT trinh dp hpc van td tudi, NCT td 75 ttd ISn cd xu hudng khdng biit vi quy THCS ttd xuong cd xu hudng khdng biit vi quy dinh dinh thdng tuyin nhiiu hon 1,9 Ian nhdm NCT dudi Ihdng tuyin nhiiu ban NCT ed trinh dd ttln THCS 75 tudi.
Bdng 3.2. Moi lien quan giiea trinh do hgc vdn vd hiiu biit vi tuyin dp dfing quy djnh thong tuyin
TBHV THCS tro xu6ng TrenTHCS
n (n=lS6)
119 37
Khdng bi^t Sdlirgrng
19 3
Tylf(%) 16,0 8,1
P
>0,05
OR (ci,„)
0,4 (0,1 -1,7)
Tu bang 3.2 cho la thdy NCT khdng biit tuyen tham 8,1%. dnhdm cd trinh dp ttln THCS, khdng cd mdi hen khdm bdo hiim y ti ap dung quy dinh thdng chiim ty IS quan giua trinh dd hpc vin cua NCT vdi hieu biSt vi tuyai 16,0%i d nhdm cd trinh dp td THCS ttd xudng va chiem y tl dp dgng quy dinh thdng tuySn.
Bdng 3.3. Mii lien quan giira nhdm xd vd thfrc trgng khdm, chira benh thong tuyin cua ngu&i cao tudi trong 1 nam qua
Nhom xa Gan trung tam huyen Xa trung \kn huySn
n (n=311)
148 163
Khdng thdng tuyen So lu^rng
135 144
Tflf(%) 91,2 88,3
P
>0,05
OR (CU 1,3 (0,7-2,9) Vdi nhiing NCT cd di khdm chua binh ttong nam qua thi khu vuc xa trung tam huyen chiim 88,3%. Khdng cd moiliSn ty lp thdng tuyin khdm, chua bpnh d nhdm NCT sdng d Idiu quan giCta khu vuc smh sdng va thgc hanh khdm, chflabTO vuc gdn trung tam huyen chiim 91,2% va d nhdm NCT sdng d thdng tuyin cua ngudi cao tudi tai dia ban nghiin cdu.
Biiu di 3.1. Mii liin quan giiea nhgn thuc vd thuc hdnh khdm, chiea bfnh thdng tuyen trong 1 nam qua (n=311)
1S,S S,2
p<0,05 OR = 4.1
--H
81,S
Co thong tuyen Khong tfaong tuy&i
•
t qiiy ^ thong tuyan QKhfii^ bi& (p^ 4ob lh6og tnySi
•DM
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p Trong nam qua, da sd NCT khdng di KCB thdng tuySn. Ty 11 thdng tuyin khdm, chira benh d nhdm biet quy djnh thdng tuyin chilm 18,5% vd d nhdm NCT khdng bilt quy dinh thdng tuyin chiem 5,2%.
• Co moi liln quan giua nhan thdc vd thgc hanh khdm, chua bpnh thdng tuyen cda ngudi cao tudi tai dja ban aghiSn cdu, theo dd nhung NCT biit quy djnh thdng tuyen cd xu hudng khdm, chda benh thdng tuyen bao hilm y tl cao gap 4,1 ldn so vdi nhdm khdng biet vS quy dinh ndy.
I V . B A N L U A N
Khoan 3 Dilu 8 Thdng tu 37/2014/TT-BYT hudng dan dang ky khdm binh, chiia benh ban ddu vd chuyen tuyln khdm benh, chua bpnh bao hiim y ti quy djnh: "Td ngdy 01 thang 01 nam 2016, ngudi tham gia bdo hilm y le dang ky kham bpnh, chua benh ban ddu tai CO sd kham benh, chua bpnh tuyen xa hoac phdng khdm da khoa hogc binh viln tuyin huyen dugc quyin kham b^nh, chua benh bao hiim y ti lai tram y ti tuyen xd hoac phdng kham da khoa, hoac benh vien tuySn huyen trong cung dia ban tinh". Cd nghta la khi ngudi tham gia BHYT cd dang ky kham chua benh ban dau d mpt ttgm y te xa hogc mdt phdng kham L da khoa hogc mdt binh viln cap huyen thi ho dugc quyin di kham chua benh d cdc ca sd khdm chda bpnh trong cung huyen dd hogc trong pham vi mdt tinh van dugc tinh la diing tuyen va khdng cdn giay chuyin viln, cd nghia Id hg khdng bi gidi hgn bdi mdt ca sd kham chua benh ban ddu, nhu vgy hg van dugc thanh toan theo quy dinh [6]. Vdi vile thdng tuyln, ngudi dan cd the BHYT thugn Igi ban rdt nhiiu trong vipc tiip cgn cdc dich vu khdm, chiia benh BHYT, ddc bipt thugn Igi ddi vdi cac trudng hgp ngudi lao dpng khi phdi dl chuyin cdng vipc td dia phuong nay sang dia phuong khdc hodc ngudi vS huu thay ddi nai cu tru.
Tuy nhiSn, IrSn thgc tS den thdi dilm hipn nay van c6n rdt nhiiu ngudi dan chua biSt din quy djnh nay, dac bill Id ddi tugng ngudi cao tudi trong cdng ddng, khi tudi cang cao con ngudi ta thudng cd xu hudng khd khdn ban ttong viSc tiSp can vdi cdc ngudn thdng tin. Do dd, kit qua nghien cdu cua chdng tdi cung cho thdy NCT trinh dp hpc vdn tu THCS trd xudng cd xu hudng khdng biit vi quy dmh thdng tuyin nhiiu hon NCT cd trinh do tren THCS 0,2 ldn, NCT td 75 trd len CO xu hudng khdng biit vi quy dinh thdng tuyin nhiiu hon 1,9 lin nhdm NCT dudi 75 tudi (Bang 3.1).
Vdi quy dinh thdng tuyin, cdc ca sd kham, chua benh bat bupe phai ddi mdi phong each phpc vu, ddu tu ve CO sd vat ehdt, nhdn luc nhim ndng cao chdt lugng KCB di tiiu hdt ngudi b^nh, ldy ngudi bfnh lam trung tam. Tai tat ca cac ca sd y ti tu nhan tuyin huypn diu cd sd lugng benh nhdn den kham, chua benh tang gip 2 din 3 ldn so vdi cdng ky nam 2015. Thdng tuyin da lam tang mdc dp hdp ddn cua chinh sach BHYT, thu hut ngudi dan tham gia BHYT va thuc dly md rdng ddi tugng tiiam gia BHYT.
Nam 2016, sd ngudi tham gia BHYT theo hp gia dinh Id 11.530.389 ngudi, tang 37,4% so vdi nam 2015 cho thdy ngudi dan da lin tudng va nhgn thay lgi ich cua chinh sdch BHrVT. Ddng thdi, thdng tuyln tgo nin sg cdng bdng hon ttong cung cap dich vu kham, chiia b|nh BHYT giua ca sd y tl cdng va tu [2].
Trong nam qua, da sd ngudi cao todi khdng di KCB thdng tuySn. Ty IS thdng tuyen kham, chua benh d nhdm biSt quy dinh thdng tuySn chiem 18,5% va d nhdm ngudi cao tudi khdng biSt quy dinh thdng tuyen chiSm 5,2%. Cd mdi lien quan giua nhan thdc vd thgc hanh kham, chua benh thdng tuySn cua ngudi cao tudi tgi dia bdn nghien cuu, theo dd nhCmg NCT hiSt quy dinh thdng tuySn cd xu hudng khdm, chua benh thdng tuyen bao hiSm y tS cao gap 4,1 lan so vdi nhdm khdng biSt ve quy dinh nay (biSu dd3.1).
Thuc hipn quy dinh thdng luyen, ly 1| dan sd tham gia bao hiSm y te gia lang nhanh chdng, dgt 81,7% vao nam 2016 [2]. Tuy nhiSn thdng tuyln cung mang lai mdt sd bat cap nhu linh trang lam dung, true Igi quy bao hiSm y tl cd xu hudng ngdy cdng gia tdng. Cd nhilu ca sd kham chua bpnh canh tranh de thu hut ngudi cd bdo hiSm din khdm khdng dung quy dinh nhu chi dinh lang cac xel nghiim cgn lam sang, nhdt la cdc dich vu ky thugt cao, chi phi ldn, cac logi thudc dat tiSn... Viec ngudi cd bao hiim di khdm chua benh nhilu Ian trong ngay, tuan, tiiang dl lay thudc khdng cdn la hipn tugng cd bilt, co chS thdng tuyln da bpc Id yeu kem cda y te xa d mdt sd dia phucmg.
Nhu vgy BHYT mang Igi rat nhilu Igi ich cho ngudi dan nhung trSn thgc tS vin cdn mdt so khd khan nhdt dinh ddi vdi bpnh nhan cd BHYT ndi chung vd ngudi cao tudi ndi rieng. Vi du nhung bat egp khi thanh loan BHYT trong nghiin cdu dinh tinh cua chdng tdi mdt sd y kiln cho rang viec thanh loan kham, chua benh BHYT tuang ddi mat thdi gian, bin canh do mdt sd y kiln phan nan vS viec phdi ung trudc tiln kham, chua benh cho ca sd y te dd cd BHYT. Nhin td gdc
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dd la nhung ngudi true tiSp cham sdc sdc khde ban ddu cho ngudi dan, chung tdi cd hdi trgm trudng cd nhdng y kiln, nhung mong mudn gi ddi vdi chinh sach BHYT dk dap dng tdt viec KCB vd thanh todn BHYT.
Cac y kien tiiu biiu cua Trudng Tram y tS cho rang nen cung cap thim trang thiet bi cho tram y tl xa;
thanh todn ddy dd quy khdm BHYT kip thdi, nhanh chdng cho trgm
V. KET L U A N
- NCT ttinh dp hoc vdn td THCS ttd xudng cd xu hudng khdng biit vi quy dinh thdng tuySn nhieu ban NCT cd ttinh dd ttln THCS 0,2 Idn
- NCT td 75 trd ISn cd xu hudng khdng biSt vS quy dinh thdng tuyin nhieu ban 1,9 lan nhdm NCT dudi 75 tudi - Khdng cd mdi liSn quan giua trinh dp hpc van cua ddi tugng vdi hieu bill cua ddi tugng vS tuyen kham, chua
benh ap dung quy dinh thdng tuyin.
- Khdng cd moi lien quan giua khu vgc sinh songva thgc hanh khdm, chiia bpnh thdng tuySn cua ngudi cao tudi lai dia ban nghiSn cdu.
- NCT bill quy djnh thdng tuyin cd xu hudng khdm, chira benh thdng tuyin bdo hiim y li cao gdp 4,1 ldn so vdi nhdm khdng biet ve quy dinh ndy.
VI. KHUYEN NGHI
1. Tang cudng cdng tac truyln thdng vi chinh sach bao hilm y tl dl ngudi cao tudi hilu rd quyin lgi ciia ngudi cao tudi cd the bdo hilm y tl; dac biet la cdc qi^
dinh thdng tuyen va quyen lgi cua ngudi cao tudi khi thdng tuyln.
2. Cac ca sd y IS can day mgnh cdi cdch thii tuc khdm chiia binh bdo hilm y ti theo hudng thugn tien, gidm phien ha, gidm thdi gian chd dgi, dac bill doi voi ngudi cao tudi.
TAI LllgU THAM KHAO
1. Bd Y ti (2015), Thdng hi si 40/2015/TT-BYT quy dinh dang ky kham binh, chua benh bdo hiim y ti ban dSu vd chuyin tuyln khdm benh, chua benh bdo hilm y te.
2. Bd Y tS (2017), Bdo cdo tdng kit cong tdc ndm 2016 vd phuang hu&ng, nhiim vg, gidiphdp chd yeu ndm 2017.
3. Dinh Nam (2016), Phdi tdng nhanh ly le ngu&i cao tuoico bdo hiem y te.
4. Qudc hdi (2009), Lugt Ngudi cao tudi Viet Nam.
5. Qudc hdi (2014), Ludt sua ddi bd sung mpt sd dilu cda Luai Bdo hiim y ti, Sd 46/2014/QH13.
6. Vien ChiSn luge va Chinh sach Y tl (2006), Danh gid viec cham sdc sdc khde cho ngudi cao tudi d Viet Nam.
