ITt'HGQUMI&HGHrEHDItUI
Srf khac bi$t v l cung cap va svl dung dich vu kham chiTa benh tai 2 tram y tdndng thon va thanh thi cua tinh Khanh Hoa nam 2011
Pham Thi Doan Hanh i% Le Hi?u Thp (*), Lfi Bao Chau (**)
Nghiin ctfu md id cdt ngang kit hap phuang phdp nghiin ctfu dinh linh vd dfnh luang dd duac tie'n hdnh tqi 2 trqm y tixd (TYTxd) cda 2 huyin dqi diin cho vung ndng thon vd thdnh thi cua tinh Khdnh Hod nhdm md td thtfc trang khd ndng cung cdp vd stf dung dich vu khdm chtfa benh (KCB) cua cdc TYT vd lim hiiu su khdc biit ve khd ndng cung cdp dich vu KCB Iqi cdc TYT. Nghiin ctfu lien hdnh phong vdn ldnh dao Trung tdm Y ti huyin, irudng trqm y tixd, cdc cdn b0 y ticdng ldc tai TYT, dqi diin 342 ho gia dinh vd ngudi benh trong cdc hd gia dinh. Ki't qud nghien ctfu cho thdy 2 TYT co ca sd vdt chdt vd nhdn Itfc dqt tiiu chudn theo Bd tieu chi Qud'c gia vi y tixd tuy nhiin trang thiit bi cua cd 2 trqm khdng dqt tieu chudn ve sd' luang vd sd loqi irqng thii't bi (TTB) theo quy dinh. Kit qud Itfa chgn dich vu KCB lai TYT cua ngUdi ddn d vUng ndng ihdn din KCB tqi TYT cao hOn 13,2 ldn so vdi thdnh thf. Do vdy cdn quan ldm de'n td chtfc KCB Bdo hiem Y titqi TYT cung nhu viic ddu tu TTB y tiding vdi viic ddo tqo tdp hud'n cho cdn bd tram y ti
Ttf khda: Khdm chtfa bfnh, cung cdp dich v« KCB, stf dung dich vy KCB.
Differences in delivery and utilization of health care services in 2 rural and urban commune health centers in Khanh Hoa
province in 2011
Pham Thi Doan Hanh (*), Le Huu Tho (**), Le Bao Chau (***)
A descriptive cross-sectional study employing both qualitative and quantitative method was conducted. The research sites located In two Communes Health Centers (CHCs) in two districts representing rural and urban areas of Khanh Hoa province. The goal of the study is to describe deliver)' and utilization of health care services as well as the related factors al CHC level. The study interviewed head of district health centers, health staffs working at CHCs, 342 households' respondents. The results show that 2 CHC facilities and health human resource achieved the national standards on commune health activities but medical equipment of CHC cannot reach the national
Tap chl Y ts' Cong cpng, 3.2013, S* 27 (27) 29
ITtNGHIM&HGHIlNeiitll
standard both in terms ofthe quantity and type of medical equipment. The number of patients who lived in rural area attending examination and treatmenl service at CHCs was 13.2 limes higher compared lo that in the urban area. Therefore, il is necessary to provide health care services with health insurance at CHCs while medical supply and training for health staffs tg CHCs should be given attention.
Key words: examination and treatment, delivery of examination and treatment, examination and treatment service ultilization.
Tdc gia:
(*) Ths.Ds. Pham Thi Doan Hanh, Chuyfin vifin phdng Ke hoach Tii chinh, Sfl Y tfi" Khdnh Hda.
Email: ds doan hanh ©gmail.com. Difin thoai' 0906 450808
(**) Ts Bs. Lfi HSu Thp: Pho gidm dd'c Sfl Y td Khanh Hba.Email: [email protected].
Difin thoai: 0914 092499
(•**) Ths.Bs. Lfi Bao Chdu, Gidng vifin Bd mdn Quan ly Hfi thdng Y te, TrUdng Dai hpc Y te Cdng cfing.
Email: lbc@ hsph.edu,vn Dien thoai: 04 62662349
1. D 3 t v ^ n d l
Cling cd' v i hoEin thifin m a n g lirdi y te' cd sd trong dd tang cu'dng cung cS'p va d a m b a o chat li/dng dich vu KCB tai T Y T la chu trUdng ldn cua D a n g va Nha nifdc d d n g thdi la ifu tien ctia tinh K h i n h H d a trong nhi?ng n a m vflra qua. Cung ca'p dich Vll KCB c6a T Y T t m h K h i n h Hda ddng vai trd quan trong trong c h i m sdc su'c k h o e n h a n dSn d a c biet la ddi vdi viing n d n g thdn. B e n canh nhffng thanh tifu dat diTdc, y tfi' tuye'n xa hifin nay phai dfi'i m a t vdi nhieu khd k h a n va thach thtfc d a c bifit \k nhan Itfc y tfi'eua tuyfi'n xa. Cd sd v t t chat da du'dc d^u tiT tuy nhifin nhffng trang ihifi't bi y tfi' de hd trd cdng t i c KCB cdn thifi'u thd'n anh htfdng ra't nhi^u dfi'n cha't Iffdng K C B . Nghien cffu nay tie'n h a n h tiif t h i n g 12/2011 den 05/2012 n h a m tra ldi cac cSu hdi: (1) Thffc trang kha n a n g cung c a p dich vu KCB cda c i c T Y T hifin nay nhff thfi' n a o ; (2) Cac ye'u t d n i o t i c dpng dfi'n kha n a n g cung c a p dich vu KCB tai c i c T Y T ; (3) Ty ie sff dung dich vii KCB tai T Y T xa, phffdng. Ke't qua nghifin cffu nbara de xua't c i c chinh sach giiip cho boat dfing cung c a p dich vu KCB tai T Y T xa cd cha't Iffdng va dat hifiu qua hdn d i p ffng nhu cau c h a m sdc sffc k h d e n g i y c i n g cao cua n h a n dan dja phffdng,
2 . PhtXtfng p h a p n g h i e n ci^u
Nghifin crfu s^ dung phffdng p h i p md ta cat
ngang ke'l hdp nghien cffu dinh tinh va dinh Iffdng, 6 cudc phdng van sau va 2 cudc thao l u i n nbdm da dffdc thffc hifin vdi dai difin lanh dao cua Trung t a m Y te' (TTYT) v i c i n bd y te dang cdng t i c tai cac t r a m y te', thffc bifin d i l u tra 342 hd gia dinh (HGD) thupc phffdng Phffdng Sai, thanh phd'Nha Trang va Difin Sdn, la mpt xa ndng thdn thufic huyfin Difin K h i n h v e sff dung dich vu KCB tai TYT.
Phffdng p h a p thu thap thdng tin: ddi vdi sd'lifiu dinh Iffdng, su'dung bfi cau hdi phdng vS'n trffc tie'p de thu t h i p thdng tin sff dting dich vu KCB tai T Y T ciia ngffdi dSn. Dd'i vdi so' lieu dinh tinh, sff dung b a n g hffdng d i n thao luan nhdm, phdng van sau d e tbu t b a p y kie'n d i n h gia cua c i c ddi tffdng.
So' lieu dinh Iffdng thu thap dildc iff phong v a n ngffdi dan dffpc nhap lieu bang phan m e m Epidata 3.1, phan tich sd' lieu b i n g phan m e m SPSS 18.0, k i e m dinh tbdng k e dffdc sff dung: kiem dinh khi blnhphuang y^. Sd'lifiu dinh tinh thu t h i p dffdc dffdc gd b i n g sau dd c i c tbdng tin nay dffdc tong h d p va p h i n tich t b e o chu d l nghien cffu.
3 . K ^ t qua
3.1. Thtfc trgng khd ndng cung cap dich vu khdm chda bfnh cua cdc TYT 3.1.1. Ke't qua hoat ddng KCB tai c i c T Y T Qua bifi'u do I cho tha'y s d l a n KCB tai xa Difin
30 T a p chi Y ti Cfing cdng, 3.2013, Sd 27 (27)
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Sdn cao hdn ban s^lan KCB tai phirdng Phtfdng Sai.
14.000 12.000
„ 10.000 ffl
•i 8.000
•s S.OOO
" 4.000 2.000
0
• PhuoiigSa
•Diet] Soil
•
2009
•
315 10 625
"•"
+ I 1
•
•
2010 366 1 1 9-6
4 - |
4 1
•
2011 352 12 989 Biiu do 1. Sdldn KCB ttf ndm 2009 • 2011
3.1.2. Cdc dich vu KCB tqi TYT Cic ky Ihuat y t^ dffdc ph6p thifc hifin tai TYT theo Quyfi't dinh sd 23/2005/QD-BYT ngiy 30/8/2005 ciia Bp Y tfi' Ii mpt trong cic yl'u tdquan trpng de dinh gii kbi nang cung ca'p dich vu KCB tai cic TYT, Ke't qua cho thay vao thdi diem dilu tra, TYT xa Difin Sdn thffc hifin 51.7% cac ky thu^t trong dd mpt sd'ky thu^t dat ty Ifi cao la ky thuat y hpc cd truyen (100%), ky thuat phu san (80%), ky thuat npi khoa (75%), cap ed'u (60%). Tuy nhien ty lfi ihffc hifin dffdc cic ky thuat y tfi'eua TYT phtfdng Phffdng Sii thS'p hdn rat nhieu. chl dat cd 13,3%
(8/60). chii ye'u la cic ky thuit thupc nhdm ky thuat nfii khoa va da lieu (50%), sau dd la phu san (20%).
Ke't qua nghien cff^i dinb tinb cho thS'y "Tram Y te khim chti yfi'u Ii cic b^nh tbdng thffdng nhtf vifim dffdng hd hip d tre em, cic bfinh ly man tinb d ngtfdi gia tang huye't ip, dii thio dffdng, ho, vifim hong cam cum ddn giin v§y thdi, cic b?nh ve dtfdng lieu hoi, benh ly tim mach, chu yfi'u Ii KCB ban dau thdi" (PVS lanh dao TTYT Difin Khinh),
3.1.3. Mdt sdyiu tddnh hudng din khd ndng cung cdp dfch vu KCB tqi TYT
* Ca sd vqt chdt cuq cdc TYT:
Cd sd vit chaft ciia Tram Y tfi' xa Difin Sdn va phtfdng Phtfdng Sai dip rfng nhu cau kham chtfa
benh cho ngffdi dan va dat tifiu chi cd sd vSt chat cua Bd tifiu chi Qudc gia ve y te xa. TYT phffdng Phffdng Sai dtfdc xay di/ng nim 2004, dien tich Ait li 100 m2, cd 7 phdng chiJc nang. TYT xa Difin Sdn dffdc xay dffng nim 2004, difin tich dat la 7.910 m2 va sd' phdng chffc nang hifin cd li 14 phdng.
* Thtfc irang trang thii't bf (TTB) cUa 2 TYTxd diiu tra
TTB cua 2 TYT trong nghifin cii'u deu khdng dat vl sd Iffdng va chung Ioai cua Bp tieu chi Qudc gia vl y te' xa. Ddi vdi TYT phtfdng Phffdng Sai ty Ifi TTB chung chi dat 45,1% so vdi tdng sd loai theo quy dinh. Nhilu TTB cin Iam sang can cho nhu can KCB nhUhg chtfa dtfdc trang bi nhff khdng cd miy sifiu am, miy dien tim. Bp khim chuyen khoa tai mui hpng khdng cd bd khim ngu quan, kep I^y di vat tai, kep la'y di vai mui. ghe ring,... chi cd duy nha't bdng thff thi Iffc.
Tai TYT xa Difin Sdn, TTB cd ve khi hdn nhff bd khim chffa bfinh chung cd miy sifiu am trang den, bfi dung cu xfit nghifim cd day dii TTB theo quy dinh cua Bp Y tfi* (BYT) nhtf miy xet nghiem sinh hda, miy xfit nghifim huye't hpc, miy xfit nghiera nffdc tieu. Tuy nhifin vln cdn thifi'u nhilu TTB vl sd'Iffdng vi ci chung loai vi ty lfi cic loai TTB dat 51,1% so vdi tdng sd'loai theo quy dinh cua BYT.
* Tinh hinh stf dung thudc tqi 2 TYTxd dieu tra Theo Quye't dinh sd05/2008 ngiy 1/3/2008 cua Bd trffdng Bfi Y le'quy dinh ve Danh mtic thudc chu yfi'u KCB cho cd sd y tfi*, so loai thudc dffng cho TYT xa cd bic sy la 680 loai va xa khdng cd bic sy la 334 loai. Tuy viy, sd Iffdng tbudc tai TYT phffdng Phtfdng Sii rat thap so vdi quy dinh cua BYT vdi sd loai tbudc cd tai TYT la 24 loai. Ddi vdi TYT xa Difin Sdn sd Ioai thudc cd tai TYT Ii 147 Ioai va ngoai sd' Itfdng thudc tbeo danh muc BHYT thi tai TYT xa Difin Sdn cdn cd tti thudc quay vdng vdn do cic nhan vifin ctia TYT ddng gdp, sd Itfdng thudc nay dam bao cho nhu clu KCB ciia ngtfdi din khdng cd BHYT,
* Thtfc trang nhdn Itfc cua TYT
TYT phtfdng Phtfdng Sii chi cd 5 bifin che, kbdng cd bic si tai TYT vi TYT xa Difin Sdn cd 7 bifin che trong dd cd 1 bic si Ii phff hdp vdi Thdng ttf 08/2007/TTLT-BYT-BNV ngay 05/6/2007 (TT08) ve hffdng dan dinh mrfc bien che sir nghiep trong cic cd sd y tfi* nha nffdc. Tuy nhien thffc te doi vdi TYT xa Difin Sdn cht cd 7 bien che la chtfa dip
Tap chi Y tfi' Cdng cdng, 3.2013, Sd 27 (27) 31
ITfiNGBHftN&NeHIEKCaol
tfng nbu cau thffc tfi'eua cdng tic KCB.
"Hien nay TYT chi cd 1 bdc si ldm cdng tdc khdm chtfa bfnh, 1 y si Id trudng trqm ldm cdng tdc qudn if, ngodi cdng Idc KCB cdn ddm nhiim cdng tac phdng chdng dich. idt cd cdc dtf dn thugc Chuang trinh muc tieu qudc gia... nin TYT hien nay cdn 1 ysTntfa diphuc vu cdng tdc KCB..." (TLN TYT Dien Sdn).
* Thtfc trgng ngdn sdch ctia cdc TYT Kfi' tff dau nam 2011, Sd Y te" Khinh Hda da thffc hifin khoin kinh phi cho mdi TYT Ii 285 trieu ddng/nam vdi muc dich tao sff chii dpng ciia cic TYT trong hoat dfing cua minh. TTYT se quan If ngudn kinh phi khoin cho cic TYT, tiln nay se dtfdc dffng chi Itfdng vi chi thffdng xuyfin cho TYT (tram xa phi). Vdi kinh phi dtfdc khoin niy. khoang 86% dffng chi Itfdng cho cin bfi y te'tai TYT, 14%
kinh phi cdn Iai dung d^ cbi thffdng xuyfin khic.
"Mdi tram 285 triiu, trong dd chi phi luang vd cdc loqi khdc la 245 tneu roi, trqm xd phi Id 40 trifu" (PVS Ianh dao TTYT Difin Khinh)
3.2. Thtfc tr^ng sUcdung dich vu khdm chffa bfnh cua ngUdi ddn tai TYT
Nghifin crfu da tien hinh thu thap thdng tin cua 342 HGD thupc phtfdng Phtfdng Sai, thinh phd Nha Trang (171 HGD) va xa Difin Sdn thudc huyen Difin Khinh (171 HGD).
Bdng 1. Ltfa chgn dich vif KCB cua 2 xd diiu tra
NKI hXR ebon dich vv KCB Khflng chaa tri Tlf ehilB \&.Bs ihufic nam Mm ihu^c i?i tueu ihuoc Phdng in?ch n/nhan T m m Y i ^ PKDKKV Benh vi$n huy$n Benh viCn tilth KUc Tdng cf ng
PhiRfng S&l T i n str
i 0 IT
u
5 33
7 4 it
Tjl|(%) 3.4
M.I 14,S 5.' 37.3
S.O 4 J J 00,0
niensifti Tins*'
1 3 Z.1 11 47 0 10 7 4 106
T) n (%) 09 2.8 21.7 10.4 443
9,4 6,6 3.8 100.0
Dd'i vdi ngffdi dan xa Difin Sdn, ltfa chpn dicb vu KCB tai TYT chifi'm ty lfi cao nha't Ii 44,3%, mua thudc tai hifiu thud'c Ii 21,7%, KCB tai phdng mach tff nhan la 10.4%. chpn benh vifin huyfin la 9,4% va benh vifin Iinh la 6,6%. Dieu niy ri't khic dd'i vdi
each chpn lira dich vu KCB cua ngffdi dan phtfdng Phffdng Sai, cich chpn dich vu KCB tai PKDKKV la cao nba^t vdi ty le 37,5%; chpn each mua thud'c tai hifiu thud'c ciiifi'm ty lfi 26,1%; KCB tai phdng mach tff nban la 14,8% va bfinh vien tinh la 8,0%.
Ly do ngtfdi benh chon dich vu KCB tai TYT Bdng 2. Ly do ngiM b^nh chgn dich vi^ KCB tqi
TYT
LS do ngitifi dUn chpn DV KCB t^i TYT (n=52) Bfnh nhe Can nhi
BHYT cfi nOi dang k^ KCB ban dau la TYT Tin chuyen m6n cua CBYT Thdi do phuc vu cua CBYT lai TYT loi Thu tuc nhanh chdng. (huan uen Cd day du tbudc Cd dSy du TTB GiS c^ hop IJ
T^nstf 9 40 32 3 4 6 6 3 i
T>ie(%) J 7.3 76.9 61.5 5.8 7.7 11.5 11.5 5.8 5.8
phan ldn I^ do Ii gan nhi chilm ty Ie 76,9%; ly do ngtfdi bfinh cd the BHYT ndi dang ky KCB ban dau tai TYT la 61,5%; ly do bfinh nhe la 17,3%; thu tuc nbanb chdng thuin tien la 11,5%; cd day dii thud'c la 11,5% (bang 2).
Dd'i vdi phffdng Phtfdng Sii cd den 48,2% ngrfdi Bdng 3. Ly do ngUi/i binh khong chgn dich vu KCB
tqi TYT
Lj da Df uOi (Un khOofi f b^n PV KCBm
Kfatef bii'l dKbw Bfnh<ltnF X^nU
Klifms o> B u n cfiiWL JJnp kJ KCB han Jiu
Kb^ En ^ID chiivED ,a^ nj> CBY1 ci.TlT
•niwcMamA aiaf ctiOiili Ihua:
Kh6nfc«d>,iluITB K W c
PlnMnH Sll fmH)) T j i j l f
7 9 1
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n Tyi»(S(
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bfinh tra Idi khdng sff dung dicb vu KCB tai TYT vi the khdng cd the BHYT cd ndi dang ky KCB ban dau tai TYT. Trong khi dd tai xa Difin Sdn khdng chpn dich vu KCB tai TYT vi Iy do khdng cd BHYT ndi dang ky KCB ban dau tai TYT chi cd 18.6% va ly do cbinh ngffdi dan tai xa Difin Sdn khdng sff dung dich vu KCB tai TYT la do bfinh nang chiem 25.49t y kifi'n (bang 3).
32 Tap chi Y tfi' Cdng cdng, 3.2013, Sd 27 (27)
IT6NB0UAN& CUU I
3.3. Mgt sdyi'u tdliin quan den sit dting dich vu khdm chtfa bfnh tqi TYT Ke't qua nghifin crfu cho tha'y ty le sii" dting dicb vu KCB tai TYT d vffng ndng thdn cao hdn thanh thi gap 13,2 Ian (OR=13,2); ty le srf dung dich vu KCB tai TYT cua xa Difin Sdn Ii 44,3% trong khi dd srf dung dich vu KCB tai phffdng Phffdng Sii rat thap chl chilm 5,7%. Stf khic biet niy cd y nghia thdng kfi vdi p< 0,001.
Ty Ie sff dung dich vu KCB tai TYT cua HGD cd khoang cich tff nbi dfi'n TYT dffdi 1 km cao hdn nhdm trfin 1 km la 4,4 lln (OR = 4,4), sff khic biet nay cd y ngbia Ihd'ng kfi (p < 0,001).
4. Ban lu4n
Viec cung cap va srf dung dich vu KCB Iai TYT ri't khic nhau giffa xa Dien Sdn va phffdng Phrfdng Sai cd the I^ giai la do hifin nay TYT phffdng Phffdng Sai van chffa trien khai KCB bang BHYT, nfin ndi ding kf KCB ban dau ciia ngtfdi din cd the BHYT da so' deu dang k;^ tai PKDKKV so 3. Kfi't qua cua nghifin crfu dinh tinh cho thi'y TYT phtfdng Phtfdng Sii gin PICDKKV sd 3 nen ngtfdi bfinh sff dung dich vu KCB tai PKDKKV sd3 nhilu hdn (37,5%).
Khic han vdi TYT phffdng Phtfdng Sii, sd lan khim trung binh/ngffdi/namciiaxa Difin Sdn la 1,3 cao gi'p 2 lln so vdi cbuan qudc gia y te xa va cao tffdng dffdng sd'hfiu KCB tai tinh Cao Bang cao nha't la 1,4 Ian trong nghifin cthi cua Vifin Chie'n Iffdc vi Chinh sich (2010) [6] va ke't qua niy cung phii hdp ket qua cua nghien cff^ ctia Bd Y te' (2011) vdi so' Iffdt KCB chung tai TYT cua cua Khinh Hoa 31,4 Iffdt/ngiy [2],
Ke't qua dinh gia cic ky thuat y tfi' dtfdc thtfc hifin tai TYT theo Quye't dinh sd 23/2005/QD-BYT ngiy 30/8/2005 cua Bfi Y te cho thSfy tai TYT phffdng Phffdng Sai cic ky thuat y te' thtfc hien chifi'm ty lfi ra't tha'p tbeo quy dinh chi dat 13,3%
trong khi dd tai TYT xa Difin Sdn ket qua dat khi hdn vdi ty Ifi 51,7% (bang 2). Ke't qua nay cung gan nhff ttfdng ttf vdi ke't qua nghien cffM cua Vifin Chiln Iffdc vi Chinb sich (2010), ty Ifi cic TYT cd the thtfc hifin dffdc toin bd cac ky thuat so vdi danb
muc phan tuyen theo quy dinh cua Bd so 23/2005/QD-BYT ri't thi'p. Ket qua nghifin cffu cung phu hdp vdi nghien cffu ctia BYT (2011) ty Ifi xa thffc hifin drfdc drfdi 50% sd'ky thuit dao dfing tff 66,7% (Khinh Hda) dfi'n 80% (Kon Tum) [1].
Ddi vdi ngtfdi dan xa Difin Sdn, Irfa chpn dich vu KCB tai TYT chiem ty Ie rat cao la 44,3%, mua thud'c tai hieu thudc la 21,7%, KCB tai phdng mach ttf nhin la 10,4%, chpn bfinh vien huyfin Ii 9,4% va benh vien linh la 6,6%. Dilu nay rat khic ddi vdi each chpn Irfa dich vu KCB crfa ngffdi din phffdng Phffdng Sii, khdng cd trien khai KCB BHYT tai tram, each chpn dich vii KCB lai PKBKKV Ii cao nhat vdi ty lfi 37,5%; chpn each mua thud'c tai hieu thudc chifi'm ly Ie 26,1%; KCB tai pbdng mach tff nhin Ii 14,8% va benh vien linb la 8,0% va Iai TYT la 5,7% (bang 1).
Kfi't qua nghien ciJu tai xa Dien Sdn cho tha'y ly lfi sff dung dich vu KCB tai TYT cao hdn trong nghifin cffu cua Dinh Mai VSn (2005) ty le srf diing dich vu KCB tai TYT l i 20,74% [5], Va thap hdn so vdi nghien crfu cua Trinh Van Manh (2007) vi Pham Khinh Tffng (2008) ty lfi niy lln Irfdt la 59,5% va 59,6% [3], [4].
Tff ket qua nghien cffu trfin chffng tdi dtfa ra mdt so'khuyfi'n nghi: cln quan tim bd tri bac si dfi'n kham chffa benh tai Tram Y Ie' thffdng xuyfin hoac It nhl't 2-3 ngay trong tuan de ap diing nhieu cac dich vu y te' theo Quyfi't dinh phin tuye'n ky thuat cua BYT quy dinh; nen td chrfc KCB bang BHYT d ti't ca cic TYT ke ca TYT d nfing thdn bay tbanh thi de tang ctfdng srf dung dicb vii KCB cua ngrfdi dan tai TYT ddm bao tinb cdng bang trong KCB; bfin canh do can dau ttf TTB nhieu hdn nffa cho cic TYT, dac bifit la cic TTB c$n lim sing nhff miy sifiu am, may xet nghifim, may do dien Iam dd, miy xet nghifim sinh hda mau,... de ning cao chi't iffdng chan doin vi dieu tri tai TYT; can khoin diJ kinh phi tff ngudn ngan sich nhi nffdc d^ TYT tang tinh tff chu vi quan \f cac boat ddng tai tram hifiu qua hdn; ngoai ra cln ting crfdng cong tic dio lao cho cin bd y te'dac bifit la cic ldp tip hua'n phuc vu cho cdng tic KCB.
Tap chi Y ti Cdng cdng, 3.2013, Sd 27 (27) 33
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TS" ll«u tham k h i o 4. PhamKhanh TinE (2008), Hanh vi dm kiem vi Sll dimg dich vu y te cda agddi din huy^n Binh Xdyen dnh Vinh Phdc 1 R - V a- °^™ 2008, Tmdng Dai hgc Y t€ cong cOng Ha Noi.
i. Bg Y ie(2011), -Bio c i o ket qua nghign cihi dioh gii vai
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34 T a p chi Y t#' C d n g cong, 3.2013, Stf 27 (27)
