Y HOC VIET NAM THANG 7 - SO 2/2012 TAI LIEU THAM KHAO
1. Tran Van Chat (2004), "Chyc nang smh ly ciia than", Benh than not Pihoa, Nha xuat ban y hoc.
Ha NOI. 10-17.
2. Phiing Xuan Binh (2005), "Qua trinh tao nUdc tieu d than", Smh if hoc, Nha xuat ban y hoc HN.
3. Nguyen Van Xang (1991), "Suy than man", Benh hoc ngi khoa, Nha xuat ban y hoc, Ha Ngi,
^. fijnh Thj k i m Dung (2004), " Suy than man tinh", Benh thin noi khoa, Nha xuat ban y hgc, Ha Not. 284-304
5. Banh Van Khiu, Pham Xuan Phong (2004), "Sy dyng thuoc Ddng y di'eu tri benh ly than hien nay va
hudng phat trien trong tuong lai". Tap chinghi^ cuU Y Duoc hoc cd tuyen Viet Nam, 28-30.
NORBERT G.ELISABETH K. et all. Low protein diet supplemented by keto acid in chronic renal failure: A prospective controlled study. Kidney international, Vo! 24, Suppl 16 (1983) pp: 263 - S267, Vol 2, Suppl 15 (1983) pp: S263-5267.
Schimicker V. Vetter K. et all. Conservative long-term treatment of chronic renal failure with Keto Acid Supplementation. Infussions theraphy 14 supp 1.5, pp" 34 -38 (1987).
KET QUA TO CHllTC KHAM CHITA BENH CHO NHAN DAN CO THU VIEN PHJ TAI BENH VIEN TRUNG UtTNG Q U A N DO1108 GIAI DOAN 2007-2011
Do Hoa Binh*
TOM TAT
Ty nam 1989, Benh vien Trung u'dng Quan doi 108 da tham gia kham chffa benh cho benh nhan nhan dan cd thu mot ph'an vien phi y te, Trong 5 nam (2007 - 2011), da kham benh cho 615.417 benh nhan, cap cijli 14 457 benh nhan va thu dung dieu tn noi trii 56,384 benh nhan nhan dan, Cac benh nhan nhan dan da duoc thuc hien 5.314,218 xet nghiem cac loai;
chyp 402.215 lan X quang, 35.490 fan chup CT scanner, MRI, 328.319 fan chan doan chyc nang. Thye hien 38.908 phau thuat cac loai, trong dd cd 70% la phau thuat loai dac biet va loai 1 va cd den 37,68% la cac phau thuat sy dung ky thuat cao cap. Do ap dung cac giat phap ve to chyc, ngay dieu tn trung binh 1 benh nhan nhan dan da giam ty 10,6 ngay xudng cdn 10,1 ngay sau 5 nam, cong suat sy dung giUdng benh trong 5 nam dao dong trong myc 30,9% den 34,8%.
Tu" khoa: kham benh, chya benh, vien phi, Benh vien 108.
SUMMARY
THE RESULT HEALTH CARE ORGANIZATION FOR PEOPLE TO COLLECT USER FEES IN HEALTH CENTRAL
MILITARY HOSPITAL 108 FROM 2007 TO 2011 Since 1989, Central Military Hospital 108 participated in medical care for patients People with partial collection of medical expenses In 5 years (2007-2011), was examined 61S,'I17 patients, 14,457 emergency patients and mpabents of earnings 56,384 patient people. Patients People 5,314,218 has been
* Benh vien Trung Udng Quan dgi 108 Phan bien khoa hoc: GS.TS. Dao Van Dung 128
made the type tests; X-ray taken 402,216 times, 35,490 times CT scanner, MRI; 328,319 bmes diagnostic functions. Perform 38,908 surgenes of all kinds, of which 70% is of special surgery and type 1 and up to 37.68% as surgeons use advanced techniques. Because application of organizational soluhons, on an average treatment pahent people fell from 10.6 days to 10.1 days after 5 years, using hospital bed capacity in 5 years to range 30.9% to 34.8%.
Keywords: examination and treatment, hospital charges, 108 Hospital.
I. OAT V A N o f
Kham ehJa benh eho nhan dan la truyen thong ciia cac benh vien Quan dpi. Benh vien TTjQD 108 ngoai nhiem vu phuc vu bo dpi v l n luon dap ifng nhu cau kham benh, chya benh nhan dan. T y nam 1989, benh vien da tiep nhan kham chu'a benh eho nhan dan eo thu mot phan vien phi y te (DVYT). Trong thdi binh, c k benh vien quan dpi tham gia kham chya benh cho nhan dan la mot xu hydng tat yeu eiia quan doi eac nyde tren the gi6i. Cae benh vien quan d6i muon duy tri va phat trien ky thuat phai dya vao nguon benh nhan eo trong nhan dan. Oong thcJi khi tham gia kham chu'a benh eho nhan dan, cac benh vien quan dpi eung tham gia vao chu tru'dng xa hpi hoa cong tac y te eiia Nha nude.
Vdi chyc nang la Benh vien hang dac biet
Y HOC VIET NAM THANG 7 - SO 2/2012 ciia Quoc gia, thanh vien y te chuyen sau ciia Ha
Npi va ca rnldc, Benh vien Tl/QD 108 tham gia kham chya benh eho nhan dan co thu vien phi eiia hau het eae dia phu'dng trong ca nyde. Benh nhan nhan dan ed thu vien phi la mot trong 3 nhdm doi tydng kham benh, chtJa benh tai benh vien, ngoai nhom bp dpi tai ngu va bao hiem y te.
Be cd ed sd danh gia ve hieu qua hoat dong kham chffa benh cho nhan dan co thu mot phan vien phi, chung toi tien hanh nghien eifu: Hoat dpng kham chya benh cho nhan dan eo thu mot phan vien phi tai benh vien TWQO 108 trong 5 nam (2007-2011) nham mue tieu: Tiep tue dieu chinh va de xuat cae giai phap to ehye de hoat dpng kham ehffa benh cho benh nhan co thu mot phan vien phi y te 6[f<ic thuan Idi va dat hieu qua eao nhat.
II. 0 6 l TUpNG VA PHUONG PHAP NGHIEN CCfU:
1. Doi tddng nghien cdu:
To chiTc kham benh, thu dung dieu tri cho benh nhan nhan dan eo thu mot phan vien phi.
Hoat dpng can lam sang phuc vy benh nhan nhan dan eo thu mot phan vien phi.
- Ket qua hoat dong ehuyen mon ciia Benh vien trong 5 nam 2007 den 2011 the hien qua cac bao eao thong ke.
2. Phu'dng phap nghien cdu:
Thiet ke nghien ciTu: Mo ta eat ngang, phan tich so lieu thir cap.
Mo ta thye trang to chUc kham chij'a benh cho benh nhan nhan dan cd thu mot phan vi§n phi tai Benh vien TL/QO 108.
So sanh sd lieu kham chffa benh eho benh nhan nhan dan eo thu mot phan vien phi qua 5 nam
3. Xdly so lieu: Ph[16ng phap thdng ke y hoc.
III. KET QUA VA BAN LUAN
1 . Cac glai phap t o chu'e k h a m chu'a benh cho benh nhan DVYT.
1.1. To chu'e kham Ijenh, dieu tri ngoai tru.
1.1.1. Bd tri khu vUc kham benli: ngoai khu kham benh, cae khoa can lam sang to ehye lam xet nghiem cho benh nhan den kham benh ngay tai khoa kham benh.
1.1.2. To chdc iai khu vUc don hep benh nhan: Benh nhan DVYT du'dc don tiep tai 1 khu vye rieng. Bd tri lai ndi lam benh an vao vien. Gid lam viee dUde duy tri nghiem tiic, benh vien md eifa khu tiep don hang ngay til 6g30.
1.1.3. Cac khoa lam sang luan phien cir' eac bae sy eo trinh do tien sy, ehuyen khoa cap 2, thac sy ra kham benh. Bd tn' 1 sd nhan vien lam nhiem vu hu'dng dan cho ngUdi benh DVYT di lam cac xet nghiem va glai dap cac thac mac.
1.1.4. Lam bang hUdng dan Quy trinh kham benh cho benh nhan DVYT. Tren cae man hinh tai khoa kham benh cd thdng bn ve quy trinh kham benh. Ke vach mau chi dydng va hydng di de ehi dan benh nhan den eac khu vyc xet nghiem.
1.1.5. l^ng dung cong nghe thong tin: Trien khai he thong mang npi bg, benh nhan ehi can dang ky eac thong tin ca nhan tai ciTa hep ddn.
Cae ket qua xet nghiem sinh hda, huyet hoc dyde tra qua mang. Tren website ciia benh vien md 1 mue hydng dan quy trinh kham benh cho benh nhan DVYT va sd do benh vien.
1.2. To chdc thu dung dieu trj.
1.2.1. Thu dung: Ber\h nhan DVYT neu nang va ean dieu tri ehuyen khoa sau se thu dung dieu tri tai cac khoa chuyen khoa. Neu eo benh viTa va nhe dyde dieu tri tai eae khoa nhan dan neng trong benh vien.
1.2.2. ThUc hien cac ky thuat: Benh vien ap dyng eae ky thuat phii hdp ehuyen mon theo quy djnh eho mpi benh nhan DVYT.
1.2.3. Thanh toan chi phi: tam thu vien phi khi vao vien, thuoc va vat t y y te mua tai ciia hang ciia benh vien, sau khi dieu tri se thanh toan theo bang gia ciia benh vien da dyde cap tren phe duyet.
2. Ket qua v e chuyen m o n . 2.1. Kham benh.
Kham b^nh DVYT
Ty ie Dvrr/tonq Oc^n vj
li/dt ll/Ot liTdt
%
Nam 2007
89.820 111.669 201.489 45,58
2008 99.196 118.473 217.669 45,72
2009 131.437 160.776 292.213 44,98
2010 136.338 172.192 308.530 44,19
2 0 1 1 158.626 219.666 378 292 41,93
Tong 615.417 782.776 1 398.193
44,02
Y HOC VIET NAM THANG 7 - SO 2/2012
Benh nhan DVYT den kham benh tang dan hang nam, t y 89.820 nam 2007 len 158.626 lydt nam 2011 (tang 177%). Trong 5 nam eo 615.417 benh nhan DVYT dMc kham benh tai benh vien Tt/QO 108. Ty trpng benh nhan DVYT kham benh so vdi so lydng kham benh chung kha 6n dmh, chiem khoang •12% den 4 5 % tong sd benh nhan kham ehung toan benh vien.
2.2. Cap cdu
Bang 2; So lydnq benh nhan DVYT cap ciTu trong 5 nam (2007 - 2011).
Cap cu'u DVYT DOI ti/dnq khac Tong Ty le DVYT/tonq
D(Jn vi
lu'dt llfOt li/dt
%
Nam 2 0 0 7
3.994 7.539 11.533 34,63
2 0 0 8 3.902 7 060 10.962 35,60
2 0 0 9 1.799 3.336 5.135 35.03
2 0 1 0 1.910 3.266 5.176 36,90
2 0 1 1 2.852 3.709 6.561 43,47
Tong 14.457 24.910 39.367 36.72 Trong 2 nam 2007 va 2008, do khoa cap ciru phye vu kham benh cho ca cae tru'dng hdp cap tinh va phan loai benh nhan cap eifu chUa chinh xac nen so lUdng cap cir'u kha cao. T y nam 2009, benh vien quy dinh phan loai cap eifu diing tieu ehuan nen so lUOng thdng ke giam hdn mot nira. Tuy nhien, ty trpng cap eyu cho BN DVYT van tang dan hang nam, tinh chung trong 5 nam cap ciru cho BN DVYT van chiem 36,72% so trydng hdp cap cyu chung toan benh vien.
2.3. Thu dung.
Bang 3: Sd lydng benh nhan DVYT thu dung trong 5 nam (2007 - 2011).
Thu dung DVYT Doi ti/onq khac Tong Ty le DVYT/tonq
f)dn vj
lu'dt lu'dt lu'dt
%
Nam 2 0 0 7
10.653 17.191 27.844 38,26
2 0 0 8 10.576 19.135 29.711 35,60
2 0 0 9 11 140 24.799 35.939 31,00
2 0 1 0 11.394 26.398 37.792 30,15
2 0 1 1 12.621 32.140 44.761 28,20
Tong 56.384 119.663 176.047 32,03 Benh nhan DVYT thu dung dieu tri npi tru tai benh vien tang khong nhieu sau 5 nam (tang
)). Ty trpng benh nhan DVYT thu dung dieu tri so vdi so lydng thu dung chung giam tir 38,26%
xudng 28,20%. Nguyen nhan la do benh vien thu dung BN BHYT tang nhieu, dieu nay cung hdp vdi chu trydng tien tdi BHYT toan dan, Tinh chung trong 5 nam, Iddng BN DVYT thu dung eijng ehi chiem khoang 32%.
2.4. Ty le sd dung giddng.
Bang 4: Ty le sir dung giycJnq ciia benh nhan DVYT trong 5 nam (2007 - 2011).
Ty le su' dung gii/6ng DVYT
Doi tl/dng khac Tonq
Don vj
% %
%
Nam 2007
{900 G) 34,8 71,0 105,8
2008 (915 G)
33,5 76,9 110,4
2009 (lOOOG)
32,8 82,8 115,6
2010 (llOOG)
30,9 80,4 111,3
2011 {1200G)
31,7 85,6 117,3 Tir nam 2007 den nam 2011, sd giudng ke hoaeh eiia benh vien tang lien tuc, tir 900 giydng len 1200 giycJng. Tuy nhien cong suat sit dung giudng benh ciia benh vien luon tren 100%, thap nhat la nam 2007, dat 105,8% va cao nhat la nam 2011, dat 117,3%. Ty le sir dyng giydng benh cho benh nhan DVYT trong 5 nam ciing ehi chiem tif 30,9 den 34,8%.
2.5. Ngay dieu trj trung binh 1 benh nhan
Bang 5; Ngay dieu tri trung binh cua BN DVYT trong 5 nam (2007-2011).
Ngay dfeu trj trung binh DVYT DOI ti/Onq khac Chung
Ddn vi ngay nqay nqay
Nam 2007
10,6 12,8 11,9
2008 10,3 12,5 11,7
2oog 9.9 11,6 11,1
2010 9,9 11,6 11,1
2011 i(y_
llj4 iifl Qua bang 5 cho thay, benh nhan DVYT cd so ngay nam dieu tri trung binh eung giam dan hang nam. Tuy nhien, so vdi ket qua ehung thi BN DVYT ed ngay nam dieu trj trung binh thap hdn ket qua chung.
2.6. Xet nghiem
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Y HOC VigT NAM THANG 7 - SO 2/2012
Bang 6: So lu'cfng xet nghiem huyet hoc, sinh hoa, mien dich, vi sinh vat cua benh nhan DVYT tronq 5 nam f2007 - 20111.
Xet nghiem DVYT Doi ti/dnq khac Tonq Ty le DVYT/tonq
Ddn vj XN XN XN
%
Nam 2007
684.670 1.354.827 2.039.497 33,57
2008 697.691 1.643.895 2.341.586 29,80
2009 1.055.533 2.285.308 3.340.841 31,59
2010 1.066.486 2.462 245 3.528.731 30,22
2011 1.809.838 3.344.600 5.154.438 35,11
Tong 5.314.218 11.090.875 16.405.093 32,39 Cac xet nghiem cd ban, thydng quy nhy: huyet hpc, smh hoa, mien dieh va vi sinh tang nhanh.
So vdi nam 2007, nam 2011 tang 253%. Ooi vdi BN DVYT, sau 5 nam, tang 264%. Kham benh tang 177%,Jhu dung tang 118% nhu'ng xet nghiem thydng quy tang 264% la mot eo gang Idn ciia benh vien de dam bao chat lydng chan doan va dieu tri benh dUdc hieu qua
Bang 7: So lUdng xet nghiem Y hoc hat nhan, sinh hoc phan t y eiia benh nhan DVYT trong 5 nam ( 2 0 0 7 - 2 0 1 1 ) .
Xet nghiem DVYT Doi tu'dng khac Tonq Ty ie DVYT/tonq
Ddn vj XN XN XN
%
Nam 2 0 0 7
9.876 3.343 13.219 70,64
2 0 0 8 4.841 9.138 13.979 34,63
2 0 0 9 4.211 10.746 14.957 28,15
2 0 1 0 4.017 13.966 17,983 22,34
2 0 1 1 4.568 14.459 19.027 24,01
Tong 27.513 51.652 79.165 34,75 Cac xet nghiem y hpc hat nhan va sinh hoe phan tif la nhyng xet nghiem hien dai, mdi dyde benh vien trien khai trong khoang 10 nam trd lai day. Cac xet nghiem nay rat eo gia trj trong chan doan va theo doi benh. Benh nhan DVYT da dUdc sir dung ngay eac xet nghiem nay va chiem tdi 34,75% tong sd xet nghiem thye hien tai benh vien trong 5 nam.
2.7. Xquang
Bang 8: So lydnq ehup Xquang thong thydng eiia benh nhan DVYT trong 5 nam ( 2 0 0 7 - 2011).
X quang DVYT DOI tu'dng khac Tong Tv le DVYT/tonq
Ddn vj lu'dt iifdt lirdt
%
Nam 2 0 0 7
61.403 61.600 123.003 49,92
2 0 0 8 66.324 76.731 143.055 46,36
2 0 0 9 79.224 90.744 169.968 46,61
2 0 1 0 86.636 98.753 185.389 46,73
2 0 1 1 108.629 127.828 236.457 45,94
Tong 402.216 455.656 857.872 46,89 Chup X quang hien nay la mot xet nghiem kha thong dung, benh vien da dau i\S cac may X quang k9 thuat so, may rira phim tu' dong. Do do thcJi gian chup va tra ket qua nhanh. So lu'dng va ty le chup X quang cho benh nhan DVYT tang dan hang nam.
Bang 9 ; So lifJnq chup CT Scanner, MRI cua benh nhan DVYT trong 5 nam (2007 - 2011).
CT Scanner
MRI Tong
4.592 6.780 DPI tu'dng khac
Tonq Ty le DVYT/tonq
men nay, tai benh vien co 3 may CT Scanner, trong do co 1 may 320 day, 2 may cong hi/iJng tiT (MRI), mot may 3 tesla va 1 may 1,5 tesla. Cac trang bi nay da gop phan tang kha nang chan doan benh, trong do benh nhan DVYT chiem ty le 5 8 , 4 1 % trong 5 nam. So Wdng chup CT Scanner va MRI Clio benh nhan DVYT nam 2011 tang 267% so vfli nam 2007.
2.S. Ciian doan cii&c nang
Bang 1 0 : So lu'dng chan doan chirc nanq cua benh nhan DVYT trong 5 nam (2007 - 2011).
Chan doan chu'e nanq DVYT DOI ti/Ong khac Tonq Ty IP DVYT/tonq
Ddn Vj lu'dt lu'dt iirdt
%
Nam 2007
46.354 57.754 104 099
44,53 2008 52.878 69.274 122.152 43,29
2009 71.664 85.921 157.585 45,48
2010 74.981 85.660 160 641
46,68 2011 82.442 124.017 206 459 39,93
Tong 328.319 422.617 750.936 43,72
Y HOC VIET NAM THANG 7 - SO 2/2Q12
_ Cae ky thuat chan doan ehye nang nhu sieu am, dien nao, dien tim, lyu huyet nao, edng nang phoi, dien ed, dien than kinh cd... dyde tnen khai kha sdm va da trd thanh ky thuat thUdng quy. Hien nay, rieng khu vdc kham benh ngoai trii, benh vien da trien khai 8 may sieu am. Chan doan chii'c nang cho benh nhan DVYT tif nam 2007 den nam 2011 6a tang 178%. Trong 5 nam, benh nhan DVYT thye hien eae ky thuat ehan doan ehye nang ehiem 43,72% tong so ehan doan ehife nang chung toan benh vien.
2.9. Phau thuat va uhg dung ky thuat cao
Bang 1 1 : Sd lu'dt phau thuat ciia benh nhan DVYT trong 5 nam: 2007 - 2011.
Phau thuat DVYT
Ddn vj ii/dt Doi tu'dng khac • lu'dt T6n5
Ty le DVYT/tdnq lu'dt
%
Nam 2007
7.527 5.588 13.115
2008 7.329 6.170 13.499 55,39 1 54,29
2009 7 755 7.973 15.728 51,62
2010 7.877 9 146 17.023 46,27
2011 8.420 11.330 19.750 46,63
Tong 38.908 40.207 79.115 49,18 Nam 2010, benh vien dUOe xep hang dae biet. Ngoai khoa la mot the manh, benh vien tiep nhan benh nhan nhan dan eiia nhieu dia phUdng chuyen den, chinh vi the so lUdn^p benh nhan phau thuat tai benh vien tang dan hang nam. Trong so phau thuat, co tren 7 0 % la phau thuat loai dae biet va loai I. Do thu dung BN BHYT nhieu nen tde do tang phau thuat eho BN DVYT tang khdng eao, nam 2011 chi tang 112% so vdi nam 2007. Trong sd phau thuat cho benh nhan DVYT, nhieu trydng hdp la do benh nang dyde cae tuyen trydc chuyen ve. Benh vien da to ehye thdng qua md" hang ngay de giai quyet nhanh, giam thdi gian chd ddi va riit ngan ngay dieu tri ciia eae benh nhan phau thuat.
Bang 12; So Itfdt phau Phau thuat DVYT Doi tu'dng khac Tong Ty le DVYT/tonq
Ddn Vi lu'dt lu'dt li/dt
%
thuat ijriq dunq ky thuat cao cua benh nhan DVYT tronq 5 nam (2007 - 2011).
Nam 2007
1.566 1.441 3.007 50,08
2008 1.381 1.793 3.174 43,51
2009 1.770 2.978 4.748 37,28
2010 1.995 3.955 5.950 33,53
2011 1.986 4.220 6.206 32,00
Tong 8.698 14.387 23.085 37,68 Cac phau thuat ky thuat eao benh vien dang
trien khai thanh thydng quy gom: Phau thuat tim md, ghep mach nhan tao, thay khdp, ehuyen vat t y do, chuyen gan dieu tri liet chi, dat stent thUc quan, tiem te bao goe, trong ndi chi the dirt rdi, phau thuat noi soi cae ehuyen khoa, npi soi lay sdi mat tuy ngUdc ddng, xa phau cac u nao...
IV. KET LUAN
1 . Ve hoat dong chuyen m o n : Trong 5 nam 2007 - 2011, Benh vien TWQO 108 da lien tue tang sd giydng benh ke hoaeh (tif 900 len 1200 giydng), tang so buong kham benh va cac trang thiet bj nhy may sieu am, X quang ky thuat so, may xet nghiem t y dpng, CT Scanner, MRI...
de phue vu nhu eau kham chu'a benh ciia mpi doi tydng benh nhan, trong do co benh nhan dien DVYT. Theo djnh hydng chung eiia Nha nydc se tien tdi BHYT toan dan, chinh vi vay sd lydng kham benh va thu dung BN BHYT tang, BN DVYT se giam. Tuy nhien, 5 nam (2007-2011) tai Benh vien Tl/QOlOS, kham chya benh eho benh nhan DVYT nam sau eao hdn nam tryde, so sanh nam
2011 vdi nam 2007, cho thay: Kham benh tang:
177%, thu dung tang 118%, xet nghiem tang 253%, X quang tang 177%, chan doan ehire nang tang 178%, phau thuat tang 112%, phau thuat ky thuat cao tang 127%. Cong suat sif dung gydng benh eho benh nhan DVYT van chiem tif 30,9- 34,8% va ngay nam dieu trj trung binh 1 benh nhan giam tif 10,6 ngay xuong con 10,1 ngay.
2. Cac giai phap ve to chu'e kham chu'a benh cho benh nhan DVYT da phat huy tac dung tot. Theo ehii trydng tien tdi BHYT toan dan thi sd lydng benh nhan BHYT se ngay eang tang, benh nhan DVYT se giam dan. Tuy nhien, de thdc hien cung can eo Ip trinh thich hdp, ehya the giam ngay ddi tydng BN t y ehi tra vien phi y te. Do vay v i n ean duy tri hinh thirc to chirc kham chiJa benh eho nhan dan t y d d n g vien phi.
Oa so benh nhan thuoc nhdm nay la ngydi ngheo, ean ngheo neu khong cd nghien eifu cac hinh thye kham chffa benh hdp ly tru'dc khi tien hanh BHYT toan dan thi hp rat re bj ton thddng do chi phi y te ngay eang tang va chi dinh sir dung djch vu ehya hop ly.
132
Y HOC VIET NAM THANG 7 - SO 2/2012
TAI LIEU THAM KHAO
1. Bo Quoc phong (1995), Thong tU so 804/TT- QP ngay 6/5/1995 hUdng dan thUc hien NGhi dmh 95/CP cua Chmh phii ve hu mot phan vien phi trong cac Benh vien Quan dpi,
2. Benh vien TWQD 108, Cac bao cao thdng ke sd lieu hoat dong hang thang trong nam 2007 - 2011, Tai lieu IUu try.
3. Chinh phii (1994), Nghi dinh so 95/CP ngay ni^iW^^ ve thu mot phan vien phi y te
Do Hoa Binh va cs, Mot so nhan xet ve hieu qua ehuyen mon sau eai each hoat dong ciia khu "^xiz kham benh va dieu tn ngoai trii ciia Benh vien TWQD 108. Tap chi y dUdc iam sang 108. Tap 6 s6 4/2011,tr 114-122
Cue Quan y (2002), Tai lieu hu'dng dan thong ke quan y, Nha xuat ban QDND, tr 22-38.
Oao Van Dung va Nguyen Du'c Trpng, To chuTc va quan ly y te d Viet Nam (2009), Nha xuat ban Lao dong- Xa hoi.
TIM KIEM DjCH VU CHAM SOC KHI SINH
NGHIEN Ciiu THEO OOI OOC TAI CO SGf THITC DjA FIUBAV11999-2010
Tran Khanh T o a n * , Pham Thj L a n * TOM TAT
Muc tieu: phan tich mo hinh tim kiem dich vu eham soc khi sinh va mot so yeu to lien quan tai huyen Ba Vi, Ha Noi. Phu'dng phap: Theo doi dpc hoi ciai tren 10.060 ba me sinh eon tren dia ban thuoc cd sd thUc d|a FilaBavi giai doan 1999-2010. Ket qua: Ty le sinh eon tai eac ed sd y te la 98%, ty le du'dc can bp y te dd de la 99,2%, cac ty le nay deu tang theo thdi gian. Ty le sinh con tai tram y te giam ty 60,5% nam 2000 xuong con 33% nam 2010. Trong khi do, ty le sinh con tai benh vien tang deu dan hang nam t y 35,7% nam 1999 len 66,2% nam 2010, dac biet la d nhyng ba me co trinh dp van hoa cao, khong lam nong nghiep, kinh te kha gia va mang thai con trai.
Ket luan: Ty le sinh con tai eac cd sd y te va ty le cac ca sinh nci dUde can bp y te dd la rat 3 0 va eac ty le nay deu tang theo thdi gian. Tuy nhien, can nang cao chat lu'dng eham soe khi sinh tai fram y te de thu hut cae ba me den sinh con, giam qua tai cho eae benh vien.
T y khoa: eham soc khi sinh, theo doi dpc, sinh con tai benh vien, FilaBavi.
SUMMARY
DELIVERY CARE SEEKING PRACTICE AND RELATED FACTORS: A LONGITUDINAL STUDY IN FILABAV11999-2010
Objective: To study the pattern of delivery care seeking practice and related factors in Ba VI distnct, Hanoi. Methods: A restrospective cohort of 10,050 delivered women through quarterly household interviews in FilaBavi DSS during the period 1999- 2010. Results; The proportions of deliveries at health facilities and delivenes suppod:ed by health workers were high (98% and 99.2%, respectively) and
* TrUdng Dai hgc Y Ha Ngi
r^.-A.. *,;=„ trhna hnn- PGS.TS. Nauvin Thi Kim Chuc
increased over time. Proportion of delivenes at commune health centers decreased while numbers of giving birth in hospitals increased, especially among women who had higher education, were not farmers, belonged to high economic groups and delivered a male baby. Conclusion: The proportions of deliveries at health facilities and deliveries supported by health workers were high and increased. However, it is necessary to improve the quality of delivery care at commune health centers to attract more women giving births there and thus contribute to reduce the oveload of hospitals.
Keywords: delivery care, longitudinal, delivery in hospitals, FilaBavi.
I.
OAT V A No i
Sinh eon tai ed sd y te, vdi sy ho trd eiia nhan vien y te la mot trong nhuTig giai phap then ehdt nham dat dyde muc tieu thien nien ky thir 4 (MTTNK4) [7], Trong nhieu nam qua, 6 nydc ta ty le sinh eon tai eae ed sd y te va ty le eac ea sinh nd dyde can bp y te eham sde ngay cang tang, dat tren 9 0 % [ 1 ] . Nhd dd, b/ le tir vong ba me va tre sd sinh da giam ro ret va Viet Nam 6\tt:ic danh gia la eo the hoan thanh eac MTTTJK ve sire khoe ba me, tre em tryde nam 2015. Mae dii vay, van eon ton tai tinh trang bat binh dang giffa eae viing mien va eae nhdm ddi tydng. O mot so xa, huyen mien nui co tdi gan 7 0 % ba me sinh eon tai nha [4], Phan I6n eac nghien ciru ve eham soe khi sinh cf nyde ta deu la nhu'ng dieu tra eat ngang va chya ed nhieu nghien ciru ve
