Chinh sach bao hiem y t e :
Ket qua dat diiac va mot so' kien nghi
ThS. NGO ANH NCaVET TrL/cfng Dgi hgc T^i chinh- Quan tri kinh doanh
Bao hi^m y t&' (BHYT) difgTc xem la m$t san phim cua si^ ti€n bd xa hOl, la cdng c^ t^o ra sif binh dang trong kham chffa bdnh. Nhif v$y, chinh sach BHYT da nhanh chong di vao cuQc sdng, d^t duf^c nhffng nhidu thanh tffu va dff^c ddng dao ngffdi dSn hffdng ffng. Tuy nhidn, thffc t ^ t r i ^ n khai chfnh sach nay con nhidu bS't c^p, cSn phai co nhffng didu chinh phu h^p.
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C H I N H SACH BAO H I E M Y TE PHAT H U Y H I E U Q U A Sau 3 nam trien khai thtfc hien, Luat BHYT da nhanh chdng di vao cupc sdng, khang dinh tinh dung dan va phii hpp trong lifa chpn chinh sach tai chlnh y td.
So vdi cdc quy dinh trtfdc ddy, quydn Idi cua ngtfdi tham gia BHYT theo quy dinh tai Luat va cdc van ban htfdng dan hien hanh la tu'dng dd'i loan didn. Quyen Ipi vd khdm chtfa bdnh lidn quan ddn thud'c, dich vu xet nghidm, chan doan hinh anh hay phau thuat, thu thuat khdng cd gidi han cu the. Hau hdt cac loai ky thuat lam sang, cdn ldm sdng dang dtfpe thufc hdnh tai cdc cd sd y te deu dtfdc Quy BHYT thanh toan.
Chinh bdi tinh ifu vidt nhif vdy, ndn sau khi ludt BHYT di vao cudc sd'ng, sd ngtfdi tham gia BHYT da tang nhanh.
Neu nam 2010, ca ntfdc mdi cd trdn 49 tndu ngtfdi tiiam gia, thi nam 2012, tfdc sd ngtfdi tiiam gia BHYT la 59,164 tiidu ngtfdi, tang hdn 2 tridu ngtfdi, ty le bao phu khoang 65% dan sd; 2.453 cP sd y te da ky hpp ddng khdm chffa bdnh eho ngtfdi cd tiie BHYT, tang 6% so vdi nam 2010. Ngtfdi tham gia BHYT dtfdc tiep cdn dich vu d tat cac tuyd'n y td theo nhu cau cham sdc stfc khde va benh tdt. Nam 2011, da cd 114 ti-idultfpt ngtfdi di khdm.
ehffa bdnh theo ehd dd BHYT (8,9 tridu ngtfdi didu tri ndi tni vd 105,5 tridu ngtfdi dieu tri ngoai tru) vdi tan sud't kham chffa bdnh binh quan 2,02 lan/ngtfdi/nam.
Ngtfdi tham gia BHYT dtfdc tiep can dich vu tat ca cac tuyen y tdtiieo nhu cau cham sde stfc khde va bdnh tdt vdi 20% sd ngtfdi cd the bao hidm dang ky khdm chffa bdnh ban diu tai cdc cp sd y td' tuyd'n xa vd ttfdng difpng; 61% tai bdnh vidn huydn va ttfdng dtfdng; con lai gin 19% dang ky tai cac cd sd tuyd'n tinh va Trung tfdng. Hinh thtfc thanh toan chi phi khdm, chffa bdnh
Economy and Forecast Review
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NQHIEM CiSU - T R A O DOI
B H Y T theo phi dich vu dang chiS'in 64,5% sn cd sd khdm chtta benh. Ben canh 66, Mnh Ihtfc Ihanh tolin chi phi Ichiim chCfa hCnh B H Y T (heo djnh sua'l cung da diroc trie'n Ithai vh lirng birtfc mfl rOng vdi 902 cO sd ilp dung{so l i ^ u nam 2012).
Sau nhiSu nSm mat criii ilcVi (luy (ich so ti^n bOi chi nam 2008 la 655,5 ty diing, nam 2009 la .1.08.1 (y d6ng), Quy B H Y T liiOn nay da d i m bJo can doi (hu chi do md r0ng dO'i ti/(Jng tham gia, d i e bi$t la nhdm do Nha mrdc d i m b i o va imTc diing dlTiJc d i ^ u chlnh hang 4,^% lirong [Ol thi^u ('( h i u licl c i c nh6m dO'i tif(?ng (trifdc day l i 3%). V d i cac bi4n p h i p k i ^ m s o i l chi phi, nam 2010, sau khi ba d i p cho thi6'u hyt nam 2009, quy B H Y T da k c i dK 2.818 ly dfing.
N H a N C , V A N C 6 N N H I ^ U T H A C H THLfC Ben canh nhifng Ihanh c6ng, chinh sich BHYT c^a Vi0l Nam dang phii dfii mit vdi 3 thich thtfc Idn. Cu th^ li:
Thi> nhd't. ty !( tham gia BHYT chua iliiy M: Luil BHYT d4'n thdi diem niy van chtfa thifc stf tiiu hut dtfljc rpng rai do'i ttfdng tham gia. Tinh den thing 10/2012, nhdm ngtfdi lao dpng trong cic doanh nghi$p mdi dat 49.9%; nhdm hpc sinh, sinh vien dat 80,4%, nhdm hO can ngheo dat khoing 18,9%, nhdm ttf nguyan chi dat khoang 24,5% tong sd'doi ttfdng... Die bi$t, ty I? ngtfdi can ngheo tham gia BHYT cdn thifp.
Mac du. Nhi ntfdc da cd chinh sich ho trd 50%
menh gii BHYT cho ngtfdi can ngh^o {ngtfdi cd thu nhap ttfdng dtfdng 100-130% chuan ngh^o quoc gia), song cong tic hd trd ngtfdi can ngh6o diam gia BHYT thdi gian qua v5n cdn mdt so khd khan vtfdng mic:
(1) Viec lap danh sich hp ngtfdi cSn nghdo tai mOl so dia phifdng cdn chim. (2) Cdng tic tuydn truyen chtfa dtfdc chu trpng dung mtfc, khdng it ngtfdi cgn nghdo khpng chu ddng tham gia BHYT, chi dd'n khi cd b?nh phii nim vien mdi nghi d^n chuydn mua b i o hi^m.
(3) Mtfc ho trd c^a Nhi ntfdc ddng BHYT (50%) cho ngtfdi cin nghde cdn thap va khdng dim b i o cho ngtfdi cin nghdo tham gia BHYT. Trong khi dd, ngtfdi b$nh khdng c6 kha ning thtfc hidn dong chi Iri do ty 1^ quy dinh cdn khi cao, die bidt doi vdi nhdm b$nh vi dich vu ky thujt cd chi ph! Idn. Trdn 50% cic cd sd y ti deu cho ring, khd cd khi ning Uiu dtfdc ciia ngtfdi c§n nghdo khi mtfc d6ng chi tri qui cao. Do viy, cln phii giim rntfc dong chi tri, thi ngtfdi cin nghdo se cd diiu kidn tiep cin binh dSng vdi cic djch vu y td' nhtf cic dfii ttfdng khic, hoic gidi han trin ciing chi tri/nim khfing vtfpt qui 2,5 tri?u dong. Day li mtfc gidi han khdng day ngtfdi cin nghdo rdi vio bSy tii nghdo.
Bdn cjnh dd, BHYT cho ngtfdi lao dfing trong cic doanh nghidp ngoii qufic doanh cdn thjp. Hifin cd gin 12 tridu ngtfdi lao dfing lim vific trong c i c doanh nghidp, nhtfng chi cd 6,36 trifiu ngtfdi tham gia BHYT, dat 53,4%. C i c dfii ttfdng chtfa tham gia BHYT chii yfiu l i ngtfdi lao dfing trong cic doanh nghidp ttf nhin. Vide ngtfdi lao ddng khfing tham gia
BHYT cd lidn quan den nhin Uitfc cdn han chfi cQa chO stf dgng lao dpng vl trich nhifim thtfc thi phip luit vi trich nhi^m b i o vfi quyln dtfpe chSm sdc stfc khde ci3a ngtfdi lao dpng. Trong khi dd, chlnh sich phip luit khfing dong bO, khfing phd hpp thi/c tfi din dfin ngtfdi si? dMng lao dpng khdng thifc hi^n trich nhifim ci3a minh. Bdn canh dd, mtfc ddng BHYT ciia phia chii stf dung lao dong cdn khi cao giy khd khin cho doanh nghidp. ViTn de nifa phii chtf ^ dd li vi tri yfiu thfi cua ngtfdi lao dfing cd khd khin trong ddi hdi quyln Idi BHYT.
Ngoii ra, vific phit triin BHYT d nhdm lao dpng khu vtfc phi chinh thtfc cdn ri't khd khin. Vifit Nam cdn khoing 36 tricu ngtfdi chtfa tham gia BHYT vi chii yeu li nhtfng ngtfdi lao dpng d khu vtfc phi chinh thtfc. Nhdm lao dfing niy dang ddng gdp khoing trdn 20% GDP, nhifng hiu nhtf chtfa dtfpe htfdng nhifng thinh qui cua chinh sich bio vd tftfdc nhtfng riii ro ve stfc khde nhtf BHYT.
Trong long sfi 25 nhdm dfii tffdng c6 trich nhidm tham gia BHYT dieo Luat da cd tdi 23 nhdm dtfdc Uiara gia BHYT, nhifng hai nhdm cdn lai that stf li thich ditfc khfing nhd.
Thii hai, vipc ddm bdo quyen loi vd phdt trien BHYT iheo chiiu sdu con han che: Trong nhifng nim qua, ty le ngtfdi diam gia BHYT da ting khi nhanh (dat 58,4%). Tuy nhidn, cic chuydn gia cho ring, md rpng do'i ttfdng mdi chichi trong phit diln Uieo chilu rfing, trong khi vide d i m bao quyln Idi hay phit trien theo chilu siu clia cic chtfdng trinh BHYT xi hfii cin dupe quan tim hdn ntfa. Diy li mfil trong nhtfng yfiu tfi diufic vl "chSft Itfpng" Clia BHYT. Chit Itfdng dich vu y te cho ngtfdi cd BHYT phii dtfpe dim bio, ngtfdi bdnh hii Idng vi ngtfdi tham gia BHYT phii thtfc stf dtfdc bio vd rii ro v l tii chinh khi dau om. Diy cung li yd'u tfi tao ndn "stf hap din" cho ngtfdi tham gia BHYT, l i yeu tfi quan trgng cho stf phit triin b i n virng c i a BHYT.
Thl) ba, nang life qudn ly con nhiiu hifn che: Tfi chtfc quin ly va nang Itfj:
quin IJ c i a BHYT cdn nhilu han che.
Quy dinh c i a Lu§t BHYT chtfa thtfc stf ro ring trong vific xie dinh chu the cua cd quan thtfc hifin BHYT vi cd mfit s6 miu thuSn v l chtfc ning, nhifim vu. Vide chfing chdo d mfit so pham vi lien quan dfin thtfc hidn chinh sich, phip tail vd BHYT, cfing nhtf stf thieu dfing hfi va
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Kinht^vaDi^Mophdn tdn trong chi dao hd tiidng da ldm han ehd vide md rdng bao phii BHYT.
Hidn nay, Vidt Nam cdn khodng 36 Q-idu ngtfdi chtfa tiiam gia BHYT vd chtf ydu Id nhffng lao dgng d khu vtfc phi chinh thtfc.
Cd cheBHYT theo cd nhan nhtf hidn nay cung chtfa mang Iai stf binh dSng cho mpi thanh vidn trong dinh. Cung Id thdnh vien trong gia dinh, nhtfng cd ngtfdi tham gia BHYT, thi dtfdc bdo vd khi dm dau, trong khi ngtfdi khdc, cd tiid Id lao ddng ehinh, hoac ngtfdi gid, ho|c trd em, lai khong dtfdc htfdng quydn bdo vd ndy.
Mdt han chd' ntfa phdi ke de'n dd Id cd mdt sdvdn bdn ban hdnh khdng ddng quy dinh, khdng ddng md'i quan hd cua cdc bdn tham gia BHYT (nhtf da de cap d trdn), tiiidu hd thdng cd sd dff lidu vd cd chd' bdo cdo ddm bdo tinh ldnh manh trong quan hd giffa cd quan qudn ly nhd ntfdc vd ed quan thtfc hidn.
VA MQT S6'KIEN NGH!
De ed the khde phuc nhffng tdn tai trdn, xin dd xud't mdt sd'kid'n nghi sau:
Mgt Id, thuc hien co chehd trg vd ddy mgnh tuyin truyin. pho biin phdp lugt ddi vdi ngudi tham gia BHYT: Doi mdi ndi dung vdi nhieu hinh thtfc de nang cao nhdn thtfc ci5a cdc cd'p tfy Dang, chlnh quydn, cdc td chtfc dodn thd va mpi ngtfdi dan ve y nghTa, tam quan trpng ctfa BHYT cung nhtf nghia vu cua mdi ngtfdi ddn ti-ong tiiam gia BHYT. Cd che hd trd vd cdng tdc tuydn truyen se dtfoc phan cdng cu the cho cdc bd, ngdnh lidn quan ddn ede nhdm ddi ttfdng.
Hai Id, ddm bdo bao phd theo chiiu sdu vi quyin lgi BHYT: Bi xay dtfng chinh sdch theo chieu sau, cln ldm td't hai yeu td giam chi ttf tidn tiii ngtfdi benh vd bdo dam quydn Idi cua ngtfdi ddn tham gia bdo hiem.
Vdi ddi ttfdng khdm chffa bdnh Id nhffng ngtfdi nghdo, thudc didn gia dinh chinh sdch, bdo trd xa hdi. thi Nha ntfdc nen thtfc hidn khdm chffa bdnh miln phi, tdn ndi, tdn nhd ngtfdi benh nhtf nhieu
ntfdc trdn thd' gidi da va dang dp dung hidu qud. Bien phdp ndy vtfa giup ngtfdi nghdo gidm ehi phi di lai vtfa the hidn rd stf quan tam cua Nhd ntfdc va xa hdi ddi vdi ngtfdi ngheo.
Nangcaochatltfdngvd ddp tfng nhu ciu khdm chffa bdnh b^ng BHYT, trong dd bao gdm: nang cao chat Itfdng khdm chffa bdnh; dau ttf trang thie't bi, xay dtfng, cdi tao vd md rpng ke't cau ha tang; nang cao ndng Itfc cung cap dich vu y td' tuyen dtfdi; chdm lo cho cdng tdc y td dtf phdng vd chdm sdc stfc khde ban dau; bdo ddm ngudn nhdn Itfc. Xay dtfng phdc dd dieu tri ehuan cung nhtf cdc quy trinh gidm sdt chat Itfdng bdnh vidn. Quy dinh han mtfc cung chi tra chi phi khdm chtfa bdnh tdi da mpt ngtfdi/mdt ndm. Nang cao trinh dp vd tinh minh bach trong quan ly BHYT.
Tid'p tuc tdng dau ttf ngan sdch nhd ntfdc cho y Id', bdo ddm chi tieu cdng cho y te', gidm chi tieu trtfc tidp ttf tidn ttfi hd gia dinh. Bdo ddm ngudn ngan sdch nhd ntfdc ddng BHYT, tdng din mtfc hd trp eho nhffng dd'i ttfdng can nghdo, hpc sinh, sinh vidn, ndng ddn, cd cd che khuydn khich bdo hiem ttf nguydn. Didu chinh gid dich vu y td' theo htfdng tinh dung, du, phil hdp vdi ngi dung dau tu:; phu hop vdi khd ndng chi trd cua ngtfdi bdnh; chuyen ed chd cd'p kinh phi tff ngdn sdch nhd nu'dc eho ca sd cung tfng dieh vu sang ddi ttfdng thu htfdng.
Ba Id, ddi mdi md hinh qudn ly. xdy dung vd hodn thien chinh sdch, phdp lugt vi BHYT: Trong tidn trinh nay, Qud'c hpi co vai tro quan trong, cung vdi viec sdm xem xet stfa ddi, bd sung mot sd dieu khdng cdn phii hpp vdi thirc tidn eila Ludt BHYT. Qudc hdi cln tdng ctfdng gidm sdt vide thifc hidn chinh sdch, phdp ludt, trdnh stf chdng chdo, thid'u thdng nha't giffa cdc van bdn htfdng dan thi hdnh va td chtfc thtfc hien Luat.
Ben canh do, nham kip thdi thao gd nhffng vtfdng mac, thtfc hien cd hidu qua chtfc nang quan I^ nha nffdc vd BHYT, nha't la bdo dam stf ch! dao, didu hdnh tdp trung, todn didn vd chd't Itfdng dieh vu y td'vd quan ly quy BHYT, tdng ctfdng quyen ban vd trdch nhiem cua ngtfdi dtfng dau, Chinh phu can nghidn ctfu, thay ddi md hinh td chtfc BHYT, tdp trung diu md'i quan ly nha ntfdc vd BHYT (ti-ong dd cd quy BHYT). Thanh I|p Hdi ddng quan IJ BHYT va giao Bd ti-tfdng Bd Y td Id Chfi tich Hdi ddng qudn Iy BHYT. Thtfc te. vdi mo hinh td chtfc he thdng BHYT nhtf hidn nay (khdng chuydn nghidp, phan tdn, chdng chdo), la nguyen nhan ciia nhffng vtfdng mac vd han chd' trong tiitfc hidn chtfe ndng quan 1;^ nhd ntfde vd BHYT trong thdi gian vtfa qua.Q
TAf !.Tr.U THAMKHAO - - 1. WHO (2007). Everbody's business: Strengthening health systems to improve health outcomes- WHO's framework for action, Geneva.
2. Bd Y td (2011). Bdo cdo tdng quan ngdnh y tindm 2011.
3. Bd Y td (2011). Bdo cdo kdt qud nghiin cdu khd ndng thuc hiin BHYT todn ddn 2011.
4. Ngdn hdng Thd gidi (2011). Bdo cdo chuyen di: Tdi chinh vd cung dng dich vt^yted Viit
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