Meeting, Hanoi. 5. Tuan T, Dung VT, Neu I, DIbley MJ 3. Axelson H, Bales S, Mlnh PD, Ekman B, (2005). Comparative quality of private and public GerdthamU (2009). Health financing for the poor health services in rural Vietnam. Health Policy produces promising short - term effects on Plan. 20 (5). 319 - 27.
utilization and out - of - pocket expenditure: 6. United Nations Country Team Vietnam evidence from Vietnam. International Journal for (2003). Health care financing for Vietnam.
Equity in Health, 8: 2 0 - 28 Discussion paper No. 2. Hanoi.
4. Chuc NTK, Diwan VK (2003). FilaBavi, a 7. World Bank Vietnam (1999). Consultation demographic surveillance site, an epidemiological with the poor. A synthesis of participatory poverty field laboratory in Vietnam. Seand J Public Health; assessment from four sites in Vietnam: Lao Cai, Ha 31 (SuppI. 62): 3 - 7 . Tinh, Tra Vinh, Ho Chi Minh city. WB report.
Summary
IMPACTS OF HEALTH CARE FUNDS FOR POOR IN BAVI DISTRICT IN 2002 - 2007
To overcome the major barrier to accessing public health provider among poor group, in 2002 the Prime Minister of Vietnam issued Decision 139, which established the Health Care Funds for the Poor (HCFP).
Objectives: to measure impacts of health care funds for poor on the out - of - pocket payments and health seeking behaviour parttern. Methods: data of FilaBavi was analyzed from 2001 to 2007. The study subjects were households with illness event. Results: health care expenditure as percentage of total expenditure dropped in both groups over time, along with the total number of health care utilizations (p < 0.05).
Concerning the patterns of health care utilization, the utilization of public health care increased while utilization of private health care halved (p < 0.05). Conclusions: health care funds for poor has met its objectives by reducing health care expenditure for the poor and increasing their use of public health care services.
Keywords: Health Care Funds for the Poor, expenditure on health, health seeking behaviour
CAC YEU TO LIEN QUAN DEN DONG LL/C LAM VIEC CUA BAC SI BENH VIEN DA KHOA TINH QUANG NINH
Nguyen Phu'dng Hoa, V6 Van Tai TrUdng Dai hoc Y Ha Noi
Ning cao ddng ldc lam viec cua doi ngu bac sT la mdt trong cac yeu td quan trong giup bao dam chi't Idang hoat ddng cua cic benh vidn. Muc tieu: xac djnh cac yeu td lien quan den ddng luc va de xuit mot so giai ' phap giup nang cao ddng ldc lam viec cua bac sT benb vien Da khoa tinh Quang Ninh. Doi tUgng va phuang
phap nghien ciifu: nghien cdu dinh tinh vdi phuang phap thao luan nhdm cac bac sT dang cdng tac tai benh vi$n Da khoa Quang Ninh nam 2010. Ke't qua: cac yeu td ve cdng viec; tien luang/ thudng; mdi trddng lam viec, dieu kien lam viec, ca hdi ddac hoc tip va^thang tien, sd danh gia cua xa hdi cd lien quan den ddng ldc lam viec cua cac bac si Can cai tien phdang thdc binh xet thi dua, quan ly kinh te tai benh vien. Mdi trddng lam vide can an toan han giup cac bac sT ySn tim va phat huy tinh sang tao trong cdng vi$c. Ket luan: Cac yeu td tai chinh va phi tai chinh deu cd mdi lien quan den ddng luc lam viec cua cac bac sT.
Til khoa: dpng life lam viec, glal phap, bac si
64
•]
I. DAT VAN DE
Ngudn nhan Iflc ed mdi lien he rat chat ehe va khdng the thieu trong he thdng y te, quyet djnh pham vi cung nhfl chat Iflpng cua djch vp y te.
Theo b i o cao cua Td chdc Y t l T h i gidi nam 2006, viec thieu hut ngudn nhan lUc y te tai eac nifdc khu vfle Chau A dang la van d l cap thiet can phai dope g i i i quye't thdng qua d c ehinh sleh, quy hoach v l thflc hien eae chien Iflde s i n g tao de duy tri va thdc day nhan vien y te [6].
Benh vien Da khoa tinh Quang Ninh la benh vien hang 2, trflc thudc Sd Y t l tinh Q u i n g Ninh.
Vdi quy md 724 gifldng benh thflc ke (so vdi 550 giudng theo ke hoach), cd nhiem vu cham sdc va bao ve sdc khde cho nhan dan d c dan tpc tren toan tinh Q u I n g Ninh. Theo so' lieu bao d o , hien CO.587 d n bp, vien chdc dang cdng tac tai benh vien trong dd cd 104 b l e sT (BS). Vdi ty sd bien che nhan vien y t l so vdi gifldng benh theo k l hoach dat 1,07 (ty sd nhan vien y te so vdi sd giudng benh thflc ke ehi dat 0,77) la thap so vdi quy dinh cua nha node ddi vdi benh vien hang 2 (td 1,25 den 1,40 neu lam viec theo gid hanh chinh). Mat khIe, cdng suit sd dung gifldng benh CLia benh vien ludn vflpt mde 120% [1]. Qua dd, chung ta thay dflpc sfl thieu hut nghiem trpng v l ngudn nhan Iflc y te tai benh vien Da khoa tinh Quang Ninh.
Dpng Iflc lam viee la sfl khao khat va tfl nguyen cua ngOdi lao dpng de tang cfldng nd Iflc nham hudng tdi viec dat d e muc tieu eua td chdc, la k i t qui tdng hda cua n h i l u ye'u td tac dpng d i n con ngUdi trong qua trinh lao dpng [3]. Viec tao dpng luc lam viee eho dpi ngu b l e sT ndi rieng va ngudn nhan Iflc y te ndi ehung se gdp phan duy tri va tdng bode thu hut, p h I t trien ngudn nhan Iflc y te tao dieu kien cho edng t i e cham sdc va b i o ve sdc khde nhan dan dat hieu q u i cao.
Chdng tdi tien hanh d l tai nghien cdu vdi
muc tieu: Xac dinh mgt sd yeu td lien quan den dgng lUc va de xuat mgt sd giai phap giup nang cao dgng lUc lam viec ciia bac sJ benh vien Da khoa tinh Quang Ninh nam 2010.
II. DOI TUONG VA PHUONG PHAP NGHIEN CL/U
Sd dung phfldng phap nghien cdu djnh tfnh.
Tien hanh 3 eupc t h I o luan nhdm vdi eae bac sT dang cdng t i e tai d c khoa lam sang he npi, he ngoai va can lam sang tai benh vien Da khoa tinh Q u I n g Ninh (6 - 8 b l e sT/nhdm).
Npi dung t h I o luan nhdm: nhan xet v l chat lupng va nang Iflc cua dpi ngu bac sT. Danh gia v l hieu q u i lam viec, sfl thieu hut ngudn nhan Iflc. Cac chfnh sach, bien phap da trien khai nham n l n g eao dpng Iflc lam viec eho dpi ngu b l e sT; d e g i i i p h l p d n thflc hien d l thu hut, phat trien ngudn Iflc y te tai benh vien.
C I c eupc t h I o luan nhdm dUpe t i l n hanh vao thang 5/2010. "Dfl lieu dflpe thu t h | p bang bang ghi am va bien b i n t h I o luan nhdm. Cd bang ghi I m va phan tich sd lieu 6 - 7/2010. Ap dung phUPng p h l p phan tfch npi dung.
III. KET QUA
1 . Ye'u to lien quan de'n dong lOc lam viec cua bac sT
Yeu td cong viec vdi dgng lUc lam viec Cae bae sT nhan xet khdi lUpng cdng viee hien dupe phan eong d i m nhiem la qua t l i do thieu bien che bac sT va hien ed mpt sd b l e sT dang dflpe di hpe nang eao trinh dp "Bac sT thi da thieu ma vin phai cd ngifdi di hoc ning cao nen nhieu khi tuin phai trdc miy budi, trdc xong sang vin phai lam khdng ddac nghi bu, benh nhin thi ddng. Cung met moi Hm" (BS khoa Chan doan hinh I n h ) .
Ddng thdi cd thflc trang nang Iflc lam viee eua
mdt sd BS edn chfla d i p flng dupe yeu c l u cua benh vien tuyen tinh: "Trang thiet bi nhieu khi hien dai nhifng ma kha nang khdng dap dng difdc do chifa difac dao tao, tdm lai vin bi han che ve con ngifdi" (BS khoa Ngoai).
Yeu td thi dua/ thda nhan thanh tich vdi dgng lUc lam viec
Viee thuc hien binh xet khen thfldng hang t h i n g theo chi tieu chfla khuyen khich dflpc d c bac sT lam viec "Hien dang quy dinh mot klioa thi bao nhieu ngifdi loai A, B, C. Nhd vay khdng cdng bing, vl nhieu khi ca khoa moi ngifdi deu tdt ca, lam cat ldc ma van cd ngifdi loai B, C. Cd nhdng khoa rat kem, nhifng van cd ngifdi loai A.
Cd chia bd diu la khdng hdp ly. Xet nhd vay thi khdng danh gia difdc" (^S khoa U%Qa\) " • - -
Yeu td ve sU thang tien vdi dgng lUc lam viec
K i t qua nghien ci'fu cho t h i y d e b l e sT r i t coi trpng viec ed eP hpi thang tien cung nhfl cP hpi dupc hpe tap nang eao trinh dp: "Khi lam viec phai can cd mdt cai vi tri nao dd d trong benh vien. Viec thang tien hay la viec di hoc de nang cao chuyen mdn rat la can thiet va quan trong" (BS khoa San).
Yeu td vc sU thanh dat vdi dgng lUc lam viec
Hau het eae bae sT deu nhan tha'y n g h i y, n h i t la b l e sT thifdng difpe gia dinh va xa hpi d i n h g i l cao: "Bac sT la mot nghe, difac hiu het moi ngifdi trong xa hdi danh gia cao va tdn trong. Neu mot bac sT gidi tay nghe se cd uy tin nhieu han va rd rang se difdc xa hdi danh gia cao, dong nghiep kinh trong" (BS khoa Npi).
Yeu td ve mdi quan he vdi lanh dao, dong nghiep vdi dgng lUc lam viec
De cap den sfl ung hp cua lanh dao benh vien cd mpt sd y kien cho thay bifdc d i u lanh dao da quan tam va hd trd bac sT lam viee: "Benh vien tinh Quang Ninh thi mdi trddng tifdng ddi tdt.
mdt sd lanh dao cung ung hd ky thuat mdi" (BS khoa YHCT).
Tuy nhien, k i t q u i nghien ci'fu cung cho thay cdn tdn tai mpt so' vfldng mac trong quan he vdi ddng nghiep cd anh hifdng den ddng Iflc lam viec eua BS tre: "Theo tdi thi dong ldc lam viec nhu bac sT tre cd thda, rit nhiet tinh. Nhifng nhieu khi mlnh qua hang hai thi cac bac dan anh ho lai khdng thich. Sau mot thdi gian lam cat life tlii rut ra rang lam tich cdc cung chang difdc cai lai gl.
Ddi khi cd hai vl cd the la mlnh khdng difac Idng ngifdi khac" (BS khoa N p i j ;
"Mot vai ngifdi mudn lam tdt cung khdng difdc. Khdng dung guong may chay, mlnh bj dao thai ludn. Cdn nhieu ngddi mudn bao ve quyen ldi cua ho. Ngifdi ta thich cd che nay - ca che ma ho khdng lam gl nhifng Idang thifdng van cd" (BS khoa Ngoai).
Yeu td vi chinh sach va che do quan tri vdi dgng lUc lam viec
Lifpng va thifdng dd'i vdi d c bac sT cdn thap, hp chfla d m thay hai Idng vdi thu nhap hi|n eo:
"Lifdng thi theo quy dinh cua Nha nddc rdi.
Lifdng ndi chung la thap, thifdng thi so vdi mot sd ndi khac benh vien Da khoa tinh Quang Ninh la cao han nhdng so vdi mat bang chung van la thip. Cdn tien tnfc cung thip qua. Trdc ca toi den sang, ca thd 7, chu nhat chi difdc 45.000 dong, day la mot rao can de cac bac sT lam td't han"(BS khoa Nhi).
Cac y kien cung eho tha'y viec thu nhap thap nay cd t h i d i thien dUpc vi li do ehu yeu la chat lupng q u I n ly kinh te tai benh vien chUa dap dng dupe: "Mac du benh vien cdng diy du cac ifu dai nhifng Idang, thifdng lai thap, bdi vl che do thu - chi khdng tdt" (BS khoa Ngoai)
Che dp dai ngd, djch vu cua benh vien chUa dupc phan ehia cdng bang lam giam ddng lUc lam viee cua cae bae sT "Uu dai cua benh vien
66
khdng duac tdt, gay ra tinh trang bat man. Can phai difac chi tra thu lao xCfng dang Cd tinh trang lam nhieu lai khdng difac hifdng nhieu, cimg bang nhd ngifdi chai, gay ra tinh trang bat man, khong mudn lam" (BS khoa HSCC).
Neu thu nhap khdng dUpc tang len se keo theo hau qua nhieu b l e sT mudn xin ehuyen cdng tac:
"7/ieo em la thu nhap phai tang len, neu khdng se cd nhieu ngifdi mudn chuyen di. Vi dii nhd em, em mudn chuyen len Ha Ndi" (BS khoa Ngoai)
De d i m b i o eupc sdng, hau het eac BS d i u lam them nham tang ngudn thu nhap: "Vdi tinh trang thu nhap nhd the nay, ai cung bit budc phai lam them vl ai cung phai cd nhu cau vdi cuoc sdng cua mlnh chd. Mang tieng bac sT ma khdng nudi ndi gia dinh thi cung khdng difdc" (BS khoa San).
Veo td vc dieu kien lam viec vdi dgng lUc lam vice cua BS
Hien nay, trang thiet bi cda benh vien da difpc cai tien nhieu nhifng van chifa ddng bd va so vdi yeu cau thi van t h i l u : "Trang thiet bi so vdi ngay xda thi da hien dai han nhieu roi. Tuy nhien, d nhieu khoa van bi thieu ke ca nhdng trang thiet bj khdng phai la dit tien" (BS khoa Ndi). D i l u nay lam d n trd den chat lifdng va hieu eua lam viec cua d c bac sT: "Han che ve may mde thiet hi thifc ra la do thieu dong bd. Nhieu cai tdt nhifng vin cdn nhieu cai toi nen rit khd trien khai" (BS khoa YHCT).
Cdng tac bao dfldng trang t h i l t bj, cd sd vat chat chfla dflpe tdt, gay khd khan eho t r i l n khai cdng viec: "Khi may mde bj hdng, can sCfa chCfa ngay thi phai ddi. Mud'n sifa phai viet giiy de nghi, ngifdi nay ky, ngifdi kia ky. Miy thing sau vin chifa thay sCfa gl Mlnh cang viet, ho cang Id di. Thiet bi hdng hdc phai sCfa lien tuc, che do bao difdng hien rat la kem. Ma cd khi ngifdi ta lai thich mua cai mdi hdn la sifa" (BS khoa Ngoai).
2. Mpt sd giai phap giup nang cao dong Iffc lam
viec cua doi ngij Bac sT i D l edng viec k h I m chfla benh difpc dam bao
va ngay cang hieu q u i , BV can tang them sd Iflpng bac sT. Tuy nhien, cung can ed ehinh sach tuyen dung phu hpp nham thu hut difpc ngudn nhan Iflc cd chat Iflpng: "Khi tuyen dung can phai ky hdp dong thd viec vai thing, neu khdng dddc thi cit ludn. Ke ca thieu cdng khdng nen tuyen nhCfng ngifdi cd trlnh do chuyen mdn qua yeu.
Nang ldc lam viec kem se nay sinh nhieu van de lam xau benh vien. Vi du, nhu bon em bay gid cd nhdng ngifdi sieu im trifc ma cha biet ve sieu im. Sieu am xong cac bac sT lam sang cung khdng doc, diy chi la thu tuc, chi la lay giay td, ho so'"(BS khoa Npi).
Dpng life lam viec lien quan den nhieu y l u td.
Qua nghien cflu, viee tac dpng vao nhflng yeu td sau day se giup tang cUdng difpc dpng Iflc lam viec cua d e BS:
•* Thu nhap I n h hifdng den dpng life lam viec ndi rieng va lien quan d i n chat lifdng ngudn nhan Iflc ndi chung. Nham d i m b i o ve thu nhap cho BS, eac y k i l n d l xuat e i n eai tien cdng t i c quan ly kinh te cua lanh dao benh vien: "Vin de bay gid la phai quan ly kinh te thai td't. Quan ly difac cdng tac kham chda benh djch vu" (BS khoa Ngoai).
Khi thu lao dflpc ehi tra xdng dang se kfch thieh dflpc cac bac sT lam viec tieh efle hdn: "De bac sT lam viec tdt, cd ddng ldc nhieu thi can cd mi'fc lifdng thifdng thich hdp. Vi du nhd khoa hd hap BV Bach Mai - ndi tdi di hoc, thay ho lam viec td sang cho tdi 16h30 chieu mdi ve. Phai thu nhip nhd the nao thi ho mdi lam viec ca budi trda chd. Budi tnfa cd benh nhin vao vien ho cung lam, lam tich cdc Hm" (BS khoa Npi)
•* Cai thien mdi trddng lam viec:
De phat huy tinh tfl ehu va sang tao trong cdng viee eho mdi can bp nhan vien cua benh vien.
d e BS d l xuat nen giao q u y l n han cho mdi ca nhan va dae biet cac trUdng khoa n h i l u hdn nfla:
"Nen md rdng them quyen cua bac sT dieu tri cung nhd lanh dao khoa. Trddng khoa nen cd nhieu quyen quyet dinh hdn. Nhd the, se tao ra each lam viec trach nhiem hdn va sang tao hdn.
Vi du nhd, em thich ky thuat nay em td de xuit va td mlnh lam va td mlnh chju trach nhiem va trifdng khoa cd the cd quyen quyet djnh, khdng nhit thiet la phai chd quyet djnh cua giam dd'c" (BS khoa Ngoai).
BV nen giao q u y l n tfl chu kinh t l v l cac ddn vj khoa, phdng: "Theo em, benh vien nen de cac khoa td thu, td chi - khoan iy ma. Vi thu nhap cua mlnh, moi ngifdi se phai diu td chat xam va nang ldc cua mlnh thdi" fBS khoa Ngoaij.
Tuy nhien, viee giao q u y l n tfl chu kinh t l d i n cae ddn vj eung se phat sinh mpt sd van d l va e i n difpc khd'ng c h i va g i i i q u y l t : "De han che mat trai cua vide khoan - nhd lam dung lam xet nghiem va ke dan - cd the phat hanh cac quy djnh, tieu chuin chin doan, phac do dieu tri. Vi du, em dl trifc d cip cdu nhi d BV Nhi Trung dang, khoa cd phac do, benh nhan cd vin de gl, cd theo phac do ma thifc hien" (BS khoa HSCC).
Mdi trfldng lam viec eua BV can chd trpng d e d i l u kien giup d e BS tre phat huy tai nang va nhiet huyet eua tudi tre: "Cac bac sT tre bon em quan trong la mdi trddng lam viec. Tien nong thi chifa den mifc bdc xuc Hm. Can mot mdi trudng thuan ldi cho mlnh phat trien. Va moi trddng phai an toan cho mlnh" (BS khoa Sin).
De cd sfl doan ke't, nhl't tri cao trong mdi khoa cung nhfl d benh vien, rat can ed sfl cdng bang trong viee dd'i xd vdi d e nhan vien, nha't la van de t l i chfnh: "Mdi quan he trong khoa phai doan ket. De tao cdng bSng cho moi ngddi trong khoa thi phai phan minh ve vin de kinh te. Phan chia tien bac cin cdng bang se giam thieu mau thuin. VI kinh te cung la nguyen nhin diu tien
giy nhifng thic mac" (BS khoa Ngoai).
* Cdng tac thi dua khen thfldng hay xd ly ky luat:
Cdng tac thi dua khen thfldng, viec binh xet thi dua dang thflc hien cd mpt sd bat cap, can dflpe e i i tie'n: "Tit ca nhdng ngddi hoan thanh cdng viec, khdng bj ky luat loai A het va difdc thifdng cung nhd nhau. Cdn ngddi nao bj ky luat, khdng hoan thanh cdng viec thi mifc khac" (BS khoa YHCT). C I c y k i l n cung eho rang viec binh xet thi dua can b i o d i m tfnh cdng bang: "Khen thifdng thi phai phan minh, cdng bang. Theo tdi, cin phai cd thdng ke sat cac hoat ddng kinh te, cung nhd hoat ddng cua cac khoa de dda vao dd tinh thifdng cho tdng khoa, chd khdng phai nhat thiet la bang nhau" (BS khoa HSCC). Ben canh dd edng t i c phe binh va xd ly ky luat cung e i n thau tinh dat ly va tao d i l u kien cho d c vien chdc phan dau sda ddi: "Cin cd difdng Idi khuyen khich duac moi ngddi lam viec. Vi du nhd ngifdi chang may mic Idi khdng nen luc nao cung dem ra nhic nhd, lam the ho se chan. Lam the nao phai giup ho Sifa ldi, chd khdng phai ngay nay ndi, ngay kia lai ndi tiep" (BS khoa Ndi).
* Nhu c l u hpe nang eao va thang tien: BV can tao dupe mdi trudng binh dang d e ' e l e BS ed dieu kien hpe tap, phat trien trinh dp ehuyen men, thang tien v l n g h i nghiep: "Em de nghj chuyen di hoc hanh nen md rdng ra. Hien nay, rao can cua chuyen mdn cdn rit Idn" (BS khoa phu sin);
"Ve chinh trj ching ban, vao dang ai cung cd the vao miin la du tieu chuin, mlnh cd Udc mong vao dang nhifng nhieu khi cdn nhieu yeu td lam.
Vd tinh, ve mat chinh trj cung bj rao can. Trong benh vien, cin phai cd chinh sach thay ddi" (BS khoa HSCC).
* Cae BS e i n dupe tham gia n h i l u hdn vao e l c quyet dinh quan trpng cua BV, dac biet la d c quyet djnh lien quan de'n cac cd sd vat chat, trang t h i l t bi ma hp d i m nhan: "Mlnh la ngifdi trifc tiep thdc hien lam, neu difac tham gia y kien thi
68
tdt han vl nhCfng may mde mua ve mlnh lam, chd lanh dao cd lam dau" (BS khoa HSCC). Cd mdt sd y kien de nghj cin phan cip nhieu han:
"May mde trong khoa thi trddng khoa cd the quyet dddc nen mua cai gl, vl ho nim duac chic han giam ddc, ho la ngifdi true tiep lam d khoa va cung la ngifdi cd chuyen mdn cao nhit d iTnh Vifc nay" (BS khoa Ngoai).
Can ed e l c quy djnh v l b i o dUdng va sda chfla hoac thay the cac trang t h i l t bj kjp thdi de cae hoat dpng chuyen mdn dupe d i m b i o : "Cac quy djnh cho viec sCfa chda trang thiet bj phai rd rang, nhit la quy djnh rd thdi gian de cac phdng ban thifc hien. Cin cd khoan kinh phi cho viec bao difdng may mde djnh ky, tranh tinh trang may nam khdng bao dddng, khi bao hdng thi phai chd ddi vl kinh phi sCfa cbCfa chda cd" (BS khoa Ngoai).
IV. BAN LUAN
Ye'u td lien quan den dgng liic lam viec Hien benh vien tinh Quang Ninh dang trong tinh trang thieu hut ngudn n h i n Iflc. Day la ldc dpi ngu nhan vien benh vien can p h I t huy tinh than lam viee sang tao, h i t minh, hp can lam viec vdi dpng Iflc eao nhat. K i t q u i nghien cdu cua ehung tdi cho tha'y cd rat n h i l u y l u t d tai ehinh va phi tai chfnh I n h hUdng den dpng Iflc eua dpi ngu cae bae sT.
Tren thflc te, muc dich khen thfldng nhan vien nham khuyen khich tinh than lam viee eua nhan vien va ddng gdp tich cflc hpn cho benh vien.
Viec khen thfldng mpt d c h dung dan va cd td chdc cd the cung c d d c nd Iflc d i n tdi sfl thanh cdng cua benh vien. Cd n h i l u y k i l n cho rang nen thay ddi d c h binh xet khen thudng hang thang va cudi nam. TU tUdng eho rang nhflng ngfldi lao dpng lam viec tieh cflc hpn va s i n xuat ra n h i l u s i n pham hPn can phai dUpe thu lao n h i l u hon difdc tan thanh d h i u h i t eac nUde. Da
sd ngUdi lao ddng cung quan niem rang hp can phai dupe thu lao tUdng xflng va cac k h o l n thu lao dd p h i i dupe phan phd'i cdng bang. N l u ngUdi lao dpng nhan thay thu lao khdng dUde phan phdi -edng bang va tUdng xdng, hp se trd nen it g i n bd vdi td chdc, g i l m nd Iflc va hp se dm kiem nhflng CP hpi thue mfldn d ndi k h I e [3]. Trong nghien cdu cua chdng tdi cung eho tha'y ed mpt sd b l e sT da cd tu tudng mudn e h u y i n di cP quan khae, nhat la eac bac sT t r i cd nang Iflc. D i l u nay se lam eho viec t h i l u hut nhan Iflc tai benh vien cang tram trpng hdn.
T r i n Thj Thuy Linh (2008) khuyen cao c i n t i l p tpc d i t i l n , hoan thien e h i dp t i l n lUPng;
thflc hien tdt cdng t i e g i l o due, dpng vien tinh t h i n cho dpi ngu can bp, cdng nhan vien. Giao due Idng tfl hao v l t r u y i n thd'ng va n i l m tin vao trien vpng phat trien va tflpng lai lau dai eua td ehfle [2]. Inke (2006) da eho thay nhflng flu dai phi tai chinh va d e cdng eu q u I n ly ngudn nhan Iflc ddng vai trd quan trpng dd'i vdi viec thdc day dpng Iflc lam viec eua d e chuyen gia y te. Cdng eu q u I n ly ngudn nhan Iflc thda d i n g ed the duy tri va tang cUdng tinh chuyen nghiep cua d c b l e sT va y t l [4]. Nghien cdu cua Lyn (2008) [5] cung cho thay mfle Ifldng va ldi fch, cung vdi d e d i l u kien l l m viee, cong t i c giam sat va q u I n ly, cd cd hpi trdng dao tao va bdi dfldng la rat quan trpng. Cac nghien cflu d i u nha'n manh tam quan trpng eua nhflng flu dai tai chinh va phi tai ehinh.
Cac qudc gia hien dang ddi mat vdi tinh trang thieu hut nhan Iflc trong nganh y t l c i n tim hieu nhflng li do ehinh gay ra tinh trang t h i l u hut nay ddng thdi p h i i xac dinh dflpc eac yeu td lien q u I n v l mat tai chinh va phi tai chinh d i n viee nhan vien y te van tiep tuc lam viec trong nganh va d i thien d p n g l u c lam viee eua hp. Cac nude can cd eae nghien cdu giup e l c nha hoach dinh chinh sach cd cae bang chdng khoa hpe [6].
K i t q u i nghien cdu eho thay nhu c l u dUpc
hpe tap, thang tien cung rat quan trpng. K i t q u i nay tUPng tfl vdi k i t cua rat nhieu nghien cdu v l t i m quan trpng eua d e y l u to phi vat chat ddi vdi dpng Iflc lam viee va sfl hai Idng trong cdng viec.
Cd mpt thflc trang da dflpc chi ra rang viee dflde tham gia d c q u y l t dinh quan trpng eua BV gan nhu chUa cd d benh vien Q u I n g Ninh. C i e b l e sT it ed ed hpi dupe gdp y vao eac q u y l t djnh quan trpng cua e l benh vien ndi ehung va ngay tai d khoa/phdng noi hp trflc tiep lam viec. D i l u nay dan d i n viee khdng p h I t huy dflpc dpng Iflc lam viee eua tflng e l nhan cung nhfl tinh t h i n lam viec tap the.
Mgt sd giai phap nang cao dgng lUc lam viec Ket qua nghien cflu chi ra mpt so g i i i p h l p dupc cac bac sT kien nghi nham lam tang them dpng Ifle lam viec. De g i l m t l i I p Iflc edng viee ben canh cdng t i e t u y i n dung can chd trpng den chat lupng cda d e bae sT dupe tuyen dung. Can bao d i m hp ed the nang Iflc tdi t h i l u dam dflpng dflde edng viec ma hp se dam nhan, tranh tinh trang chi dpn thuan la lam tang sd Iflpng, gay bat binh trong npi bp nhan vien y t l .
Nang eao thu nhap, c h i dp thfldng cho d c bac sT la mpt y l u td rat quan trpng giup d e BS yen tam edng tac va khuyen khich sfl nhiet tinh cua hp. D l ed the tang thu nhap, d e y kien d l xuat c i n d i tien edng tac q u I n ly kinh t l cua lanh dao benh vien, dac biet la phat trien cdng t i c k h I m chfla benh djch vu. Can q u I n ly va phan chia ngudn kinh phi n l y mpt d c h cdng bang.
Nghien cflu cung cho thay mdi trfldng lam viec cua benh vien e i n dflpc d i thien trd nen an toan hpn. Ban lanh dao can he't sdc ung hp va eung vdi mdi thanh vien trong benh vien xay dflng mdi quan he doan ket hdn nham phat huy tinh sang tao trong cdng viec cua mdi d n bp nhan vien, dac biet la cae b l e sT t r i ed nang Iflc.
Cae y k i l n kien nghi p h i i thay ddi d c h binh
xet thi dua, d i l u nay theo ehdng tdi rat e i n thiet.
Vi hien tai cae chi tieu thi dua dflde phan bd theo sd Iflpng d n bd. Nhfl vay, d i n den tinh trang mpt sd danh hieu nhfl "Chien sT thi dua" hang nam ehi cd mpt so' vien chdc dat dflpe ma chu y l u la d e lanh dao ddn vj. Dieu nay lam g i l m tinh than phan dau cua eae vien chdc k h I c . Benh vien nen dfla ra cac tieu chuan dat d e danh hieu thi dua va xet e l c danh hieu dd ma khdng e i n khdng che so' lupng. v l tieu ehuan chia tien djch vu cung can thay ddi, t r l n h tinh trang binh q u I n chu nghTa ehia d i u ma nen dfla vac khdi Ifldng va hieu q u i cdng viec. Can I p dung d e phUdng phap d i n h g i l hieu qua cdng viee s i t thflc hdn dfla tren md ta cu the cdng viec ma hp phai d i m nhan cung nhu hieu q u i eua cdng viee dd.
V . K E T L U A N
1. C I c yeu to' ve cdng viec, tien lUPng/thudng, mdi trUdng lam viec, d i l u kien lam viec, cP hpi duoc hpe tap va thang t i l n , sfl danh gia cua xa hpi va benh nhan ed lien quan den ddng Iflc lam viee eua d c bac sT.
2. Mpt so' giai p h l p giup nang cap ddng lUc lam viee cho dpi ngu b l e sT:
- T u y i n dung e l c dd'i tUpng dd chat lUpng/
nang Iflc dam nhan cdng viee dope giao bang'giai p h l p thd viee va cd danh g i l .
- Cai tien phOPng p h l p cdng tac q u I n ly kinh te, dac biet 11 phat trien cdng t i e k h I m chfla benh djeh vu. Can q u I n ly chat ehe va phan ehia ngudn kinh phi nay mdt each cdng bang.
- Mdi trudng lam viec eua benh vien e i n dUpe cai thien trd nen an toan hpn, lanh dao benh vien e i n he't sdc ung hp eac d i tie'n, s i n g tao cua nhan vien, xay dflng md'i quan he doan k i t hon giup nang eao dpng Iflc lam viec.
- Phflpng thflc binh xet thi dua, tieu chuan ehia t i l n djch vu e i n p h i i thay ddi dfla vao hieu qua
m
cdng viec khdng nen phan bd chi tieu.
- Can quan tam hon nfla den eae y l u t d phi vat chat nhfl: nhu cau dupc hpe tap, thang t i l n , tham gia elc q u y l t dinh quan trpng cua benh vien.
T A I L I E U T H A M K H A O
1. Benh vien Da khoa tinh Quang Ninh (2010). Bao cao kiem diem viec thflc hien nghj quyet cua Dang, phap luat Nha nifdc, nghi quyet hpi nghj CBVC nam 2009 va ke hoach cdng tac nam 2010.
Giao trinh Quan tri nhan life, Nha xuat b i n Dai hpe Kinh te qudc dan. Ha Npi.
4. Inke M , Ingo I (2006). Health worker motivation in Africa: the role of non - financial incentives and human resource management tools.
Human Resources for Health, (4), 24, available at:
http://www.human - resources - health.com/
content/4/1/24.
5. Lyn N H , Jim T (2008). Incentives for retaining and motivating health workers in Pacific.
Human Resources for Health 2008; (6), p.18, available at: http://www.ncbi.nlm.nih.gov/pmc/
articies/PMC2569066/.
6. World Health Organization (2006), The world health report 2006: working together for health, W H O Press, Geneva, available at: http;//
www.who.int/whr/2005/en/
2. Tran Thj Thuy Linh (2008). Cae g i i i phap nham tao dpng life cho ngudn nhan Iflc chat Iflpng cao eua Tdng Cdng ty Hang khdng Viet Nam, Luan van thac sT quan tri kinh doanh, Trifdng Dai hoc Kinh te qudc dan. Ha N p i .
3. Trodng Dal hoc Kinh te qudc dan (2007), Summary
I D E N T I F Y I N G FACTORS FOR JOB M O T I V A T I O N OF P H Y S I C I A N S A T P R O V I N C I A L H O S P I T A L I N Q U A N G N I N H
To provide good quality health care services at hospital, it is important to improve job motivation of physicians. Objectives: to identify factors for job motivation of physician and to provide some solutions for improving job motivation. Method: qualitative research with focus group discussion among physicians who worked at Quangninh hospital. Results: factors of job, salary, incentives, and environment at work, chance of post - graduate and promotion were related to motivation. Method of selection, economic management and work environment were needed to be revised. These things would make physicians to performance better. Conclusion: the study showed that motivation was influenced by both financial and non - financial incentives.
Key words: job motivation, solution, physician