TCNCYH Phu tnmng 79 (2) - 2012 verslty pharmacists (0.93%). The number of health workers per bed Is 0.9; the ratio of nurses and midwives per doctor is 2.07. The percentage of graduate degree is low (masters 2.17%, specialty I 30.12%. none of specialty II and PhDs). In conclusion, all six district hospitals in Ha- noi has a large shortage of health human resources in terms of both quantity (missing 35.8%).
and professional qualifications are limited that did not meet current needs for health care.
Keywords: Health human resources; district hospital; health workers; professional level
6 M D A U B E N H TAT, SLP D U N G DjCH VU VA CHI PHi CHO Y T i d
MOT S6 NHOM LAO DONG PHI CHINH THLfC TAI HA NOI
Doin Thi Thu Huyen', Hoing Van Minli', Pham Thj Ngpc Bich', Le Thanh Tuan' ' Tnrirng Bai hoc Y Hi Nii, ' Tnrdng Cao dang Y ti Thanh Hoa Nghiin cim nhim xic dinh tf Id hidn mic bdnh man tinh, dp tlnh tp khai bio a mdt si nhdm ngudi iao ddng trong khu vuc kinh ti phi chinh thirc Id tai Hi Ndi nam 2011 vi md ti md hinh sir dung dich vu y ti vi ehi phi diiu tri cua dii tuang nghidn cdu. Kit qui cho thiy cd 31,3% ngudi dupe diiu tra mic bdnh man tinh, 61,2% ngudi mic bdnhAridu chimg cip tlnh. Si iin kham chu'a bdnh ndi trit, ngoai trii vi tu mua thuic diiu tri eia ngudi iao ddng khu vpe kinh ti phi chinh thirc tai Hi Ndi iin lupt ii: 1,0 ±0 iin, 1,8 + 3,7 lin vi 2,2 ± 1,4 lin vdi chi phi trung binh (bao gim ci chi phi giin tidp, true tiip) tuang irng la 3624,8 ± 2656,6 nghin ddng, 767,5 ± 977,1 nghin ding vi 238,5 + 461 ding. Tu dd ed thi kit luin tf id mac benh man tlnh, dp tlnh cOa ngudi iao dpng khu vpe lao ddng phi chinh thirc kha cao, nir gidi vi ngudi nghdo ed tf li mic cao han so vdi nhirng ngudi edn iai; tf id mic bpnh man tinh cd xu hudng ting theo dp tudi.
Ngudi nghdo cd mire chi cho yti tuang dii eao.
Tir khoa: 6m dau benh tat, su> dung dich VLI y t l , chi phi y t l , lao dgnn phi chinh thu'c 8, 10] vd phg ny la ngydi chju dnh hydng, thiSt thoi nhilu hon so vdi nam gidi [4, 9]. Tai Viet Nam, KVKTPCT chilm 11 tripu viec Idm trong ting s i viec Idm todn qgie, tap trgng chu y i u d Hd Npi va Thdnh p h i H i Chi Minh I. DAT V A N Bt
Khu vyc kinh te phi chinh thirc (KVKTPCT) bao g i m cdc dang hoat dpng ea t h i hoac tap t h i (nhyng khong qud 10 ngydi). KVKTPCT thydng ed quy mo nhd, dilu kiSn Idm viSc thap kem hon vd hdu nhy that thydng. khdng i n djnh [5]. Mpt s i nghiSn cii'u trSn T h i gidi eho thdy lao dpng trpng KVKTPCT dydi dieu kiSn lam viec kSm, thu nhap vd tinh ehlt cdng viSe khong I n djnh dd Idm tang nggy eo mac gian dopn giac ngii, cdc van d l sire khde tam thin, tam iy [6, 8]. Ty IS i m dau, tai nan thyong tieh/tai npn nghi nghipp, mac benh xyong khdp vd bpnh dydng ho h i p d nhdm lao ddng KVKTPCT cDng d mu'C cao hon so vdi nhdm lao ding thupc khu vyc kinh t l chinh thirc [7.
vd cc xu hydng gia tang nhanh [1]. Tuy nhlSn thdng tm ve tinh hinh sire khde va sir dyng djch vg y t l ciia lao dpng thupc KVKTPCT phuc vy eho viec xdy dyng k l hoach. chiln lyoc vdn edn it do thilu ede nghien ciru khoa hpc ve cdc npi dung ndy. Xult phdt tir nhyng yeu cau trSn. chiing tdi tien hdnh d l tdi nghiSn ciru vdi mue tISu:
Xdc djnh ty IS hien mac bSnh man tinh.
elp tinh t y khai bdo d mot s i nhdm ngydi lao dpng trong khu vye kinh te phi chinh thirc tai Ha Npi nam 2011.
121
TCNCYH Phu truung 79 (2) - 2012 Mi ti mo hinh sir dung dich vp y te vi chi phi diiu tri eua dii tupng tren.
II. D O I T U O N G VA PHLTONG PHAP 1. D i i typ'ng nghlSn eiru: Ngydi lao dpng trong dp tuli tir 18 - 60 tuii tpi cdc phydng thupc 04 qudn npi thdnh Hd Npi.
2. T h i l t k l nghlSn c y u : NghiSn ciru m i ta eat ngang.
3. Dja d i l m nghlSn cii'u: NghlSn eiru dypc tiln hdnh tpi 30 phydng eiia thdnh p h i Ha N|i.
4. Cd m l u vd chpn miu: Cd m l u nghlSn ciru dypc tinh theo cdng thire d l yde lyong 1 ty Ip trpng quin t h i ;
[1-p]
n = Z , p. 6 - Trpng dd:
Z(1-a/2)=1.96; a = 0,05; E dp chinh xdc tyong d i i = 20%; p = ty IS mac benh man tinh t y khai bde la 30%). Cd mdu cdn ed d l xdc djnh ty IS i m dau Id 225 ngydi. Ap dgng ehpn mdg nghien eirg theo egm. ta se nhan thSm vdi hS s i ehpn mdg thep cgm Id 1.85 Idn. s l ngydi dypc lya ehpn tham gia nghiSn eii'g Id 416 ngydi vd dypc Idm trdn thanh 420 ngydi. NghlSn ciru dypc tiln hdnh tpi todn bp 30 phydng dypc lya chpn nglu nhiSn tir 72 phydng thupc 04 qudn. Tpi m i l phydng. chiing toi chpn ra 2 ngydi/nhdm cua 7 nhdm lao dpng bao g i m ; tho u i n tdc.
thp may tai nhd. tho sira xe mdy. bdn hdng rong. bdn hdng via he. bdn hdng tai nhd va xe may 6m.
5. Thu thdp s i lieu: S i liSu dyye thu thpp thdng qua phyong phap phdng v l n dya trSn bp cau hdi thiet ke sin. Bp cdng cu thu thpp s i lipg dypc nhdm nghlSn eiru xdy dyng sag khi tham khao ede tdi liSu trong nydc vd quic t l .
6. Quan ly, xir ly va phan tich sd lipu:
S i liSu sau khi dypc thu thpp dypc lam spch
va nhlip bang phln m i m Epidata 3.1. Phln m i m thing kS Stata 10 dyp'c sir dyng trong phdn tich s i liSu-
III. K ^ T QUA
Ting s l cd 419 ngydi dypc diig tra, trong dd ed 156 nam (37.2%) vd 263 nir (62.8%). Bang 1 cho thiy ed 31.3% ngydi dypc phing v l n hipn cd mdc it nhlt m|t bpnh mpn tinh (131 ngydi) vd 62.1% ngydi cd mac bSnh/triSu chyng/thyong tich (260 ngydi). Trong dd nhdm ny gldi cd ty IS mlc bpnh eao hon so vdi nam gldi. d l i vdi bSnW thyong tich d p tinh thi sy khdc biSt ndy c i y nghla thing kS (p < 0.05). Theo nhdm tuii, nhCrng ngydi tir 50 - 60 t u i i ed ty Ip mlc bSnh mpn tinh (49,5%) cao hon so vdi cdc nhdm tuli khae mdt cdch y nghTa cd thing ke (vdi p < 0.05). Tuy nhiSn d l i vdi cdc bpnh cap tinh thi nhdm lao ddng tir 30-49 tuli co ty le mac eao hon so vdi hai nhdm con Ipi.
Ngydi ngheo cd ty Ip mac bpnh man tinh va d p tinh cao hon so vdi cdc nhdm cdn lai. tuy nhlSn sy khdc biSt ndy khdng cd y nghTa thing kS (p > 0.05).
V l md hinh bSnh tpt. k i t qua cho thay cac bSnh mpn tinh thydng gpp nhlt d ngydi lao dpng thude KVKTPCT Id dau cpt sing/xyong khdp (34.4%). bSnh dp ddy/tiSu hda (29.8%), cao huylt dp (9.2%), huylt dp thip (5,3%).
Cdc bpnh mpn tinh khde ehilm tir 0,7% din dydi 4%. Cdc bSnh/tripu chirng d p tinli thydng gpp nhlt eua d l i typng nghiSn ciru trong vdng 3 thdng qua Id dau d l u (30,8%), cdc bSnh/tripu chirng eiia dydng hd hip, tilp d i n Id triSu chirng dau lyng (10,5%). Cac triSu chirng khdc nhy sit^ tiSu chay, dau bgng. dj irng...cd ty Ip mac dydi 7%.
S i l l n khdm chira benh n|i tru. ngopi trO vd t y mua thulc d i l u tri eiia ngydi lao dOng KVKTPCT tpi Ha N i l lan lypt Id: 1.0 ± 0 lln, 1,8 ± 3,7 l l n vd 2,2 ± 1.4 l l n vdi ohi phi trung
• % ^
TCNCYH Phu tnmng 79 (2) - 2012 binh bae g i m oa chi phi tryc tilp (cho y t l )
vd ehi phi gidn tiep (cho an uing, di lai...) tyong irng la 3624,8 ± 2656,6 nghin ding, 767.5 ± 977.1 nghin d i n g vd 238.5 ± 461 nghin ding (Bang 2). Ngydi khdng ed the BHYT CO chi phi kham chO'a bpnh npi trii cao hon so vdi ngydi ed the BHYT nhyng khdng mang y nghTa thing kS (p > 0.05). Ngyoe lpi.
nhu'ng ngydi cd the BHYT co ehi phi khdm chira bSnh ngopi trii vd t y mua thuic dilu tri cao hon so vdi ngydi khdng cd the BHYT 20% nhu'ng ngydi cd thu nhpp thip nhlt cd
chi phi khdm chu'a bpnh npi trii. ngoai trii cao hon so vdi ede nhdm khac (Bang 2). Ba s i ngydi lao ddng KVKTPCT tai Ha Npl lya ehpn cac bpnh vien trung yong (43,8%), tilp den Id benh vipn d p thdnh p h i (31,3%) eho dilu trj npi trii. Tuy nhien khi cd nhyng bpnh/
tripu chirng d p tinh thi da s i d l i typng ndy ehpn cdc co sd y t l ty nhan (27,9%), tilp d i n Id cdc bpnh viSn trung yong (26%) vd bSnh vipn huypn (18,8%). Ty IS kham chu'a bSnh tpi trpm y t l xd/phydng rlt thdp (7,7%) ( b l l u d i 1).
Bang 1. Ty le m i c bSnh man tinh, bSnh/trlSu chirng/thu'o'ng tich theo gidi, t u i i vd nhdm thu nhap
Ty Ip m l c
Benh man tinh 12 thang qua
Bpnh/triSu chLpng/thyong tich 3 thdng qua
n
%
n%
Theo gidi tinh Nam Ny p(testX^)
47 84
0.44 30.1 31.9
83 177
0.04*
53,2 68,1 Theo nhdm t u i i
18-29 3 0 - 3 9 4 0 - 4 9 5 0 - 6 0 p(testX^)
5 40 35 51
0.0001 7.4 33.6 27.1 49,5
•
40 73 88 59
0.33 58,8 61,3 68,2 57,3 Theo thu nhpp od nhdn
NghSo Can ngheo Trung binh Khd Gidu p(testX^) Chung
67 47 55 65 49 131
0,93 71,3 65.3 67,1 69,9 68,1 31,3
59 41 52 62 46 260
0.83 60,8 57.8 61,9 66,7 62,2 62,1
TCNCYH Phu tnmng 79 (2) - 2012
E
. • II
•S i^
E "
124
TCNCYH Phu tnmng 79 (2) - 2012
m a . B raKh^m chCva b^nh ngogi tr
a KhSm ChO'a b$nh n^j trii
•"127.9
BV Trung LFCrng
BV thdnh ph6
^ 4 3 8
BV qu^n/huy^n
I 16 3^
O 10 20 30 40 SO
"A
Bi4u dd 1. No*! kham chu'a benh ndi tru, ngoai tru IV. BAN LUAN
Nghifen ci>u cua chiing toi cho thiy ty le hien mac cac benh man tinh, benh/trieu chupng cSp tinh cua nhom lao dong trong KVKTPCT tgi Ha Noi tu-crng d6i cao (31,3%
va 62,1% tu'O'ng li-ng). Hai benh man tinh thu'dfng gap nhat la dau cpt song/xyo-ng khap (34,4%), benh da day/tieu hoa (29.8%).
Cac b?nhrtri#u chi>ng cap tinh thu'dng gap nhat cua nhom lao dong nay la dau dau (30,8%), benh/tri#u chu-ng cua du-o-ng ho h i p (bieu d6 1). K§t qua (^eu tra cua chung toi cung tu'O'ng ti^ nhu- kit qua nghien cu-u tai Zimbabue [7], Nam Phi [10] va Dhaka [3].
Lao dpng nu- trong KVKTPCT Xg\ Ha Npi co ty \i mac b$nh man tinh, dgc biet la bgnhl tri^u chu-ng d p tinh cao ho-n so voi nam gio-i.
Ket qua nay cua phu hp-p vo-i bao cao cua Co- quan an toan lao dpng cua Ciy ban chSu Au [4]. Nguy co- mac benh mgn tinh co xu hu-o-ng tang theo dp tu6i (bang 1) phan anh sy anh huwng cua y4u to tu6t d6i vdi cac b$nh man tfnh. Ngu-Q-c Igi, nguy co- mac benh/cap tinh thuo-ng tich thu-o-ng ggp 6- nhom lao dong c6 dp tu6i tre hcyn (bang 1). NhO-ng ngu-6-i co thu nhgp thip nhat co nguy co- mac benh man tinh, benh/tri$u chu-ng thu-cng tich cao ho-n
so vo-i cac nhom con lai, tuy nhien sy khac bipt nay mang y nghTa thong ke.
Ngu-6-i lao dong KVKTPCT tai Ha Noi co s6 \kn dieu tri benh npi tru, ngoai trii va tu- mua thu6c dilu tn tu-o-ng u'ng la 1,0 ± 0 lln, 1,8 ± 3,7 lan va 2,2 ± 1,4 lln. Benh nhan co the BHYT co chi phi dieu tn npl tru trung binh la 2649,7 ± 3261,4 nghin dOng, thip hon so voi ngu-oi khong co the BHYT la 4210,0 ± 2199,7 nghin dong. K i t qua nay phan anh du-pc Ig'i ich cua BHYT mang lai cho ngu-oi dan khi kham ch&a bpnh npi tru. Trai Igi, 20%
nhu-ng ngu-o-i co thu nhap thap nhlt c6 chi phi kham chu-a bpnh npi tru, ngogi tru trung binh (4550,0 ± 3675,6 nghin dong va 1179,8 + 1705,2 nghin dong) cao hon so voi cac nhom khac (bang 2). Oieu nay phan anh nhij'ng ngu-oi lao dpng ngheo co nguy co roi vao "biy ngheo y te" do benh t|t 6m dau cao hon. Ngu-oi lao dpng KVKTPCT tai Ha Npi thyong d i n dieu trj tai cac co so y te tuyen tren cho dilu tri npi tru (bpnh vien trung u'ong, thanh phd/tinh), va lya chpn cac co so y te tu' nhan, b#nh vien trung u'ong khi hp co 6m dau/trieu chii-ng d p tinh. Kit qua nay cung dong nhat vo-i ke qua cua dilu tra y t l qu6c gia nam 2001 - 2002 [2].
125
TCNCYH Phu tnmng 79 (2) - 2012 V. KfiT LUAN
Ty IS mac bfnh man tinh, dp tinh cua ngydi lao ddng KVKTPCT oao, nCr gidi vd ngydi ngheo cd ty IS mac cao hdn so vdi nhu'ng ngydi cdn lai; ty IS mac bSnh man tinh cd xu hydng tang theo dp tuii.
TAI LIEU THAM K H A O 1. Dy dn TCTK/IRD-DIAL (2010). Sy nang dOng cua khu vyc phi chinh thirc d Hd Ndi va thdnh p h i H i Chi Minh glal do^n 2007 - 2009 - Mpt s i phdt hlSn chinh tir D i i u tra Hd San xuit Kinh doanh vd Khu vyc Phi chinh thirc (HB&IS): Hd Noi. 1 - 37.
2. T i chyc Y tS ThS Gidi (2007). Tdi khoan Yte Quic Gia 2007. Hd Ngi.
3. Alexander Kramer, Mobarak Hossain Khan, and Frauke Kraas (2011). Health in ii^ega cities and Urban Areas in Contributions to Statistics, Springer 280.
4. European Agency for Safety and Health at Work, Risks and Trends in the Safety and Health of Women at Wor1<.
5. ILO, (2002). Decent work and the infor- mal economy, Sixth item on the agenda, in
International Labour Conference 90th Ses slon2002. Geneva 1-133.
6. Joan Benach, et al. (2007). Employ ment Conditions and Health Inequalities ir Final Report to the WHO. Jacqueline Munay Editor. 172.
7. Loewenson Rh (1998). Health impact of occupational risks in the informal sector in Zimbabwe, nt J Occup Environ Health, 4(4):
264 - 74.
8. Ludermir AB., and Lewis G (2003).
Informal work and common mental disorders.
Soc Psychiatry Psychiatr Epidemiol. 38 (9):
485 - 9.
9. Ludermir AB., and Lewis G (2005). Is there a gender difference on the association between Informal work and common metal disorders. Soc Psychiatry Psychiatr Epidemi- ol. 40 (8). 622 - 7.
10. Pick Wm., Ross Mh, and Dada Y (2002).
The reproductive and occupational health of women street vendors in Johannesburg. South Africa. Soc Sd Med. 54 (2): 193 - 204.
Summary
PATTERN OF ILLNESS, HEALTH SERVICE UTILIZATION AND HEALTH CARE PAY- MENT AMONG SELECTED INFORMAL WORKERS IN HANOI, 2011 The study was carried out to describe health status of selected infonnal workers in Hanoi, in 2011 and describe the pattern of health sen/Ice utilization and health care payment among the study sub- ject. The results indicated that there were 31 3% of inten/iewees reported having chronic diseases during the last 12 months. 61.2% of them had acute disease/symptoms in the last 3 months. People from 50-60 years old had the highest prevalence of chronic disease, the most common chronic dis- eases are spinal paln/osteoarthrltis (34.4%). stomach/digestive (29.8%). The most common acute conditions the study respondents had were headaches and respiratory diseases. Number of inpa- tient, outpatient health sen/ices and self-treatment were 1,0 ± 0 times. 1.8 ± 3.7 and 2.2 + 1.4 times, respectively The average treatment costs were 3624.8 ± 2656.6 thousands VND. 767.5 ± 977.1,.6s thousands VND and 238.5 ± 461 thousands VND, respectively In conclusion, the prevalence o(
chronic diseases and acute condition were high among the infomnal wori<ers in Hanoi. The women and the poor had higher prevalence of illness Chronic diseases were more prevalent among older people. The poor incurred high level of health care expenditure.
Key words: Illness, health care, health care expenditure, informal worker
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