TCNCYH Phu truung 79 (2) - 2012
NHAN LyC BENH VIEN HUYEN HA NOI NAM 2008 - 2010:
THyC TRANG VA CAC Y^U T 6 A N H HU'DNG
Nguyen Duy Lu^, Nguyen Thj Thiry ' Trudng Bpi hpc YHi Nil, ' So Yti Hi Ni
Nghiin eiru nhim md ti thpc trang nhin ipe y li ciia 6 binh vidn huyin thudc Thinh phi Hi Ndi nim 2008 - 2010 vi Phin tich mdt si yiu ti lidn quan din thpc trpng nhin ipc y ti ciia 6 bdnh viin huyin niu bin. Kit qui eho thiy nhin Ipe ci)a 6 binh vidn huyin gim: Diiu dudng - NO hp sinh (BD - NHS) chiim tf Id eao nhit (44,32%), bic sT (BS) (18,43%), y sl da khoa (YSBK) (14,34%), dupe sT (DS) tmng hpc (5,51%), duac sJdpi hoe (0,93%). Si ein bd y ti (CBYT)/giudng bdnh li 0,9: Tf si BD - NHS/BS li 2.07. Trlnh dp sau dpi hpe thip (2.17% thpc sl, 30,12% ii bic sl chuyin khoa dp 1 (BSCK1), khdng cd bic sT chuyin khoa dp 2 (BSCK2), tiin sl trd iin). Tu dd ed thi kit luin, ci 6 BVH thiiu nhin lpc y ti trim trpng ci vi si lupng (thiiu 35.8%) vi trinh dd chuyin mdn cdn hpn ehi. chua dip img dupe nhu du hidn tpi.
Tir khda: Nhdn 1 ^ y t l , bfnh vlfn huyfn, cdn b$ y t l , trinh d$ chuyin mdn
I. DAT VAN o e
Hd Npi Id trung tam chinh trj. thyong mpi, kinh t l , van hda eua ea nydc, diSn tieh sau khi md rong Id 3.324,92 km^, dan s l 6.700.000 ngydi, mat dp dan s i 1.979 ngydi/km^, cc 29 qu$n, huySn, thj xa, 577 xa, phydng, thi trln, 11 bSnh vipn da khpa (BVOK) thdnh p h i , 13 bSnh vi;n huySn, 19 bSnh viSn chuySn khoa (BV3K) vdi 8.025 giydng bpnh. 17 trung tdm chuyen khoa. 29 Tnjng tdm y t l (TTYT) qupn. hgySn. thj xa, 577 tram y t l (TYT) xa, phydng, thj trln [7].
BSnh vipn huypn ciia Hd Npi ddng vai trd quan trpng trong hp thing y t l Hd Npi, tn/e tilp he tro, chi dso viSc thyc hiSn khdm ehtra bSnh ban d l u cho nhan ddn. Du'ng trydc nhu c l u khdm chu'a bSnh ngdy cdng cao cua nhdn dan Hd N|i ea v l s l lypng vd ehlt lypng, cdc bSnh viSn huypn chya dap irng dypc d l y du va hiSu qua nhu c l u dd, ede bSnh huypn edn gap khong it khd khan v l nguin nhdn lye. Hipn nay, s l lypng, eo c l u vd chit lypng nhdn lye cua ede bpnh vipn huypn nhy t h i ndo r l t can dypc tra Idi trSn phpm vi quic gia cQng nhy riSng eho thdnh
p h i Hd Ndi. Do v|iy chung t i i nghiSn ciru d l tdi ndy v j i muc tiSu:
Mo ta thuc trpng nhan Ipv y te cua 6 bpnh viin huyen thupc Thanh phi Hi Nil nim .2008 - 2010
Phin tich mit so yeu to anh huimg din thuc trpng nhan luc y ti eia 6 binh viin huyin do.
II. t ) d l TU'ONG VA PHU'ONG PHAP 1. Ddi typ'ng nghien ci>u: Chpn chu dich todn bp nhdn lye y t l cua 6 bSnh viSn huySn (Phil XuySn, My Oyc, Thanh Oai, Ba Vi, HodI Oye va MS Linh) ndm 2008 - 2010 d l md ta ddnh gid s l lypng, co c I g vd chit lypng nhdn lye y t l . H i so s l sdch. tai liSg san c6, bdo cdo thing kS bSnh viSn d l m l ta m|t s6 ehi s l hopt dpng t>Snh viSn, cdc y i u t l anh hydng d i n nhan lye y t l .
2. Phipang phdp nghiSn ciru: Thilt k l nghiSn eiru md ta c l t ngang, cd h i i ciru s6 lipg. S i liSg nhdn lye dypc thu thap tir h i so s l sdch, tdi liSu san cd cua so y t l Hd Nil, bSnh viSn, trung tdm y t l , phdng y t l eua 6 hgySn m i t cdch hS thing vd thing nhlt thsl 116
b i cong cg da xdy dyng. S i lyong vd co c l u 153/2006/ QO - TTg (00153) cua Thu tydng nhdn lye y te dyoc ddnh gid dya trSn dinh Chinh phu [4]. Chit lypng nhdn lye y t l myc biSn e h i cua cac bSnh viSn huySn theo dypc md ta tren eo sd blng elp chuyen mon ThSng ty liSn tjch s i 08/2007 cua Bp Y t l - dd dypc dae tpo S i liSu dypc xir ly bdng Bp Npi vg (TT08) [3] va Qgylt djnh phan m i m Excel 2007.
III. K£T QCIA
1. Thdng tin chung cua 6 huypn nghlSn ciru
Bang 1. S i CBYT/10.000 dan vd CBYT/GB cua 6 huyen tir 2008 - 2010 STT
1 2 3 4 5 6 7 8 9 10 11
Npl dung S i CBYT/10.000 dan S i BS/10.000 ddn S i OD-NHS/10.000 ddn S l DD - NHS/BS SlDS/10.000 ddn SlYsT/IO.OOOddn S l CBYT/GB S i BS/GB S l OD - NHS/GB S i DS/GB S i GB/10.000 dan
Nam 2008 20.11
2.88 4.98 1,17 3.19 5.29 0.88 0.13 0.2 0.05 6.25
Nam 2009 22.27
3.07 6.66 2.22 3.4 5.42 0.96 0.18 0.3 0.06 6.81
Nam 2010 23.66
3.27 7.00 2.24 3.63 5.02 0.88 0.20 0.38 0.07 7,54
Chung 3 ndm 22,01
3,07 6.22
" 2.07 3.41 5.44 0.91 0.17 0.29 0.06 6.87 Cdc chi s i CBYT dSu tang hdng nam. tang nhilu nhlt Id s l OD - NHS. tang it nhat Id s i BS/10.000 dan (0.39). s i DS/GB (tang 0.02).
2. Thire trang nhan lire y tS cua 6 benh vien huyen tir nam 2008- 2010 Bang 2. Sd l i w n g CBYT cua 6 benh vien huyen t y 2008 - 2010 Si
TT 1 2 3 4 5 6
TBCM Bdesy O D - NHS DSOH DSTH YSOK Khdc
Nam 2008 n 122 186 6 39 105 160
%
18.77 28.62 0.92
6.0 16.15 23.08
Nam 2009 n 148 246 7 42 111 184
%
18.71 31.10 0.88 5,31 14,03 23.26
Nam 2010 n 145 278 8 43 107 174
%
17.88 34.28 0.99 5.30 13.19 21.45
Chung 3 nam n 138 237 7 41 108 169
%
18.43 44.32 0.93 5.51 14.34 22,56 S l OD - NHS chilm ty Ip cap nhlt 44.32% 3- Thyc trang ehlt lypng nhdn lye y t l vd tang nhilu rihit, tiep d i n Id CBYT ed trinh eua 6 bSnh viSn huySn tir ndm 2008 - 2010.
do khde (22,56%), s i BS (18,43%), s i YSOK Ca 6 bSnh vipn hgySn d i g khong eo CBYT (14.34%). s l dypc sT trgng hpe (DSTH) ed trinh dd ehgySn mon ehuySn khoa elp 2.
(5.51%). s l dypc sT dai hpc (DSOH) (0.93%) tiln sT. phd gldp sy. gido sy, ehi ed 2,17% Id vd tang it nhlt * ' " = ®'' 30.12% Id BSCKI. S i BSCKI. Thpc si
117
TCNCYH Phu tnmng 79 (2) - 2012 khong tang thdm ehi eon giam hang nam. s l DSOH tang hdng nam (bSnh vipn huypn Hoai DU'C khong ed DSOH). s i OD - NHS eao dang tdng hang nam vd chilm 4.08%. trung hpc chiem 94.51%. vdn cdn so elp ehilm 1.41%.
4. M|t s l y i u t l dnh hydng d i n thyc trpng nhdn lye y t l cua 6 bSnh viSn huypn.
Nhu c l u NLYT Theo dinh mire NLYT tpi TT08. s l CBYT cua 6 bSnh viSn huySn edn thilu khoang 1/3. (bSnh viSn huypn Hoai Dire thilu 43.22%. s l DSOH thilu 1/2. s i DSTH thilu 14%. s i BS thilu 1/4. so DD - NHS thilu 35.8%. s l edn b l ed trinh d | khae ohi thilu ed 4.2%).
Tuii vd gidi; Nhdn lye < 30 tuii ehilm 34.09%. ty 30 - 50 tuii chilm 46.88%. s l nhan lye > 50 tuli tang nhanh tir 14.0% nam 2008 ISn 24.42% nam 2010. S i ny ehilm 2/3 ting s i . nam gidi ohi ehilm 1/3 ting s l .
- Hoat dpng khdm chu'a bSnh cue 6 bpnh vipn huySn: Cdng suit su" dung giydng bSnh k l hoach (CSSDGBKH) giam tir 163.31%
nam 2008 xuing con 127.4% nam 2010.
Cdng suit sir dung giydng benh thyc ke (CSSDGBTK) Id 105,77%. S i ngdy dieu tri npi trii, s l ngydi benh dilu trj npi trii, s i l l n khdm bSnh vd s l l l n khdm trung binh ciia mpt bac sl/ngay (dat tren 27 ngydi/ngdy/BS) tdng qua cdc nam; S i ngdy dilu trj trung binh ciia ngydi bSnh noi trii (NBNT) Id 5.93; Binh qudn s l ngydi bSnh dieu trj npi tru (NBOTNT)/BS giam tir 524 nam 2008 xuing 499 nam 2010; S i lln khdm trung binh cga ngydi dan/ nam tang tir 0.57 nam 2008 ISn 0.63 nam 2010. ty IS bSnh nhdn chuyin tuyen 0,19; ty IS phlu thuat 0,08, s i xet nghiSm trung binh cua ngydi bSnh/ nam tang tir 1,18 ndm 2008 ISn 1,76 nam 2010, S i chdn dodn hinh anh trung binh eua ngydi bSnh/ndm tdng tir 0.24 nam 2008 ISn 0.34
nam 2010. V l phdn tgyin ky thgpt san kho thyc hiSn nhllg nhlt 85,62%; s i thyc hipn nhlt Id nhi khoa 66,32%.
IV. BAN LUAN
Cd 6 huypn d l u khdng ed bSnh vipn eui Trung yong, thanh p h i , b i ngdnh. do v^]
bSnh viSn huySn v l n Id don vj duy nhlt thyi hiSn dilu trj n|i trii cho bSnh nhan. Cd der 1/4 CBYT ndm trong bSnh vipn huySn (bSnl;
vlSn huySn My Oirc 38.39%). Vdi s i GB ciia 6 bpnh vlSn huySn (153.3) phii hop vdi myc chung eua ed nydc vd quy md cua BVH hpng 3 (163.3GB) S l GB/10.000 ddn tdng hdng nam va tang g i n g i p dSl. song mdi bang 1/2 chf tieu cua thdnh p h i (20.7) [7] vd ca nydc nam 2009 (18.1) [1]. thap hon tinh Ninh Binh (7.9) [5]. eao hon Bdc Ninh (6,3) [6J . Sl CBYT/10.000 ddn dpt 2/3 mire ehung ca nydc (34,7) vd thdnh p h i (28.78). S i CBYT/
GB t h i p hon mire trung binh ea nydc nam 2009 (1.47) vd t h i p hon so vdi quy fflnh cua TT08. bdng mire trung binh cua Ninh Binli (0.92). S i BS/10.000 dan dpt 1/2 mu'C chung ca nydc (6.59). blng 1/3 Thdnh p h i (9.0). So BS trung binh eua 6 BVH (18.8%) dat bang mire cd nydc. S i BS/GB thap hon cua thdnh p h i . ehi bang 2/3 mde ehung ca nydc nam 2009 (0.28). S i OD - NHS/10000 dan dpi 2/3 mire cua ea nydc ndm 2009 (8.82). d?t 1/2 so vdi thdnh p h i (10.4). S l OD - NHS/BS chya dpt bdng ca nydc. ehi dat 2/3 so vii thdnh p h i . RiSng s l DS/10.000 ddn dat bang ca nydc vd thdnh p h i . chi ed DSOH thap hon. S i YS/10.000 ddn. YS/GB eao so vdi thdnh p h i (3,2), bdng vdi ea nydc (5,7).
Thyc trang v l s i lu^ng CBYT ciia 6 bpnh vien huyen
s l BS dat bang chi tiSu ciia ed nirov (18,8%), s i OD/BS (1,92) chi dat 1/2 chi tieu cua thdnh p h i vd ea nydc (3,5), S i OD- NHSi, ehilm hon 2/5, s l BS ehilm 1/5, s i DSBH 118
chilm 0,93%. Theo TT08 quy djnh cir cd 1 DSOH cd 2 DSTH, 8 BS. 24 OD - NHS. nhy vdy ca 6 BHV d l u khong dpt theo quy dinh.
Theo quy dinh cdc co sd khdm chij'a bSnh ed 3 bp phpn chinh Id Lam sang. C^n ldm sdng va dypc, quan ly hdnh chinh, ty IS phan bo dypc qgy djnh tyong irng 60 - 65%, 22 - 15% vd 18 - 20 [3], Nhdn lye y t l ciia 6 bSnh yiSn huypn dypc phdn b i tyong d i i du v l s i lypng, tuy nhiSn phan b i NLYT d khoa Idm sdng vd cSn Idm sang - dypc ehi dpt 2/3 so vdi quy dinh, bp phpn quan ly hdnh chinh nhilu gip 2 l l n so vdi quy d|nh.
Thyc tr^ng vS ehdt lyp'ng CBYT cua 6 BVH: Khi ndi d i n NLYT khdng ehi ndi d i n s i lypng md quan trpng hon la chit lyong cua CBYT tdc la trinh dp ehuySn mon. nghipp vg.
Chinh y i u t i ndy sS quyit djnh d i n ehlt lyong. hipu qua hoat dpng cua cdc bSnh vien huySn. Thep quy Smh ciia Bd Y t l thi d l i vdi bSnh viSn huySn hang 3. BS va DSOH phai cd trinh dp ehuySn mdn trSn OH Id 15%. DD- NHS ed trinh dp chuySn mon eao dang. OH trSn 15%. Ca 6 benh viSn nay d l u khdng dat tham ohi dpt r l t t h i p ehi bang 1/5 - 1/3 quy anh d l i vdi BS. 1/7 -1/4 d i i vdi DSOH. 1/20 -1/7 d i i vdi OD-NHS.
Mpt s i y i u td anh h y d n g
Nhu ciu nhin luc: Theo SinU mire NLYT tai TT08 d 6 benh vipn huySn ndy thilu nhieu nhdt vdn Id DSOH tilp d i n Id bde sT. OD - NHS. s i CBYT khdc cdn thya 4.2%, nhu cdu NLYT chya dap irng ca ve s l lypng vd ehlt lyong, trong s l 6 bSnh viSn huyen, bSnh vien huySn My Biro Id khd khan hon ea.
Nhu cau ve gluung benh ki hoach: D l dam bao s i CBYT oho giydng benh kS hoach thi tai 6 bSnh viSn nay da thilu khoang 1/3 CBYT, n l u tinh theo s l giydng bpnh can thilt d l eae bSnh viSn duy tri dypc ty le su'
dgng giydng bSnh d mire 85%, vdi cdng sgat sii' dgng giydng bSnh 127,4% nhy hipn nay thi so giydng bSnh se la 1.378, s l CBYT eIn thilt se Id 1 653 (edn thilu 842 (tren 50%)), nhy vpy so BS, DSBH, OD - NHS sS thieu nhilu hon so vdi TT08. O l thyc hipn eae ehi tieu theo QO 153 thi 6 huypn ndy se phai ed 3.135 giydng bpnh, nhy t h i s i giydng bpnh cdn thilu 2.215 (70,7%), s l GB hipn cd chi dat 29,3%. S l CBYT se phai cd 3.762 (edn thilu Id 2.951(72,5%), vdi con s i nhy hipn nay mdi ehi dat 27,5% .
Phin bo nhan luv y ti theo tuoi vi gidi:
Tgii vd gidi cd anh hydng Idn d i n hopt dpng vd ehlt lypng cua bSnh vien, bSn cpnh s l edn bp tren 50 tuii tyong d l i cao thi d cac enh vien nay ed so cdn bp dydi 30 tuii chiem ty IS 34,09%. Thep s l liSu dlSu tra d cdc viing lanh t h i cd 70% nam gidi Id bde sy. cd 70% ny gldi Id DD - NHS. 6 bpnh vien huyen nay cd k i t qua nhy cdc viing lanh t h i trong khu vye
Hoat ding kham chira bpnh: Ca 6 bSnh vien huyen d l u qua tai v l giydng bSnh k i t qua ndy phii hop vdi eong suit su' dgng giydng benh trung binh eua cdc bSnh vien huySn tren ca nydc ndm 2009 (128.1%).
Theo s l IISu cua ca nydc ndm 2008 sir dung tren 150% GBKH chi cd 22,2% bSnh vipn, sir dgng GBTK chi cd 11,7% bSnh vipn; Sir dung GBKH dat tir 100 - 150% ed 68.3 % bSnh vlSn. GBTK ed 54.2% bSnh vien [2]; (3 6 benh vipn huySn ndy chi c6 bSnh vipn huyen MS Linh sir dung trSn 150%, 5 bpnh viSn eon lpi (83.3%) sii' dung d mire 100 -150%. k i t qua nay cao hon so vdi ea nydc. K i t qua dilu tri npi trii. khdm chu'a benh d l u eao hon so vdi cdc benh vien huySn trong ca nydc.
Ngdy dilu tn trung binh ciia ngydi bSnh npl trii (5.93) thap hon sp vdi cdc benh vlSn trong ca nydc (6.7 ngdy) So lypt kham trung
TCNCYH Phu tnmng 79 (2) - 2012 binh eua 1 ngydi dan/nam t h i p so vdi cdc bSnh ViSn vting ding bang sing Hing nam 2009(1,34).
Phin tuyin ky thuit. 6 bSnh viSn huySn chi triln khai dypc 75,23%, ed d i n 24,77%
chya triln khai dypc (nguySn nhdn do khdng cd NLYT chilm 23%, do TDCM ehilm 46,7%.
do eo sd v^t ehlt chilm 12.1%. nguySn nhdn khdc ehilm 12.1%). 6 bpnh viSn huySn thyc hien dyoc 31 ky thupt vypt tuyin d 4 khpa n|i. ngopi. san. nhi.
Cd m i l liSn quan chat che giu'a s l lypng vd chit lypng CBYT vdi hiSu qua khdm chu'a bSnh. giu'a CB sau DH vd s i ngdy dilu trj trung binh. phlu thupt. chuyin tuyin.
V. K^T LUAN
Thyc trang nhdn lye y t l eua 6 huySn da vd dang thilu tram trpng (thieu 35.8%). Tuy s l CBYT/10.000 dan vd CBYT/GB tang hdng nam song s i tdng chya dap irng vol yeu c l u thyc t l eua cdc S\a phyong k l ca chya ddm bdo dii theo TT08.
S l CBYT trong 6 bSnh viSn huySn edn thieu nhilu ca v l s i lypng vd ehlt lypng, phdn b l NLYT chya hpp ly giOa cac khoa phdng, ode bpnh vipn huySn. S l CBYT thilu chu y i u Id DSOH, BS, s i cd TOCM cao. K i t qua nghiSn ci>u cdn cho thiy hiSu qua hopt ding ciia bSnh viSn huySn la chya eao, chya dap irng dypc nhu elu kham chu'a bSnh ngdy cdng eao ciia ngydi ddn trong huypn.
T A I LIEU THAM K H A O 1. Bd Y t l (2010). NiSn gidm thing ke >
t l ndm 2009, NXB Y hpc.
2. Bp Y t l (2009). Nhdm d l i tdc y t l . Bdo cdo chung T i n g quan nganh Y t l ndm 2009, 14-19.
3. B$ Y t l - Bp N$i vg (2007). Thong ty liSn tich s l : 08/2007/TTLT-BYT-BNV ngdy 05/06/2007. Hydng d i n djnh mire bidn chi sy nghlSp trong ede eo sd y t l nha nydc
4. Chinh phu (2006). Quyit dinh cua Thu tydng Chinh phii s i : 153/2006/QO-TTg ngdy 30 thdng 6 nam 2006 PhS duySt Quy hopch ting the phdt triln hS thing y t l ViSt Nam giai dopn d i n ndm 2010 vd t i m nhin din nam 2020.
5. Nguyin Thj HuySn Linh (2004). NghlSn cyu nguon lye y t l vd hopt dpng eua cdc bSnh vipn huyen ciia Ninh Binh trpng 4 nam (2000 - 2003), Ludn van t i t nghiSp cii' nhdn y t l c6ng cpng, Tnrdng Dpi hpc Y Hd Npi.
6. Nguyin Tiln Dong (2010). NghiSn cim md hinh bSnh tpt n|i trO tpi cae BV da khoa huySn tinh Bde Ninh giai depn 2005 - 2009 vd tim hieu mOt s l yeu t i liSn quan, Tnrdng Dpi hpc Y Hd Npi, luSn vdn t i t nghipp BS ehuySn khea e l p II.
7. S d y t l Ha Npl (2009). Quy hepch phat triln sy nghipp y t l Ha Npi d i n 2015, Tim nhin 2020.
Summary
HUMAN RESOURCES OF DISTRICT HOSPITALS OVER 2008 STATUS AND DETERMINANTS
2010:
The study was conducted to describe a status of the health personnel of the 6 district hospi- tals in Hanoi over the period of 2008-2010 and Analyze factors related to the status of health workforce from the above 6 district hospitals. The results showed, human resources of 6 district hospitals comprised; nurses and midwives - accounting for a highest percentage (44.32%), general practitioners (18.43%). physicians (14.34%), high school pharmacists (5.51%) and unl-
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.
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