TAP CHl Y HOC VIET NAM TAP 4S9 - THANG 10 - SO 2 - 2017 tinh TTiift Thien Hue nam 2011", Cong bao, Uy
ban Nhan dan tinh ThiTa Thien Hue, tr. 3 - 4.
6. Sara N BIddi, Emre Ozafdn, Christopher 3L Murray (2009), "How does satisfedkin with the healthore systen relate to patient experience?", BuBdin cf ttie Wr^ Health Organization, 87 (4), pp. 271 - 278.
7. SreenivasT., Babu Nethi Suresh (2012), "A Study On Patient SatsfecSon In Hospitals (A Study On Three Urban Hospitals In Guntur District, Andhra Pradesh)", Int^nadcxi Jounal of Managsnent Research anri Business Sbatsgy, 1 (1), pp. 101 -118.
TINH TOAN CHI P H I D A Y D O CHO TRiraNG Hgp Dfi THiraNG VA DE MO TAI BENH VIEN QUAN THO DU'C,
THANH P H O HO CHI MINH NAM 2016
Viromg Thi Sinh*, Hoang Van Minh**, ThW Chi Dung***
T 6 M TAT
Muc tieu: Tinh toan chi phi day du va so sanh chenh lech dii phi day dii va mii'c vien phi cho tru'dng hdp de thufing va de md tai Benh vien Quan Thii DiTc, Thanh pho Ho Chi Minh nam 2016. Phu'dng /jhip.
nghien oTu cat ngang mo ta sir dung phu'cfng phap hoi cu\j so lieu san co va jjhieu thanh toan eiia benh nhan liic ra vien va cac so sach lien quan den ehi phi tir phong tai chinh cho tru'dng hdp de thu'dng va de mo.
K& qua: Chi phi de thudrig: 3260,0 nghin dong (±690,5); de md lay thai i n 1: 9761,6 nghin dong (±1353,4); de md lay thai lan 2: 8410,3 nghin dong (±934,2); Chi phi dSy dii cao hOn gia djch vu eho mot deft de tfiu'dng la 914,6 nghin ddng; va gia djch vu ehi bSng 71,9% so vdi dii phi day du. Chi phi day dii cao tidn gia dich vu eho mot ddt de mo lay thai lan 1 la 4197,2 nghin ^ n g ; va gia djch vu chi bang 57,0% so vcli chi phi day dii. Ch[_^phi d^y dii eao hOn gia djch vu cho mot ddt de de md lay thai lan 2 la 2284,2 nghin di6ng; va gia djch vu chi bang 72,8% so vdi chi phi day dii. K& lu$n: De giam ganh nang tai chinh cho cac cd sd y te, B6 y te tan quy dinti miTc thu chi phi dSy dii aJa tru'dng hop de thu'dng va de mo tai benh vi?n. Khuyen khich BHYT thanh toan chi phi cac d|ch vu kham ehQ^ benh day dii hdn, gdp phan giam ganh nSng cho ngu'di benh va eO sd y te.
Ttf'AAds: Chi phi day dii, de thudng, de mo, Tliii Dire SUMMARY
CALCULATION OF FULL COST FOR VAGINAL BIRTH AND C-SECTION AT HOSPITAL, HO CHI M I N H CITY, 2 0 1 6 Objectives. To calculate the full cost and (flmpare tiie full cost difference and hosptal fee for normal delivery and delivery at Thu Due District Hospital, Ho Chi Minh City 2016. Me^ods : cross- sectional descripHve study using the available data retrospedive and patient payment cards at discharge
*Binh vien Quan Thu Ode, TP HCM
**Ph6Hieu tn/dng dddng DH YTCCHN
***B6YTe
Chiu trach nhiem ehi'nh: Vu'dng Thi Sinh Email: [email protected] Ngay nhan bai: 3.8.2017 Ngay phin bien khoa hoc: 29.9.2017 Ngayduyet bai: 4.10.2017
and records relating to costs from the finandal department for die normal delivery and cesarean sedion. Results. Normal cost: 3260,000 VND (±
690,5); First cesarean sedion: 9761.6 thousand VND (± 1353.4); Second cesarean section; 8410.3 thousand VND C± 934.2); The full cost is higher than tlie service cost for a normal delivery period of VND 914.6 thousand; and service costs are only 71.9% of full cost. The full cost is higher than the service cost for a first cesarean sedion is 4197.2 thousand; and service fee is only 57.0% of full cost. The full cost is higher than the cost of services for a second caesarean section Caesarean sedion is 2284.2 thousand VND; and the sen/ice fee is only 72.8% of the full cost. Conclusion: In order to reduce the financial burden on health facilities, the Ministry of Health should regulate the full cost of birth and hospital delivery. Encourage health insurance to cover the cost of medical services more fully, contributing to redudng the burden on patients and health fadlities.
Keywords: Full cost, lay often, caesarean sedion, Thu Due.
I. OJC^T VAN BE
De md va de thu'dng la eac tru'dng hdp ehiem ty trpng Idn kham, chu^ benh BHYT ca ve tan suat va chi phi tai eae benh vien tuyen quan, huyen. Tai Canada, ehi phi trung binh cho mdt tru'dng hdp de thu'dng la 2.700 USD va de md ia 4.600 USD [ 4 ] . Tai My, chi phi trung binh cho mpt tru'dng hdp de thu'dng la 3.347 USD va de md la 4.655 USD [ 6 ] . Nhu'vay, tdng chi phi y te cho mdt tru'dng hdp de md' thu'dng cao gap 2 lan so vdi tru'dng hdp de thu'dng [ 5 ] . O Viet Nam, chi phi dieu trj trong benh vien ehi mdi ddric u'dc tfnh mdt each tong quat, tu'dng doi, viec phan tieh chi phi dieu tn bang phu'dng phap phan bo tirng bu'dc dang edn han che ve sd lu'dng de tai, dae biet trong viec tfnh toan chi phf eho mpt tru'dng hdp de thu'dng hay de md. Vi vay, viee lu'a chpn phu'dng thirc thanh toan hdp ly, kiem soat chat che chi djnh dieu trj, can thiep y te phu hdp trd thanh moi quan tam dac biet eiia xa hdi nham kiem soat tot chi phi y te, gdp phan han che su" gia tang chi phi y te va sir dung nguon
VIETHAM MEDICAL JOURNAL N°2 - OCTOBER - 2017 IlTc tai ehinh han che mdt each cd hieu qua.
Hien nay, Benh vien Quan Thii Ddc, Thanh pho Ho Chf Minh eiing dang hu'dng den td chii tai ehinh theo xu hu'dng ehung, eho nen tien hanh nghien ciru: "Tfnh toan ehi phf day du cho tru'dng hdp de thddng va de md tai Benh vien Quan Thii Ddc, Thanh phd Ho Chf l^inh nam 2016"yd\ hai mue tieu cu the sau:
1. Tfnh toan ehi phf day du cho tru'dng hdp de thu'dng va de md tai Benh vien Quan Thu Ddc, Thanh phd Ho ChfMinh nam 2016.
2. So sanh chenh lech chi phf day dii va rndc vien phf cho trddng iidp de thddng va de mdtal Benh vien Quan Thii Ddc, Thanh phd Ho Chf Minh nam 2016.
II. €)6l TU'QISIG VA PHU'aNG PHAP NGHIEN CLTU 2.1 Thiet ki' nghien cdu: Day la nghien cirtj chi phi y te sir dung phu'dng phap hoi cuTu sd lieu sin cd tai Benh vien Quan Thii Dire, Thanh phd Hd Chi Minh nam 2017.
2.2 Ddi tu'dng nghi§n cu'u: Phieu thanh toan eiia benh nhan luc ra vien va cac so sach lien quan den chi phf tir phdng tai chinh cho tru'dng hdp de thu'dng va de mo.
2.3 Thdi glan - dja diem: Nghien ciru du'dc tien hanh trong thdi gian 08 thang (tir thang 01 den thang 8/2017), trong dd thdi gian thu thap so lieu la tir thang 9 den thang 12/2016
2.4 C8 mau: Oe tinh toan chi phi triTc tiep cho tru'dng hdp de thu'dng va de md, nghien eiru da tien hanh lay 60 hd sd ciia moi phu'dng phap de thu'dng va de mo de dam bao tinh chinh xac.
Cd m l u nay la Idn hdn cd mau u'dc tinh chi phi III. KET QUA
trong dieu tra quoc gia va eung du'dc ap dung tu'dng tu" trong nghien cu'u "Chi phi dieu trj mot sd nhdm benh tai benh vien da khoa tuyen tinli"
eiia Bd Y te (2005) [ 3 ] . Cd mau nay phii hdp vdi nang li/e eung cap djch vu cua Benh vien va dai dien clio cac tru'dng hdp de thu'dng va de mo, vi Ktioa San cd trung binh khoang 300 tru'dng hdp ea de thu'dng va de mo moi thang.
Nhu' vay, nghien cii'u da lay 60 ho sd x 3 phu'dng phap =_ 180 ho sd tai ehinh ve de thu'dng va de mo tai Khoa San, Benh vien Quan Thu Ddc.
2.5 Ky thuat chon mau: Chpn ngau nhien ddn 180 tru'dng hdp san phu dda theo danh sach san phu den sinh de tai Khoa San. Sau dd se kiem_ tra hd sd benh an ed phu hdp vdi tieu chuan li/a chpn ciia de thu'dng (tu'dng dng ICD- 10: O80) va de mo (tu'dng utig ICD-10; 082) tai Khoa San Benh vien Quan Thu Ddc trong thdi gian nghien edu.
2.6Xdly vi phin tich sdlleu: So lieu thu thap du'dc ma hda, quan ly bang phan mem Microsoft Excel (MS, 2010) va xd ly bang phan mem SPSS (Statistical Package for Social Sciences, phien ban 20.0).
Cac bieu dd, do thi du'dc trinh bay trong ket qua nghien ciru, sir dung phan mem SPSS va Microsoft Excel (MS, 2oio).
Nghien eiru ap dung phu'dng phap phan bo tirng bu'dc (step-dow/n) de phan bd ehi phi ciia cac bp phan glan tiep cho cac bp phan tru'c tiep [1], Phu'dng phap tinh toan mu'c vien phi va so sanh chi phi y te day dii va mu'c vien phi.
Bang 1. Chi phi day du de thddng va de mo So lu'dnq (n)
Trunq binh Og lech chuan
Trunq vl Thap nhat
Cao nhat
De thu'dng 60 3260,0
690,5 3022,0 2275,5 5811,9
De mo 1 60 9761,6 1353,4 9651,8 6521,8 17206,8
Odn vi tinh: 1.000 dong De mo 2
60 8410,3
934,2 8153,9 7198,1 12136,4 Chi phi day dii cho mot ddt de thu'dng va de md tai Benh vien Quan Thii Du'c khdng du'di 3 trieu;
chi phi trung binh cho mdt ddt de thu'dng la 3260,0 nghin dong,_thap nhat la 2275,5 nghin dong ya cao nhat la 5811,9 nghin dong; chi phi trung binh cho mdt ddt mo de lay thai lan mpt la 9751,6 nghin ddng, thap nhat la 6521,8 nghin dong va eao nhat la 17206,8 nghin ddng; ehi phi trung binh cho mpt ddt mo de lay thai lan 2 la 8410,3 nghin ddng, thap nhat la 7198,1 nghin ddng va cao nhat la 12136,4 nghin dong.
Bang 2. Phan bo
Cac djch v[j du'dnq benh Chan doan hinh anh
zhi phi theo dich vu de thddng fchi phi trung binh) Ddn vi Con
nguf&i 602,1 85
Thuoc, vat tu*, hoa
chat,..
344,5 219,1
Van hanh su'a chu'a 495,6
71,4 Khau hao nha
eu'a 41,0 1,9
Khau hao trang thiet bi
59,7 15,7
tinh: l.OOOt TONG CONG 1.542,9 393,1
TAP CHl Y HOC VIET NAM TAP 459 - THANG 10-S62-2017 Xet nqhiem
TTiu thuat Tdng cong
56,9 340,4 1.084,4
344,5 1 43,2 194,8 280,2 1.102,9 8 9 0 , 3
1,4 23,2 67,S
5,6 33,8 1 1 4 , 8
451,6 872,4 3.260,0 Trong 3260,0 nghin chi phf trung binh cho djch vu de thu'dng thi chi phi cho giu'cJng cao hdn cac dich con lai ^1542,9 nghin dong); chi phi chan doan iiinh anh la 393,1. Trong cac nguon chi phi phan bo thi chi phi ve thuoc vat tu', hoa chat,... nhleu hdn cac nguon chi phi khac.
Bang 3. Cac thanh phan va cd cau chi phi de mo lan 1 fchi phi trung binh) Cac muc chi
Chi phi true tiep Chi phi thddng xuyen
Con ngi/dl Thuoc Vat tu'tieu hao, hoa chat, mau
Van hanh su^ chu'a Chi phi dau td Khau hao nha eu'a Khau hao tranq thiet bi
Chi phi gian tiep Con nqUdi Van hanh stfa chii^
Khau hao nha cira Khau hao tranq thiet bi
T5ng cong
Chi phi ( 1 . 0 0 0 donq) 6.193,0 6.080,3 2.454,1 1.210,8 1.728,5 686,9 112,7 70,8 41,8 3.568,7
607,4 1.997,6
113,2 850,4 9.761,6
Tv le (»/o) 63,44 62,29 25,14 12,40 17,71 7,04 1,15 0,73 0,43 36,56 6,22 20,46 1,16 8,71 100,0 Trong chi phi day du cho mot ddt de thu'dng thi chi phi con ngu'di chiem cao hdn han cac loai con lai (31,26%); de mo l^n 1 co chi phf vat tU tieu hao, hoa chat chiem 17,71%; tuy nhien chi phi khau liao trang thiet bj la 0,97%.
Bang 4. Phin bo chi phi theo dich vu de mo lan 1 fchi phi trung binh}
Cac djch vu Gil/dnq benh Chan doan hinh anh
Xet nqhiem Phau thuat l o n g cong
Con ngu'di 1320,4 166,2 64,4 1510,5 3 0 6 1 , 5
Thuoc, vat tu*, hoa
ehat,..
1024,6 388,5 383,8 1142,4 2 9 3 9 , 3
k/an hanh sura chu'a 1086,8
139,5 48,9 1409,3 2684,5
Khau hao nha eu'a
90,0 3,6 1,6 88,9 1 8 4 , 1
Khau hao trang thiet
bi 131,0
30,6 6,4 724,3 8 9 2 , 3
TONG CONG 3652,8 728,5 505,0 4875,3 9761,6 Trong chi phi cho mpt lan de mo lay thai lan 1 thi chi phi cho phau thuat chiem da sd (4.875,3 nghin dong), chi phi nay du'dc phan bo nhieu nhat tiJ'thuoc, vat ti/hoa chat,., la 1.142,4 nghin dong.
Bangs. Cacthanhphin vi cd cau chi phi de mo lan 2 fchi phi trung binh) Cac muc chi
Chi phi true tiep Chi phi thddng xuyen
Con ngUdi Thuoc Vat tu'tieu hao, hoa chat, mau
Van hanh siTa chu^
Chiphii^utd Khau hao nha cira Chi phi gian tiep
Con nqu'di Van hanh siTa chiJ'a
Khau hao nha cira Khau hao tranq thiet bi
Tdnq eong
Chi phi ( 1 . 0 0 0 dong)
5616,5 5517,6 1993,9 1248,8 1671,5 603,3 99,0 62,2 36,7 2793,8
490,7 1564,1
87,8 651,2 8 4 1 0 , 3
Ty le ( % ) 66,78 65,60 23,71 14,85 19,87 7,17 1,18 0,74 0,44 33,22 5,83 18,61
1,04 100,00
VIETNAM MEDICAL JOURHAUN°2 • OCTOBER - 2017
Trong chi phf day dii cho mot ddt de md lay thai lan 2 thi ehl phi tri/c tiep chiem 66,78%, trong do con ngu'di chiem eao hdn han cae loai edn lai (23,71%); trong ehi phf gian tiep thi chi phi van hafih ehiem ty le cao nhat 18,61%.
Bing 6. Phan bd ehl phi theo djch vu de molin 2 (chi phi trung binh) Cac djch v u Con
ngu'di
Thuoc, v a t t u , hoa
chat,..
Van hanh sD'a chu'a
Khau h a o nha ciira
KhSiu hao t r a n g t h i e t bi
TONG CONG
du'dng benh 1.159,7 954,5
Chan doan hinh anh 124,7
Xet nghiem 449,1 6,7
Tong cong I 2.484,7 I 2920,2 I 2167,4 | 150 | 688 | 8.410,3 Chi phi de mo lay thai lan 2 du'dc phan bo tir cac nguon chi phi con ngu'di, thuoe, vat tu', hoa chat, chi phf van hanh, khau hao nha cda va khau hao ^ n g thiet bi. trong dd chi phf ve thuoc, vat tu", hoa chat Idn nhat (2920,2 nghin dong); chi cd 150 nghin dong la du'dc nhan phan bd tir khau hao nha cuci. Chi phf trung binh dky dd eua mdt lan md de lay thai lan 2 la 8410,3 nghin dong
So sanh chi phi va gia djch v u de thu'dng va de m o t a i Benh vien Quan Thu Du'c nam 2016 Bang 7. Gii dich vu de thUdng va di md Ddn vf tfnh: 1.000 dong
B e thu'dng B e mo 2
So lu'dng (n) 60 60
Trung binh
Od lech ehuan 393,3
Trung vj
Thap nhap 1445,8 1247,7
Cao nhat 11373,6
Gia djeh vu eho mdt tru'dng hdp de thu'dng la 2345,4 nghin ddng (±393,3 nghin dong); ddi vdi md" lay thai lan 1 va lay thai lan 2 lan lu'dt la 5564,4 nghin dong (±1194,3 nghin dong) 6126,1 nghin ddng (±1510,2 nghin ddng)
Bing 8. So sinh mdc ehi phi day dii vi gli de thu'dng Chi p h i day d u
( 1 0 0 0 d o n g
Gia dich v u ( l O O o ' d o n g )
Chi phi chenh lech ( 1 0 0 0 dong)
GiUdng benh 1542,9 920,0
Chan doan hinh anh 393,1
Xet nghigm 451,6 344,5 107,1
Thu thuat 872,4 861,8 10,6
Tong c^ng 914,6
So sanh chi phi day dii va gia djch vu ciia mdt tru'dng hdp de thu'dng la ro sir thay doi ro ret, chi phi djch vu chi bang 71,9% so vdi chi phf day du; ehi phi chan doan hinh anh, giUdng benh, thii thuat, xet nghiem deu eao hdn so vdi gia djch vu, trong dd ehi phi giu'dng benh tang cao nhat 622,9 nghin dong.
Bang 9. So sinh ed ci'u chi phi day du vagia de thu'dng
Cac muc chi Cd cau o/o
Chi p h i day d u
Cd cau %
Gia d i c h v u Chenh lech cd cau Giu'dng benh
Chan doan hinh anh 12,1 10,28 1,82
Xet nghiem
Cd cau giu'a chi phi day dii va gia dich vu cd sir t h i y ddi; cd cau chi phi day du cd sd djch ehuyen manh ve phia giu'dng benh.
IV. BAN LUJOLN
Ket qua phan tfch ve cd cau thu phf tru'dng hdp de mo trong nghien ciTu nay ed mdt so diem tu'dng ddng vdi nghien cu'u tai Benh vien Thanh Oai nam 2009 cau phan ehi phi ve PTTT (Benh vien Thanh Oai 19%, Benh vien Quan Thii Ddc
49,94% mo lay thai lan 1, 43,36% mo lay thai lan 2); tien giu'dng (Benh vien Thanh Oai 27%, Benh vien Thu Dire 37,43% mo lay thai Ian 1^
44,15% md lay thai lan 2), nhuYig cd mpt so diem khac vdi benh vien Thanh Oai (cau phan chi phf thuoc va VTVT chiem cao nhat (49%), chi
TAP CHi Y HOC VIET NAM TAP 459 - THANG 10 - S O Z - 2017 phi ve xet nghiem chiem khoang 4.7%). Ly do eo
the la gia djch vu nghien culi tai Benh vien Thanh Oai nam 2009 chu'a du'dc tfnh day du nhu' trong nghien cu'u ciia chiing tdi. Trung binh tong dii phi tru'dng hdp mo de trong nghien ciili tai Benh vien Thanh Oai nam 2009 la 3.908.453 d8ng [ l ] . chi bang 31,69% chi phi trung binh de mo lay thai lan 1 va bang 29,32% chi phi trung binh de mo lay thai lan 2 tai Benh vien Quan Thii Du'c nam 2016. Dieu nay ed the do cae chi phi dau tu* (khau hao nha, khau hao trang thiet bj va tai san khac) va cac chi phf ve van hanh va quan ly da du'dc hach toan dii trong nghien ciru tai Benh vien Quan Thii Du'c va da dddc dieu chinh gia vien phi theo 16 trinh ciia Bp Y te.
Khi phan bo cac chi phi tren vao djch vu de thu'dng thi ta thay cac khoang chi phi dd se nhu' sau: chi phi giu'dng tienh la 1.542,9 nghin dong;
ehi phi chan doan hinh anh ia 393,1 nghin ddng;
dii phf xet nghiem la 451,6 nghin dong; chi phi thii thuat la 872,4 nghin ddng. Nhu' vay, chi phi giu'dng benh ehiem ty le cao nhat 47,2% trong tdng chi phi ^ y dii ciia mpt tru'dng hdp de thu'dng.
Ddi vdi nhij'ng tru'dng hdp de mo lan 1 va lan 2, ehi phf trung binh giu'dng benh eho moi tru'dng hdp theo thu" t y la la i851,4 nghin dong/4,5 ngay va 2068,8 nghin ddng/4,5 ngay hay tu'dng irng vdi 1234,3 nghin d6ng/3 ngay va 1378 nghin dong/3 ngay thap hdn chi phf giu'dng benh theo thong tu' sd 37/2015AtTLT-BYT-BTC la 1717 nghin d6ng/3 ngay, sd khac biet nay eho thay chi phf de md lan 1 va lan 2 tai benh vien dang cdn thieu so vdi thdng tu". So vdi chi phi day du ma chung tdi tfnh toan thi gia djeh vu ciia de md lan 1 va lan 2 thap hdn nhieu, ehi phi giu'dng benh de mo lan 1 va lan 2 chenh lech tu'dng u'ng la 1801,4 nghin ddng va 1644,1 nghin dong; chi phi chan doan hinh anh theo thir td la 340 nghin ddng va 255 nghin ddng; chi phi xet nghiem theo thir ty" la 121,2 nghin dong va 126,9 nghin dong; clii phf phau thuat theo thir t y la 1904,2 nghin dong va 258,2 nghin ddng. Nhu' vay v d moi san phu de md (an 1 va lan 2 thi benh vien da chi tra them 4197,2 nghin ddng vdi de md lan 1 va 2284,2 nghin dong vdi de mo ISn 2.
111. KET LUJSiN VA KIEN NGH!
- De thydng: 3260,0 nghin ddng (±690,5);
- D e md lay thai lan 1: 9761,6 nghin ddng (±1353,4);
- De md lay thai lan 2: 8410,3 nghin dong (±934,2);
Cac thanh phan ehi phi cho ddt de thu'dng va de md:
- De thu'dng: ehi phi tru'c tiep 2555,9 nghin dong (78,40%); chi phf gian tiep 704 nghin dong (21,60%).
- D e md lay thai lan 1: ehl phf trye tiep 6193,0 nghin dong (63,44%); chi phf gian tiep 3568.7 nghin ddng (36,56%).
- De md lay thai lan 2: ehi phi trye tiep 5616,5 nghin ddng (66,78%); chi phi gian tiep 2793.8 nghin ddng (33,22%)
So sanh ehi phi day dii va vien phf eho tru'dng hdp de thu'dng va de mo tai Benh vien Quan Thii oye, TP. Hd Chf Minh nam 2016
- Chi phi day dii cao hdn gia djch vu eho mdt ddt de tliu'dng la 914,6 nghin ddng; va gia djch vu ehi bang 71,9% so vdi chi phi day du.
- Chi phi day dii eao hdn gia dieh vu cho mot ddt de md lay thai lan 1 la 4197,2 nghin (Kng; va gia djch vu chi bang 57,0% so vdi chi phi day du.
- Chi phi day dii eao hdn gia djeh vu cho mpt ddt de de mo lay thai lan 2 la 2284,2 nghin ddng; va gia djch vu ehi bang 72,8% so vdi ehi phi day dii.
Tiep tue duy tri hoat ddng hien tai, phat huy nhu'ng diem manh va khac phuc nhu'ng khuyet diem cdn tdn tai cua benh vien. Xay dyng danh mue bang gia vien phi bao phii day dii cac yeu t d chi phi dieu trj de dam bao duy tri va phat trien hoat ddng cua benh vien. Thyc hien thu'dng xuyen cdng tae kiem tra, giam sat, danh gia hieu qua viec cung cap cac djeh vy y te khi dieu chinh myc thu.
TAI LIEU T H A M KHAO
1. Ban vat gia chinh phu, Bo Lao dong, Thu'dng binh va Xa^hoi, et al. (1995) Thong tu' so H/TTLB ve hu'dng dan thu'c hien thu mot phan vie phf.
2. Chinh phii (2d08)'Ngh| djnh so 69/2008/ND-CP ngay 30/5/2008 ve chinh sach khuyen khich xa hpi hoa ddi vdi cac hoat dong trong linh vyc ^lao due, day nghe, y te, van hoa, the thao, moi tru'ong.
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