TAP CHi Y HOC VIET NAM TAP "^SS - THANG 10 - SO 1 - 2017
KHAO SAT CHI PHI THANH TOAN BAO HIEM Y TE NOI TRU TAI cAC c a Sdf KHAM CHU'A BENH TREN DIA B A N
TINH DONG T H A P NAM 2 0 1 5
Nguyin Thi Thu Thuy', Vo Pham Hao^
TOIVI TAT
Hieu biet ve ehi phi thanh toan bao hiem y te noi trii rat quan trong va can thiet trong xay di/ng chinh sach nham nang eao sife khoe, chat lucfng song va giam ganh nang kinh te cua benh. Nghien ciili mo ta cSt ngang idi/a tren dd lieu ciia 187.214 ngUdi benh npi trii ciia tat ea benh vien tren dja ban tinh Dong Thap nam 2015 da dUpc den hanh nham phan tich ehi phi thanh toan bao hiem y te cho ngudi benh noi trii.
Ket qua cho thay chi phi tiung binh trong dieu tri cao nhat d benh vien hang 1 va tuyen tinh. Benh ho hap, nhiem khuan va he tuan hoan co chi phi dieu trj trung binh cao nhat. Chi phi npi trii chii yeu danh cho thuoe, dich vu y te va thii thuat phau thuat. Chi phf bao hiem y te chi tra cao gap 6 lan chi phi ngUdi benh td ehi tra.
Tdkhoa: thanh toan, bao hiem y te, Dong Thap, kham chuti benh npi trii, chi phi
SUIVIMARY
SURVEY OF INSURANCE PAYMENT FOR INPATEENT TREATMENT I N MEDICAL FACILITIES I N DONG THAP PROVINCE
I N 2 0 1 5
An in-depth uniderstanding about inpatient costs is very important and necessary to create reasonable policies for improving health, quality of life and decreasing patient's economic burden. A cross- sectional study based on treatment data of 187.214 inpatients in all hospitals in Dong Thao province in 2015 has been conducted to evaluate the insurance payment fbr patients, treated in hospitals. Total inpatient cost was highest at first class hospital and provincial hospital. Respiratory diseases, parasite infecdons and circulatory diseases were overall highest treatment costs. Inpatient costs largely focused on dmg costs, medical costs and surgical medical procedure costs. Medical insurance paid 6 times higher than the cost of self-pay patients.
Td khoa: payment, insurance, Dong Thap, inpatient treatment, cost
'khoa Dude Dai hgc Y dWdc thanh pho Ho Chi Minh
^Bao hiem xa hgi tinh Dong Thap Chju bach nhiem chinh: Nguyin Thi Thu Thuy Email: [email protected] Ngay nhan bai: 3.8.2017 Ngay phan bien khoa hoc: 4.10.2017 Ngay duyet bai: 9.10.2017
I. OAT VAN OE
Ngay nay cimg vdi sir phat trien eiia khoa hoc ky thuat, chat lu'dng cham soc sife khoe ciia ngu'di dan ngay cang tang eao dl kem vcfi no la sir gia tang dang ke chi phi dieu trj.Vdi dp phii bao hiem y te ngay cang gia tang, sir gia tang ehi phf dieu trj tren moi lu'dt kham chij:a benh gay ganh nang ldn len ngan sach bao hiem y te (BHYT). Chinh vi vay de co eai nhin khach quan ve thi/e trang thanh toan BHYT tao cd sd xay diTng cae chinh sach y te phii hdp can thiet phai danh gia chi phi tren m6i lu'dt kham chife benh (KCB) BHYT. Hien tai nhieu nghien ciru khao sat thu'c trang thanh toan bao hiem y te da du'dc thifc hien [1,3]. Tuy nhien nhihig nghien cifu nay gidi han thifc hien tai mot hoac mgt so benh vien cu the, chu'a danh gia thifc trang thanh toan bao hiem y te tren dja ban toan tinh. Hien tai chda cd nghien cifu danh gia thifc trang thanh toan BHYT tai tinh Dong Thap, hdn nii^ chi phi thanh toan BHYT ngi trii Iu6n chlem ty le cao trong tong thanh toan BHYT. Vi vay de co eai nhin tong quan ve thifc trang thanh toan BHYT noi tru tai cae ed sd kham chiJa benh tai tinh Dong Thap, de tai "Khao sat chi phi thanh toan bao hiem y te noi tru tai eae ed sd kham chij'a benh tren dia ban tinh Dong Thap nam 2015"
du'dc thifc hien vdi eae muc tieu sau;
1. Khao sat thut trang kham chda benh bao hiem y tenol tru tai tinh Dong Thap nam 2015
2. Khao sat chi phf thanh toan bao hiem y te trung binh tren mdi Iddt kham chda benh noi tru tai tinh Dong Thap nam 2015.
II. OOI TLTOWG VA PHlTONG PHAP N G H I I N CCTU Odl tu'dng nghien cu'u: Chi phi thanh toan BHYT trung binh tren moi lu'dt kham chUci benh noi trii tai tinh Dong Thap nam 2015.
Phu'dng phap nghien cu'u: Mo ta cat ngang difa tren so lieu bao cao thanh toan KCB BHYT tai cae cd sd KCB tren dia ban tinh Dong Thap nam 2015,
Bien so nghien cu'u: Cae bien so nghien cull du'dc trinh bay trong bang 1.
VIETNAM MEDICAL JOURNAL H°1 • OCTOBER - 2017
Bang 2. Cac bier Nhom bien so
nghien ci^u Thifc trang kham
chij'a benh bao hiem y ie ngi tru
Chi phf thanh toan bao hiem y te trung binh tren moi lu'dt kham chu'a benhnpi tru
so nqhien cuU Bien so nghien cu'u Tuoi, gidl tinh, tuyen benh vien,
hang benh vien, mifc hu'dng BHYT, tuyen dieu trj, nhom benh
pho bien Gia trj chi phf Cau triic chi phf - Tuyen benh vien
- Hang benh vien - Tuyen dieu tri - Mifc hu'dng BHYT
- Dieh vu y te - Nhom benh pho bien
Cach thong ke
So lu'dt KCB (ty le phan tram) hoac gia trj trung binh (do lech chuan) theo cac bien
so nghien cifu Gia trj trung binh (do lech chuan) Gia trj trung binh (do lech chuan) theo:
- Tuyen tinh, huyen, xa - Hang benh vien I, I I , I I I , IV
- Diing tuyen/tral tuyen - 80%, 95%, 100%
- Thuoc, xet nghiem, phau thuat thu thuat, kham, khac - Ho hap, tieu hoa, ed xu'dng khdp, npl
tiet dinh dddng, tuan hoan Thong ke va xuf ly so lieu
Dd lieu du'dc xu" ly thong kg bang phan mem R vdi ket qua du'dc trinh bay d dang hinh va bang, Sir khac biet trong chi phf giu'a cac nhom dddc danh gia thong qua kiem djnh gia thiet thong ke bang cae phep kiem phii hdp (t-test, anova) vdl dp tin cay 95%.
UI. KET QUA NGHIEN CUU VA BAN LUAN
Thu'c trang kham chu'a benh bao hiem y te noi tru nam 2 0 1 5 tai tinh Ddng Thap Vdi'187.214 lu'dt KCB BHYT npi tru nam 2015 tai cac cd sd KCB tren dja ban tinh Dong Thap, de tai ghi nhan thiTc trang kham chu'a benh du'dc trinh bay trong bang 2.
Bang S-Thifc trang kham chifa benh bao hiem y te npi tru Dac diem GTTB (BLC)
Tan so (Wo) Gicli tinii Nam
NU
80.588 C43,05%) 106.626 (56,95%) Tuven benii vien Xa
Huyen Tinh
Han 1 2 3 4
214 (0,11%) 66.162 (35,34%) 120.838 (64,55%) q benli vien
43.637 (23,31%) 44.886 (23,98%) 98.477 (52,60%) 214 (0,11%) Mdc tiiTdng 80%
95%
100%
90.650 (48,42%) 18.574 (9,92%) 77.990 (41,66%)
Dac diem Tuoi
GTTB (OLC) Tan so C/o) 38,85 (29,44) Tuven dieu tri
£)unq tuyen Trai tuyen
158.684 (84,76%) 28.530 (15,24%) Nhom benh
Benh ho hap Benh nhiem trung va ky sinh
trung Benh he tuan hoan Thai nghen, sinh de va hau san
Benh he tieu hoa Vet thildng, ngo doc va hau qua
cua mpt so nguyen nhan ben nqoai Benh he cd - xUdng l<hdp va mo
lien ket Benh he sinh due - tiet nieu Benh npi tiet, dinh duBng va
chuyen hoa U (U tan sinh)
Benh khac
37.241 (19,89%) 29.142 (15,57%) 27.034 (14,44%) 21.418 (11,44%) 18.369 (9,81%) 10.136 (5,41%)
7.029 (3,75%) 6.448 (3.44%) 4.310 (2,30%) 3.615 (1,93%1 22.472 (12,00%)
TAP CHi Y HOC VlfeT MAM TAP 459 - THANG 10 - SO 1 - 2017
Theo bang 2, de tai ghi nhan ty le nam: nd la 1: 1,32 vdi dp tuoi trung binh 38,85 ± 29,44. So lu'dt KCB npi tru giam dan tir tuyen tinh den huyen va thap nhat d tuyen xa vdl ty le lan lu'dt la 64,55%; 32,34% va 0,11%. So lu'dt KCB n6i trii du'dc ghi nhan cao nhat d benh vien hang 3 (52,6%); tu'dng du'dng d benh vien hang 1 va 2 vdi ty le tu'dng irng 23,31% va 23,98% va khong dang ke d benh vien hang 4 (0,11%). Da so ngu'di benh KCB npi trii dung tuyen (chiem ty le 84,76%) vdi mifc hu'dng BHYT pho bien la 80%
(chiem ty le 48,42%) va 100% (ehiem ty le 41,66%); mifc hu'dng 95% chiem ty le khong dang ke (9,92%). Ve nhdm benh dieu trj, de tai ghi nhan nhii'ng nhdm benh npi tru pho bien bao
2.000.000
gom benh ho hap (19,89%); benh nhiem triing va ky sinh triing (15,57%); benh he tuan hoan (14,44%); thai nghen, sinh de va hau san (11,44%), benh he tieu hda (9,81%); vet thu'dng, ngo dpc va hau qua eua mpt so nguyen nhan ben ngoai (5,41%); nhii'ng nhom benh eon lai chiem ty le du'di 5%.
Chi phi thanh toan bao hiem y tS mSi lu'dt kham chu'a benh noi tru
Chi phi thanh toan BHYT moi lu'dt theo tuyen benh vien
Khao sat chi phi thanh toan BHYT moi lu'dt KCB npi trii nam 2015 theo tuyen benh vien, de tai thu du'dc ket qua trinh bay trong hinh 1.
1.500.000
1.000.000
5 0 0 . 0 0 0
0 i
151.969
X a
1.736.998
583.028 H H
• I IH
H u y ? n Tiiili Hinh 4.Chi phi thanh toin BHYT moi Iddt KCB theo tuySn bSnh vien Ghi chd: * p < 0,05 - sif khac biet co y nghTa
thong ke giuci tuyen xa va cac tuyen khac vdi dp tin cay 95%; #p < 0,05: su" khac biet co y nghTa thong giD:a tuyen huyen va tuyen tinh vdi dp tin ceiy 95%.
Theo hinh 1, de tai ghi nhan chi phf thanh toan BHYT noi tru tang dan tif tuyen xa den tuyen huyen va tuyen tinh vdi gia trj lan lu'dt la 151.969 so vdi 583.028 va 1.736.998 VND. Sif khac biet d chi phf thanh toan BHYT npi trii giiJci
cac tuyen benh vien cd y nghTa thong ke vdi dp tin cay 95% (p<0,b5). Dieu nay co the du'dc gial thich bdi SLf gia tang pham vi sif dung phan tuyen chuyen mon ky thuat vdi cae djch vu ky thuat y te tang dan theo tuyen.
Chi phi thanh toan BHYT moi lu'dt theo hang benh viSn
Khao sat chi phi thanh toan BHYT moi lu'dt KCB npl trii nam 2015 theo hang benh vien, de tai thu du'dc ket qua trinh bay trong hinh 2.
3.000.000 2.500.000 2.000.000 1.500.000 1.000.000 500.000
1.525.1C
I
-278-16I
Hinh 5,Chl phi thanh toan BHYT moi IWdt KCB theo h^ng benh vien
VIETNAM MEDICAL JOURNAL N°1 • OCTOBER - 2017
Ghi chd: *p < 0,05 - su' khac biet ed y nghTa thong ke trong ehi phf moi lu'dt KCB glti'a eac hang benh vien vdi do tin cay 95%.
Theo hinh 2, de tai ghi nhan ehi phi thanh toan BHYT moi lu'dt KCB npi trii giam tif benh vien hang 1 den liang 4 vdi gia tri lan lu'dt la 2.525.100; 1.278.162; 821.616 va 151.969 VND.
Sif khac biet nay cd y nghTa thdng ke vdi dp tin ciy 95% (p<0,05). Oieu nay co the du'dc giai tliich bdi hang benh vien hang cao hdn cd danh
myc thuoe va dieh vu ky thuat nhieu hdn benh vien hang thap hdn. Ngoal ra, eac thuoc thupc nhom tieu ehi ky thuat 1, 2, biet du'dc goc eung du'dc sir dung tai hang benh vien eao hdn benh vien hang thap.
Chi phi thanh toan BHYT moi lu'dt KCB npi tru theo mu'e hu'dng bao hiem y te
Khao sat ehi phf moi lu'dt kham chii^ benh nam 2015 theo mifc hu'dng bao hiem y te, de tai thu du'dc ket qua trinh bay trong hinh 3.
1.779.370 1.342.358 I ^ ^ H
^ ^ ^ H 1.202.300
I I I
Hinh 6.Chi phi thanh toan BHYT mdi Iddt KCB theo mdc hWdng BHYT Ghi ehu: *p < 0,05 - sif khac biet eo y nghTa
thong ke giu^ nhom cd mifc hu'dng 95% vdi eac nhdm con lai vdi dp tin cay 95%.
Theo hinh 3, d ^ tai ghi nhan ehi phf thanh toan BHYT moi lu'dt KCB noi tru cao nhat d nhom CO mifc hu'dng 95% (1.779.370 VND), thap hdn d nhdm cd mifc hu'dng 80% (1.342.358 VND) va tiiap nhat d nhdm co mu'e hu'dng 100%
(1.202.300 VND). Sif khac biet trong chi phf
thanh toan BHYT npi tru giu'a nhom cd mufc hu'dng 95% vdi cae nhdm con lai ed y nghTa thdng ke vdi dp tin cay 95% (p<0,65).
Chi phi thanh toan BHYT moi lu'dt KCB noi tru theo dich vu y t e : Khao sat chi phi thanh toan BHYT moi lu'dt KCB noi tru nam 2015 theo djch vu y te, de tai thu du'dc ket qua trinh bay trong hinh 4.
500 000
400 000 300 000
200 000 100.000 0
456.060
207.592 ^m
I I
281.317
!18.660 B j l
I I I
XX Thuoc PTTT Kliam Khac Hinh 7. Chi phi thanh toan BHYT moi IWdt KCB noi tru theo dich vuyte ehi chu: Xti -xet nghiem; PTTT - phau thuat thu thuat
*p < 0,05: sy" khac biet co y nghTa thong ke gliJa CP thuoc vdi cac nhom CP khac vcfi dp tin cay 95%.
Theo hinh 4, (Je tai ghi nhan trong cau true chi phithanh toan BHYT moi lupt KCB tai tinh Dong Thap nam 2015, CP thuoc co gia tri cao nhat (456.060 VND); cao gap 1,62 ian CP kham(281.317 VND). Cac CP con lai bao gom CP phau thuat thu thuat, CP xet nghiem va CP khac co sir khac biet 282
TAP CHl Y HOC VigT NAM TAP 459 • THANG 10 • SO 1 - 2017
khong dang ke va dao dpng tir 163.740 den 218.660 VND.SiT khac biet glti^ CPthude vdl eae loai CP eon lai tnang cau true CP npi truedj/ nghTa thong ke vdi dp tin cay 95% (p<0,05).
Chi phi thanh toan BHYT moi lu'dt KCB theo nam nhom benh pho bien nhat
1 ' 4 5 T 0 ? 0 . 2
I 1
l - - * 9 2 . 2 S 0 . 2
II
Hinh B.Chi phi Oianh toan BHYT m5i Iddt KCB theo nam nhdm benh phd bien nhat Khao sat chi phf thanh toan BHYT moi lu'dt
KCB ndi trii theo nam nhom benh pho bien nhSt, de tai thu du'dc ket qua trinh bay trong hinh 5.
Ghi chii: HH - benh ho hap; TH - benh he tuan hoan; CXK-MLK - benh he cd xu'dng khdp - mo lien ket; T.Hda -benh he tieu hda; NTDDCH - benh he npi tiet, dinh du'dng va chuyen hoa
*p < 0,05: su" khac biet cd y nghTa thong ke giS^ tifng cap nhdm benhvdl dp tin cay 95%.
Theo hinh 5, de tai ghi nhan chi phf thanh toan BHYT moi lu'dt KCB npi trii cao nhat d nhdm benh npi tiet, dinh du8ng va chuyen hda (1.492.280 VND), thap hdn la nhdm benh he tieu hoa (1.492.277 VND), nhdm benh he tuan hoan (1.457.056VND), nhdm benh ho hap (1.352.262 VND), nhom benh cd xu'dng khdp - md lien ket (1.306.060 VND). Sif khac biet nay cd y nghTa thong ke vdi dp tin cay 9 5 % giu^ nhdm benh cd xu'dng khdp- mo lien ket vdi nhdm benh npi tiet- dinh du9ng-chuyen hda, nhdm benli tuan hoan va nhom benh tieu hoa; giCfa nhdm benh tieu hoa vdi nhdm benh tuan hoan va ho hap vdi p<0,05.
V. KET LUAN
Vdi 187.214 lu'dt KCB BHYT npi tru nam 2015 tat cac cd sd KCB tren dja ban tinh Dong Thap d do tuoi trung binh ngu'di benh 38,85 ± 29,44;
tren 50% so lu'dt KCB d benh vien tuyen tinh va
hang 3; gan 85% dimg tuyen; tren 90% co mifc hu'dng BHYT 80% hoac 100% vdi benh thu'dng gap la benh du'dng hd hap, benh nhiim triing, ki sinh triing va benh he tuan hoan, de tai ghi niian chi phi thanh toan BHYT moi lu'dt KCB npi tru cao nhat d benh vien tuyen tinh va benh vien hang 1. Benh npi tiet-dinh dudng-chuyen hoa, tieu hoa va tuan hoan cd chi phi thanh toan BHYT eao nhat eho moi lu'dt dieu trj npi trii.
Trong eau true ehi phi thanh toan BHYT, chi phf eho thuoe ehiem phan Idn. Ket qua nghien cifu ed the la ed sd de Bao hiem xa hpi tinh Dong Thap phan bo' va u'dc lu'dng ehi phf thanh toan tdt hdn eho nhifng nam ke tiep.
TAI UEU THAIVI KHAO
1. Le Tri Khai (2014), Thanh toan chi phi kham chifa benh bao hiem y te theo djnh suat tai mpt so tram y te xa thuoc huyen D3k To tinh Kon Turn, Luan an tien sT y te cong cpng, Vien ve sinh djch te Trung u'dng.
2. Tru'dng Thj Thu Mai (2015), Phan tich ehi phi dieu trj npi trii eiia ngu'di benh viem phoi tai benh vien da khoa Dong Thap, nam 2015, Luan van thac sT quan ly benh vien, Tru'dng dai hoe Y te cong cpng.
3. Do Cong Tam (2015), Khao sat tinh hinh dang ky va kham chij'a benh bao hiem y te tai Benh vien Cap cirtj TrUng Vu'dng nam 2012 - 2013, Benh vien Trung Vu'dng.
