Y HOC VlfT NAM THANG 5 • SO 2^014
PHAN TICH HANH VI SU DUNG DICH VU KHAM CHU'A BENH
BAO H I E M Y T E ctJA N c i r a i DAN T O C D A O V I E T NAM
T 6 M TAT
Nghien cuXi su* dung so lieu thuf cap cua ket qua Wiao s^t mu'c song dan cU nam 2004 den 2012.
PhUtfng phap: Phan ti'ch mo hinh hoi quy tuyen tinh 6<Sr\, t test, p value, du* bao bSng mo hinh chuyen dich tmng binh, ti'nh sai so du* bao bSng MAE, MSE va MAPE. Ket q u i : Chi phi vd ty l# KCB cua ngu'di Dao kh6ng co xu hu'dng tSng hay giam theo thdi gian (p >
0,05), dao dpng tii 407 dSn 446 nghin dong v&\ MAE = 43,2; MSE = 4981,lvd MAPE = 10,09; Ty le KCB dao dOng tir 21,6 den 25,8% vdi MAE = 1,35 ; MSE = 3,84 vh MAPE = 5,6; Ngu'di Dao sii' dung DVYT tai tram y te x l nhieu gap 2 den 4 lan ngu'di Kinh.
Tit Ichda: Ngudi Dao, hdnh vi siit I<h6e, djch vu y te
SUMMARY
HEALTH SEEKING BEHAVIOR OF DAO ETHNIC M I N O R I T Y W I T H I N THE
COVERAGE OF SOCIAL HEALTH INSURANCE I N V I E T N A M This study was conducted on second data analysis using results of Vietnam Living Standard Surveys (VLSS) from 2004 to 2012. Methods: Simple linear regression model, ttest, p value, forcasting by moving average model with MAE (Mean Absolute Error), MSE (Mean Squared Error) and MAPE (mean Absolute Percentage Error). Results: No time trend of health expenditures and no time trend of health servive used rate (p>0.05) with MAE = 43.2; MSE = 4891.1; MAPE
= 10.09. Health service use rate of Dao eOinlc minority variant from 21.6 to 25.8% with MAE = 1.35; MSE = 3.84 and MAPE = 5.6. Dao ethnic minority used health
Pham Hong Hai*
service at Commune Health Station (CHS) from two to four times higher than Kinh ethnic majority.
Keywords: Dao ethnics, health behavior, health service
L O A T V A N DE
Dan tpc Dao la mgt trong so 54 dan ^ thieu so ciia Viet Nam. Ncju'di Dao thu'idng cu" tru ^ i cac vung niii cao, hiem t r d , giao thong di lai kho l(han. Dan tpc Dao co nhu'ng net van hoa rat dac trutig nhat la van hoa sii'c I(h6e, cac bai thuoc dan gian co tac dung phong va chijS benh, tuc cung ma hay kieng khem cua phu nlj' co thai, khi sinh nd... cac tuc le nay da co arih hu'dng khong nho den hanh vi tim kiem va SLT dung dich vu y te cua ngu'di Dao. Ngoai ra, dieu kien^kinh te lac hau, ha tang giao thoni^ chu^ phat trien, phu'dng tien thong^tin thieu thon, trinh do dan tn thap...
dii chi phoi hanh vi cham sdc su'c khoe cua ngu'di dan toe Dao. Cau hoi dat ra la: Xu hu'dng va du"
bao ve hanh vi su" dung DVYT (chi phi y te, ty I?
kham chiJa benh BHYT) cua ngu'di Dao trong thdi gian tdi nhu'the nao?
II. o d l TUVNG VA PHU'ONG P H A P NGHIEN COU 2 . 1 . Om tu'dng nghien curu
So lieu thu" cap ctia ket qua khao sat mii'c song dan'cU tu' 2002 den 2012
2.2. Phu'dng phap nghiSn diu Phan ti'ch kinh te bang phuWng phap thong ke, to hdp va so sanh.
Phan tich xu hu'dng bSng phu'dng trinh hoi qui tuyen tfnh ddn
IIL KI^TQUANGHIENCO'U
Bang 3.1. Ty le nguidi co kham chuS benh trong 12 thang chia theo dan toe t i r 2004 den 2012 Odn vi tinh: %
\Vkm 2004 2006 2008 2016 2012
Chung DT Kinh
35,2 35,8 35,0 42,1 40,7
DTDao 24,4 18,8 27,4 30,1 28,2
Noi tru DT Klnli
7,1 6,2 6,4 8,1
,.1? .
DTDao 6,8 3,5 5,1 8,4 7,9
Ngoai tru DT Kinh
31,9 33,3 31,8 38,5 37,7
DTDao 19,8 16,6 24,3 23,1 23,8
(Nguon: Kit qua khao sat mdc sdng din cdnarn 2012, trang 168-169) Hh$n xit; Ty l | KCB cua ngudi Kinh cao hBn n g u i i Dao va co xu hudng B n g theo thdi gian, trong Ithi do ty I? nay d ngu'di dan toe Dao i(h6ng co xu hu'dng ro rang.
'Bai hoc Thii Nguyin
Phin biin khoa hoc: PGS.TS Ph?m Huy Tuan iG#t
Y HOC VIET HAM THANG 5 - SO 2/2014
Bing 3.2. Tv le iUdt ngUdi i<ham chuS benti ngoai tru trong 12 thang qua chia theo ioai aJ sd y te Odn vl tinh: %
Noi dung
BV TYT
PKBK P K t U Khac2 0 0 4 Kinh 25,4 20,5
3,2
44,32,7 4,0
Dao 9,9
73,61,5 3,2 5,1 6,7
(Nguo2 0 0 6 Kinii
29,6 23,9
3,5
33,32,5 7,3
n:KetQDao
29,0 49,12,8 1,1 9,n 9,1
ui kha2 0 0 8 Kinii 31,3 21,1
2,6
39,93,2 1,9 ositm
Dao 7,9
80,25,2 1,7 4,7 0,3 utsdn
2 0 1 0 Kinii 38,5 17,8
2,8
37,02,1 1,7
'J dancDao
10,3 48,2 10,6 30,50,4
/nam-
2 0 1 2 Kinii 40,3 18,5
2,4
35,41,7 1,7
2012, dDao
32,5^59,6
5,1 2,8
- -
ang 17C Nhan xdt; Ngu'di Kinh siJ dung cac dich vu KCB ngoai tru tai benh vien va phong i<ham tu' nhan cao hdn ngu'di Dao va co xu hu'dng tang. Ngu'di Dao sii dung dich vu KCB tai tram y te va lang y cao gap 2 - 4 l l n so vdi ngu'di Kinh.
Bing3.3.rY le lu'dt ngu'di kham chDa benh noi tru trong 12 thang qua chia theo loai cd sdyte Ddn Id tinh: % N6i dung
BV TYT
PKOK PKtU' Langy Khac2 0 0 4 Kinii 85,5
9,0 4,5 5,3 0,5 -
Dao
55,8 40,04,0
- -
•
2 0 0 6 Kinii 80,4 11,8
4,6 1,8 0,4 ,1(.9
Dao
78,8 19,31,9
- - -
2 0 0 8 Kinh 85,8
7,3 3,6 2,3 0,1 0,7
Dao
62,0 17,2 20,7- - -
2 0 1 0 Kinh 85,3
4,8 3,5 5,6 0,2 0,4
Dao
72,3 20,96,6
- -
"
2 0 1 2 Kinh 85,4
6,1 2,6 5,3 0,2 0,2
Dao
bO,l 43,9i,9
- -
(Ngudn: Kit qua khao sat mdc sdng dan cdnarn 2012, trang 173-174) Nh$n xit: Ngu'di Kinh va ngud Dao sii dung dich vu KCB noi tru tai benh vien chiem ty le cao, nguSI Dao sir dung dich vu KCB npi tru tai tram y te cao gap 2 - 4 lan so vdi ngu'di Kinh.
Bing 3.4. Chi tieu y te binh quan 1 ngUdI co l<ham chDS benh trong 12 thang qua chia theo dan tdc
Ddn \ri tmh: 1000 d KCB
Chung Noi tru Ngoai tru
Dan t$c Kinh
Dao
KinhDao
KinhDao
2004
698,3 230,5 1783,5
488,4 379 116,5
2006
643,1 585,0 1960,1 1598,9 404 299,7
2008
1095,5
480,6 3136,6 1938 685,6 126,3
2010
1474,3
366,5 3804,3 943,9 817 133,9
2 0 1 2
1921 463,7 5460,7 1117,7 1015,7 176,5
(Ngudn: Ket qua khdo sat muc song dan cu" nam 2012, trang 199-20QJ Nii$n xet: Phan tfch hoi qui tuyen tfnh g i u ^ thdi gian - chi y te chung, thdi gian - ty le KCB chung va Chi y te - KCB cua ngu'di dan tpc Dao va Kinh, cho ket qua:
- Vdi ngudi Kinh: Co tu'dng quan thuan giife thdi gian - chi y te (p = 0,05) va thdi gian - ty le KCB (p
< 0,05), xu hu'dng tang theo thdi gian. Khong co tu'dng quan g i u ^ chi y te va KCB (p > 0,05) - Vdi ngu'di Dao: Khong co tuUng quan g i u ^ cac yeu to tren.
Noi dung Chi y t S Chung - Kiem dinh t test theo Intercept - Kiem dinh t test theo thdi gian
Nhan xet:
KCB Chung - Kiem dinh t test theo Intercept - Kiem dinh t test theo thdi qian
Dan tdc Dao y = 326,1 + 12,4 x
t = 1,6; p = 0,19 t = 0,53; p = 0,63 Khong CO tu'dng quan giifa thdi
qian va clii y te y = 24,2 + 0,44x t = 9,76; p = 0,002
t = 1,5; p = 0,22
D a n tSc Kinh 1 y = 233,8 + 100,8x j
t = 0,86; p = 0,45 1 t = 3,15; p = 0,05 * Co tu'dng quan t h u | n ^ giuii thdi qian va chl y t i y = 27,24 + l,46x 1 t = 7,22; 0 = 0,005 . t = 3,2; p = 0.04 ,-,
Y HQC VlgT HAM THANG 5 - SO 2/2014
Nhan xet
Co tutfng quan thuan neu theo intercept ban d3u Khong cd tu'dng quan neu theo
thdi gian
Co tu'dng quan thuan giu^ thdi gian va ty le
KCB Chl y te va KCB -614,5 + 37,4x V = -959,8 + 51,3x - Kiem dfnh t test theo Intercept t = -0,75; p = 0,5 t = -0,9; p = 0,43 - Kiem dinh t test theo thdi gian t = 1,2; p = 0,28 t = 1,8; p = 0,15 Nh3n xet Khong co tu'dng quan giii'a chi y Khong cd tu'dng quan
teva tyle KCB | giiJta chi y te va KCB
soo
600 S 400
200
4S0e 463 A - ^ JS6 3
- A a . i d l - F o r . r c a i t
Bie'u do 3,1. Dl/ bao chi tieu y te binh quan 1 ngudi dan tpc Dao co KCB
F'lHimig tiiuli iiiyoii tinli ve clii pliiy te (1111 DT Kliili
2000
5 j f X - Dirbjo 6500
0 ThffPgian 10
Bieu 06 3.3. Di/ bao xu hu'dng chi tieu y te cua ngu'di Kinh
T y I ? K C B 40
se 20 '
Pliuoaig tl inh tuyen tinh ty le Kf'B nin DT Kinh
• ' * m
28 1 2S75 29 15 - A c t u a l - F o r r c a s l
GO
^ 40
0
w*^*'
R^=i)7v;j'iBiiu as 3.2. Dl/ bao ty le kham chu'a benh cua ngu'di dan tpc Dao
Thcci gian
Bieu do 3.4. Dl/ bao xu hu'dng l<ham chiJa benh ciia ngu'di Kinh
Bing 3.S. Du' bao chl phi' v te cua ngUdi dan toe Dao den nam 2020
1.Nam 2004 2006 [2008 j2010 2012
!2014 2016
<2018 J2020
I
Chi phi 230,50 585,00 480,60 366,50 463,70 444,80 446,69 446,53 446,54
bio
407,75 532,80 423,55 415,10 454,25 445,75 446,61 446,54 Totais:
Forecast Err
177,25 52,20 57,05 48,60 9,45 0,94 0,08 0,01
Absoiute vaiue of Forecast Err 177,25
52,20 57,05 48,60 9,45 0,94 0,08 0,01 345,58
Squared Forecast Err 31.417,56
2.724,84 3.254,70 2.361,96 89,30
0,89 0,01 0,00 39.849,27
Percentage Err
43,47 9,80 13,47 11,71 2,08 0,21 0,02 0,00 30,03
Absoiute vaiue of percentage
Err 43,47
9,80
13,47
11,71
2,08
0,21
0,02
0,00
80,76
(Ngudn: Kit qua khao sat mdc song dan cdnarn 2012, trang 199-200 va tie gii b'nh)
Y HOC VliT NAM THANG 5 • s 6 2/2014
Nlian xet: Phan tfch chuyen dich trung binh va dy" bao dio thay, chi phi KCB dao dpng tCr 407 deli 446 nghin dong vdi MAE = 43,2- MSE = 4981,lva MAPE = 10,09.
Nam 2004 2006 2008 2010 2012 2014 2016 2018 2020
Bing
KCB 24,40 18,80 27,40 30,10 28,20 25,65 25,91 25,88 25,89
3.6. Du' bao ty le kham chtja benh cue Du'
bao 21,60 23,10 28,75 29,15 26,93 25,78 25,89 25,88 Totai
Forecast Err 2,80 4,30 1,35 0,95 1,28 0,13 0,01 0,00
Absoiute vaiue of Forecast Err
2,80 4,30 1,35 0,95 1,28 0,13 0,01 0,00 10,81
nqu'di dan toe Dao den nam 2020 Squared
Forecast Err 7,34 18,49 1,82 0,90 1,63 0,02 0,00 0,00 30,70
Percentage Err 12,96 18,61 4,70 3,26 4,74 0,49 0,04 0,00 2,81
Absoiute vaiue of percentage
12,96 ; 18,61 4,70 3,26 4,74 0,49 0,04 0,00 44,81 (Nguon.
Nhan xihJ'iie KCB Sao
Kit qua khio sit mdc sdng din cdnarn 2012, trang 199-200 vi tac gii ttilij dong tCr 21,6 den 25,8% vdi MAE = 1,35 ; MSE = 3,84 va MAPE = 5,6
IV. BAN LUAN
4.1. Ve hanh vi su' dung djch v^ KCB BHYT cia ngu'di dan tqc Dao
Ket qua bang 3.1 cho thay, ngu'di Dao co su' dung djch vu bao hiem y te de kham chu^ benh nhutig xu hu'dng khdng ro rang, trong khi do, xu hudng SlJ dgng DVYT cua ngu'di Kinh kha ro va t3ng dan theo thdt gian. Phan tich si/ lu^ chpn ndi KCB la benh vien, tram y te, phdng l<ham da khoa khu vUc, tu' nhan, lang y... cho ket qua;
Ngudi Dao sil dung djch vu y te ngoai trii va noi tnJ tai tram y te va lang y cao gap 2 den 4 lan so vdi ngu'di Kinh (Bang 3.2. va bang 3.3)
Mdt so nghien cilu khac ve siJ dung DVYT cua cac tinh mien nui phta Bac cho thay:
Theo ket qua cua Pham Hong Hal (2011)[2]
khi nghien cilu ve sif dung DVYT cua ngu'di Dao BSC Kan; Ty le hp Dao ngheo cao (30,03%), trinh dp van hoa thap, it nhan dUdc nguon thong tin y te da khien cho nhan thifc ve benh ciing nhu' each xit tri ciia ngu'di Dao khi bj benh gap nhieu khd khin: 37,37% phu nii' ngu'di bao khi bj om khong diing gi ho5c chi niem than chii va phii phep; tu chiia bang thuoc nam (29,29%); t d mua thuoc Tay (13,13%); tdi cd sd y t§ (9,09%);
chi cung bai d nha chiem 7,07%.
Nghien cifti ciia Ly Ngpc Kinh (2003) [6] ve danh gia hieu qua ciia cham sdc sifc khoe ba me va tre em tai xa Hdp Tien, Oong Hy, Thai Nguyen cho thay: 100% cac phu nit Dao deu sinh con tai
nha, trong dd 50,9% cd can bd y te giiip; ty le kham thai dit 3 lan la 49,7%; 'co 24,8% tie si sinh dUdc tiem phong udn van, khong ed trS nao dddc can va theo doi can nang.
Nghien eifu ciia Khdng Thj Ngpc Mai (2003) [5] ve danh gia hieu qua cham soc tre em d mot so ban viing eao mien niii cho thay: Vai tro cui nhan vien y te thon ban la rat can thiet tronj viSe tuyin truyen v$n dpng thdc hlSn cac chuBng trinh y te ve cham sdc sifc l<hoe ba me va lie em; giam ty le ciing bai tif 8,97% xudng cin 1,14%; giam ty le tre bj om khong dl kham be*
tif 35,62% xuong 0%.
Ket qua nghien cifu cua Vu Thanh Hiti (2003) [3] ve cham sdc sifc khoe ban dSucto ngu'di ngheo tinh Ha Giang cho thay; Ty If h^gii dinh cd ngu'di 6m cdn cao (40,7%). NgU6l 'dan khi bj om chil yeu la mua thuoc ve tu chija. ^ ( ngudi dm den KCB tai TYT xa edn tliap (23,85(i], ly do khong den TYT phan Idn la do qua ai mat thdi gian ehd dpi.
Tac gia Nguyen Van Hien (2004) [4] ngi*
cifu ve md hinh truyen thong giao due sifc Id*
tai mpt so xa thupc huyen ddng bang Bac bd'il thay 44,9% can lid y t f chda dddc dao t?0 ldi!
thife, k9 nang truyen thdng gi^o due sifc idiae Trong l<hi dd, cd 99,5% ngu'di dan cd nhu Si dddc truyen tiiong - giao due sife khoe 4-:
Nghien cud cita Ly V5n Canh (2006) [1] ^
huy dpng epng dpng truyen thong - giao di^s*
Y HOC VlgT NAM THAHG 5 • SO 2/2014 khoe n w t so noi dung chSm soc su'c khoe ban
dau cho thay: So phu nu* co thai du'dc kham day dil la 48,2%; so ba me du'dc cham soc tru'dc sinh tot la 30%; ty le ba me de tai nha la 30,7%; ty le ba me bj tai bien san khoa 6,6%; t y le ba me sau de dutfc nhan vien y t ^ chSm soc la 19,5%.
Mot so ket qua cua cac nghien cu'u tren chi ra thu'c b^ng chung ciia cung u'ng va sii dung DVYT d mien niii, trong d d co ngu'di Dao do la:
Hanh vi sir dung DVYT cua ngu'di Dao chju anh hu'dng cua nhieu yeu t o , trong dd co yeu to phong tuc tap quan (ciing bai, phii phep, niem t h i n chii, de con tai nha, kieng khem), cd yeu to do giao thong (du^ng xa, khd di), do kinh ti {khong co tien, tu" dieu trj thuoc nam), do khong hai long vdl DVYT {Phai chd ddi mat thdi gian, cdn b9 y te chuyen mon thap, khong tin tu'dng thBy thuoc, thieu thuoc), do thieu thong tin (du'dc nghe truyen thdng giao due sire khde it, khong thu'dng xuyen)
4 . 2 . V& xu hu'dng vh dM* bdo hdnh vi suf di;ng DVYT ciHa ngu'di Dao
Chl phf KCB ciia ngu'di Dao khong co xu hu'dng tSng hay giam theo thdi gian (p > 0,05) md Id chuydn djch trung binh. Phan tfch chuyen dich trung binh vd d y bao bdng phu'dng phap chuSi thdi gian cho thay, chl phf KCB dao dong tir 407 den 446 nghin dSng vdl MAE = 43,2; MSE = 4981,lvd MAPE = 10,09; Ty I? KCB dao dong tir 21,6 den 25,8% vdl MAE = 1,35 ; MSE = 3.84 vd MAPE = 5,6
So sdnh xu hu'dng hdnh vl sir dung DVYT cua ngu'di Dao va ngu'di Kinh (Bleu do 3 . 1 , 3.2, 3.3 va 3.4) cho ket qud, ngu'di Kinh cd xu hu'dng tSng sii" dyng DVYT theo thdi gian khd ro ret (p
< 0,05). M^c du vay, ngu'di Dao sir dung DVYT t^i tram y te xa vd den lang y nhleu gap 2 den 4 lan ngu'di Kinh (Bang 3.2, 3.2) ca khdm chite b§nh ngo?i tru vd n§i t r i i . Oieu ndy cho thay, tuyen y t g cd sd (tram y te xa, benh vi^n huyen)
ddng vai tro het sifc quan trong trong viec cung uTig DVYT cho dong bao dan tpc thieu so trong do CO ngu'di Dao
V . KFT LUAN
- Chi phf KCB cua ngu'cfi Dao khong cd xu hu'dng tang hay giam theo thdi gian (p > 0,05), dao dong tir 407 den 446 nghin ^ n g vdi MAE = 43,2; MSE = 4981,lva MAPE = 10,09.
- Ty le KCB dao dong tir 21,6 den 25,8% vdi MAE
= 1,35 ; MSE = 3,84 va MAPE = 5,6, khong cd xu hu'dng tang hay giam theo thdi gian.
- Ngu'di Dao siT dung DVYT tai tram y te xa nhleu gap 2 den 4 lan ngu'di Kinh.
TAI LI|U THAM KHAO
1. Ly Van Canh (2006), "Huy dpng cong dong truyen thong giao due siTc khde m5t so noi dung chSm soc sire khoe ban dau cho ngu'di dan xa Tan Long, Oong Hy, Thai Nguyen", Tap chf Y hpc thyt hanh, 2 (174), B6 Y te, tr. 37-38.
2. Pham Hong Hal (2011), Phan tich mot so y§u t5 lien quan den sir dung djch vu y te ciia phg nij' ngudi Dao tren khi'a canh vSn hoa - xa hoi tai huy§n Bach Thong, B3C Kan, LuSn ^n Tien si y hpc, Dai hpc Thai Nguyen
3. Vu Thanh Hien (2003), 'Thi/c trang chSm s6c sire khoe ban dau ngu'di ngheo 6 tinh Hi Giang", T^pchiY hpc Viet Nam.
4. Nguyen V i n Hien (2004), Nghidn cdu ho^t dgng giao due sut khde t^i mdt so xa d mdt huyfi dong bSng Bic bd va thd nghi$m md hinh an thiep giao due sdc khde, Luan dn tien sT y hpe, Tn/dng dai hpe Y Ha Npi, tr. 129.
5. Khong Thj NgQC Mai (2003), "Oanh gia hi^u qua cham sdc sire khoe tre em qua m6 hinh y te ban 6 mpt so ban viing cao mien niii", T^p chi Y DUgc hpc miin mil, Tru'dng dai hpe Y Thai Nguyen.
6. L^ Ngoc Kinli (2003), Nghien cuV thin: trang mang ludi y teed sd va xay dyhg md hinh can thi$p tai huyin Dong Hy, tinh Thai Nguyin theo cd chexa hpi hda, LuSn an tien sT y hpe, Trudng Dai hpc Y Ha Npi.
7. K£t qua diSu tra mu'c song h$ gia dinh (2012), Nha xuat ban Thong ke
