TU CHiNH SACH DEN CUOC SC
Nang cao hieu qua trien khai cac chmh sach bao hiem y te cua Viet Nam trong thofi gian tdri
N G U Y I N THI Lf MINH' v a THI Lf"
Chinh sach bao hi^m y t6'(BHYT) drfrfc coi nhtf chi^c phao cihi sinh cho ngtf&i b^nh, gop phin giam ganh n^ng chi phi kham chita b^nh cho ngtfcfi cUin, d$c bi^t la nhvhng benh nhSn ngheo. Tuy nhl§n, thcfi gian qua, da co nhiiu b^t c$p xay ra trong qua trinh tri^n khai thi^c hi$n chinh sach nay. Thtfc trang n^y doi hoi c i n co nhtfng giai phap hoan thi$n va nSng cao ti'nh thtfc ttii cua chinh sach BHYT trong th&i gian tm.
N H C T N G K E T Q U A DAT Di/grc BHYT la cd chS' tai chinh trong linh vLfc cham s6c siic khoe, d6ng thdi UL mSt chinh sdch an sinh xa h6i quan trpng, vl muc ti6u cfing bang, hi6u qua va phat tri^n trong linh vtfc cham s6c, bao ve siJc khoe nhan dSn. Chlnh sach BHYT & Vi$t Nam thdi gian qua da bSo dam nguy6n tSc chia se rui ro giffa nhffng ngitcfi tham gia BHYT, dong thdi cung dam nhSn nhilu chlnh sach phuc ldi xa hpi khac, giiSp cac nh6m d l bi t^n ttuTdng trong xa hdi d l u dtfdc chSm sdc stfc khde thdng qua Quy BHYT, vdi stf h6 trd ciia ng§n sdch nha ntfdc.
Chinh sdch BHYT cung da chuyen din cd che trd cSp cua Nhd ntfdc ti3f vi$c diu ttf ngdn sach trtfc tiep cho cd sd kham b?nh, chffa benh sang vi$c hd trd ngrfdi dan mua BHYT; gdp phin ldm thay d^i nhdn thffc cfia ngifdi dan tron^ vide Irfa chpn cac gidi phap tdi chinh de chdm sdc sffc khde. Quy BHYT dang din trd thdnh ngu6n tdi chinh cd bdn phuc vu cho hoat dOng cija cdc bSnh vi8n, tffng btfdc giam mffc chi trd tff tien tiii cfia ngtfdi benh cho cong tac chdm sdc sffc khde.
Chinh sdch BHYT cua ntfdc ta phat tri^n qua nhieu giai doan, b i t din vdi srf ra ddi cua Nghi dinh so 299/HDBT, ngdy 15/8/1992 cua Hdi d6ng Bd trrfdng ban hanh Dieu le Bdo hie'm y t^. Ti^p dd, Nghi dinh s6' 299/HDBT dtfdc thay th^
bdi Nghi dinh s^ 58/1998/ND-CP, ngay
13/8/1998 cua Chlnh phu; Nghj dinh s^ 58/1998/ND- CP sau do dtfdc thay th^ bdi Nghi dinh sd* 63/2005/
ND-CP, ngdy 16/5/2005 cua Chinh phu. Srf thay ddi chinh sdch dang chu y nhat dd la ngdy 14/11/2008, Ludt Bdo hiem y te, sd 25/2008/QH12 dtfdc Qudc hdi thong qua va cd hieu Itfc tff 01/7/2009. Ludt Bdo hilm y te' ra ddi da tao hdnh lang phdp ly quan trpng cho cdng tdc BHYT, dac bi6t la viec thtfc hien myc tieu BHYT todn dan.
Ngay 13/6/2014, Qudc hdi ban hdnh Ludt sd 46/2014/QH13 sffa ddi, bd sung mdt sd dilu cua L u | t Bao hilm y t l nam 2008, cd hidu Itfc thi hanh tff ngay 01/01/2015. Day la mdt btfdc tien quan trpng trong qua trinh xdy drfng, hodn thien chinh sdch, phdp ludt ve BHYT va tdc dong tich crfc den qud trtnh to chffc thrfc hidn chinh sach BHYT. Dd cung Id cd sd phdp ly t h i chd hda quan dilm, dinh htfdng cfia Ddng vd Nhd nrfdc trong vide thtfc hien chinh sdch tai chinh y td' cdng thdng qua BHYT todn dan, thtfc hien muc tidu chdm sdc srfc khoe cho ngrfdi dan theo dinh hrfdng cdng bang, hidu qua va phat trien.
Thifc hidn Ludt Bao hiem y te, den nay, sd ngrfdi tham gia BHYT d nrfdc ta da khong ngffng tdng ldn nhanh chdng. Theo Bao hilm xa hpi Vidt Nam, nd'u nam 2009, ty le ngrfdi ddn tham gia BHYT Id 45%, thi nam 2019 da tang ldn 90% ddn sd (vrfdt chi tidu Qudc hdi giao cho Chinh phfi (Nghi quyet sd 68/2013/QH13, ngdy 29/11/2013 cfia Qudc hdi ve viec day manh thrfc hidn chinh sdch, phdp ludt v l BHYT, tien tdi BHYT todn ddn dd giao chi tidu cho Chinh phu Id phSi: "Bao ddm din nam 2015, dat it nha't 75% ddn sd tham gia BHYT vd de'n ndm 2020, dat It nha't 80% ddn sdthamgia BHYT").
Trong dd, ngrfdi ngheo, ngrfdi dan tdc thidu sd, tre em dffdi 6 tudi va cdc dd'i trfdng chinh sach xa hpi da drfdc Nha nrfdc hd trd todn bO mffc ddng BHYT nhdn ddn.
, " , Trtfdng Cao d^ng Y t^ Thai Nguyen
IH SACH DEN CtlOC SONG
Nganh y te phoi hg^ hieu qua trong thuc hi^n chtnh sach bao hiem y te Tinh ridng tff nam 2015 ddn ndm 2019, todn qudc
tang khodng 15 tridu ngrfdi tham gia BHYT. Chat Irfdng khdm chffa bdnh BHYT ngdy cdng dffdc cai thidn, nhieu lo^i thudc mdi, ky thudt, dich vu y td hi$n dai, khi drfa vdo Vi0t Nam, deu nhanh chdng drfdc Quy BHYT chi tra, tao dilu kidn cho ngtfdi b$nh tidp can thudn ldi, bao dam nguyen tac chia sfi rfii ro giffa nhffng ngrfdi tham gia. Cung vdi vide md r0ng so Irfdng ngrfdi tham gia BHYT, nganh y te cung t^p trung ndng eao chat Irfdng khdm chffa bdnh BHYT vdi hdng loat bien phdp ddi mdi, eai each thu tuc hanh chlnh, gidm philn ha eho ngffdi bdnh, nhff: l^y ngrfdi bdnh ldm trung tam; ddi mdi v l qudn ly, each lam va phrfdng phdp kilm tra, danh gia bdnh vidn hang nam;
trien khai cdc de an giam tdi, bdc sT gia dinh. Ddc bidt, Bd Y te'cung da diy manh rfng dung cdng nghe thdng tin trong quan IJ benh vidn, quan ly BHYT d l gidm thu tuc, gidm thdi gian chd ddi eua ngrfdi bdnh, thtfc hidn cdng khai, minh bach cdc khodn chi phi, ma ngtfdi bdnh phdi chi tra. Cd t h i ndi, vide tinh dung, tinh du gid dich vu y le' da gdp phin quan trpng vdo vide thrfc hidn ehu trrfdng chuyen chi thtfdng xuyen tff ngan sdeh nha ntfdc cap eho cdc cd sd y te sang h5 trd ngrfdi dan tham gia BHYT. Ndm 2019, da sff dung khodng 32.000 ty ddng chi srf nghidp y td (chie'm khodng 35%) de h6 trd ngrfdi nghdo, ede dd'i ttfdng ehinh sdch tham gia BHYT.
Chinh sdeh BHYT da gdp phan giam chi trtfc tie'p tff tiln tui hd gia dinh eho dich vu y te. Theo Bao hiem xa hdi Vidt Nam, thrfc hien kham chffa bdnh b^ng the BHYT giup ngtfdi ngheo va can ngheo bdt di ganh n$ng chi lieu cho gia dinh khi dm dau, tai nan. Hidn nay, d ntfdc ta t^ Id ehi trd chi phi y te tff tien tfii cfia ngrfdi sfir dung dich vu giam tff 49% ndm 2012 xudng cdn khodng 40% ndm 2018 vd dang phan dau dat drfdi 30% vdo ndm 2025. Ddy la ket qud c6 drfdc tff chlnh
sach BHYT vd Id mpt ttong nhffng chi tidu quan ttpng ddnh gid muc tidu cdng bang ttong cham sdc sffc khde nhan dan.
VAN CON NHIEU KHO KHAN, THACH THLfC
Ben canh kdt qud dat drfdc, thrfe te cho thd'y, cdng tdc triln khai ehinh sdch BHYT eon mgt sdkhd khan, thdch thffc nhrf sau:
Mot la, cde vdn ban ban hdnh cdn thidu ddng bd. Mdt sd van bdn hffdng dan ve BHYT con ehrfa rd rang, dan tdi nhffng each hilu vd vdn dung khdng thdng nhd't. Ty Id tham gia BHYT ehrfa day dfi, tinh tuan thfi phdp luat chffa cao.
Thffc tiln nay da va dang ddt ra mpt sd vd'n d l cin ffilu chinh Ludt Bdo hilm y te ndm 2014 nhdm hrfdng tdi mtic tidu phdt trien BHYT bin vffng hdn, bdo dam quyen ldi khdm ehfla benh BHYT eho ngrfdi dan; tid'p tuc md rdng di?n bao phfi BHYT tdi cdc nhdm chift tham gia, dilu chinh mffc ddng d l phu hdp hdn vdi nhu cau khdm chffa bdnh cua ngffdi dan, gidm mffc chi tff tien tui cfia ngrfdi b?nh...
Hai Id, chinh sdch BHYT ehrfa bdo ddm tinh ben vflhg. Cd t h i thay, nguy cd
"vd quy" BHYT rat cao, bdi thrfc tr^og hidn nay dang Id "ddng thi it, hrfdng thi nhieu", cfing ehia se lai thap, thdra ehi Id khdng ed. Dilu ndy klidng ldm cho chinh sdch BHYT ttd nen bin vffng drfdc.
Daic biet, neu nhin vdo cd cau tham gia BHYT hidn nay se thiy, ty 1$ tham gia
dtfdc ngdn sach nha nrfdc ddng BHYT van chiem ty trpng eao, tdp trung chfi ydu vao hd nghdo, ttfi em dtfdi 6 tudi, hpc sinh, sinh vidn. Vdi cd cau thd ndy, se khdng t h i khSng dinh rang, BHYT Id chlnh sdch b i n vitog v l quy.
Ba Id, chat Irfdng khdm chffa bdnh tai tuyd'n cd sd cdn nhieu h^n ehe', ddi ngu y bdc sy 6 cdc tuydn xd, huydn con thie'u, nen vide ndng cao chd't Irfdng kham chffa b$nh Id mdt thdch thffc eho ed quan y te dia phrfdng.
Bdn Id, tinh ttang lam dung Quy BHYT vSn dien ra phd bid'n, do nhilu nguydn nhdn, nhrf: phdt tttng thfi BHYT;
Mdt sdbdnh vidn ke khdng, l§lp benh dn khdng chi phi kham chffa bdnh; Bdnh nhdn da ra vidn vdn chi dinh thudc, dieh vu ky thudt d l benh nhdn dtfdc mang thudc v l nhd sfi; dung...
Nhihig hinh thffc chfi ydu true ldi Quy BHYT drfdc cd quan bao hilm xa hdi phdt hidn tff cac cd sd y td' khd da dang. Nhilu ed sd y td ldi dung khdm chffa bdnh nhdn dao, td chffc cac cupc hdi thao, ehi trd hoa hdng, chi ttd chi phi vdn ehuyla.. d l ldi keo ngrfdi bdnh ddn ed sd khdm chffa benh vd eung tfng dich vu ky thu§t khdng can thidt, gdy lang phi Quy BHYT.
Ngodi ra, ed tinh ttang thd'ng kd thanh todn khdng dich vu ky thudt cfia mdt sd cd sd kham chffa bdnh; thdng kd thanh toan tiln hdi chan d l chuyin tuyen... Nhiftig vu vide nhrf: chi dinh xdt nghiem qua mffc cin thie't tai Bdnh vien Da lidu TP. Hd Chi Minh; cung cap djeh vu khdng bao ddm ky thudt, nhrf: vu cat ddi que thu" HIV tai Benh vidn Xanh Pdn (Ha Ndi) bi phdt hidn vffa qua..., la nhmig minh chffng cu thi.
Theo Bao hilm xd hpi Vidt Nam, ttong 11 thang cfia ndm 2019, da phdt hidn 158 ca di kham benh tff 150-295 lln/thdng ttd ldn, trfdng drfdng tff 13-27 ngay di khdm bdnh mdi thdng. Sd lidu ndy da loai trff cdc ttirdng hdp mac b?nh man tinh phdi sff dung nhilu dieh vu ky thudt thrfdng xuydn, nhrf bdnh nhan suy than phdi chay thdn chu ky... Tinh ttang gian Idn ttong sff dung thfi BHYT khd phd bidn. Thi du, cd ttffdng hdp phdt hidn ngrfdi dd ehet vdn di khdm chffa bdnh.
Ddy la do cd sd khdm chffa bpnh sff dung thfi BHYT cua ngrfdi da chdt ldp h i sd thanh todn khdng. Thd ndn, da xud't hidn ttfdng hdp di md mat thff ba, ngffdi da bi cat cd tff cung vSn di dfi... Hidn trfdng
ttdn Id do bi mrfdn thfi, lam dung the BHYT (Xudn Dffc, 2019).
MOT sd GIAI PHAP C A N JH\JC HIEN D I kh^e phue nhffng tdn tai, han chd ttong thtfc hidn chinh sach BHYT, thdi gian tdi cin triln khai ddng bp cdc giai phdp sau:
Thd nhdt, ndng cao nhan thiic vi chinh sdch BHYT.
Theo dd, can tang ctfdng cdng tdc tuyen truyin, phd bidn chlnh sach, phdp ludt v l BHYT de nhdn dan thd^y rd nhffng ldi ich, J nghia efia chinh sach BHYT ddi vdi viec on dinh ddi sd'ng nhdn ddn, dn dinh kinh te' - xa hOi va bdo dam an sinh xa hdi, tao stf ddng thudn xa hdi.
Thd fiai, hodn tkiin hi thong phdp ludt ve BHYT:
Hodn thidn hd thd'ng phdp ludt v l BHYT va phdp luat cd lien quan de t h i ehd hda cde chfi trffdng, cdi cdch chinh sdch va chdm soc, nang cao stfc khde nhdn ddn theo tinh than cdc nghi quydt cua Dang va Qudc hOi.
Cde ed quan qudn ly nhd nrfdc cin tid'p tuc nghien cfi\i sffa ddi, bd sung cde ehe tdi xff IJ vi pham phdp luat v l BHYT, nh^t la ddi vdi cdc hanh vi ttdn ddng, nd ddng, true ldi BHYT; ddng thdi, cdc doanh nghiep vd ngrfdi lao dpng cd quyln khid'u nai hoac khdi kidn cd quan thrfc hidn BHYT, ndu phdt hidn cd sai pham ttong thtfc hidn chinh sach.
Hidn nay, Bd Y td' dang xdy dulig trtnh Chlnh phfi di^ thao Lu§t Bdo hilm y td sffa ddi gdm 12 chtfdng, 61 dilu. Nhiftig npi dung sffa ddi se tdp trung vdo cdc dilm ehinh: Dilu chinh quyln ldi BHYT theo hrfdng cdng bang, hidu qud, ding thdi giam ehi phi dieu tti, chi phi n^m vien, giam tai bdnh vidn; Kilm soat chi phi theo hrfdng bao ddm sff dung dich vu y tdhdp IJ, ndng cao ttdeh nhidm cfia cd sd y td va ngffdi sff dung dich vu, ttdnh ldng phf, cdn dd'i Quy BHYT; Dieu chinh bao ddm srf cdng bang ttong md'i quan hd giffa cd sd cung iJng dich vu va cd quan bdo hiem xa hdi... Hidn tai, dtf thSo Ludt Bao hilm y te sffa ddi dang drfde Bd Y td tidp tue ldy y kid'n d l hoan thidn va da drfdc Qude hdi drfa vao danh sdch cac ludt can sffa ddi, drf kien se drfa ra ban thao ttong nam 2021.
Thii ba, ndng cao hiiu luc, hiiu qud qudn l^ nhd nudc vi BHYT: Ndng cao ndng Irfc cfia cd quan nhd nrfdc ttong vide hoach dinh chidn lrfdc phdt triln BHYT, xdy drfng vd hodn tiiidn hd thdng phdp ludt;
Nang eao tinh tudn thfi phdp ludt thdng qua thrfc hidn ddng bp cdc bidn phdp hdnh chinh, kinh td', ttf phdp d l tang sd'ngtfdi tham gia BHYT di ddi vdi chii ttpng tdng sd' ngtfdi thu hrfdng quyln ldi. Tdng crfdng cdng tde thanh tra, kilm tta, giam sdt vide eh^p hdnh phdp ludt v l BHYT, kip thdi phat hidn vd xff IJ cdc vi pham, nhat Id cde hdnh vi ttd'n ddng, nd ddng, gian l$n, tiTic ldi BHYT.
Hodn thien bg mdy td cfaffe thrfe hidn ehinh sdch BHYT theo hrfdng tinh gon, hidu qua, phfi hdp vdl tinh than eua Nghi quyd't sd 18-N(3/TW, ngay 25/10/2017 efia Hdi nghi lan tiiff Sdu, Ban Chap hanh Trung ffdng
'JH SACH DEN CUQC SONG
Nganh y l^ phoi h(;p hifu qua trong thiic hi|n cliinJi sach bao hiSm y te Tinh ridng tff nam 2015 ddn ndm 2019, todn qude
tang khoang 15 trieu ngrfdi tham gia BHYT. Chat Irfdng khdm chffa bdnh BHYT ngdy edng dffdc cai thi^n, nhieu Ioai thudc mdi, ky thuat, dich vu y te hien dai, khi drfa vao Viet Nam, d l u nhanh ehdng drfde Quy BHYT ehi tra, tao dieu kien eho ngtfdi bdnh tiep c^n thuan ldi, bao dam nguydn tac ehia se rfii ro giffa nhffng ngtfdi tham gia. Cfing vdi vi?c md rdng sd Itfdng ngtfdi tham gia BHYT, ngdnh y t i c u n g tdp ttung ndng cao chd't Itfdng khdm chffa bdnh BHYT vdi hdng loat bi^n phdp ddi mdi, cdi each thfi tuc hanh chlnh, giam philn hd cho ngtfdi b^nh, nhtf: lay ngtfdi benh lam ttung tdm; ddi mdi ve qudn ly, cdch lam va phrfdng phdp kiem tta, ddnh gid bdnh vidn hang nam;
ttiln khai cdc d l dn gidm tdi, bdc si gia dinh. Dac bidt, Bd Y td' eung da day manh fftig dung cdng nghd thdng tin trong qudn IJ bdnh vidn, quan IJ BHYT d l giam thfi tuc, gidm thdi gian chd ddi cfia ngrfdi benh, thrfc hidn cdng khai, minh bach cac khoan ehi phi, md ngrfdi bdnh phdi chi ttd. Cd t h i ndi, vide tinh dfing, tinh du gid dich vu y td' da gdp phin quan ttpng vao vide thtfc hidn chfi tttfdng chuydn chi thrfdng xuyen tff ngan sdeh nha nrfdc ed'p cho cac cd sd y te sang hd ttd ngrfdi ddn tham gia BHYT. Nam 2019, da sff dung khodng 32.000 t;y ddng chi srf nghiep y te' (chidm khodng 35%) di hd tt^ ngrfdi nghdo, cdc ddi trfdng ehinh sach tham gia BHYT.
Chinh sdch BHYT dd gdp phin gidra chi ttifc tiep tff tiln tfii hd gia dinh eho dieh vu y te'. Theo Bao hiem xa hOi Vidt Nam, thrfe hidn khdm chffa bdnh bdng the BHYT gifip ngffdi nghdo vd edn ngheo bdt di ganh nang chi tidu eho gia dinh khi dm dau, tai nan. Hidn nay, d nrfdc ta ty IB chi tta chi phi y te tff tiln tfii cua ngffdi sff dung dich vu giam tff 49% nam 2012 xudng cdn khoang 40% ndm 2018 vd dang phd'n d^u dat dffdi 30% vdo ndm 2025. Ddy la ket qud ed dffdc trf ehinh
sach BHYT vd Id mdt ttong nhfltig chi tidu quan ttpng ddnh gia muc tieu cdng bang ttong chdm sdc sffc khde nhdn ddn.
VAN CON N H I ^ U KHO KHAN, THACH THLfC
Bdn c^nh ket qud dat dffdc, thffc td cho thd'y, cdng tdc triln khai chinh sdch BHYT edn mgt sd khd khdn, thdch thffc nhtf sau:
Mot la, cdc vdn bdn ban hdnh cdn thieu ddng bg. Mgt sd vdn ban hrfdng din v l BHYT cdn ehrfa ro rang, dSn tdi nhffng cdch hilu vd vdn dung khdng thdng nhat. Ty Id tham gia BHYT ehrfa dly du, tinh tuan thfi phap ludt chtfa cao.
Thrfe tiln ndy da va dang dat ra mdt sd van de ein dilu chinh Ludt Bdo hilm y td nam 2014 nham hrfdng tdi muc tidu phdt ttiln BHYT ben vffng hdn, bdo dara quyln ldi khdm ehfla benh BHYT cho ngtfdi ddn; tidp tuc md rdng didn bao phfi BHYT tdi cdc nhdm chffa tham gia, dilu ehinh mffc dong d l phfi hdp hdn vdi nhu eau khdm chffa bdnh efia ngffdi ddn, gidm mffc chi tff tiln tfii eua ngrfdi bdnh...
Hai Id chinh sdeh BHYT ehrfa bdo dam tinh b i n vffng. Cd t h i thay, nguy ed
"vd quy" BHYT rS"! cao, bdi thrfc ti^ng hi$n nay dang Id "ddng thi it, htfdng thi nhieu", cfing chia se lai thap, thdm ehi Id khdng ed. Dilu ndy khdng ldm cho chinh sdeh BHYT ttd nen ben vflhg drfdc.
Ddc bidt, ndu nhin vdo ed cau tham gia BHYT hidn nay se thdV. ty Id tham gia
drfdc ngan sdch nhd nffdc ddng BHYT vdn chidm tJ ttpng cao, tdp trung chu yeu vao hd ngheo, ttfi em dtfdi 6 tudi, hge sinh, sinh vien. Vdi cd ed'u thd ndy, se khdng t h i khang dinh rang, BHYT Id chinh sdch b i n vffiig v l quy.
Ba Id, chat Itfdng khdm chffa benh tai tuyd'n cd sd cdn nhilu han che, ddi ngQ y bae sy d cdc tuydn xd, huyen cdn thid'u, ndn vide ndng cao chSft Iffdng khdm chffa benh la mpt thdch thffc clio cd quan y td dia phffdng.
Bdn Id, tinh ttang lam dung Quy BHYT vdn d i l n ra phd bien, iio nhieu nguydn nhan, nhff: phdt trung thfi BHYT;
M6t sdbdnh vidn ke khdng, l|lp bdnh dn khdng chi phi khdm chffa bdnh; Bpnh nhdn da ra vien v i n chi dinh thudc, dich vu ky tiiu$t d l bdnh nhan dtfdc mang thude v l nhd sff dung...
Nhiftig hinh thffc chfi ydu true ldi Quy BHYT dffdc cd quan bdo hilm xa hdi phdt hidn tff cdc cd sd y t l khd da dang. Nhieu cd sd y te' ldi dung khdm chffa bdnh nhdn dao, td chffc cdc cudc hgi thdo, chi ttd hoa hdng, chi ttd ehi phi van chuyea.. de ldi kdo ngffdi benh den cd sd kham chffa bdnh va cung ffng dich vu ky thudt khdng cin thidt, gdy ldng phi Quy BHYT.
Ngoai ra, cd tinh ttang thdng kd thanh todn khdng dich vu kJ thudt cfia mdt so' cd sd kham chffa bdnh; thd'ng ke thanh todn tien hdi eh^n d l chuyen tuyd'n... Nhffng vu vide nhrf: chi dinh xfit nghidm qud mffc cin thiet tai Bdnh vidn Da liSu TP. Hd Chl Minh; cung cS'p dich vu khdng bdo ddm ky thudt, nhrf: vu cat ddi que thff HIV tai Bdnh vien Xanh Pdn (Ha Npi) bi phdt hien vffa qua..., la nhffng minh ehutig cu the.
Theo Bdo hiem xa hdi Vidt Nam, ttong 11 thdng efia ndm 2019, da phdt hidn 158 ea di khdm benh tff 150-295 lan/thdng ttd ldn, ttJfdng drfdng tff j_3-27 ngdy di khdm bdnh mdi thdng. So heu ndy da loai trff cae ttrfdng hdp mac bpnh man tinh phdi sff dung nhilu dieh vu ky thu§t tiirfdng xuydn, nhrf bdnh nhdn suy thdn phai chay thdn chu ky... Tinh ttang gian l$n ttong sff dung thfi BHYT khd phd bid'n. Thi dii, ed ttrfdng hpp phdt hidn ngtfdi da chdt vin di khdm chffa bdnh.
Day la do cd sd khdm chffa bdnh sff dung the BHYT efia ngffdi da chd't ldp hd sd thanh todn khdng. Thd ndn, da xud't hidn tiifdng hdp di md m^t thff ba, ngtfdi da bi e^t cd tff cung vdn di de... Hidn trfdng
trdn Id do bi mrfdn the, lam dung thfi BHYT (Xudn Drfe, 2019).
MOT S 6 GIAI PHAP CAN THUt HIEN D I khac phuc nhflng t i n tai, han ehd ttong thrfe hidn chlnh sach BHYT, thdi gian tdi ein triln khai ddng bd ede gidi phap sau:
Thunhdt, ndng cao nh^n thdc vi chinh sdch BHYT.
Theo dd, can tang crfdng cdng tac tuyen truyen, phd bidn ehinh sdch, phdp luat v l BHYT d l nhdn dan thdy rd nhflng ldi Ich, J nghia cfia chinh sdch BHYT ddi vdi vide on dinh ddi sdng nhdn ddn. In dinh kinh te - xa hdi vd bao dam an sinh xa hpi, tao srf ddng tiiudn xd hdi.
Thd hai, hodn thiin hi thd'ng phdp ludt ve BHYT:
Hoan thien hd thd'ng phap ludt v l BHYT vd phdp ludt cd lidn quan d l the ehd hda ede chfi trrfdng, cai each chinh sdeh vd eham sde, nang eao sffe khde nhdn dan theo tinh than cac nghi quyd't cfia Dang va Qudc hdi.
Cdc ca quan qudn IJ nhd nffdc cin tidp tue nghidn efiU sffa ddi, bd sung cde chd' tai xu" 1J vi pham phap l u | t ve BHYT, nhat Id ddi vdi cdc hanh vi ttdn ddng, nd ddng, true ldi BHYT; ddng thdi, cde doanh nghidp va ngffdi lao ddng ed quyln khidu nai hode khdi kidn cd quan thrfe hidn BHYT, ndu phat hien cd sai pham ttong thffc hien chlnh sdch.
Hidn nay, Bd Y td' dang xdy diftig trtnh Chlnh phfi drf thdo Lu$t Bdo hilm y td sffa ddi gdm 12 chrfdng, 61 dieu. Nhflng npi dung sffa ddi se tdp trung vdo cdc dilm chlnh: Dilu chinh quyln ldi BHYT theo hrfdng cdng bang, hidu qua, ding thdi gidm ehi phi dilu tri, chi phi nam vidn, giam tai benh vien; Kiem soat chi phi theo hrfdng bdo dam sff dung dich vu y td' hdp IJ, ndng cao ttdeh nhidm cfia cd sd y t l va ngrfdi sfi: dung dich vu, ttdnh lang phi, cdn ddi Quy BHYT; Dilu ehinh bao dam stf edng bang ttong mdi quan he gifla cd sd cung ffng dich vu vd ed quan bao hiem xa hpi... Hidn tai, drf thdo Luat Bdo hiem y te sffa ddi dang drfdc Bd Y td' tid'p tuc lay J kien d l hoan thidn vd da drfdc Qud'c hdi drfa vdo danh sdch cdc luat cin sffa ddi, dff kid'n se drfa ra bdn thao ttong ndm 2021.
Thd ba, ndng cao hiiu lUc, hieu qud qudn V^ nhd.
nUdc ve BHYT: Ndng cao ndng Irfe efia ed quan nha nrfde ttong vide hoach dinh ehidn lrfdc phdt triln BHYT, xay dtfng va hoan thidn he thd'ng phdp luat;
Nang cao tinh tudn thfi phap luat thong qua thrfc hien ddng bg ede bidn phdp hanh ehinh, kinh td', trf phap de tdng sd ngrfdi tham gia BHYT di ddi vdi chu trgng tdng sd' ngrfdi thu htfdng quyen ldi. Tdng ctfdng cdng tdc thanh tta, kiem tra, gidm sdt viee chap hanh phap ludt ve BHYT, kip thdi phdt hidn va xff ly ede vi phEim, nhd't Id cac hanh vi trd'n ddng. nd ddng, gian l|tn, ttuc ldi BHYT.
Hoan thidn bd mdy td chffc thrfc hidn chlnh sdeh BHYT theo hrfdng tinh gon, hidu qua, phu hdp vdi tinh tiian eua Nghj quyd't sd 18-N(3/TW, ngdy 25/10/2017 efia Hdi nghi lan thff Sdu, Ban Cha'p hdnh Trung ffdng
NH SACH DEN CUQC SONG
khda XII v l mdt sd vd^n d l tidp tuc ddi mdi, sdp xdp lo chffc bd mdy efia hd thdng chlnh tri tinh gpn, hoat ddng hidu Iffc, hidu qud; Kidn toan va nang eao ndng Irfc hoat ddng cfia Hdi ddng qudn IJ BHYT... Ben canh do, day manh eai edeh thu tuc hanh chlnh, thffc hipn dich vu cdng trtfc tuydn mffc do 4 tten tat ea cde iinh vtfc BHYT; Tiep tuc dau tff phat trien edng nghd va phffdng phap quan IJ tien tidn ttong td chffe thffe hien BHYT.
Thd tu, cdn bdo ddm tinh ben vdng ciio chinh sdch BHYT. Mpt ttong nhiftig muc tidu hrfdng tdi nen tang vffng chdc d l thffc hien BHYT todn dan ttong thdi gian tdi la khuyen khich va thu hfit nhflhg ngrfdi cd thu nhdp cao ddng gdp va han ehd' din nhfing ngrfdi ma ngan sdch phdi hS ttd. Theo Bui Sy Ldi (2019), mffc dong BHYT hidn nay dang Id 4,5% mffc Iffdng cd ban, nhimg Ludt Bdo hiem y td cho phdp Id 6%. Vide bdo dam ngudn quy hoan todn ed drf dia khi tdng mffc ddng. Tuy nhien, ndu tdng nhanh, cung se gay dp Irfc cho ngffdi ddn, cho doanh nghidp, ndn cin cd Id trtnh vd khdng the tdng ngay len drfdc. Do dd, dilu quan ttgng Id phai sff dung ngudn vd'n ndy mdt cdch hieu qud.
TTirfc te, BHYT khdng hodn todn Id ehinh sdeh ed ddng cd hffdng, ma ddy la chlnh sach cung chia sfi, tffc la ddng d l phdng ngffa, hode ngrfdi tham gia ddng lfic khde di hd ttd ngrfdi yeu, thi mdi bao dam drfde.
Dilu cin thidt Id, nhffng ngffdi ed mffc Iffdng cao, hd gia dinh nhffng ngffdi kinh doanh tff do vd nhffng ngrfdi cd thu nhdp eao tham gia vdo Quy BHYT, thi Quy mdi on dinh. Cho nen, each thffc, giai phdp phdi tdp trung d l khai thdc tuydn truyin, ldm rd BHYT Id chinh sach nhdn dao.
Thd ndm, tdp trung hodn thdnh muc tiiu todn ddn tham gia BHYT. Nghi quydt sd 2d-NQ/TW, ngay
25/10/2017, Hdi nghi lan thrf Sdu, Ban Chdp hdnh Trung ffdng khda XII v l tdng crfdng edng tdc bdo vd, ehdm sdc vd nang cao sffc khde nhdn dan ttong tinh hinh mdi xae dinh muc tidu cu the ddn ndm 2025 Id: " f j Id tham gia BHYT dat 95%
ddn so. Ty Id chi trrfc tidp tff tien tui cfia hd gia dinh cho y td gidm cdn 35%; den ndm 2030 ty le tham gia BHYT ttdn 95%
ddn sd. T^ Id chi tttfc tidp tff tiln tfii cua hd gia dinh cho cham soc y td gidm con 30%"... D l thrfc hien dffdc muc tidu ndy, ben canh vide tuydn truyin, ngdnh bdo hilm xa hdi cung ein thiet ke nhtog gdi hoac triln khai cdc mffc ddng, phffdng tiiffe ddng BHYT linh hoat, da dang phfi hdp vdi tiftig nhdm ddi trfdng khde nhau.
Ngdnh bdo h i l m xd hOi vd y td' cin phdi hdp cfing xdy drfng ed ed^u phi phfi hdp theo thu nhap, cd nghia Id ndu tham gia mffc phi cao, thi se dffdc hrfdng nhffng dich vu y td', khdm chffa bdnh eh^t Irfdng cao. Con ndu thara gia mffc tha'p, thi drfdc hffdng nhflng dich vu y td' tffdng ffiig. De xdy dffng drfdc ed eCu pM nhrf vdy, e i n cd nhflng cudc nghidn cffu tff nhffng ddi tffdng ed thu nhdp cao, nhrfng khdng tham gia vao BHYT h0 gia dinh nhdm tim ra drfde cd cd'u gid tdi rfu cho tffng mffc thu nhdp khde nhau. Bdi, thffc te", nhffng ngffdi cd thu nh$p cao thffdng cd nhu ciu chdm sdc sffc khde, cung nhrf ydu elu dieh vu y td drfde thu hrfdng eao hdn.Q
_ T A T T.IF.IT T H A M J O I A Q ^ _ 1. Ban Chap hdnh Trung tfdng (2017). Nghi quyet sd20-NQ/TW, ngdy 25/10/2017 vi tdng cudng
cdng tdc bao ve, chdm sdc vd ndng cao sdc khoe nhdn ddn trong tinh hinh mdi 2. Qudc hdi (2008). Lupt Bdo hiem y te, sd 25/2008/QHl 2, ngdy 14/11/2008
3. Qud'c hdi (2014). Ludt sda ddi, bo sung mdt sddieu cda Ludt Bdo hiim y ti', sd46/2014/QHI3, ngay 13/06/2014
4. Qud'c hpi (2013). Nghi quyet so 68/2013/QH 13, ngdy 29/11/2013 ve ddy manh thUc hiin chlnh sdch, phdp ludt vi BHYT, tien tdi BHYT toan ddn
5. Bdo hilm xa hdi Viet Nam (2018). Bdo cdo sd5I04/BC-BHXH, ngdy 05/12/2018 ve ket qud thuc hi$n Quyet dinh sd70/QB-CP, ngdy 01/11/2012 ban hdnh Chuang trinh hdnh dpng eUa Chlnh phu thuc hiin Nghi quyet so 15-NQ/TW, ngay 01/6/2012 cua Ban Chdp hdnh Trung uang Ddng khda XI mgt sdvdn di ve chinh sdch xd hdi giai doan 2012-2020
6. Bd Y te (2019). Tdi lieu Hdi nghf tdng ket 5 ndm thuc hien Ludt Bdo hiem y tegiai doan 2015- 2079, Hd Ndi, ngdy 12/12/2019
7. Bdo hilm xa hdi Viet Nam (2019). Tdi liiu Hdi nghi cung cdp thdng tin ket qud thUc hiin bdo hiem xd hoi, BHYT, bdo hiem thdt nghiep ndm 2019, Ha Ndi, ngdy 27/12/2019
8. Xudn Dffe (2019). Nhieu hinh thiic true tpi quy bdo hiem y ti, truy cdp tff https://www.nhandan.
com.vn/xahoi/item/42752502-nhieu-hinh-thue-true-loi-quy-bao-hiem-y-te.html
9. Bui Sy Ldi (2019). Gidi phdp hodn thiin chinh sdch bdo hiim xd hdi, bdo hiimyte, truy edp trf http://tapchitaiehinh.vn^ao-hiem/giai-phap-hoan-thien-chinh-saeh-bao-hiem-xa-hoi-bao-hiem-y- te-302885.html
