VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018
THyC TRANG SIT DUNG QUY KHAM CHU'A BENH B A O HIEM Y TE TAI BENH VIEN DA KHOA T I N H NAM DINH NAM 2 0 1 6
D?ng Thi Mai Linh', Vu Trung Kign\ Vu Phong Tiic^
Key words: Medical examination, heaitti insurance.
I. OiCkT VAN OE
Cong bang trong cham sdc sffc khde nhan dan dffde hieu la mpl ngffdi deu dffdc b'ep can va sff dung eac djch vu y te cd ban eo chat Iffdng, khong phu thupc vao kha nang tai chinh eua tirng ea nhan. Oe dat dffdc mue tieu nay, eac nffde tren the gidi co hai lffa chpn; hoae sff dung ed ehe tai chinh y te dffa tren thue (ngan saeh nha nUde) hoac cd che tai chinh y te dite tren Bao hiem y te (BHYT) bat buoc. Tat Viet Nam, BHYT dffdc thanh lap nam 1992 theo Nghi dinh 299/HDB ngay 15/8/1992 Hpi dong Bp trudng (nay la Chi'nh phii). Ngay lap tffc, BHYT da xac djnh dffdc vai tro quan trpng khong the thieu tnang thanh toan cht phi kham, chffa benh noi rieng va trong tong the cham soc sffc khoe nhan dan ndi chung. Vi nam 2016 nhieu chfnh sach mdi dddc ap dung nen phat sinh nhieu kho khan, vffdng mac trong quan ly va to chffe thffc hien nhff: khd khan trong quan ly KCB thdng tuyen, gia djch vu y te (DVYT) tang... Vdi mong muon tim hieu thffc trang cung nhff xac djnh dffdc nhffng ton tat vffdng mac, cae nguyen nhSn lam cd sd de dUa ra giai phap, vi vay chung toi tien hanh nghien ciru de tat nay vdi mue tieu: Md^
thut trang sd dung quy khim chO^ benh bio hiem y tetai Benh vien da khoa tinh Nam Dfnh.
IL DOI TU'ONG VA PHLTOTSIG PHAP N G H I I N OJTJ 1. Oja diem, thd! gian, Qo\ tu'dng nghien cuti - Dja dle'm nghien cuti: Benh vien da khoa tinh Nam Djnh.
- Ddi tu'dng nghien culi: Ho sd benh an, so sach, bao cao ve so lieu kham ehffa benh, sd tien thanh quyet toan tff quy Bao hiem y te ciia benh vien da khoa tinh Nam Dmh nam 2016.
- 7770'/ gian nghien cuV: Nghien cu\i dude thuc hien tff 10/2017 - 5/2018.
2. Phu'dng phap nghien cu'u 2 . 1 . Thiet ke nghien cu'u: Nghien cffu dffdc tien hanh theo phu'dng phap djch te hpc mo ta thong qua cuoc dieu tra cat ngang.
2.2. Cd mau va phu'cfng phap chon mau Tien hanh chpn toan bp so Iffu thong kS, bao cao so lieu KCB thang, quy nam, thu chi vien phf, BHYT n i m 2016, bao eao tai chmh nam 2016 ciia benh vien.
T O M TAT
Myc tigu: Mo ta thi/c trang sff dung quy kham ehiia benh bao hiem y te tai Benh vien da khoa tinh Nam Djnh. Doi tUtfng nghien cffu: Ho sO benh an, so saeli, bao eao ve so lieu kham ehu^ benh, so tien thanh quyS: toan tff quy Bao hiem y te cua benh vien da khoa tinh Nam Dinh nam 2016. Phu'dng phap nghien cffu: phUdng phap m6 ta qua cuoc dieu tra d t ngang. Ket qua nghi€n c6'u: So lu'dng the bao hiem y te dude phan bo cho benh vien eo xu hUdng tang qua eae nSm. Hau het ngu'di tienh den kham dung tuyen (chiem 98,4%). Ty le benh nhan den Wiam ngoai tjii ehiem 81%. Ba nhom benh dUdc thanh toan bao hiem y te ngoai tru nhieu nhat la benh ve npi tiet, dinh duSng, chuyen hoa; benh tuan hoan;
b|nh sinh due tiet nieu. Ba ntiom b|nh du'dc bao hiem y
^ thanh toan npi tru nhieu nhat la benh ho hap; benh ti&J hoa; benh tuan hoan. ICioa co s5 tien thanh toan bao hiern npi tnJ nhieu nhat la khoa Npi t£ng hdp.
Tdkhda: Kham chffa benh bao hiem y te, quy bao hiSm y te.
SUMMARY
CURRENT S r r U A n O N OF USING HEALTH INSURANCE FUND AT GENERAL HOSPITAL
OF NAM D I N H PROVINCE I N 2016 Objective: To describe the current situation of using health insurance fund in General Hospital of Nam Dinh Province. Study subjects: medical records, books, reports on medical examination and treatment, amount paid from the Health Insurance Fund in General Hospital of Nam Dinh Province in 2016. Methodology: Descriptive cross-sectional survey. Research results: Ttie number of health insurance cards contracted to hospitals tended to increase over the years. Most of the patients came to the hospital on the right track (98.4%). Outpatient visits accounted for 81%. The three highest health Insurance paid outpatient disease groups were endocrine, nutrition, metabolism; circulatory diseases;
and diseases of urinary tract. The three highest health insurance paid inpatient disease groups were respiratory diseases; digestive diseases; drculatory diseases. The Department with the highest in-patJent insurance payment amount was Department of General Internal Medicine.
'Bio hli'm xa hoi ti'nh Nam Dinh
^Trudng Dai hoc YDUdC Thii Binh Chju trach nhiem chfnli: Dang Thi Mai Linh Email: [email protected] Ngay nhan bai: 2.2.2018 Ngay phan bien khoa hoc: 30.3.2018 Ngay duyet bat: 10.4.2018
TAP CHl Y HOC V l i T NAM TAP 465 - THANG 4 - SO 2 - 2018 2.3. K9 thuat ap dung trong nghien cuii
"•Trfeh lue thdng tin benh an: Thong tin trong benh an dUdc ghi nhan day dii vao phieu dieu tra tienh an da diidc ehuan bj san bao gom 12 thong tin ve hanh cinfnh, 8 thong tin ve chi phf.
*Thu thap thong tin tff so Iffu bao cao kham, chffa benh BHYT nam 2016: Dieu tra vien thu nhan tat ca nhffng thong tin can thiet tff so iffu trff, bao cao benh vten thang quy nam theo quy djnh ciia Bp Y te va cd quan BIHXH vao mau dteu tra da dddc chuan bj sSn.
2.4. Xii ly so lieu: Lam sach so lieu tff phieu. So lieu dffdc nhap bang phan mem Epidata 3.1. Cac sd lieu thu thap dffde xff ly theo thuat toan thong ke Y sinh hpc, sff dung phan mem SPSS 16.0.
III. KET QUA NGHIEN CU'U
Bing 3.1. Tong sd thi BHYT dUdc phan bd cho BVDK tinh Nam Binh trong S nam td 2013-2017
Da tuyen den 119.122.092.600 Oa tuyen di 40.825.249.900 Qua bang 3.2 cho thay Tong so tien kham benh, ehu^ benh BHYT dffde phan bo eho benh vien da khoa tinh Nam Oinh nam 2016 la 12.777.611.300 dong. Tong so tien kham chu^
benh BHYT tai cho la 52.827.177.500dong. Tong so tien kham benh, chiici benh da tuyen den la 119.122.092.600 dong vaTong sdtien kham benh, chffa benh da tuyen di la 40.825.249.900 dong.
Bang 3.3. Ty li ddi tUdng di khim diing tuyen, trii tuyin cd tnnh the BHYT
Chi so Lu'dt KCB dunq tuyen
LMi KCB trai tuyen t o n q luat KCB
So IiTtfng 160.772
2.568 163.340
Ty le % 98,4
1,6 100,0
Nam So ll^dng
the 2013 65.812
2014 69.745
2015 70.376
2016 75.412
2017 76.548
Ket qua bang 3.3 cho thay nam 2016 benh vien da khoa tinh Nam Oinh da kham ehij^ benh eho 163.340 iffdt benh nhan bao hiem y te.
Trong do, cd 160.772 Iffdt benh nhan kham ehife benh dung tuyen chiem 98,4% va 2.568 Iffdt benh nhan kham chu^ benh trai tuyen chiem 1,6%.
Bing 3.4. Ty li dc loai h/nh kham benh, chu'a binh cd trinh the BHYT
Ket qua bang 3.1 cho thay so the phan bo cho Benh vien da khoa tinh Nam Oinh c6 xu hffdng tang hang nam. Tff 65812 the nam 2013 ten 76548 the nam 2017.
»W Bang 3.2 Td'ng sdtien khim chda binh BHYT tai BV0K iinh Nam Binh nam 2016
'%
i
Chi so Lu'dt nqoai tru
Li?dt noi tru Tonq lu'dt KCB
So lu'dng 132.266
31.074 163.340
Ty le »/o 81,0 19,0 100,0
Chi so Quy Kham chffa benh theo the
Kham chu'a benh tai cho
Tong so tien 12.777.611.300 52.827.177.500
Qua bang 3.4 cho thay nam 2016 benh vien da khoa tinh Nam Oinh da kham chffa benh ctio 163.340 Iffdt benh nhan bao hiem y te. Trong do, CO 132.266 Iffdt benh nhan kham chffa benh ngoai tru chiem 8 1 % va 31.074 Iffdt benh nlian kham chffa benh not tru chiem 19%.
Bang 3.5. Phan bo 10 nhom binh du'dc Bao hiem y te thanh toan ngoai trt/ nhleu nhat
sn
1 2 3 4 5Nhom benh theo ICD Benh ye noi tiet, dinh dUSnq, chuyen hoa
Benh tuan hoan Benh he sinh due -tiet nieu
Benh xu'dnq kh6p Benh ve than l<inh
So lu'dt 29.476 39.798 11.420 5.884 5.560
BHYT thanh toan 17.717.364.843 14.517.464.800 7.679.830.908 2.865.830.312 2.423.125.462 Ket qua bang tren cho thay so Iffdt benh nhan va so tien bao hiem y te da thanh toan ngoai tru eho 10 nhdm benh co sd Iffdng nhieu nhat tai benh vien da khoa tinh Nam Djnh nam 2016 lan Iffdt la: benh npi tiet:, dinh dffdng, chuyen hoa; benh tuan lioan; benh he tiet nieu sinh due; Benh xffdng khdp; Benli ve tiian kinh; Bffdu tan smh, Benh ve mau; Benh tieu hda; Benh ho hap; Benh ve mat;
Benh da. Benh cd so tten bao hi^m thanh toan trung binh cho 1 IUdt dieu tri nhieu nhat ia benh he sinh due tiet nieu vdi 672.490 dong; tiep theo la benh ve ndi tiet, dinh dffdng, chuyen hoa,.,.
Bang 3.6. Phan bdlO nhdm binh dUdc Bao hiem y ti'ihanh toin npi tru nhieu nhai stt
1 2 3 4 5
Nhom benh theo ICD Benh ho hap Benh tieu hoa Benh tuan hoan Bu'du tan sinh, Benh ve mau
Benh xu'dnq Ithdp
So lu'dt 4.510 5.449 5.558 2.707 1.604
BHYT thanh toan 25.991.304.840 22.189.111.623 14.901.105.517 9.740.250.000 8.608.898.029
VIETMAM MEDICAL JOURNAL N°2 - APRIL - 2018 Ket qua bang tren cho thay so Iffdt benh nhan
va so tien bao hiem y te da thanh toan not tru cho 10 nhdm benh co so IUdng nhieu nhat tai benh vien da khoa tinh Nam Dmh nam 2016 lan lu'dt la: Benh ho hap; Benh tieu hoa; benh tuan hoan; Bffdu tan sinh, Benh ve mau; Benh xffdng khdp; benh he tiet nieu sinh dye; Benh ve mat;
Benh ve than kinh; benh npi tiet, dinh duSng, chuyen hda; Benh nhiem triJng va ky sinh trung.
Benh CO sd tien bao hiem thanh toan trung binh cho 1 IUdt dieu trj nhieu nhat la benh ho hap vdi mffc ehi trung binh la 5.763.039 ddng; tiep theo la benh xffdng khdp (5,367,143 dong); benh sinh due tiet nieu (4,412,045 dong).
Bing 3.7. Phan bd binh nhin theo khoa/phong diiu tri npi tru dUdc bio hiem y te ihanh toin.
Khoa Noi tonq hdp Nqoai tonq hdp
Chan thu'dng
So lu'dt 4.078 3.154 1.873
BHXH thanh toan 22.633.488.616 15.087.193.483 15.430.124.733 Ket qua bang tren eho thay so iUdt benh nhan va so tien bao hiem y te da thanh toan npi tnj eho cac khoa dieu tri. Trong do, 3 khoa c6 so tien bao hiem chi nhieu nhat la Noi tong hdp (22.633.488.616 dSng); Ngoai tong hdp (15.087.193.483 dong) va ehan thffdng (15.430.124.733). ' IV. BAN LUAN
Nghien effu dffdc thffc hien tai Benh vien da khoa tinh Nam Dinh la benh vien da khoa tuyen tinh vdi 37 khoa, phong (21 khoa lam sang, 9 khoa can lam sang, khoa dffdc va 7 phong chffe nang), nam 2016 chi tieu giao 800 giffdng benh, nguon nhan lUc cua Benh vien da khoa tinh Nam Dinh trong nhffng nam qua tffdng doi on dmh da giup cho Benh vten ed dieu kien ngay eang phat trien vffng manh. Ket qua bang 1 cho thay so lu'dng the dffdc phan bo cho benh vien da khoa tinh Nam Djnh cd xu hu'dng tang ten hang nam.
Tff 65812 the nam 2013 len 76548 the nam 2017. So Iffdng the tang ten se keo theo nhu cau kham ehffa benh tang cao dot hot benh vien phat khong ngffng cai thien ca ve nhan iffe va vat Iffc de dap uhg dffdc nhu cau eham soc va bao ve sffc khde nhan dan. Bang 3.2 cho thay Tong so tien kham benh, chda benh BHYT diidc phan bo cho benh vien da khoa tinh Nam Dinh nam 2016 la 12.777.611.300 dong. Tong sdtien kham ehffa benh BHYT tai cho la 52.827.177.500 dong. Tong so ben kham benh, chda benh da tuyen den la 119.122.092.600 dong va Tong so tien kham benh, chffa benh da tuyen di la 40.825.249.900 d3ng.
Nhff vay, tong so tien da tuyen den tat benh vien da khoa tinh Nam Djnh la rat Idn.
Ket qua bang 3.3 cho thay nam 2016 benh vten da khoa tinh Nam Dmh da kham chda b i n h cho 163.340 Iffdt benh nhan bao hiem y te.
Trong do, cd 160.772 Iffdt benh nhan kham chffa benh dung tuyen chiem 98,4% va 2.568 Iffdt benh nhan kham chda benh trai tuyen chiem 1,6%. Qua day cd the thay Bao hiem xa hot tinh Nam Dinh da lam kha tdt cong tac quan ly kham
ehffa benh cua ngffdi benh cd the bao hiem y te, tinh trang kham vffdt tuyen la rat ft.
TnDng nam 2016 benh vien da khoa tinh Nam Oinh da kham chuci benh eho 163.340 Iffdt benh nhan bao hiem y te. Trong do, c6 132.266 Iffdt benh nhan kham ehffa benh ngoai tru ehlem 8 1 % va 31.074 Iffdt benh nhan kham ehffa benh noi tru ehiem 19%. NhU vay, so iffdng benh nhan dieu tri ngoai tru la rat cao, dieu nay doi hdi benh vien can tru trpng dau tu' eho khoa kham benh de nang cao chat IUdng benh vien.
V. KET L U A N
- So Iffdng the bao hiem y te dffdc khoan cho benh vien cd xu hffdng tang qua eac nam.
- Hau het ngffdi benh den kham dung tuyen (chiem 98,4%).
- Ty le tienh nhan den kham ngoai tnj ehi§n 81%.
- Ba nhdm benh ducfe thanh toan bao hiem y te ngoai tru nhieu nhat la benh ve npi tiet, dtnh dffdng, chuyen hda; benh tuan hoan; benh stnh dye tiet nieu.
- Ba ntidm benh du'dc bao hiem y te thanh toan npi tru nhieu nhat la benh ho hap; benh tieu hoa; benh tuan hoan.
- Khoa CO so Hen thanh toan bao hiem npi tru nhieu nhat la khoa Not tong hdp.
TAI UEU T H A M KHAO
1. Bo Y te (2013), Bao cao chung tong quan nganh yte nam 2013.
2. Bgnh vien da khoa tinh Nam Djnh (2017), Bao cao tong ket cong tae benh vien nam 2015.
3. Ta Van Dat (2010), ThUc trang sff dung the bao hiem y te cua ngUdi dan tai 4 phUcJng/xa thanh pho Phu Ly, tinh Ha Nam, nam 2010, Luan van thac si y te cong cong, TrUcfng Dai hoc Y Th^t Binh
170
TAP CHi Y HOC VigT NAM TAP 465 - THAHG 4 - SO 2 - 2018 4. Le Thj Minh Hue (2014), Thi/c trang cong tac
r kham chij'a benh bao hiem y te tai Benh vien da F Wioa tinh Thai Binh nam 2014, Luan vin thai: sT y I t? cong cpng, TrUdng Dai hoc Y DUtJc Thai Binh..
5. Qu6c hoi (2014), Luat sci 46/2014/QH13 ve "Siia f. dot, bo sung mot so diiu cua Luat Bao hiem yte"
6. Ngan Do, Juhwan Oh, and 3in-Seok Lee (2013), Moving toward Universal Coverage of Health Insurance in Vietnam: Earners, Facilitating Factors, and Lessons from Korea, Korean Lessons fbr Universal Health Coverage in Vietnam,
DAC DIEM HINH A N H CHUP CONG HirCTNG TIT VA MOT SO YEU TO TIEN LUgNG 6" BENH N H A N NHOI M A U THAN N A O GIAI DOAN CAP
Vo Hong Khoi*, Le Van Thinh*, Dang Huy Du*
T6IVI TAT
Muc tieu: Mo ta dae diem hinh anh chup eong tiling" tff va mot so yeu to co gia tri tien lUpng nang d benh nhan nhoi mau than nao giai doan cap. Doi ti?cfng: Chung toi chpn 93 benh niian diidc chan doan la lihoi mau ttian nao giai doan cap tai Benh vien Bach Mai trong thdi gian tff tliang 7/2016 - 7/2017.
Phu'dng phap: Nghien cffu mo ta tien cffu, theo doi doc. Kei qua: Tren phim cpng hu'dng tff, vj tri ton thiAJng 6 cau nao chiem ty le 41,93%, ton tliudng d hanh nao chiem 25,81%, va eac vi trf ket hop la
;25,81%. Tren thi T l chu yeu la dong tin hieu (75,27%), so it ia giam tin hieu nhe; tren thi T2 ciiu .^u la tang tin hieu nhe (73,12%), dong tfn hieu
•(26,68%), tren xung FLAIR 100% tang tfn hieu nhe, quan tipng nhat la tren xung Diffusion thay 100%
lang tin hjeu. tuoi tren 60, diem hon me Glasgow tff 3 den 8 diem, diem NIHSS tren 20 diem, roi loan ho hap, roi loan nuot, liet nua ngu'di hai ben la nhffng y ^ to CO pia trj tien IUdng nang. K€t ludn: Chan doan hinh anh hoc va tien IUdng nhoi mau than nao giai doan cap luon la mot thff thach ]dn do cae trieu diutig va eae dau hieu rai thay doi, bieu hien hinh anh hoc da dang. Hinh anh chup eong hu'dng tff nao dong vai tro hit sffc quan trpng trorig ehan doan nhoi mau th3n nao. Diem hon me Giasgow^ dilm NIHSS, liet ni^ ngudi hai ben, rdi loan ho hap, roi loan nuot la nhijVig yeu to tien lu'dng benh nang.
Tdkhda: Nhoi mau nao, nhoi mau than nao giai doan cap, hinh anh cpng huSng tff va yeu to Wen IUdng.
SUIVIMARY
STUDY ON M R I CHARACTERISTIC AND SOME PROGNOSTIC FACTORS I N PAnENTS W I T H BRAIN STEM ISCHEMIC
STROKE DURING THE ACUTE PHASE Objecdve: To determine the MRI Imaging characterisdcs and some prognostic factors in patients with brain stem ischemic stroke during the acute phase. Subjects: We selected 93 patients with brain
*Benh viin Bach Mai
**Binh viin Da khoa Lang Sdn.
Chiu trach'nhiem chfnh: Vo Hong Khoi Email: [email protected] Ngay nhSn bai: 23.2.2018 Ngay phiin bien khoa hpc: 6.4.2018 Ngay duyet b^i: 13.4.2018
stem ischemic stroke in the acute phase at Bach Mai Hospital from July 2016 to July 2017. Methods: The prospective, longitudinal descriptive study. Results:
On MRI, pons lesion was the most common lesion, accounted for 41.93%. The figure for medulla oblongata lesion was 25.81% and for other combined lesion was 25.81%. On T l sequence, the same signal intensity was the most common (75.27%). On T2 sequence, the most common was slightly high signal intensity (73.12%), same signal intensity (26,68%), on FLAIR sequence, slightly high signal intensity accounted for 100%, and the most important was 100% high signal intensity on Diffusion sequence. Age over 60, Giasgow coma score between 3 and 8, NIHSS score more than 20, respiratory disorder, swalling disorder, two-sided paralysis, seizure, functional disorder of sphincter muscle were severe prognostic factors. Conclusions: MRI imaging and pnagnosls of brain stem ischemic stroke in the acute phase were due to various dinieal symtoms and signs, and imaging charactenstics. MRI imaging characteristics played an important role in acute brain stem ischemic stroke. Giasgow coma score, NIHSS score, respiratory disorder, swalling disorder, two-sided paralysis were prognostic factors in severity.
Key words: ischemic stroke, brainstem ischemic stroke in the acute phase, MRI imaging and prognostic factors.
I. DAT VAN OE
Tff nhieu the ky nay tai bten maeh nao (TBI^N) luon la van de thdi sff dffdc gidi y hpe het sffc quan tam, do ty le thffdng gap va tfnh chat nang ne cua loai benh iy nay, ty le tff vong do TBhlN dffng hang thff ba sau ung thffva benh tim, mat khac ty le mae TBMN ngay cang gia tang, chfnh vi vay day la van de luon thaeh thffc doi vdi y hpc. Nhoi mau than nao la mot trong nhffng benti ly cap effu than kinh do cd nguy cd tff vong cao hoae de lai di chffng nang ne. Than nao la khu vffe giai phau dae biet quan trpng nen khi xay ra nhoi mau than nao cac trieu ehffng iam sang thffdng rat nang ne, de dpa tff vong nhanh ehdng, kha nang phue hoi kem va da sd CO chi dinh dieu tri npi khoa [1].
Ky thuat tao hinh anh cpng hffdng tff ra ddi
