NHiNRATH£GI(3l
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T R E N T H I Qldl Uln
^ ThS-NCS. NGUYJN KHANG
TRUdNG P H O N G N G H I E N C U U D U B A O , V I E N KHOA HOC BHXH
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hUng nghiin eUu gdn ddy cho thdy, t r i em trong dp tuoi tU 10 din 18 chilm 18% ddn sd t h i gidi, da cd ty le t^ vong cao hon lUa tudi tU 1-10. Tri em d lUa tudi ndy Id giai doan phdt triln dac biet ve tam slnh ly va la lUa tudi nhay cdm vdi nhiJng cdi mdi, vdn di mdi (tinh ylu, kfch thfch tU nhOrng gidm gidc manh nhU rupu, bia, thudc la...). Dieu tra d My cho thay, t r i em trong lUa tudi dang di hoc ed tdi 26% hut thuoc la thudng xuyin tai trudng, trong do cd 7% da sU dung thudc Id cd chat hudng than, 41% da sti diing rupu bia. Chilng ta diu bilt, viec sU dung cac chat cd con va tiln chit hUdng thdn Idm dnh hudng Idn den nhdn thUe va phat triln the chdt cila t r i ; viec thieu hieu bilt v l sUc khde sinh sdn va eac binh Idy nhiem qua dudng tinh due, viec nghiin hilt, tai nan giao thdng, bao lUc hpe dudng, tram cdm do bien ddng tdm ly hodc do dilu kiln kinh t l - xd hdi Id nhUng tdc ddng xdu vd cd dnh hudng lau ddi din cudc sdng cila t r i emsau ndy.
Nhdm gidm thieu nhUng rCil ro v l mat sUc khde d l ddm bdo cho t r i trong li!fa tuoi hpe sinh dUpc eham sde sUc khde mpt cdeh ddy dil, mdt sd nUdc thUe hiln BHYT theo hp gia dinh, mdt sd quoc gia khac thUc hiln BHYT hoc sinh. SU lUa chpn md hinh ndo phu thupc vdo dilu kiln kinh te-xa hdi, t h i che ehfnh trt cung nhU cdc ylu td van hda cila tUng qudc gia.
Van d l dat ra la tai sao mdt sd nUde lai chpn md htnh BHYT hoc sinh thay vl md hinh BHYT theo hd gia dinh? Cac nghien cUu tren cUa Td chUc Y t l t h i gidi va cdc Viln nghiin cUu khde trin t h i gidi da chl ra rdng thue hiln BHYT hpe sinh mang lai Ipi fch cho cd bdn thdn cac em, gia dinh cdc em va cdxa hdinhUsau:
- Tham gia BHYT hpe sinh, t r i em cd ngudn tdi chfnh ddm bdo cho chdm sdc sUe khde ddc bilt hilu qud dil sUc chdng dd neu khdng may gia dinh hodc xa hpi dUng trUdc cac rui ro v l kinh t l , xa hdi, vi dij mdt
34 Tap chl BAO HIEM XA HOI kj' 01 thdng 8/2015
nghiin cUu tai Indonesia cho thdy tai thdi diem khiing hodng kinh t l todn cdu, sd lupt di khdm cCia tre em khdng cd BHYT tai cdc benh viln cdng gidm ddng ke trong khi nhdm t r i em cd t h i BHYT khdng gidm md cdn tang lln;
- Dupc tilp can vdi y te dti phdng hilu qud (khdm sUc khde djnh kjr, cham sdc rdng milng, tilmchOng...);
- Dupc tao khd ndng Ung phd vdi thay ddi v l hdnh vi, Idi sdng vd mdi trUdng thdng qua cdc chuong trinh tdng cudng vd nang cao sUc khde hpe dUdng;
- Ddgc dilu trj kjp thdi day dCi khi dm dau benh tdt xdy ra - Nghiin cUu mdi nhat d My edng bd ndm 2014 cho thdy, tham gia BHYT hoc sinh do Nhd nUdc to chUe, t r i em cd co hdi tilp cdn vdi djch vu chuyin khoa sdu va ky thudt cao cQng nhu viec dilu trj cdc benh mdn tfnh cao gdp ba tan so vdi t r i tham gia BHYT thuong m?i;
- Nhieu chuong trinh BHYT hoc sinh cdn hd trp cdc em phdt then cdm xUc, hoan thiln trf, the li/e; ddm bdo tilp can cdng bdng trong khdm, chOfa benh BHYT gdp phdn lam gidm bdt sUthilu tUtin eCia t r i trong cdc gia dinh cd thu nhdp khd khdn;
- Cdc bdc cha me dang kji cho con em minh tham gia chuong trinh BHYT hpe sinh yIn tdm cd v l tdi ehfnh vd tdm ly khi eon hp khdng may gdp phdi nhUng biln cd v l mdt sUe khde, gdp phdn giup cdc bac cha me t$p trung Idm vile vd theo dudi su nghilp cila minh.
TUgdc d$ xdy dUng vd qudn ly chUPng trinh BHYT, ngudi ta ludn quan tdm rdng mdt chuong trinh dupc thilt k l vd thuc thi nhU t h i ndo dupc gpi Id thdnh cdng. Nude My sCr dgng cde tilu chf sau:
(1) Sd cdi thi^n khd ndng nhdn thUc;
(2) Sd ngdy phdi nghl hoc;
(3) Sd ngdy ndm vi^n cd the phdng trdnh dupe (vf dg nhu tai
nan do van ddng, ede binh truyin nhiem...);
(4) T;^ I I tCfvong, Dua trin nhufng tieu chf ndy, mdt nghien cUu d My do gido su Julia tiln hdnh ndm 2014 cho thay kit qud kha rd ret nhU sau:
- Hpe sinh cd BHYT thudng khde manh hOn vd cd kit qud hpe tdp tdt hon. Nghiin cUu d My ctio thdy diln bao phu t r i em tham gia BHYT tang 10% thi tJ le luu ban giam 5% vd ty II trupt tdt nghilp pho thdng gidm tU 3- 3,5%.
- Hoc sinh cd BHYT ft dm dau hdn nin cha me hpe sinh cung it phdi nghl vile trdng con dm ddc bilt la cde t r i em dUdi 6 tudi.
- Ty II chit cita tre em lUa tudi hoc dudng gidm 3%, khi ty' II diln bao phU tdng 10%.
- Sd nam tham gia BHYT va hdnh vi sUc khde Idnh manh, hpp ly cd mdi tuong quan dUdng (sd ndm tham gia BHYT cd tdc ddng tdt din hdnh vi cham sdc sUc khde cOa cdc em hpe sinh vd cd tdc ddng ldu ddi).
Ddy Id mdt minh chiimg rd ret cho tfnh hilu qud cila chuang trinh BHYT hpe sinh, vdn van dupc dat nhilu cdu hdl nghi ngd v l tfnh hilu qud cda nd so vdt cdc chuong trinh BHYT khde nhu BHYT cdng ddng hay BHYT theo nhdm dan cU. Xin luu y rSng lpi fch tham gia BHYT hoc sinh thudng chl thdy dupe khi t r i cd qud trinh tham gia tdi thilu 12 thdng (ddi hdi tfnh liln tyc). Hpe sinh dupe tham gia chuong trinh BHYT thudng cd chi sd ndng lUc hdnh vi, khd ndng van ddng, khd ndng tdp trung trin Idp, khd ndng de thfch Ung vdi cdc hoat dOng cua nhd trUdng cao hon so vdi t r i em cila cac gia dinh khdng cho con em tham gia chUPng trinh BHYT hpe sinh. DUa trin nhUng ddnh gid hilu qud v l thye hiln BHYT toan liln bang, chuong trinh BHYT hoc sinh d My ddnh Uu tiln cho cdc ho^t dOng du phdng: khdm sUc khde djnh k^ tdng quat, tilm chilng,
NHlNRATHfGidn kilm tra thfnh life, kiem tra tht lUe, cdc djch vu kham sdng Ipc chdn dodn sdm, tu van sufc khde sinh sdn, sCif dung thudc Id, rUpu bia, sUc khde tdm thdn.
Tuy nhiln, tU chinh sdch den thue hiln ludn la mpt khodng cdch eho dU da cd nhilu c6 gdng vd no life cila cdc Chfnh phil trong thue hiln BHYT hpe sinh. NUdc My trien khai BHYT hoc sinh tU ndm 2009 theo cdi each cua Tdng thdng Obama hiln vdn edn khodng 05 trieu t r i em chUa dupe tham gia BHYT.
Di CO t h i thUe hiln tdt ehuong trinh BHYT lipc sinh, kinh nghiim qudc t l eho thdy rdng vdn ddng qua phuong tiln thdng tin dai chilng v l cac thdng tin chung cCia chuong trinh Id rdt can thilt nhUng quan trpng hem Id thdng dilp cy the eho cha me hoc sinh phdi din ddgc vdi ddi tupng nay. Thdng diep din tay cha me phdi Id ca quan hodc ngudi cd uy tfn: 40% cha me hpe sinh tai My mudn dUpc nhdn viln y t l tu vdn trudc khi tham gia BHYT tai eo sd y te hodc tai trudng noi con em hp dang theo hpe. Gdn 60% cha me hpe sinh tai My chl mudn nghe tU vdn true tilp Xii bdc sy cCia hp trUde khi quylt djnh tham gia BHYT hoc sinh eho eon em hp. Rdt nhieu ehuong trinh cho rdng nhdn viln tr^m y t l dja phUdng Id ngudn tilp cdn vd thuyit phyc hilu qud nhdt vdi cdc gia dinh trong cdng ddng cDa hp di vdn ddng tham gia BHYT. Thil tyc ddn gidn, cdn bp tilp nhdn hd so cdi md thdn thiln, den tUng nhd vdi ngudl cd uy tfn trong cdng ddng Id gidi phdp tdt d l duy tri vd tdng diln bao phli. Bin canh dd, cha me hpe sinh can dupc lam thd tuc ddng kjf cho con cOa hp bdt ciJf IUc ndo eung nhU thCi tuc tdi mua BHYT don gidn cung dUpc coi la quyln, ddng thdi Id biln phdp nhdm duytri tfnh dn dinh cCia quy BHYT hoc slnh.
Cdc nhd nghiin cUu qudc t l cQng eho rdng cd cd cp sd y te dat -http^/tapchibctfohiemxahoi.gov.vn 35
INHINRATH^GIOI t^i trudng dudi sy chl dao d i l u phdi, thdng nhdt hdnh d d n g cua CO quan qudn ly y t l ^ a phucmg t h i hi$u qud chdm sdc sUc khde cho cdc em tdng l l n rd r i t d^c b i ^ vi^c theo ddi, t r p giup cdc em mde cdc b^nh man tfnh, cd vdn d l sUc khde tdm thdn, h^n c h l sCf d y n g rupu bia-thudc Id, gido due silc khde sinh sdn cho cdc em trong dO t u d i t U 10-18 tu6L Tuy n h i l n , cdn luu y rdng, hpe sinh lijta tudi 10-18 s l cd xu hudng tCr chdi sijf d y n g djch vy y t l n l u chilng ed cdc vdn di y t l l i l n quan d i n cdc vdn di nh^y cdm nhU cdc b^nh Idy n h i l m qua dudng tinh due hodc cd thai ngodi y mudn n l u edn bd y t l / h$ thdng y t l khdng tdn trpng vd ddm bdo bf mdt thdng tin cd nhdn cho cdc em.
Bdi hpe tii cdc nudc phdt trien cho thdy chupng t r i n h BHYT thudng dupe cdc nhd qudn 1^ y t l , qudn l|^ gido due vd coquan BHYT t h i l t k l khd ddng nhdt md chua cd sy khde bi^t giUa cdc lUa tudi, cdc mdi trudng khde nhau. Thdng k l cho thdy, d lUa tudi hpe sinh t i l u hpe thi cdc b$nh v l hd hdp, ngO d$c thyc phdm, ede b^nh ngodi da c h i l m tdi hon 90% sd lupt phdi xU t r i trong khi d lUa tudi tU 10 d i n 18 l^i Id nhiJmg vdn d l v l v$n ddng, sUc khde sinh sdn, sUc khde tdm thdn. Chi phi cho chUPng trinh y t l hpe dudng cCia hoc sinh t r u n g hoc p h d thdng 6 My cao gdp hon 2,5 Idn so vdi hpe sinh t i l u hpe. Do vdy, k h u y i n cdo cOa cdc n g h i i n cUu gdn ddy cho rdng, edn ed su khde b i | t trong t h i l t k l chUdng trinh BHYT cho phCi hpp vdi tdm sinh ly cila cdc em hpe sinh cung nhU svr phdi hpp gJCfa nhdn v i l n y t l nhd trudng vdi cha me hoc sinh vd cdc em cdn chua tU b i l t qudn ly van d l sUc khde cda minh n h u nhdc udng thudc tai trUdng, hudng ddn v$n d ^ n g ddng cdeh, hda nh$p vdo cdc ho^t d d n g tap t h i (qudn ly hpe sinh cd vdn di ve sUc khde tdm t h d n . . . ) , nhdm Idm tdng hi^u qud can t h i l p dieu trj tii gdc dd c h u y i n m d n y t l cho
cde em cung n h u tao co sd cho vlec xay dUng ke hoach tai chinh cho chuong trinh.
Ve p h u o n g dien tdi chinh, nguon Quy BHYT dong gop mpt phan quan trpng ho trp cdi thien mdi t r u d n g sUc khde va hoat dong sUc khoe tai nha trudng tuy nhien ngudl ta van cho rdng hoat dpng nay can dua chu yeu vao nguon ngan sach Nha nudc (ngan sach trung uong va ngan sach dia phuong) de ddm bdo hoat dpng nay la thudng xuyen, on djnh, t h o n g nhat vdl cac chuong trinh sUc khoe quoc gia.
Ngoai ra, sd ilng hp cda cac nha hdo tam dja phuong cung la mdt trong nhCfng yeu t d quan trpng thuc day dien bao phu BHYT hoc slnh tai dja phuong.
Cung vdl chuong trinh BHYT theo hd gia dinh, BHYT hoc sinh la mot cdng cu hUu h i l u gdp phan thuc hien muc tieu tien tdi BHYT toan dan. BHYT hoc sinh khong chi dUng lai n h u m p t chuong trinh BHYT don thuan ma
nd thuc chat mang lai lpi Ich cho cac em, gia d'inh cde em, cdng dong va toan xa hpi cd ve phuong dien tdi chinh cung nhu hanh vl cham sdc sUc khde, mang lai su cong bdng trong tlep can djch vy y t e cho con em cua moi giai tang trong xa hpi. Oe co chuong trinh ngdy cang hieu qud, ben canh vlec ddm bdo nguon kinh phicdn cd nhUng nghien cUu thau ddo ve chuang trinh BHYT cho phu hpp vdi nhu cau cua tUng cap dO giao due cung n h u tUng ddi t u o n g hoc slnh sao cho chuong trinh BHYT hpe slnh that sU Id chuong trinh tin cay cho mpi gia dinh hoc s i n h . *
T i i Il4u tliam kl>io Health for World's Adolescents A second chance in the second decade Why Do School Aged
Children Need Health Insurance?
Washington, DC 20043
The Impact of the Children's Health Insurance Program (CHIP): What Does the Research Tell Us? J u l ! 7, 2014 | Julia Paradise
School-Based Health Centers In an Era of Health Care Reform: Building on History, 2012.
HUTA HEN...
h u y i n vUa vdt vd, vUa cd cdm giac nom ndp, cang thdng lo khdng dat chi tieu. Vdi su kien tri, quyet l i l t cila BHXH h u y i n , i i l n tyc qua cac nam, nhan thiJc, su vdo cudc cda cdc co quan, trudng hpe tren dja ban da chuyen b i l n m d t each tich cue. Den nay, cd t h i khdng d i n h , CTng Hoa da dan xay dUng dupe nen nep thUc hien BHYT hoc slnh den hdu het cac trudng hpe, cac phu huynh hpe sinh. Tuy n h i l n , khi chia s l ve k l hoach thuc hien BHYT hoc sinh nam hoc 2015-2016 tdi day, Giam ddc BHXH huyen vdn kha lo ldng d u da lien tuc cd dupc thanh tich t d t trong cac ndm trUdc. MUc d d n g BHYT hoc sinh tang len, d d id khd
(Tiip theo trang 3 V
khan thdy rd nhdt. Di vupt qua thdch thUc, bdi hpe kinh n g h i e m t h u c hien cdc ndm trUdc se dUpc phdt huy triet d l , h i l n BHXH h u y i n da chCi d0ng sdm CO van bdn hUdng dan cdc trudng v l quy djnh thu BHYT hoc slnh cua nam nay. K l hoach thuc h i l n tham mUu, phdi hpp, t d chUc hdl nghj cung da sdm dUpc chudn bj ehu dao, bdi bdn. Trudc d d , ngay t r o n g nhUng ngdy ddu thang 07/2015, da cd mpt sd t r u d n g gpi dien hdi v l k l hoach thuc h i l n thu BHYT hpe sinh nam hoc ndy, tfn h i l u vui cho mpt "mua" BHYT hoc sinh mdi thanh cdng, giO vCtng vj t h i Id ddn vj thUc hi^n h i | u qud t r i n dja bdn Thd dd.B
38 Tap chl B A O HlilW X A Hdl k^ 01 th^ng 8/2015
