Tap chi Khoa hpc Nghen cuu Sic khde vd Phdt triin (Tpp 04, So 01-2020) Joumal ofHealth and Development Studies (Vol.04, No.01-2020)
BAI BAO NGHIEN C t U GOC
Thirc hifn quyen an sinh xa hdi ve kham chiia benh cho n g u ^ dan thong qua hoat dong cong tac xa hgi 6t A^et Nam hien nay.
Nguydn Thi Kim Hoa'*, Nguyen Thi Lien^
Myc tieu: Mo ta thuc tr^ng thuc hifn quyen an sinh xa hpi ve kham chira bfnh ciia nguoi dSn thong qua hogit dong c6ng t i e xa hpt (CTXH).
Phmrag phap nghien clhi: Thiet ke cat ngang mo t i . Nghien curu dupc thvre hifn tai 7 tmh Ha Npi, Quang Ninh, Hoa Binh, Da NEng, B i n Tre, Ddk Ldk va thanh p h i H6 Chi Minh, tii thing 6/2018 d i n thing 5 nam 2019.
Kit qua: Kit qua nghien cijru cho thiy v€ quyen dupc h6 trp dieu dudng, cham soc sue khoe hoEit dpng cong tac xa hfi ndi bat nhit la tuyen tniyen chinh sich va bifn hf chinh sich la boat dpng dupc sur dung vcri ty le thip nhdt. Ve quyen dupc ho trp tiem chimg nguta bfnh, ho9.t dong dupc chii trpng nhieu nhdt cCing la tuyen (ruyen chinh sach va thap nhat la hoat dpng ho trg chuin bj ho sa chinh sach. Ve quyen dupc ho trp chi phi di€u tri, kham chiia benh, hoat dpng chii dao l i tuy€n truySn va tu vin chinh sach, ho^t dong it dupc thuc hien nhit la k^t n6i ngu6n lyx; ho tro. Ve quySn dupc c4p the b i o hiem y t£ (BHYT) mien phi, ho^t dpng dupc thuc hifn voi ty If cao nhat van la hoat dpng tuyen tniyen chinh sach va t h ^ nhat la ket n6i nguon lye h5 trp.
Ket lu^n: Tijr cac can thiep va su trp giiip ciia CTXH, nguin dan co the tiep c|ui va thuc hien quyfin khim chiia bfnh ciia minh. Nha nu6c cin co r i sodt va b6 sung c i c van ban luat, chinh sich, chuang trinh, djch vy ve y te de mpi ngucri dan dupc tiep csin va thy huong dich vu. Trong thai gian toi can day manh han nua sir tham gia cila CTXH trong vifc thiic dSy thuc hifn quyin an sinh xa hpi (ASXH) ciia nguai dan trong cf ng dfing n6i chung va trong c i c ca scr y te n6i riSng.
Tu- khoa: quy^n an sinh xa h6i, k h i m chua bfnh, thuc hifn, CTXH chuySn nghifp.
DAT VAN DE
Cong tac bao vf va cham s6c sdc khoe eda ngudi dan l^ mOt ttong nhiing nhifm vu quan trong, uu tien hang dku eua Dang, Chinh phu, cae eSp chinh quyen va can s\r tham gia cua moi ngudi dan, d^c biet l^ nhung ngudi tham gia tiong linh vuc y te va nhung ngirdi dam nhiem cong tae cong tac cham soc va bao vf sdc khoe nhan dan.
Nghj quySt s6 15/NQ-TW ngay 1/6/2012 cua Ban Chdp hanh Trung uong khda XI
* Bia chi Hin hf: Nguyin Thj Kim Hoa Email: kimhoaxhh®.vahoa. com ' Tnrang DH Khoa hpc Xd hpi vd Nhdn van
• Truang DH Lao dpng Xa hpi
m6t s6 v^n d^ v6 chinh sach xa hoi giai do^n 2012-2020 dh ra muc tieu din nam 2020, CO ban bao dam an sinh xa hgi toan dan, bao dam mdc tdi thieu ve y tl cho ngudi dan. Tuy nhien, vi nhiiu Iy khac nhau ma mpt b6 ph^n ngudi dan vln chua duoc tiep can va thi^ hudng cae chinh saeh, chuong trinh, dich vu y tl, trong dd eo quyen kham chua benh. Do do hp ikt ein dugc sir trg giup thdng qua boat dong CTXH noi rieng va cae hogt dong ciia cae nganh ngh6 khae noi chung. Trudc b6i canh dd. Dang va Nha
Ngay nhgn bdi 14/01/2020 Ngdy phdn bi^n: 09/3/2020 Ngdy ddng bdi. 24/312020
Nguyin Thi Kim Hoa vd cgng s|r Tgp eh.
nude ta da ban hanh de an 32 ve phat triSn ngbl CTXH giai doan 2010-2020, nh4m tao nln tang co ban cho viec cho tiien khai cac hoat dgng CTXH trong bfnh vien. Bo y te da ban hanh Quylt dinh s6 2154/QD- BYT ng^y 15/7/2011 phe duyet "Dl an phat triln ngbl CTXH trong nganh y tl giai doan 2011-2020" hudng din muc tieu hinh thanh va phat triln nghi CTXH trong nganh y tl, gop phan tang cudng chat lucmg, hieu qua eua su nghiep bao ve, cham soc va nang cao sdc khoe nhan dan. Din nam 2015, Bo Y te tilp tuc ban hanh Thong ta s6 43/2015/TT- BYT quy dinh vl nhiem vu v^ hinh thuc to chuc thuc hifn nhiem vu CTXH cua bf tta vifn, tiong do quy dinh ro nhifm vy hd trg, tu vdn giai quylt cac van de ve cong tac xa h^i cho ngudi benh va ngudi nha ngudi bfnh tiong qua trinh kham bfnh, chua benh vv... Cac van ban tien da dugc cac co quan ehdc nang trien khai rgng trong cac ea sd y te v^ ngoai cgng dong.
Thong qua bai viet nay, itaom nghien cdu mo ta thuc ttang ta\rc hifn quyen an sinh xa hgi ve kham chua benh cua ngudi dan tadng qua boat dOng cong tac xa hoi. Tu cac boat dgng cua CTXH nhu ta van chinh saeh, bien hg chinh saeh, h6 tig chuan bj ho so va ket noi cde nguon lire w... ngudi dan c6 the tiep can va thuc hifn quyen kham chua bfnh ciia minh mgt each hifu qua.
PHLTONG PHAPNGHlfeN ClTU Bai vilt d\ra tien ket qua khao sat xa hgi hgc cua de tai cap Nha nude, Ma sd KX.Ol .36/16- 20 ve "Thuc hiin quyen an sinh xd hgi ciia ngu&i ddn thdng qua hogt dgng CTXH chuyin nghiep & Viit Nam hiin nay" do nh6m nghien
' -wisa f.Mc .-.sr..iv. i-_^ ^_-L ,>,-•'. >„ ,, - "_ '"•_ - - j , Joumal of Health and Development Studies (ybl04. rto"' "
cdu frudng Dgi hgc Khoa hgc Xa hgi va Nhan van (DHKHXH&NV) va mgt s6 tiirdng, ca quan khac ph6i hgp taye hifn.
Thiet ke nghi§n cuu: Thilt kl c^t ngang m6 ta .
Dia dilm, thdi gian: Dl tai dugc thuc hien tai 7 tinh/thanh ph6, do la Ha Ngi, Quang Ninh, Hoa Bind, Da Ning, Bin Tre, Dak Ldk va taanh phd Hd Chi Minh, tiit 4/ 2018 din 5/2019.
Doi taong nghien cdu: Ngudi dan dang sinh song tai 07 tirta da duge chgn vao nghien cdu taugc Ha Ngi, Quang Ninh, Hoa Binh, Ben Tre, Da Ning, Dak Lak va thanh pho Ho Chi Minh. Ngudi dan duge lira chpn tham gia frong nghien cdu la nhiing ngudi yeu tae, bao gdm: Ngudi ngheo, can ngheo, ngudi khuylt tgt, ngudi mac bfnh hiem ngheo, ngudi c6 cong vdi each mang. Nghien cdu logi tid nhung ngudi dan la ngudi giau c6 v^ nhihig ngudi ed van de ve sdc khoe tam thdn. Dfii tagng nghien cdu dugc thdng bao tiirdc vl muc dich cua nghien euu, cac boat dgng se tham gia (tra Idi phieu hoi, phong vdn sau) va tu nguyen tham gia nghien cdu.
Co mlu, each chgn mSu: Tai moi tinh/
thanh, dl tai lira chgn 02 quan/huyfn va m6i quan/huyen lira chgn 01 xa/phudng dl tiln hanh khao sat. Cd mlu khao sat cua dl tai la 2.100 ngudi dan. Vifc lua ehpn tinh/
thanh ph6 ya quan/huyen eo tinh din eac dja ban da triln khai nhiiu hogt dgng nhu tSp huan, hgi thao va tuyen tiuyln vl CTXH Xa/phudng dugc ly:a chgn la co can bg tit nghifp chuyen nganh CTXH Iam can bg van boa xa hgi, hp nam chde cac van ban, chinh sach va thudng xuyen ho frg cac d6i'taong cua CTXH.
Tgp chi Khoa hpc Nghien cuu Sic khde vd Phdt tnin (Tgp 04, S6 01-2020) Joumal ofHealth and Development Studies (Vol.04, No.OI-2020) Bdng 1. C o c^u mau khao sat tai 7 tinh/thanh ph6
STT
2 3 4 5 6 7
Tinh D5k U k Quang Ninh Hoa Binh Ha Noi TP H6 Chi Minh Da Ning Ben Tre
Huyfn, xa Xa Yang Tao, Huy^n Lak Phuang Tan Lap, Tp.Buon ma Thuot Phucmg cam Binh, Tp.Cam Pha Phuang Hong Gai, Tp.Ha Long Xa Du Sang, huyen Kim B6i Xa Yen Lap, huyen Cao Phong Thi tran Van Dinh, huyen U"ng Hoa Phuang Lien Mac, Quan Bac Tir Liem Phuong Phii Trung, QuSn Tan Phu Phuang 6, Quan 5
Phuang Thanh Khe Tay, Quan Thanh Khe Phuang Nam Duang, Qu|in Hai Chau Phuong Ph6 Khuang, TP BSn tre Phucmg 6, TP Ben Tre
Tong Chung
So lurnig ngiroi dSn 150 150 150 150 150 150 150 150 150 150 150 150 150 150 2100
D^o due nghiSn cuu
Trude khi thue hien khao sat ngudi dan hay nhan vien CTXH, dilu tra vien d i u giai thich day du, ro rang y nghTa cua hoat dpng khao sdt, cam ket gift kin thong tin ca nhan cua ngudi dugc h6i, td d6 huy dOng su tham gia ti; nguyfn cua cdc b8n.
Ky thuat, cong cu vk quy trinh thu thap so lifu: Bg c6ng eu bao gdm bang hoi da dugc sd dung dg thu thap s6 lieu d 07 tinh/thanh. Tgi moi tinh/thdnh p h i da to chuc toa dam vdi Sd lao dgng thuang binh xa hgi, tiong do c6 npi dung v l hoat dpng CTXH thuc hien quyen an sinh ve cham soc sue khoe. Doi vdi ngudi dan tgi moi xa/ phudng lap danh sach theo to khu pho va taon xom, chpn 150 ngudi dan theo bude nhdy K. Dieu tia vien la to trudng ddn pho/tnrdng thon hogc can bg hpi phu nft dieu tia 10 ngudi trong to/thon cua minh fren ca sd da dugc tgp huan dilu tra vien. Thong tin thu dugc dam bao khach quan va du do tin cgy.
Phmmg phap thu thap so lifu: phong van true tiep ngudi dan taeo bg cau hoi duge taiet ke san v l mgt so yeu to lien quan den ta^c trang thirc hifn quyin khdm chua bfnh cua ngudi dan (nhan khdu hgc, tadi, gidi tinh, ngbl nghiep...).
Xd Iy va phan tich so lieu: Cac s6 lifu dupe kilm ti^ ma boa, nhap hfu bang phdn mem Epidata phi6n ban 3.1, dupc lam sgch tiirde khi nhap hfu v a x d l y taeo chuong trinh SPSS 16.0.
K E T QUA NGHIEN CUtJ
Quyin ASXH vl kham chua benh thuc sy la mot trong nhung quyin quan trgng va la bifn p h ^ cdu canh dii vdi ngudi dan, nhdt la doi vdi cdc nhom ngudi khuylt tdt, ngudi cao tiioi, ngudi ngheo/can ngheo, w... trong cac trucmg hpp doi mat vdi riii ro Im dau, benh tat cho ngiKri dan; dong tiidi ciing tao tdm ly yen tam hon eho ngudi dan trong qua trinh dilu trj bfnh tat. Chinh vi thi, cac iJian vien CTXH chuyen nghifp, ban chuyen nghifp vd khong
Nguyen Thi Kim Hoa vi c§ng stf
Joumal ofHealth and Development Studies (Vol 04. No.O'
chuyen tieh cue thirc hifn, tiong do tj^ tmng nhiiu Cae hogt dgng h6 frg ngudi dan tauc hifn quyen vao eong tac h6 frp edp the BHYT miln phi va bd ASXH vl kham chua bfnh taong qua hogt dgng tep ngudi dan tiem chung ngua bfnh. CTXH dugc tai hifn ro net qua cdc bang dudi ddy
Bang 2. Quyin duoc ho trg- dieu dudng, cham soc sue khoe
Hoat d$ng CTXH Tuy6n truyen chinh sach
Tu van chinh sach Bien ho chinh sach Ho trg chuan bi ho sa chinh sach Ket noi ngudn l\rc h6 tro
Khac
Ha Ngi N=300
3,3 11,0 5,0 4,3 5,3 0,0
Quang Ninh N=300
14,7 17,3 5,0 3,3 3,7 3,3
II I
28,7 11,7 2,3 4,7 5,7 0,7
S4 Ning N=300 14,0 8,7 1,3 4,3 2,3 1,0
TP HCM N=300 9,7 5,3 3,0 1,0 0,7 0,0
Ben Tre N=300
28,0 7,3 1,7 3,7 1,0 0,0
Ball Lii<
N=300 17,3 10,0 6,0 6,7 7,3 1,0
Tong N=2100
16,5 10,2 3,5 4,0 3,7 0,9
Trong s6 2100 nguoi dan duoc khao sat, ket qua tai bang 2 cho thay phan Ion hoat dong tuyen truyen chinh s4ch ducfc thuc hi$n kha t6t (16,5%) tiep dSn la hoat dong tu v§n chinh sAch ciing co ty le kha cao (10,2%), thap nhat a kSt qua chung ciia 07 tinh la hoat dong bien ho chinh s4ch va hoat dpng khac (3,5 % va 0,9%).
V6i hoat dong tuyen truyen chinh sach dia phucmg CO ty 1^ cao nhat la Hoa Binh (28,7%) va thip nhit la TP. H6 Chi Minh (9,7%), hojt dong ket noi nguon l\rc cung c6 ty le thdp (3,7%), a boat dpng nay TP. H6 Chi Minh la thanh ph6 co ty le thap nhjt (0,7%) va cao nhit laD5kLSk7,3%.
Bang 3. Quyen dirprc ho t r g tiem chiJng ngira b^nh
„ , j ^ . . Qnang Hoa D i TP Ben Djk Hoat dpng CTXH ° ' " Ninh Binh Ning HCM Tre Laii ^ ^ " ^
N=300 N=300 N=300 N=300 N=300 N=300 ^"'^^^
Tuyen truyen chinh sach
Tu van chinh sach Bi$n hO chinh sach Ho tn? chuan bi ho sa chinh sach Kit nii nguon luc ho tri?
22,3 24,3 64,7 27,7 29,0 18,7 22,3 17,0 14,0 9,7 4,0 3,3
7,0 2,0
4,0 3,7 4,7
1,0
6,3 37,7
1,0 7,0
0,7 0,0
33,7 31,0 21,3
7,7 8,7 7,3
17,0 5,9 4,0
,.^__ _, Tgp chi Khoa hpc Nghiin ciu Sic khde vd Phdt trien (Tpp 04. S6 01-2020) Joumal ofHealth and Development Studies (Vol.04, No.01-2020)
Bang 3 vl quyin dupe tiem chung ngda bfnh ty le thdp (4,0% vd 4,4%). Hogt dgng tayfin cho thdy hogt dgng hfi frg chudn bi hd so truyin chinh sach vdn la boat dgng chilm ty chinh sdch va kit ndi nguin lire h6 tig ehilm le cao nhdt (31%).
Bdng 4.Quyln &tr^c ho trijr chi phi dilu tri, kham chira benh
Hoftd$ngCTXH TuySn truyin chinh sdch
Tu van chinh sdch Bien hp chinh sach Ho trp chuin bi h i sa chinh sach Ket noi nguon luc h5 trp
Khac
Hii NOi N=300 10,3 29,7 17,0 9,0 11,7 1,3
Quang Ninh N=300 21,0 18,0 9,3 2,0 3,7 5,7
H6a Binh N=300 58,3 23,0 5,7 10,7 10,0 1,7
Da Ning N=300 29,3 11,0 2,3 4,0 4,7 2,3
TP HCM N=300 9,7 6,3 2,3 2,3 0,3 0,0
Bin Tre N=300 28,7 8,0 1,0 1,7 1,7 0,0
Dik Lik N"300 22,7 13,7 5,3 11,0 7,7 0,7
Ting N=2100 25,7 15,7 6,1 5,8 5,7 1,7
Quyin dupe ho frg chi phi dilu tii, kham Chi Minh. Hogt dpng ket noi ngudn luc ho chua bfnh bang 4 cho thdy vdi boat dgng frg, chudn bi ho sa chinh sdch cd ty If taang tayen trayin ehinh sach tinh cd ty le cao nhdt duong (5,7% va 5,8%).
la Hoa Bmh (58,3%) va thdp nhdt la TP. H6
Bang 5. Quyen duwc c^p the BHYT miln phi
Hoat dOng CTXH Tuy^n truyen chinh sach
Tu van chinh sach Bien hp chinh sach Ho trp chuan bj ho sa chinh sach
H i NOi N=300
8,3 25,3 15,3 2,7
Quang Ninh N=300
20,3 16,7 8,3 9,7
H6a Binh N=300 70,0 26,3 7,0 17,7
Da Nang N=300 26,0 16,0 2,0 7,3
TP HCM N=300 12,0 5,7 1.7 3,0
Ben Tre N=300
36,7 11,0 1,7 7,0
Dik Lik N=300
30,7 15,3 7,3 12,7
Ting N=2100
29,1 16,6 6,2 8,6 Ket noi nguon l\rc ho
trp 10,0 1,0 12,7
5,0
5,7
0,0 0,7
5,8
Nguyin Thi Kim Hoa vd cgng sp Tgp chlr
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Q[ia ket qua tai bang 5 cho tady ty If boat dgng tayen tmyen ehinh sach van dgt ty If cao nhdt frong s6 cdc boat dpng (29,1%), hogt dgng bifn hp chinh sach va ket noi nguon Iuc eo ty le tiidp va d mdc taang duang (6,2% va 5,8%).
BANLUAN
Kit qud khao sat d 4 bang tien da tai hien cd su taong ding trong each thuc thuc hien cdc nghiep vu CTXH h6 tip ngudi dan tiep can ea 4 chhih sach h6 tig thuOc quyen ASXH ve kham chiia bfnh (gim: H6 tig chi phi dieu tii khdm chua bfnh; Dieu dudng, cham soc sue khde;
Tiem chung phdng ngda bfnh; Cdp the BHYT mien phi). Trong do, ca 3 nhom nhan vien CTXH chuyen nghiep, ban chuyen nghiep va khong chuyen deu uu tien tauc hien cac nghiep vu tayen tmyen, ta vdn ehinh sdch vdi ty If eao nhat tiong cd 4 quyen kham chiJa bfnh cua ngudi dan 16,5%, 31%, 25,7% va 29,1% w....
Thue tl, hogt dpng dilu tri, khdm chua bfnh thi h6 trp quan frgng va can thiet nhdt ddi vdi ngudi dan la ket noi nguon luc ho trg; giup hg bien hp chinh sach va chuan bj ho so de nghi hudng cac trg giup lien quan den kham ehiia benh. Tuy nhien, nhiing each thde ho trp nay van cdn chua dugc chu y dau ta nhieu trong so hogt dgng CTXH. Ty If nhdn vien eung cdp eac dich vy ho trg thong qua CTXH chuyen nghifp ^ dung cac phuang phdp ho trg taong qua 3 nghifp vu CTXH (kit nil nguin lire h6 tip; bien hg chmh sach va chudn bj h i so chinh sach) nay va ty le ngudi dan nhan dugc h6 trg taeo 3 each tauc ho tra nay diu d mdc rat tadp (dudi 10%) d cd 4 chmh sdch h6 tig taupe quyin nay.
v l quyen duyc ho trgf dieu dudng, cham soc sue khoe
Duge ho trg dilu dudng, cham sdc sdc khde la quyin cua moi ngudi ddn, dieu nay da phan nao dugc d l cgp din tiong cac van ban Lugt
Joumal ofHealth and Development Studies (VoL04. N0.<"
eua nude ta nhu Luat bdo ve sue khde nhan ddn, Luat so 21 LCT/HDND 8, ban hanh 30/6/1989 (Dilu 1 va 2, chuang 0 ( 0 , Luat kham bfnh, chua bfnh (So 40/2009/QH 12, du tado s6 02/2019 sua dii Luat so 40) (3).
Trong do eae doi tagng ngudi ngheo, cgn ngheo, ngudi khuylt tgt, ngudi mdc benh hiem ngheo vd ngudi c6 cong vdi edeh mang w . . . Id nhom ngudi ddn dugc uu tien vd quan tam frong Luat vd chmh sach eua nude ta. Quyen dugc h6 frg, dilu duang da duge thuc hifn vdi ty If eao nhdt taong qua boat dgng tayen tmyen chinh saeh va ta vdn chinh sdch (16,5%
va 10,2%), hogt dgng bifn hg ehlnh sdch co ty le thdp nhdt (3,5%). Sd dT hai hogt dpng tay&i tmyen va ta vdn chinh sach dupe tauc hien kha tot do day cung la eac hogt dgng thudng xuyen frong cong viec cua NVCTXH, hai hoat dgng nay eung kha de khi tri&n khai frong thue te, con boat dgng bifn bg chirta sach it dupc chu y thuc hien ban vdi NVCTXH bdi thuc hien no doi hoi NVCTXH phdi dau ta khd nhiiu tadi gian vd cong sdc, cdn co su quylt tam cua ngudi dan vd sy taam gia cua nhiiu bSn lien quan frong qua trinh bifn hg.
Ve quyin du^fc hS trgf tiem chung ngua bfnh Quyen duge h6 ttp tiem ehiing ngua bfnh cung la mgt frong so eae quyin v l cham soc sdc khoe cua khong chi nh6m ngudi y l u thi ma cua toan dan, hogt dgng tayin tiuyln chmh sdch van chilm ty Ie eao nhdt frong s6 eac hogt dgng CTXH h6 frg ngudi dan thuc hien quyin nay (31,7%), hogt dpng chudn bj ho so ehinh sdch va kit n i i nguin l^c h6 tip e6 ty If thdp va d mde taang duong 4,0% yd 3,7%. Nghien cuu cua Nguyin Thi Van va cpng SV (2016) (4) cho thdy bd con dac bift la phu nu mang taai d ndng tiidn va miln nui (phy nu taupe hg ngheo. can ngh^o, khuylt tgt) tiiudng khong di tiem chung ngfta benh do dnh hudng phong tyc tap quan, sue khde va thilu thong tin. Do vgy rat cdn c6 ho
Tgp chi Khoa hgc Nghiin ciu Sie khde vd Phdt triin (Tpp 04. SS 01-2020) Joumal of Health and Development Studies (Val.04. No 01-2020) dOng tmyln thong nang cao nhan thde cua
ngudi ddn frong tiem chiing ngda benh.
v l quyin dugrc ho trgr chi phi d i l u tri, kham chira bfnh
"Mpi ngudi khi 6m dau, bfnh tdt, bi tai nan dupc kham bfnh, chda bfnh tgi cac ca sd kham benh, chua bfnh d nai eong ddn cu tid, lao dpng, hgc tap" dilu ndy da dupc quy djnh ro tiong Dieu 23, chuang IV eua Ludt Bdo ve sdc khoe nhan dan. (Lugt s6 21 LCT/HDND 8, ban hanh 30/6/1989) (1). Tgi Dilu 3, chuang 1 cua Luat Kham bfnh, chua benh (3) neu ro uu tign kham ehua bfnh vdi ngudi khuyet tgt ngng, ngudi eo cong vdi cdch mgng...va tai dieu 4, muc 1 ciia chuang nay co neu nha nude danh ngdn sdch (chi phi dieu tii) cho viec cham soc sue khoe dii vdi ngudi c6 c6ng vdi cdch mang, ngudi ngheo w . . .ddy deu la nhom doi tagng taam gia nghien cuu. Thuc te nhdm ngudi yeu thi gap nhiiu khd khan, rao can tiong vifc tiep can cac dich vii y te va dugc ho ttg chi phi dieu tri, kham chua benh, do do boat dgng tayen tmyen, ta van ehinh sach cho nhihig ngudi yeu thi da dupc eae nhan vien CTXH ehu tipng tiiue hien (25,7% va 15,7%).
Vdi eac boat dpng bien hg ehinh sdch, ho tig chudn bj ho so chinh saeh va ket ndi nguon l^rc h6 frg cung dugc chu trpng nhung ty If thdp hom, Ian lugt la 6,1%, 5,8% va 5,7%. Cac hoat dgng nay c6 ty If thap ban mOt phan do kh6ng nhiiu dii tagng co mong muln va nhu cdu tairc hien bien hg. Yiec ket noi nguin lue ho tig eiing Id hogt dgng kho thuc hifn hon so vdi hogt dpng tayen truyen va ta vdn chinh sdch bdi tinh chdt cong viec va quy thdi gian ciia nhan vien cdng tde xa hpi eung nhu su sin sang tham gia eua cac co quan lien quan trong thyc hien quyen nay cho ngudi dan.
Ve quyen dirg-c cdp the BHYT m i l n phi Ngudi dan tham gia khao sat (thuge nhung nhdm ylu thi nhu ngudi ngheo, ngudi khuylt
tat, ngudi co cong vdi each mang...) dugc nha nude edp the BHYT miln phi hoac ho frg mua the BHYT vdi nhiing hp gia dinh can ngheo, dieu nay da dupe quy djnh ro tgi Khoan 3 va 4, Dieu 12 Luat 2008, sua dii b l sung tai Lugt bao hiem y t l 2014 (2). D I ho tip ngudi dan thyc hien quyen nay, nhan vien CTXH taong qua 4 hogt dpng chinh frong do boat dgng tayen tixiyen, ta van chinh sdch dugc ddy manh vdi ty If cao (29,1% vd 16,6%). Td nhung hogt dgng nay quySn dugc cap the BHYT mien phi ciia ngudi dan da dugc thyc hien khd tot (44,6%). Tuy nhiSn vln c6n nhung hgn chl nhdt dinh frong t l chde tauc hifn cung dng cac dich vu h6 frg khi vdn con co 8,1% ngudi dan chua hai long va 5,2% ngudi dan khong hoan toan hai long vdi nhirng each tadc can thiep ho tig tiep edn cac djch vu taugc quyen ASXH ve kham chiia bfnh bdi le chdt luong eiia djch vy y te duge cung cap con kha thap. ). Van dS ndy da dugc d l cap den tiong mgt so nghiSn cuu eua Mai Linh, Nguyin Thi Kim Hoa (2016) (5,6,7) da chi ra cdc djch vy dupe cung cap eho cac benh nhdn khi kham chua benh bang the BHYT hdu nhu chua ddp dng dupc vdi nhu cdu dilu tri benh cua benh nhan. Do do rat can CO nhung ddnh gia va cdi thien chat luong dich vu dupe eung cap cho ngudi dan frong thdi gian tdi.
K E T LUAN
Bao ve va cham soc sdc khoe luon la nhu can eua dgi da s l ngudi dan, tiong do co nhu cau dugc h5 tig khdm, chua bfnh. Kit qua khdo sat da chi ra thye trang thyc hifn quyin cham sdc sue khoe va khdm chua benh cua ngudi dan tiiong qua boat dgng cong tac xa hpi nhu tiiyen tmyln va ta vdn chinh sach, bifn hg chinh sach, kit nii nguin lye ho tip w... ngudi dan duge hd tra dilu dudng, cham sdc sue khde, ho frg tiem ehung ngda bfnh, dugc ho tig chi phi chua bfnh vd dupc h6 tiv cdp tiie BHYT
Nguyen Thi Kim Hoa va cgng sp
miln phi. Trong do c6 tai tady quyin duge h6 ttg cap the BHYT miln phi dugc tiiyc hien khd tit so vdi eac quyin edn lai. Trong so cdc hogt dgng can thifp, bd frg cda nhan vien CTXH thi boat dgng tayen truyen chinh sdch dugc taye hien tot nhdt. Cae quyin nhu bifn hp, kit noi nguon Iyc ho ttg chua dugc danh gia cao.
Tuy nhiSn, td cac ean thifp va sy trp giup nay ngudi dan c6 tae tilp c$n va thyc hifn quyin kham chua bfnh cua minh. Trong tadi gian tdi cdn ddy mgnh hem nua sy tham gia cua CTXH frong viec tauc ddy taye hifn quyin an sinh xa hpi eua ngudi dan ttong cgng ding noi chung va frong cdc ca sd y tl n6i rieng.
KHUYEN NGHI:
Vdi Dang va Nha nude: cdn ed ra sodt vd bo sung cdc van ban luat, ehinh sdch, chuang trinh, dich vu ve y te de mgi ngudi dan dupe tiep cgn vd thy hudng dich vu dgc biet la nhom yeu tae. Nhd nude can c6 quy dinh eu till tiong vice ddnh gia chat lugng djch vu kham chua benh eho ngudi dan tgi cdc co sd y tl, c6 CO che phoi hgp va tauc ddy vai tto cua CTXH ttong bfnh vifn.
Tang eudng truyin thong ve chinh sdch an sinh frong kham chda benh de ndng cao nhan thuc eua ngudi dan.
Cac ca sd cung cap djch vu kham chua benh cho ngudi ddn: chu tigng va dam bao chdt
\iKhoa hpc Ngmen csm iittif: ioxtKt !'t:'u:ui'"iL'iLi-i. .> .t^-: ^••.
Joumal OfHealth and Development Snidies (Vol. 04. No.0l-20J(f)
Iupng cae djch vy y te ca sd cung cap, c6 co chl phoi hpp vdi cdc ban nganh cd lien quan frong vifc cung cdp djch vy.
Vdi cac nhan vien cdng tac xa bpi; Nhan vien CTXH frong bfnh vifn cin dugc trao quyen giam sat vifc thyc hifn cac chmh sdch.
TAI Lifu THAM KHAO
1. Lu$t Bao ve siic khoe nhan dan. (Lugt so 21 LCT/HDND 8, ban hanh 30/6/1989) 2. LuEit B4o hiim y tl 2008, sua doi bl sung LuSt
bao hiem yte 2014
3 Luat kham bfnh, chira bfnh (S6 40/2009/QH 12, du thao so 02/2019 siia dii Luat sl 40) 4. Nguyen Thj Van va cpng su, Thyc trang va mf t
sl yeu tl ^nh hirong den ty If tiem chung MR t^iTu Mo Rong (2016).
5. Mai Linh, Nguyen Thj Kim Hoa, "Thuc trgng Jtr dvng the bdo hiem y te ciia ngutji ddn ", Tgp chi xa hdi hgc so 2 (130). 2015. ISSN 0866 - 7659. Trang 75-85. (2015)
6. Mai Linh, Nguyen Thi Kim Hoa. "Mp/ s6 tra nggi trong thuc hiin lg tnnh tien tdi bdo hiem y te todn ddn". Tap chi Xah^i hpc s6 3 (135), 2016, ISSN 0866-7659.(2016)
7. Mai Linh, "Thgc trang iham gia bdo hiem y te vd chat litgng dich vy khdm chira binh bang the bdo hiem y le". Tap chi Khoa hgc Xa hfi va Nhan van ISSN 2354-1172, tap 2, so lb, 2016.
Trang 78-87/ "La participation. (2016) 8 Quylt djnh so 1125/QD-TTg ngiy 31/7/2017
ciia Thii tuong Chinh phu phe duyft.
9. Chuang trinh muc tieu Y tl - Dan so giai dogn 2016-2020
10. Quyltdinhsl32/2010/QD-TTgagay25/3/2010 ciia Thil tudng Chinh phii phe duyft D I an phat triln nghi cong tac xa hfi giai doan 2016 - 2020.
Tpp chi Khoa hgc Nghien ciu Sic khoe vd Phdt triin (Tgp 04, So 01-2020) Joumal of Health and Development Studies (Vol.04. No.01-2020)
Implementation of social security rights to medical examination and treatment for people through social work activities in Vietnam
Nguyen Thi Kim Hoa', Nguyen Thi Lien^
' University of social sciences and humanities
^ University of Labour and Social Affairs
Abstract
Objectives: To describe the current sitaation of the unplementation of social security rights for medical examination and tteatment by people through social work activities. Research methodology: Cross-sectional design described. The stady conducted in 7 provinces of Hanoi, Quang Ninh, Hoa Binh, Da Nang, Ben Tre, Dak Lak and Ho Chi Minh City, from June 2018 to May 2019. Results: The research results show that the right to nursing and healthcare support for social work activities, tae most prominent policy propaganda and advocacy tae activity used at the lowest rate. Regarding tae right to support vaccination, tae most focused activity is also policy propaganda and the lowest is supporting the preparation of policy documents. Regarding tae right to support the cost of freatment, medical examination and treatment, tae main activity is propaganda and policy advice, tae least performing activity is to connect support resources.
Regarding the right to get free health insurance cards, the activities conducted wita the highest proportion are still policy propaganda activities and the lowest is connecting support resources.
Conclusion: From tae intervention and assistance of social assistance, people can access and exercise their right to medical examination and treatment. The State needs to review and supplement medical laws, policies, programs and services so that all people ean access and benefit from services, in the coming time, it is necessary to promote more the participation of social work in promoting social security rights of people in tae commuruty m general and in health facilities in particular.
Keywords: social security rights, medical examination and treatment, implementation, professional social work
