QUYEN DirOC CHAM SOC StTC KHOE:
THANH TUtJ VA THACH THITC
NGUYEN THI ANH DAO ' Quan dilm cua Dang va Nha nude ta ve quyen dugc cham sdc sire khde (CSSK) va phat trien con ngudi (PTCN) gan ket vdi nhau da dugc neu ro trong cac phat bieu tai Hgi nghi quoc te: "Nhan thirc Quyen ve sue khde va phat trien cho mgi ngudi"' - hgi nghj xem xet each tiep can eae djch vu y te ca ban, nhilng thach thire doi voi y te cong cong, nhu dai djch HIV/AIDS va sot ret, mdi de dga tir bien ddi khi hau va toan cau hoa kinh tl. Day la hgi nghi quoc te dau tien dugc to ehiic d ehau A ve y te, nhan quyen va phat trien, nham thong qua each tiep can dya tren quyen dua ra cac giai phap ling pho vdi euge khung hoang ve sue khde, nhan dao va phat trien dang de dga hang ty ngudi thuoc nhom xa hgi de bj ton thuong, nhat la phu nil, tre em, ngudi ngheo.
Van de siic khde, phat trien va quyen con ngudi la mot ngi dung quan trgng trong mue tieu dan giau, nude manh, xa hgi cong bang, dan ehii van minh ciia Viet Nam . Quan diem nhat quan cua Dang va Nha nude Viet Nam la lam tat ca, tir nhilng viee nhd nhat de cham lo cho siic khde con ngudi, dat ca sa de eon ngudi cd ea hgi phat trien toan dien, thye hien day du nhat quyen quyet djnh doi vdi van menh ciia minh va quyen lam chii xa hgi, lam chii dat nude.
Ve mat phap ly quoc te, quyen dugc cham sdc sire khde dugc nhac tdi Ian dau d Dieu 25 Tuyen ngon qude te Nhan quyen (UDHR), trong quyen dugc cd miic song thieh dang, va dugc cu the hoa d Cong udc qude te ve Quyen kinh te, xa hgi va van hoa (ICESCR) trong cac Dieu 7, I I , 12, Cong udc quoc te ve binh dang gidi (CEDAW) trong Dieu 10, 12, 14, Cong udc quoc te ve quyen tre em (CRC) vdi Dieu 24, Cong udc qude te ve xoa bd mgi hinh thiic phan biet ehimg tgc nam 1965 vdi Dieu 5, Tuyen bd Vien va Chuong trinh hanh dong thong qua tai Hgi nghj The gidi ve Quyen con ngudi Ian thii hai nam 1993^ Trong eae quy djnh nay, noi bat cd Dieu 12 ICSCR quy dinh ro ve quyen ciia tat ca mgi ngudi dugc hudng mot tieu ehuan sire khde ve the chat va tinh than d mire eao nhat cd the dugc, nhilng bieri phap nham thye hien day dii quyen nay bao gom nhilng bien phap lam giam bdt ty le tir vong cua tre sa sinh va tre em; eai thien ' TS.; Dai hoc Kinh te - Dai hoc Quoc gia Ha Ngi.
' Han 200 chuyen gia quoc te va quoc gia trong cac ITnh vuc y te, phat trien va quyen con nguoi tham gia
\i da dong g6p y kien vao cugc trao doi ve nhCrng rao can trong cong tac chSm s6c su'c khoe v^ phit trien.
Hgi nghj do "To chirc Sang kien vi Y te va Quyen con ngufii" ciia Dai hgc New South Wales \k Ban Tuyen giao Trung uong cua Dang Cong san Viet Nam dong to chirc, dien ra tir 26 - 29/10 tai Hi Ngi.
' Ong Phiing HQ-u Phu, Uy vien Truiig uang Dang, Pho truang ban thuong true Ban Tuyen giao Trung uong da khjng djnh nhu vay tai hgi nghj (VOV Online 10/2009).
' Ngoai ra. quyin dugc cham soc sire khoe con dugc ghi nhan trong mot so \in kien khu virc ve quyin con ngufiri nhu Hiin chuong xS hgi ehau Au nam 1961 sira d6i (Diiu 11), Hien chuong ehau Phi vi quyin con nguai va quyin ciia cac dan tgc nam 1981 (Diiu 16), Nghj dinh thu bo sung Cong udc ehau My ve cac quyen kinh ti, xa hgi va van hoi nam 1988 (Dieu 10),...
, - Nghien ciiu Con ngudi si 1 (58) 2012
Nguyen Thi Anh Dao toan dien ve sinh mdi truong, ve sinh cong nghiep; ngan ngira, xir ly va han che cac djch berth, benh ngoai da, benh nghe nghiep va cac loai berth khae; tao cac dieu kien de bao dam mgi djch vu va su cham sdc y te khi dm dau. Trong Binh luan chimg sd 14 (phien hgp thir 22/2002), Uy ban ve quyen kinh te, xa hgi, van hoa cua Lien hiep quoc con giai thieh mot each kha toan dien va chi tiet ve quyen nay, dae biet de cap den quyen dugc CSSK dugc hieu la "quyen dugc thu hudng nhirng ea sd vat chat, hang hoa, djch vu va dieu kien can thiet de dat dugc tieu ehuan sue khde eao nhat cd the"; quyen dugc cham sdc sire khde phu thuoc vao nhirng yeu to ea ban la: (a) Kha nang sin ed vl ca sd cham sdc siic khde va y te cong, cac loai hang hoa va djch vu, ciing nhu eae chuong trinh cham sdc siic khde cua quoc gia thanh vien, (b) Kha nang cd the tiep can cua mgi ngudi vdi eae co sd cham sdc sire khde, hang hoa va djch vu y te; dac biet de cap tdi nghla vu ton trong, bao ve va thicc hien"'' quyen cua cac qude gia thanh vien, trong do nghla vu thuc hien ddi hoi nhilng dieu sau:
Phai eong nhan day du quyen dugc CSSK trong he thong phap luat va ehinh trj qude gia, thieh hgp nhat la thong qua hinh thiie thye hien lap phap va ban hanh chinh sach y te quoc gia vdi ke hoach chi tiet de thye hien quyen dugc CSSK.
Phai dam bao viee eung cap djch vu cham sdc y te, bao gom ca cac chuong trinh tiem ehimg chdng cac benh truyen nhiem co ban va dam bao su tiep can binh dang nhilng ylu t6 quylt djnh ca ban den sire khde cho tat ea mgi ngudi, chang han nhu lucng thye an toan, dii dinh dudng va nude uong sach, dieu kien ve sinh ea ban, dieu kien song va nha d diy dii. Co sd ha tang y te cong can dam bao eung cap cac djch vu CSSK tinh due va sire khde sinh san, bao gom ea ky nang lam me an toan, dac biet la d eae viing ndng thon.
- Phai dam bao dao tao thieh hgp dgi ngii bac sT va can bg y te khac, eung cap dii sd benh vien, tram y tl va cac co sd khae lien quan din CSSK va thiic day, ho trg thiet lap eae vien nghien eim va djch vu y te phan bd deu tren toan qude.
- Phai cd trach nhiem xay dung he thing bao hilm y tl tu nhan va nha nude ed the dap irng dugc mgi ddi tugng, thiic diy nghien ciiu va giao due y te eiing nhu tuyen truyin thong tin, dae biet la vl HIV/AIDS, sire khde sinh san va gidi tinh, thdi quen truyin thong, bao lye gia dinh, lam dung rugu va thude la, thude gay nghien va eae chat cd hai khac,..."
Trong bai vilt nay*^, dl danh gia thye trang quyin CSSK vi PTCN, chiing tdi dya tren nhirng van ban phap luat cua qude tl \ a trong nude eoi quyin dugc CSSK la quyen ma ngudi dan duge hudng eae djch vu CSSK do nha nude eung cip thong qua cac ehii truang, bien phap ehinh sach, va he thong y tl tir co sd din trung uong (sau day ggi la
- Giao tiinh Ly luan vn phiip luat vc Quyin con nguai, Khoa Luat - DHQGHN, Nxb. Chinh trj Quoc gia, 2009, Mill-211.'
'Sdd. , , . . . , , . . .
° Bai viit trong pham vi de tai cap Bg "Mot so van de ca ban ve quyen van h6a, xa hgi va dieu kien dam bao thiic thi tai Viet Nam giai doan 2011-2020 vi mue tieu phat triin con nguai". Di tai da tiin hanh phong van sau can bg vi ngudi dan (90 nguai) a cac tinh Ha Ngi, Hui, Tp.H6 Chi Minh va Bin Tre ve quyin van h6a va quyen xa hgi (trong do co qu\en CSSK).
NghlSn ciiu Con ngUcA s61 (58) 2012 13
Quyen duac cham soc sue khoe..
he thong CSSK) nham mue tieu: lam giam bdt ty le tir vong, cai thien toan dien ve sinh mdi trudng, ve sinh edng nghiep; ngan ngira, xir ly va han chi cac loai benh tat, djch benh, tao dieu kien bao dam mgi djch vu, cham sdc y te khi dau dm. He thing CSSK ve CO ban se dugc xac djnh theo ngi dung eiia nglua vu thirc hien neu d tren, dd la he thong phap luat, djch vu cham sdc y te, ddi ngii bac si va he thong bao hiem. Them vao do, quyen dugc CSSK vi mue tieu PTCN d day se duge danh gia theo cac tieu chi tuang thieh vdi cac tieu chi danh gia PTCN, cu the la tinh san co hay miic do bao phii cua he thong (tuong duong vdi tinh cong bang eiia PTCN), tinh co the tiep can he thong (tuang duong vdi tinh tham gia ciia PTCN), tinh ed the chap nhan (tuong duong vdi tinh hieu qua ciia PTCN) \ a tinh cd the thieh ling ddi vdi nhirng thay ddi (tuong duang vdi ///;/;
ben vicng cua PTCN).
1. He thong bien phap chinli sach tlie hien d' cac van ban luat quy dinh ve quyen diro'c cham soc sire khoe
Q Viet Nam, cac bien phap ehinh sach ciia nha nude nham thye thi quyen dugc CSSK the hien tap trung nhat d rat nhieu van ban phap luat cd lien quan tryc tiep va gian tiep, cd the ke ra mot sd van ban ehii yeu sau.
- Hiln phap 92 (Dilu 6^)
Luat Bao ve sire khde nhan dan (1989)*
- Chi thi sd 06/CT/TW ciia Ban bi thu ve viee ciing cd va hoan thien mang ludi y te CO sd nham nang eao chat lugng va day manh edng tac cham sdc sire khde ban dau cho nhan dan (2001)
Phap lenh ngudi cao tudi do Uy ban Thudng vu Qude hgi ban hanh (2000) - Phap lenh Dan sd (2003)
- Luat Bao hilm y tl (2009)
Luat Kham benh, chiia benh (23/11/2009, cd hieu lye tir 1/1/2011)
Quyet djnh sd 139 cua Thii tudng ve kham chira benh cho ngudi ngheo, tao dieu kien de mgi ngudi dan deu dugc cham sdc sire khde
- Chien luge qude gia ve bao ve va cham sdc siic khde nhan dan (2001-2010) - Chiln luge Dan sd (2001-2010)
- Chuong trinh mue tieu qude gia ve Dan sd va ke hoach hoa gia dinh den 2010 - Chien luge bao ve mdi trudng qude gia den 2010 dinh hudng 2020
- Chiln luge phong chdng HIV/AIDS cho din 2010 va phuang hudng tdi 2020 (2004).
De danh gia mot each khai quat he thong luat lien quan tdi quyen dugc CSSK, cd the dan ra day Idi nhan xet ddi vdi Luat Kham benh, ehila benh, bd luat tryc tiep va tieu bieu nhat cho he thong luat nay, ciia TS., bac sT Duong Quang Trung - chii tjch Hgi Y
' Cu the nhu sau: "Cong dan dugc huong che do bao \e sire khoe. Nha nuac quy djnh che do vien phi, che dg mien giam vien phi."
* Cu the nhu sau: "Cong dan co quyen dugc bao ve sire khoe, nghi ngai, giai tri, ren luyen than the; dugc bao dam ve sinh trong lao dong, \e sinh dinh duong, ve sinh moi truang s6ng va dugc phuc vu ve chuyen mon y ti-" (Dieu 1); "Moi nguai khi 6m dau benh tat, bj tai nan dugc kham chiia benh tai cac co so kham, chiia b?nh nai cong dan cu trii, lao dong, hgc tap. Nguai benh dugc chgn thay thuoc hoac luong y, chgn ca sa kham b?nh. Trong truang hgp cap cuu, nguai benh dugc cap eim tai bat k> co sa kham chira benh nao (Dieu 23).
, j Nghien ciiu Con ngudi s61 (58) 2012
Nguyen Thi Anh Dao hgc Tp.Hd Chi Minh: Nude ta da cd luat kham chira benh, nhung luat nay edn ehung ehung, ehua dii sire dam bao phong ngira dugc nhirng sai sdt ve trach nhiem, tai biln \e chuyen mdn xay ra. Q eae nude tren the gidi, de dam bao quyen Igi ciia benh nhan va thay thude, ngudi ta xay dyng nghia vu luat vdi hang tram dieu quy djnh chi tilt, chat che trong hanh nghe. Nghla vu luat quy djnh nhirng gi bac sT duge va khdng dugc lam.
Ddng thdi hg edn ed bd phan theo doi, quan ly, giam sat viee thye hien nghia vu luat ma mot sd nude ggi la y sT doan, bac sT doan hay hgi ddng y khoa qude gia, hgi ddng quan ly hanh nghe,... de quan ly viee hanh nghe eiia thay thude. Hgi ddng quan ly hanh nghi gom nhirng ngudi ed uy tin, dao dtlc, tham nien, hieu bilt de phan xir khach quan, cong bang. Con d ta, trong mot sd benh vien, nhieu trudng hgp thay thude vi pham y due mdi dimg lai d viee nhac nhd, khien trach, mat thi dua, cat thudng,...'
2. Khai quat tinh hinh thuc thi Quyen diroc cham soc sifc khoe: thanh tiru va thach thii'c
2.1) Thanh tu'u dat duv'c trong viee thirc thi quyen du'ffc cham soc si'rc khoe Viet Nam tao dieu kien de mgi ngudi dan thy hudng quyen duge CSSK, uu tien cac ddi tugng phu nir, tre em va ngudi dan tgc thieu sd. Cac chuong trinh, chinh sach cd tinh chien luge nhu tiem ehung cho tre em, hd trg bao hiem y te (BHYT), kham chiia benh (KCB) mien phi cho ngudi ngheo va tre em dudi 6 tudi, phdng chdng lao, phong chdng HIV/AIDS,... da mang lai hieu qua tich eye. Ty le tir vong d tre em dudi 5 tudi giam tir 58%o (1990) xudng edn 25,9%o (2007), dudi 1 tudi tir 3I%o (2001) xudng edn 16%o (2007); ty le suy dinh dudng d tre em chi con 21,2% (2007); ty le tir vong d phu nir sau sinh giam tir 233/100.000 tre de sing (1990) xudng 75/100.000 tre (2007). Hiu hit cac xa dac biet kho khan tai eae viing dan tgc thieu sd da cd tram y te; da sd thon, ban ed y te edng ddng, gdp phan co ban ngan chan eae benh djch xa hgi hiem ngheo, nang eao sire khde, eai thien ddi song ddng bao
Trude hit, he thing CSSK da hinh thanh duge mot mang ludi benh vien ngay cang md rdng: tir 741 co sd KCB va 13.000 giudng benh (1940) da tang len thanh 1.557 co sd (1976), 13.149 ea sd va 136.590 giudng benh (2005). Sd giudng benh binh quan tren 10.000 dan la 24" so vdi Phap la (77), Canada (37), My (36) thi khilm tdn, song so vdi cac nude trong khu vuc thi dimg thir 3 trong khdi ASEAN, sau Singapore (29), Bruney (26), tren Thai Lan (22), Malaysia (19), Philipin (10) Campuehia (5),...
He thing CSSK ban diu la he thing tram y tl xa, phudng da duge rai deu khap, tinh din nam 2005, ea nude ed 11.305 tram y tl xa, phudng, ea quan, xi nghiep (tang 1.063 tram so vdi 1986) vdi 52.800 giudng benh, them vao dd la 100% cac huyen, tinh trong ca nude dIu cd benh vien huyen, tinh. He thong benh vien cac cip nay da_dap ting nhu eau KCB eiia ngudi dan trong ca nude, gdp phin tuyen truyin, hudng dan ngudi dan kiln thuc bao \ e sire khde, phdng chdng benh tat, thye hien hieu qua cac ehucmg trinh cham sdc sire khde nhan dan do nha nude td ehiic. Kit qua dieu tra khao sat eiia de tai
' Bao di?n tir Dim tri ngay 17/10/201.
'" Biio ciio quoc gia him diim dinh ky viee thuc hien quyin con nguai 2009. Cong thong tin dien tir Bo Sgogigiao.
" Co tliong tin khac cho rang con so nay chi la 18 - Bao cao PTCN quoc gia 2011 - hoac 20.
NghlSn cuu Con ngutt so 1 (58) 2012 \ 5
Quyen duac cham soc sue khoe..
cap Bd: "Mot sd van de eo ban ve quyen \'an hda, xa hgi \a dieu kien thye thi tai Viet Nam giai doan 2011-2020 vi mue tieu phat trien con ngudi" (sau day ggi tat la De tai) tai mot sd tinh, thanh pho d ba mien bac - trung - nam'^ ciing cho thay, tai tat ca cac dilm khao sat dIu cd tram y te xa va benh vien tinh.
Thii hai la ddi ngii thiy thude ciing khdng ngirng gia tang: nam 2004 ca nude cd 99.300 y, bac si (tang 35.600 ngudi so vdi 1986), 49.000 y ta, 17.500 nir hg sinh (so vdi 1986 tang 2.400 ngudi), 14.700 dugc sT trung, eao cip (so vdi 1986 tang 2.600 ngudi).
Binh quan 10.000 dan ed gin 12 y, bac sL Sd xa, phudng cd 2.413 bac sT (1977) tang len thanh 5.366 (2000), dua ty le nay tang tir 24% len 51%. T> le xa, phudng ed y sT san nhi hay nir hg sinh la 74,5% (7.691 ngudi) vao nam 1977 da tang len thanh 87.9%
(9.240 ngudi) nam 2000. Tinh din 2005, so can bd y tl tuyen trung uong la 31.668 ngudi (12% ca nude) trong dd 7,5% c6 trinh do tiln si va thae si. 37%) trinh do dai hgc;
can bd y tl tuyin tinh la 79.759 ngudi, trong dd 2% ed trinh do tien sT va thae sT, 28%
trinh do dai hgc, 48% trinh do cao ding va trung cap, 5% trinh do so cap.
Thit ba la he thing BHYT, vdi Quylt dinh 139, cip phat the BHYT cho ngudi ngheo, viee bao dam quyin KCB eiia ngudi ngheo da tao duge bude dot pha: nam 2003, sd ngudi ngheo tilp can djch vu y tl la 13,5 trieu, trong dd ngudi nhan the BHYT la 3,7 trieu, din nam 2005 da tang len thanh 14, 3 trieu (4,4 trieu ngudi dugc cip the BHYT).
Ting chi tir quy eung tang tir 224,9 ty dong (2003) len 664,3 ty ddng (2005). Tinh den nam 2005 ed 8 trieu ngudi ngheo duge cip the BHYT hoac giiy KCB miln phi vdi tdng kinh phi la 205 ty ddng. Ngan sach y tl eung lien tuc tang ke tir 1986 din nay, rieng 5 nam (1999 - 2004), tdng chi ngan sach nganh y tl tang tir 3.610 ty dong len 6.276 ty ddng.
Kit qua ciia viee gia tang he thing KCB va nguon nhan lye nganh y te neu tren da dua din kit qua dang ghi nhan, the hien d mot vai con sd kha quan nhu:
Ty le tir vong \i benh sit ret giam 10 - 15% hang nam, vi benh budu cd giam 2 - 3% va 90% trong sd hg duge tilp can djch vu y tl. Sd lugng ngudi tham gia BHYT nam
1993 chi ed 3,8 trieu ngudi (5,4% dan sd) da tang len thanh 16 trieu ngudi (15%) dan so).
Benh bai liet da bj xda bd hoan toan tir nam 1996, cac benh djch mdi eung kjp thdi dugc dap djch va ngan chan bimg phat hieu qua (SAR, H5N1).
Ty le hg gia dinh su dung nude sach tang len hang nam, tir 45,19% (1995) len 51,8% (2001); ty le hg gia dinli sir dung hi xi hgp ve sinh tir 27,33% (1995) len 44,07%
(2000). dd la kit qua ciia viee Chinh phii thye hien mot sd Chuong trinh eung cap nude sach, ve sinh ndng thon nhu la nhiing bien phap nang eao siic khde edng ddng, ngan ngira benh tat tir trudc.Tuy nhien, van con ed sy khae biet rd rang giira thanh thj va ndng thdn vl hai ty le nay: 61,4% va 37,8% vl nude sach, 81,77% va 32,49% vl hi xi hgp ve sinh.
Tiem ehimg, ho trg BHYT, KCB mien phi, phdng chdng lao, HIV; diu tu 782 ty ddng (2005) dl thye hien KCB mien phi cho tre em dudi 6 tudi... Nam 2000, Viet Nam dugc thi gidi edng nhan da thanh toan benh bai liet; ty le til vong tre dudi 5 tudi giam tir
16
Da chii thieh a Uen ve chi tiet cugc khao sat.
Nghien ciiu Con ngudi sol (58) 2012
Nguyen Thj Anh Dao 5,8% (1990) xudng 3,28% (2003) va 2,59% (2007); ty le tre tir vong dudi 1 tudi giam tir 3,1% (2001) xudng 1,6%> (2007); nam 2004, tre em dudi 5 tudi duge udng dung djch bii nude khi bj tieu chay dat 97%, ty le khdng thieu vitamin A dat 100%, ty le mic sdi giam 82,1%) so vdi nam 1986, ty le chet sdi giam 97,3%) so vdi 1986, ty le sa sinh cd can nang thip dudi 2.500 gram giam tir 14%) xudng 7,1%), ty le thilu mau phu nir cd thai chi edn 30%). Ciing vao nam 2004,10% tre em md edi khdng nai nuang tua dugc cham sdc giiip da tai edng ddng, 100% tre em hdi huong hgp phap dugc cham sdc tai hda nhap, 80% tre em bj sut mdi dugc phau thuat nu cudi (tir 1997 din 2001 cd tit ca 7.228 em). Mot sd chi tieu khae eiing giam dang ke (tuy ehua dat mue tieu) nhu ty le suy dinh dudng tre dudi 5 tudi tir 42%) (1993) xudng 28,4% (2003), ty le tir vong tre dudi 1 tudi giam tir 43,3% (1995) xudng 21%) (2003), ty le chet me lien quan den thai san giam tir
110/100.000 ca de (1995) xuing 85/100.000 ea (2004).
- Cac tinh deu cd trung tam cham sdc sire khde sinh san, cac tram y te deu dugc eung cap thiet bj ca ban, quy thude va phuang tien cham sdc sire klide sinh san va ke hoach hda gia dinh (trong do 21% dat tieu ehuan qude gia), 76% thdn ban cd y te ca sd thye hien cham sdc sire khde sinh san va ke hoach hda gia dinh, rieng viing duyen hai mien Trung dat 90%). Din nam 2002 da thanh toan tinh trang "trang" ve can bd y te cap ca sd, sd xa ed bae si tang tir 33,8% (1999) len 61,5% (2002), 93,2% tram y tl cd nir hg sinh hoac y si san nhi. Tai 61 trung tam bao ve sOrc khde ba me - tre em va ke hoach hda gia dinh cd 321 bac si chuyen khoa san, 60 bac sT chuyen khoa nhi, 228 y sT san nhi va 367 nir hg sinh'^ Kit qua la, ty le tir vong ba me khi sinh da giam tir \% (1997) xudng 0,9%
(1999), 0,85%o (2003). Theo danh gia ciia Td chirc Y tl thi gidi, ty le tir vong tre dudi 5 tudi, dudi 1 tuoi va ba me khi sinh la thap ban nhieu so vdi eae quoc gia cd mire thu nhap binh quan diu ngudi tuong duong. Chinh phu edn thye hien tren quy md rdng khip nhilu chuong trinh cham sdc sue khde phu nir cac lira tudi, nhat la lira tudi lam me ("Lam me an toan"), vi vay chi tinh rieng 1998 da cd 7,4 trieu phu nir dugc kham phu khoa, 1,2 trieu phu nir cd thai dugc kham du 3 lin, 95,8% phu nir khi sinh dugc can bd y tl cham sdc (2003), phu nir ed thai dugc tiem phdng uon van 2 mui tang tir 66%
(1996) len 92% (2005); Sd lin kham thai trung binh tang din, tir 1,6 lin (1998) len 3,1 lin (2005). Nhd dd, ty le tai biln san khoa ciia phu nir ndi chung va phu nu ndng thdn ndi rieng diu giam dang kl: theo nien giam thing ke cua Bd Y tl tir 9.879 ngudi (1995) xuong 3.275 ngudi (2005).
- Ben canh ehl do uu dai do nha nude trg cip \a nudi dudng thuong, benh binh nang, ngudi bj di ehimg chit doe da cam, mang ludi cham sdc sire khde phuc hdi ehiic nang cho ngudi khuylt tat eiing duge thilt lap tir trung uong din ca sd. Rieng ddi vdi nan nhan chit doc mau da cam, nha nude ciing nhilu td ehiic ca nhan khac da chung tay trg giup hang chuc ty ddng dl eae nan nhan dn djnh cugc song va ed the tham gia san xuat.
Ngoai ra, da cd hon 300.000 ngudi dugc chinh hinh, phuc hdi chiic nang, dugc eung cip dung cu chinh hinh miln phi, phuong tien trg giup nhu xe lan, xe day, hang tram nghin ngudi duge cip the BHYT trong vong 10 nam qua...
'•" Bao cao thi;c hien Cong uoc CEDAW lan 3, 4. 5. 6.
NghlSn ciiu Con ngudi so 1 (58) 2012 \ "J
Quyen duac cham soc sice khoe..
Nhirng thanh tuu ve thye thi quyin CSSK tren day ciia N'iet Nam da dugc qude tl danh gia va edng nhan: Ngan hang kinh te thi gidi nhan djnh ring, cac chi sd y t l ciia Viet Nam kha hon dieu ed the trdng dgi d mot nude cd mue do phat triin tuong ty. Ong Anand Grover, bao eao vien dac biet eiia Lien hiep qude \ e Quyin dugc cham sdc siic khde ciing dua ra nhan xet nhu sau: "Tdi ciing ghi nhan nhilng no lye dang hoan nghenh eiia Viet Nam trong vdng hai thap ky vira qua nham cai thien he thing y te ndi chung, ciing nhu cam ket cua Viet Nam nham dam bao tat ca mgi ngudi dan deu dugc tiep can vdi he thdng cham sdc sue khde. Mot he thdng cham sdc siic kltde boat ddng tdt la co sd cho viee thye hien quyen duge cham sdc sire khde, va cac sd lieu cho thay da co nhiing tien bd dang ngudng md trong nhieu linh vyc cham sdc siic khde trgng yeu, trong dd cd sire khde ba me va tre em"''*
2.2. NhHitg kho khan thach thuc trong viee thirc thi quyen duffc cham soc sire khoe
Bien doi moi truang loan cau
Nhirng bien ddi ve khi hau, mdi trudng trai dat ndi chung da gay ra nhimg djch benh mdi de dga sire khde va mang sdng cua con ngudi d khap noi tren the gidi, va Viet Nam eung khdng la ngoai le. Nhieu dich benh mdi da duge Viet Nam nd lye day liii trude day nhu SARS ("Severe acute respiratory syndrome")'^, H5N1"' hien van con nguy co tai phat. Them vao dd, dang de dga sire khde ciia ngudi dan, nhat la tre em la nan djch
"chan tay mieng" (CTM), "benh da la",... Tir cudi nam 2011, benh biing phat nhanh chdng, lay nhiem ra khap 53 tinh, thanh trong ea nude. Tir dau nam den nay da cd khoang 30.000 ca mac benh, sd tir vong da len tdi 18 ehau. Theo Bd Y te, nude ta ed sd tre em bj mac benh CTM tinh tren 10.000 dan, cao thii tu trong khu vyc ehau A'^. Bd Y te da phai td ehiic nhieu hdi nghj chuyen de tim bien phap ddi phd nhung cho den nay van ehua dap tat djch dugc hoan toan.
Suy giam chat licang moi truang Irong nuac
Mdi trudng d Viet Nam ngay cang d nhiem, trd thanh nguyen nhan gia tang cac can benh hiem ngheo, tham chi lam sdng lai mot sd can benh da dugc day liii nhu lao, sdi va anh hudng khdng nhd tdi hieu qua nd lye eua nha nude trong viee thye thi quyin dugc CSSK cho ngudi dan.
Ndi rieng \ e mdi trudng nude, mot nghien curu dugc dang tai tren td Proceedings eiia Vien Han lam khoa hgc My cho biet, thach tin va nhieu hda chit doc hai khae dang gay '•* Hgp bao tai UNDP Viet Nam, ngay 05/12/2011 ciia ong Anand Grover, Bao do vien Dac biet ciia LHQ ve Qu\en con nguai tai Viet Nam.
" Thing 3/2003, Djch SARS tiep tuc lan rgng a Trung Quoc, so ngucri nhiem len din 4000 nguai va g^n 200 nguai tir vong. BSc Kinh va H6ng Kong la hai nai djch benh hoanh hanh nang nhlt. Nhiiu truang hgc, khu vui chai giai tri phai dong cua. Nhieu ngucri nuac ngoai tim each ve nuac, trong do co du hgc sinh \'i?t Nam tai Trung Quoc. Tir do SARS bat dau lay truyen qua cac nuac khac tren thi giai, dac biet tai khu vuc Dong Nam A (nhu Singapore).
"Tinh den nga\ 28 2'2008, tren thi giai da co 369 truong hgp nguai nhiem virus nay, trong do 234 nguai da tir vong. Quoc gia chju ton that ve nguai nang ne nhat la Indonesia va Viet Nam.
'• Tuin Ha. \'ietnamnet. 7-5/2012.
] g Nghien ciiu Con ngua sd 1 (58) 2012
Nguyen Thi Anh Dao 6 nhiem nguon nude d Ddng bang sdng Hdng, trong dd cd Ha Ndi, de dga nghiem trgng den siic khde ciia khoang 7 trieu ngudi (Dan tri) . Nguyen nhan ciia viee nhiem doe do ngudi dan bom nude tir cac tang ngam nude sau trong sudt hon mot thi ky nay, khiln asen d trong nude tren mat dat ngam xudng dudi.
Tir nhieu nam trude day, thye trang nude nhiem asen d nude ta da d miie bao ddng tai hai khu vyc la Ddng bang sdng Hdng va Ddng bang sdng Cim Long, da duge Bd Y te va Bd Ndng nghiep Phat trien ndng thdn bao eao. Ket qua mot sd nghien curu do Unicef tien hanh tai hai khu vyc nay da dua den nhan djnh: mire do d nhilm asen trong nguon nude ngam d Viet Nam rat nghiem trgng (TS. Nguyen Duy Bao, Vien Lao ddng va Ve sinh mdi trudng, Bg Y te). Ket qua phan tich mlu nude ciia 512 gilng d Viet Nam tir thang 5/2005 1/2007 do Michael Berg va cac ddng nghiep thude Vien Cong nghe va khoa hgc ve nude eiia Thuy Sy tien hanh cho thay: 27% gieng trong viing nghien ciru bj nhiem asen va khoang 1 trieu ngudi diing nude vdi ham lugng nhiem gap 5 lan tieu ehuan an toan ciia Td chirc Y te the gidi. Theo quy dinh cua qude te va edng ddng ehau Au, ndng do asen trong nude chi dugc phep dudi 0,01 mg/1, nhung tai khu vyc Ddng bang sdng Hdng nhu Ha Ngi, Ha Tay, Hung Yen, Nam Dinh, mire nhiem asen thudng eao gap hang chuc lan mire nay, trong dd nhiem nang nhat la tinh Ha Nam, ed tdi 80% gieng khoan d tinh nay nhiem asen d mtic nguy hiem, gap 100 den 500 lan mire cho phep.
Ve sinh an loan thucphcim
Vin dl ve sinh an toan thye pham trong ca nude dang la mot trong nhirng van de gay bat an hang dau cho cugc sdng ciia ngudi dan. Thye chat, nhieu sy kien nhu viee tiep tuc sir dung nhung hoa chat cam diing trong nudi trdng, che bien ndng thiiy san, thye pham, viee san xuit mot sd san pham kem chat lugng hoac do quy trinh che bien hoac do nhiem doc tir mdi trudng, dang gay anh hudng xau den xuat khau va tieu dimg. Cac vu ngd doc thye phim do mot sd bip an tap the eung cap, nhieu thdng tin lien tuc ve tinh hinh an toan ve sinh thire pham d trong \a ngoai nude, edng them djch cum gia cim tai phat, benh heo tai xanh d mot sd noi cang lam biing len sy lo au trong edng dong. Gin day mot sd vin dl lien quan din quan ly an toan ve sinli thye pham, sy khac biet giila cac kit qua phan tich kilm tra chit lugng san pham vira gay khdng it kho khan clio ngudi san xuat vira tao them lo lang cho ngudi tieu diing.
Bac sT Nguyen Thj Thu Thiiy, Benh \ ien Thu Dire (Tp.HCM) cho bilt, tinh trang benh nhan nhap vien \'i ngd doc thye phim dien ra phd biln thdi gian qua. Sau khi xet nghiem, ddi thoai \ di benh nhan, benh vien phat hien nhiing ngudi nay da an phai cac chit doe hda hoe trong cac loai thye pham dugc ban tran lan tren thj trudiig. Dd la cac chit bao ve, bao quan thye phim tuai lau hay ehdrig nam. Ket qua phdng van sau (PVS) eua D I tai eung cho thiy, hiu hit ngudi tra Idi deu neu van de an toan thye pham vao
" Cic nghien cuu ciia \'ien Nghien ciru Chulabhom Thai Lan da canh bao: ngu6n nuac nhiem asen nang se anh huong rdt \<m tai sire khoe ciia ba me co thai va tie sa sinh eung nhu su phat trien ve thi chat va tti me ciia tre. Theo Bg ^^ ti \'icl Nam, nguoi u6ng nuoc nhiem asen lau ngay se co trieu chimg dau tien nhu co cac d6m sam mau tren than the hay dSu cac chi, doi khi ga> niem mac tren ludi hoac simg hoa tren ban tay, ban chan. Asen con co the ga> ung thu gan, phoi, bang quang va than, gay benh tim mach, cao huyet ap,...
NghlSn ciiu Con ngUdI so 1 (58) 2012 ] 9
Quyen duac cham soc sue khoe..
hang dau danh sach nhirng bat an trong cugc sing hien nay.
Chinh sach bao hiem y te ehua hieu qua
Chinh sach BHYT ehua hieu qua ed the nhan thiy trude hit thi hien d tinh hinh thye hien Luat BHYT - da duge Qude hdi thdng qua ngay 24/11/2008, cd hieu lye tir ngay 1/7/2009. Theo danh gia ciia Bg Y te, sau 2 nam thuc hien, Luat BHYT da timg budc di vao cugc sdng. tac ddng tich cyc den chinh sach BHYT tai Viet Nam, khing dinh tinh diing dan va phii hgp trong lya chgn ehinh sach tai chinh y te thdng qua BHYT. Tuy nhien, theo Vu trudng Vu BHYT (Bd Y te) Tdng Song Huong, trong qua trinh trien khai Luat BHYT vira qua ciing da xuat hien nhieu kho khan \a \udng mac. Nhieu benh vien qua tai, nhat la d eae co sd tuyen tinh, tuyen trung uong va tinh trang benh nhan khi KCB theo bao hiem phai chd dgi lau, nam chung giudng benh con kha phd bien khien nhieu ngudi ngai tham gia va sir dung cac dich vu do BHYT chi tra. Dac biet, tai nhieu viing, co sd vat chat, trang thiet bj, nhan lye y te edn nhieu han che, nhat la d tuyen y te co sd % a tai cac viing sau, viing xa (ty le cac tram y te xa cd bac sT hien mdi dat khoang 70%). Ben canh dd, che tai xir phat hanh vi vi pham phap luat BHYT ehua cd, CO quan BHXH khdng ed chirc nang thanh tra, xir ly nhiing hanh vi vi pham phap luat ma phai thdng qua cac ea quan quan ly nha nude hoac ca quan chirc nang, cho nen sd vu \ iec dugc thanh tra, xir ly edn it, ed nhieu trudng hgp khdng duge thuc hien.
Ve miic do bao phii ciia BHYT, cd the ndi mot trong nhirng rao can ddi vdi viee mua va sir dung BHYT la chat lugng djch vu va sy cham tre trong dieu trj, thai do eiia nhan vien eung cap dich \ u bat ke la mien phi hay thanh toan qua BH. Nhirng ngudi cd kha nang chi tra thudng chgn djch vu khdng nam trong danh mue bao hiem de tranh phae do dieu trj "hang hai". Ngudi khdng ed kha nang chi tra thudng tri hoan viee tham kham cho den khi \an de sire khde tram trgng. Miic phuc Igi tir bao hiem thudng thap, dac biet la bao hiem thude dien giam ngheo va an sinh xa hdi. Ket qua, 30% ngudi ngheo cd BHYT van phai ddi mat vdi cac khoan chi Idn cho CSSK. Do bao phu cua BHYT d Viet Nam duy tri d mire eii 5 ngudi thi van cd 2 ngudi ehua ed, trong do ed rat nhieu ngudi \ a hg gia dinh thude dien ngheo va can ngheo.
I 'Cm de y dice bae sT
Mot trong nhilng \'an de biic xiie nhat ciia ngudi benh khi den benh vien la nan phong bi, lot tay cho nhieu khau, bat dau tir khau lay sd thii ty cho den khau cham sdc, dieu trj,... Cung vi y due eiia mot bg phan bac sy xudng cap, nen viee di vien vdi ngudi benh trd thanh ndi am anh. Mdi khi vao vien, ngudi benh phai "bdi tran" nhieu khau de ddi lay cai ma hg ed quyen va xung dang duge hudng. Dau tien la ddi vdi nhan vien y te lam edng tac hanh chinh de cd the dugc kham chira nhanh chdng, tiep den, khi vao kham hoac nam dieu trj, rat nhieu benh nhan khang djnh hg da phai "Idt tay" cho bac sy, dilu dudng (y ta) dl nhan dugc sy tham kham. cham sdc nhiet tinh (mot ngudi tra Idi PVS khing djnh: mudn eon minh khong bi tiem dau phai co phong bi. Mot ngudi khac di trdng ngudi nha nim vien thi cho ring mudn yen tam thi mdi dem trong sudt thdi
..^ NghlSn cuu Con ngutu so 1 (58)2012
Nguyen Thi Anh Dao gian ngudi nha nam vien deu phai cd "phong bi" cho ca tryc, neu khdng, la co viee gi phai di goi thi eo the phai eha...din sdng!). Bg trudng Bd Y t l Nguyen Thj Kim Tiln eung thira nhan, van de bj phan nan nhieu nhat trong nganh y hien nay la thai do giao tiep, viee gay khd de cho ngudi benh, nhan phong bi,... Chinh mit Bg trudng cung da timg ehimg kien chuyen ngudi nha benh nhan phai bd tiln vao tui dilu dudng dl nhan vien nay thay drap mdi cho ngudi benh! "Can phai cd cac Idp dao tao lai vl y dire cho nhan vien y te. Y dire truyen thdng la bao mat thdng tin ngudi benh, an cin cham sdc ngudi benh nhung y dire eua thdi co ehl thj trudng edn phai la: ke don, la chi djnh, chin doan, xet nghiem". Ngoai hinh thiie "truyin thing" la "trao tay" tryc tilp, trong nganh y edn tdn tai nhirng hinh thire "ngam ngam" mdc tiii ngudi benh mot each tinh vi, kin dao, khdn ngoan eiia bae sy. Dd la chuyen ke don thude mot each "cd chii dich" dl dugc hudng hoa hdng tir hang dugc pham; lam dung thude, lam dung cac xet nghiem, chup chieu de nhanh chdng "khau hao" may mdc (do bac sy gdp vdn diu tu),... Dd chinh la
"y dire", tren bao Thanh nien, Bd trudng Y te hire xite ndi trong ngay lam viee diu tien tren cuang vi Bd t r u d n g "
Trinh do doi ngu chuyen mon va dieu kien trang thiet bi nganh y
Mot trong nhung nguyen nhan eiia tinh trang qua tai benh vien duge neu ra la sy yeu kem ve trinh do ciia dgi ngu y, bae sT va dieu kien trang thiet bj ciia he thdng y te cap co sd lam mat Idng tin ciia ngudi dan, khien hg ddn het ve cac benh vien Idn, nhieu khi qua mire can thiet (ed ngudi tra loi PVS rang chica mdi khong khdi, cudi eimg vdn phai len tuyen tren nen thd len tricae eon da ton kem thai gian va tien bae). De giai quyet van de nay, y te Tp.HCM da thuc hien chu truang eir bae sT benh vien Idn luan phien ve hd trg xay dung phdng kham ve tinh tai tuyen dudi. Chieu 3/5/2012, gan 100 bac si cua cac benh vien Idn tai Tp.HCM da dugc biet phai den lam viee tai eae phdng kham ve tinh d 12 benh vien quan, huyen, nham nang eao chat lugng kham chira benh tai tuyen dudi va giam tai tuyen tren.
Mot trong nhihig \ u viee tieu bieu the hien thai do va nang lye lam viee ciia nhan
\ ien y t l la cac trudng hgp dugc bao chi dua tin gan day, tir ngay 20/04/2012 den thang 5/2012 ed 9 trudng hgp tai bien san khoa (trong dd ed 6 trudng hgp chet ea me va con, 3 trudng hgp chi ciru dugc eon) xay ra tai cac co sd y te ca nha nude va tu nhan tren dja ban 6 tinh, thanh pho la Bic Ninh, Himg ^'en. Quang Nam, Quang Ngai, Ddng Nai, Ha Noi vii Tp.Hd Chi Minh^°
Tmh trgng qua tai a benh vien
Theo thong ke ciia Cue Quan ly kham, chira benh Bd Y te, hau het edng suat sir dung giudng benh d cac benh vien tuyen trung uong deu vugt tren 100%). Tinh trang qua tai cao nhit tap trung \ ao cac chuyen khoa nhu tia xa, ngoai, ngi tiet, tim maeh, sa sinh. Ve
" Thanh nien , so ra ngay 8 8 2011.
"" Dim tri. 29 5 12 - Bao cao cua Bg Y te giri Pho thii tuong.
NghlSn cuu Con ngudi sd 1 (58) 2012 21
Quyen duac cham soc sire khoe..
nguyen nhan qua tai benh vien dugc ngudi trong nganh ly giai vdi nhilu ly do dugc dua ra nhu, do nhu eau kham chira benh eiia ngudi dan, md hinh benh tat thay ddi, dau tu cho y te thap, nang lye y te co sd han che. Trong do, mot trong sd cac ly do la chi kinh phi cho y te d Viet Nam thap, mdi dat 53,3 USD/ngudi, thip hon so vdi Thai Lan (136,5 USD/ngudi) va Malaysia (307,2 USD/ngudi). Ty le giudng benh trung binh ciia Viet Nam tren 1 van dan so vdi ty le trung binh ciia cac nude trong khu vyc tay Thai Binh Duong la kha thap (24 so vdi 33) va edn rat xa so vdi eae nude phat trien trong khu vyc (Nhat la 140 giudng/1 van dan; Han Qude la 86 giudng/1 van dan).
Trude tinh trang nay, GS. Pham Gia Khai, Chii tich Hdi ddng chuyen mdn (phia Bic) Ban Bao ve va cham sdc sire khoe can bg Trung uong, Phd Chii tjch Hdi ddng chuyen mdn toan qude Ban Bao ve va cham sdc siic khoe can bg Trung uong danh gia: "Ngudi benh Viet Nam hien khdng dugc kham va dieu trj theo each ma hg xung dang dugc co"
Cdn theo PGS.TS Le Thanh Hai, Phd Giam ddc benh vien Nhi Trung uong thi nhilng quyen chinh dang, tdi thieu ma bat ky mot ngudi benh nao ciing phai duge hudng, dd la quyen dugc tham kham can than, chinh xac; quyen duge cung cap thdng tin va tu van day dii ve tinh trang benh, duge nam dieu trj trong dieu kien tdt (nhu mot minh mot giudng), duge cham sdc chu dao, day dii, kip thdi;... nhung trong bdi canh mot bac sT phai kham 100 benh nhan/ngay nhu hien nay thi chuyen kham "sieu toe" la khd tranh khoi, khien ngudi benh mat di quyen duge cung cap thdng tin va tu van tir bac sT.
Dieu kien phdng dc chat ehgi, xudng cap da day ngudi benh vao the bat budc phai chap nhan dieu trj trong dieu kien khdng the tdi te hon. Ke tir nam 1983 den nay. Ha Ndi ehua ed them mot benh vien Nhi nao ra ddi. Nd lye lam thi cac benh vien da khoa thude Tp.Ha Ngi mdi cd them khoa nhi vdi quy md nhd. Trong khi do, dan sd Viet Nam tang mdi nam gan bang dan sd mot tinh! Sy chenh lech qua Idn nay da tat yeu khien toan bd ngudi dan "khdn khd" mdi lan phai di vien. Ban than ong Hai eiing thii nhan mdi khi bi dm hoac ngudi nha bi dm phai di vien, thi ong cung bi "am anh" va rat so
hai!='
Chi tieu choy te vd bdt cap trong tinh gid vien phi
Ngan sach daith cho y te tang len mot each deu dan theo eae nam trong giai doan 2002-2008 \ a Chinh phu cam ket tang vdi toe do eao hon tang ngan sach nha nude. Tuy nhien, phan Idn mire tang nay nham vao viee dam bao duy tri djch vu va trg cap cho ben cung cap djch vu, cdn chi cho BHYT gom ca trg cap cho ngudi ngheo, ngudi thiet thoi it hon nhieu" Dieu do ham nghla rang, ty trgng chi tieu cho y te so vdi GDP cd xu hudng tang len nhung ehi tieu tu nhan ddng vai trd Idn trong tdng chi vdi eae khoan chi tir tien tui eiia ngudi dan. Hay ndi khac di, mac dii tang lien tuc nhung chi tieu qude gia lai the hien sy kem edi hoac khdng gan ket vdi cac uu tien nang cao thanh qua y te.
'' cam Quyen, I'ietnamiiel.vn,24/&/20\\.
" Bao cao Quoc gia ve Phat triin con nguoi nam 2011, tr.96.
, , NghlSn ciiu Con ngudi sd 1 (58) 2012
Nguyen Thi Anh Dao Hien nay d Viet Nam, ehi tieu tir hd gia dinh dang chiem khoang 60% tdng chi tieu y te, trong dd 55%) tir tien tiii ngudi dan. Ty le nay duge eoi la rat eao trong sd cac nude cd thu nhap thap va trung binh va cao han nhieu so vdi miic ly tudng de dat mue tieu phd cap y te tdi da la 30%. Neu vugt qua mire nay nghla la cac gia dinh se thudng xuyen phai ddi mat vdi cac chi tieu y te qua kha nang chi tra. Mot nghien cuu cua WHO va Dai hgc Y Ha Ngi ve ganh nang tai chinh d cac khoan chi cho y te cho thiy 5,7% sd hg gia dinh danh ban 40%) thu nhap cho y te va 3,7%o da bi bin ciing hda vi khoan chi nay"
Bao eao chung y te thudng nien nam 2008 cho thiy su khdng phii hgp vdi uu tien ciia ehinh phu ve cham sdc dy phdng, cham sdc d cip dja phuang va hd trg cho eae viing khd khan. Nguyen nhan la do kinh phi cho phat trien tap trung vao cip qude gia va cap tinh va phan Idn ehi tieu danh cho KCB hon la dy phdng (28% nam 2007, it hon eon sd 30% trong Nghj quyet 18). Chi tieu thap d cac cap huyen, xa khiln cho he thing y te d day (nhu tram y te xa) bj han che ve chat lugng co sd ha tang, ve viee thu hiit va giir chan nhan vien va ve ngan sach thap cho chi thudng xuyen. Tat ca nhiing dieu nay khien chat lugng djch vu nhin ehung thap. Tir tinh trang chat lugng thieu ddng bd nay, Bd Y te da dua ra quy djnh phan tuyen ky thuat, benh vien d cac tuyen khae nhau cd pham vi kham chiia benh khac nhau. Qu\' djnh nay mat khac da dan tdi tinh trang: mac dii ve ky thuat, tuyen dudi ed dii kha nang thye hien nhung chieu theo phan tuyen ky thuat thi lai khdng dugc phep, vi the benh nhan huge phai len tuyen tren, khien cho tinh trang qua tai d tuyen tren cang gia tang.
Mot bat cap nira la hien nay theo quy djnh eiia Luat BHYT, ciing mot benh nhung cd sy phan biet rd ret ve mire thanh toan giii:a cac tuyen. Cd nhirng benh d tuyen TW thi duge BHYT thanh toan toan bg nhung d tuyen tinh, tuyen huyen thi benh nhan khdng dugc thanh toan din mire nhu \ay. Vi the, benh nhan duong nhien mudn bd len benh
\ ien tuyIn TW dl kham. Thir tnrdng Bg Y tl Nguyen Viet Tien ddng tinh cho rang hai diC-m nay ein duge xem xet, sira ddi de tao dieu kien cho y te tuyen tinh, huyen phat huy nang lye, nang ddng va chii ddng hon trong kham, chiia benh, gdp phan giam tai cho benh vien tuyen tren.
Bdt cap trong quan ly he thong y te tuyen ca sa
\'h quan ly he thing y te cap ca sd eiing cdn nhieu van de dang phai ban, dien hinh la trircmg hc^ji eiia fp.Ha Ngi. Tir thang 12,2008 din nay, UBND thanh phd da ban hanh lien tilp 3 quylt djnh tha> ddi dan vi quan ly khien cho nliieu can bg y te ea sd cam thay bat an va khdng rd !> do \ i sao?
Gan 3 nam, 3 qu\el dinh thay doi: "Dii quan. huyen hay sd y te quan ly trung tam y il (Tl^T) quan, hu\en. thi xa thi deii la phuc M,I nhan dan. nhung phia can bg \ te
-' Sdd. tr.99.
Nghien ciiu Con nguc^ so 1 (58) 2012 23
Quyen duac cham soc sice khoe..
chiing tdi rat can sy dn djnh. Viee thay ddi don \ i quan ly lien tuc da \ a dang lam xao trpn tu tudng can bd tuyen co sd", ong Tran Minh San, Giam d i e TTYT hu\en Phiic Thg (Ha Noi) phan anh. Ngay ban than dug ciing khdng ro vi sao trong mot thdi gian ngan ma cd nhieu quyet dinh ve viee thay ddi don vj quan ly TTYT din vay. Thang 12/2008. tai Quylt djnh (QD) 51, UBND Tp.Ha Ndi quy djnh quan, huyen quan ly TTYT (bao gom phdng kham da khoa quan, huyen va tram y te phudng, xa)... Sau do, thang 7/2009, UBND thanh phi lai cd QD 79 sira ddi, bd sung mot sd dilu eiia QD 51, viee quan ly TTYT lai thude thanh phd. tiic la Sd Y te Ha Ndi true tiep quan ly. Den nay, mdi ed khoang 2 nam thye hien QD 79 thi ngay 2/3/2011, UBND thanh phd lai co QD 11. chuyen TTYT ve quan, huyen quan ly.
3. Tinh trang cham soc site khoe mot so doi tuong dac biet
Trude nhung thach thiic ndi tren, viee CSSK cho ngudi dan, nhat la mot sd ddi tugng dae biet nhu ngudi eao tudi, tre em, ngudi khuyet tat, ngudi ngheo da vap phai nhieu vudng mac, ha thap ket qua cong tac y te.
Nguai cao tudi
6 Viet Nam hien cd 69%) ngudi cao tudi van song vdi eon ehau, nhung theo bao cao ciia Quy Dan sd Lien hgp qude thi eon sd nay giam nhieu trong thdi gian qua, tir hem 80% vao nam 1993 giam xudng chi edn khoang 70%) sau 15 nam. Day la ket qua nghien ciiu qude gia lan dau ve ngudi eao tudi edng bd sang 4/5/2012 tai Ha Ngi. Hdi Lien hiep Phu nir Viet Nam, Hgi Ngudi eao tudi Viet Nam va cac dem vj khac da tien hanh cupc dieu tra tir thang 10 den thang 12/2011, tai 12 tinh thanh d ca ba mien, vdi su tham gia ciia 4.000 ngudi tir 50 tudi trd len. Trong sd nhilng ngudi cao tudi phai tra tien cho cac dich vu cham sdc sire khde, gan 50% khdng du tien de ehi tra. Ngoai ra, ty le ngudi cao tudi cd cam giae budn hoac that vgng hau nhu ca tuan la 7-8%), sau do tang len gan gap hai d nhom ngudi eao tudi tren 80 tudi. Cd gan mot phan ba tra Idi khdng the chia se vdi ai khi cam thay khdng vui hoac budn.
Cac thdng ke va nghien euu gan day cho thay, ngudi cao tudi van thude nhom dan so de bj tdn thuong \ a ngheo nhat. Ong Dam Hiru Dac, Phd Chii tich thudng tryc Hdi Ngudi cao tudi cho biet, dan sd the gidi dang gia hda nhanh d hau het eae nude. Dii mdi chi la nude ed mue thu nhap trung binh thap, nhung dan sd Viet Nam da bat dau budc vao giai doan gia hda khi ehua tich luy dugc gi. Dieu nay dat ra thach thirc rat Idn trong edng tac cham sdc ngudi eao tudi trong thdi gian tdi^**
.Xgicai ngheo
Dilu tra mire sdng hg gia dinh (VHLSS) cho bilt cac con sd cua nam 2008: 51,6%) si ngudi duge hdi da timg bj dm, 10% can nam dieu trj, 34%o ngudi dan ed tiep can cac djch \ u >• tl. Trong giai doan 2002-2008, ty le sir dung djch vu y te da tang dang kl.
Viee sir dung djch vu y t l ehii ylu la dudi hinh thiie kham chiia benh tai co sd y t l nha -' Nam Phuang, "Nguai gia ngay cang it s6ng vai con ehau", ( ncxpress, 5 5 2012.
NghlSn ciiu Con ngudi s61 (58) 2012
Nguyen Thi Anh Dao nuoc, djch vu y te tu nhan cung cap chi chiem 38%). Nhirng con sd nay cho thiy ngay cang cd nhieu ngudi sir dung djch vu y te, tuy nhien van cdn tin tai nhilu khac biet. Xet theo nhom thu nhap thi ngudi ngheo it sir dung eae djch vu y tl. Ty le sir dung djch vu y te ciia ngudi cd BHYT la cao hon (BHYT la ly do khiln ngudi dan quylt djnh sir dung hay khdng djch vu y te), ngudi thanh thj sir dung dich vu phdng benh nhieu hon so vdi ndng thdn. So lieu tir Dilu tra Danh gia cac mue tieu tre em va phu nir (MICS) nam 2006 cho thay, tre em do tudi 2-4 khdng duge tiem phdng la 31%, dd thj la 20% va ndng thdn la 35%, 25% tre em ngudi Kinh va ngudi Hoa, 58,5% ngudi dan tgc thilu sd.
Sy khac biet trong tiep can djch vu y tl bj anh hudng bdi chi phi djch vu gia tang va sy sin cd cua BHYT la bien phap lam tang sir dung va giam chi tieu ca nhan cho y tl.
Tre em
Ty le tir vong tre em dudi 5 tudi giam tir 58/1000 (1999) xuIng 24,4/1000 (2009); ty le tir vong tre sa sinh giam tir 44,4/1000 (1999) xudng 16/1000 (2009). Ty le tir vong ba me giam tir 233/100.000 (1999) xudng 69 (2009), d ndng thdn eao gip hai lin dd thj.
Da sd tre diu duge tiem chiing (82%), 94,8% ca sinh ed nhan vien y tl ho trg (ty le nay d vung Tay Bic chi la 79,9% so vdi Ding bing sdng Hdng la 100%). 83% dan si ndng thdn dugc tiep can vdi nude uong sach (2010) so vdi 30% (2000). Ty le tre em edi xuong la 31,9%o nhung khu vyc ndng thdn va viing sau vimg xa cao gip 2, 3 lin ding bang va thanh thj. Chenh lech nay ddi hdi cai thien djch vu y te bang viee tang cudng su sin cd va chat lugng quy djnh giam sat hieu qua ciia djch vu y tl.
Ngudi khuyet tdt
Ngudi khuyet tat can dugc cham sdc y te nhieu ban, khoang 80%) sd ngudi dugc hdi da timg bj dm va tim den djch vu y te, mot sd ngudi dugc tham kham tai nha song da phan ty cham sdc va dieu trj, khoang 1/2 cho biet hg gap khd khan trong tiep can djch vu va ly do chinh la chi phi dieu trj, thieu phuong tien di lai, khoang each dja ly xa, co che quan lieu, thieu djch vu phii hgp va phan biet ddi xir. Cd mot ty le Idn tra Idi khdng ed BHYT (28% d Quang Nam, Da Ning va 60% d Ddng Nai).
Viet Nam da ky Cdng udc Lien hiep qude nam 2008 ve Quyen cua ngudi khuyet tat va nam 2010 da ban hanh luat mdi ve ngudi khuyet tat trong do ghi rd sy tham gia binh dang cua ngudi khuyet tat trong xa hdi ke ca tiep can y te, giao due. Tuy nhien, tren thye te chi cd ngudi khuyet tat phai gdng minh len ddi phd va thieh nghi vdi djch vu san ed, cdn ngudi eung cap dich vu thi ehua cam thay sire ep phai dam bao dich vu eiia hg de dang tiep can ddi vdi ngudi khuyet tat \ a hg can lam sao de dam bao eo hdi tiep can binh dang cho mgi ngudi dan^^
-' Sdd. tr.78.
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