KUSH Tg' vA qjcis iS
ANH HUliNG CUA VIEC MUA BAO HIEM Y TE VA D N H I I M KHDNG KHJ LEN GHi TIEU Y T i n VIET NAM
Nguven Thi Phuang Dai hgc Thang Long Email: [email protected]
Nguv6n Thi TuvIt Dai hgc Thang Long Email: [email protected] Ngdy nhgn: 18/11/2019 Ngdy nhgn lgi: 01/12/2019 Ngdy duyet ddng: 10/12/2019
• T ^ A / e n cuu xem xet muc chi tieu ^ te tgi Viet Nam tic ndm 2010 den ndm 2016 ddng thai ddnh gid ' drf^dnh huang cua viic mua bdo hiim ytivdd nhiim mdi tru&ng lin cdu y ti cua cdc cd nhdn trong mdu diiu tra. Kit qud tnc&c tien chi ra chiphiy te trung binh cita cdc cd nhdn tdng tic 1,36 trieu ddng ndm 2010 lin 2,76 trieu dong nam 2016. Mice chi tiiu y te cda cdc hp gia dinh trong giai dogn nghiin cuu chiim Ichodng 3-4% long thu nhgp ciia cdc hd. Thic hai, nghiin cuu tim thdy rang viec mua bdo hiem y ti Idm gia tdng chi tieu y te cua ngu&i mua. Thic ba, 6 nhiim khong klii tdc dpng nghiem trpng doi v&i sue khoe cdng ddng vd gdy dp luc chi phi y ti hiin nay.
Tir khoa: cdu y ti, chi lieu y ti, bdo hiim y ti, 6 nhiim khdng khi I. Gidi thigu
Siic khoe la mgt khia canh quan Upng ciia vdn con ngudi, tac dpng tich cyc den dau ra kinh te d ca cap dp vi m6 va vi mo. Siic khoe tdt htm cd thg giiip ca nhan nang cao duge hieu qua lam viec va nang suat lao dpng tir do gia tang thu nhap cho ban than ca nhan va cuoi cung lit gia tang t6ng san pham xa hpi noi chung, Vdi cac yeu td khac khong doi thi tinh tr^g sue khde cua mgt ca nhan cd Ihg duge nang cao bang viec sir dung cac dich vu cham sdc sire khoe. Cham sdc siic khoe la mgt hang hoa dac biet va cau ve hang hda nay cung ehiu tac dpng ciia nhieu nhan to khac nhau, Uong dd cd cac nhan td vg kinh te, xa hpi, nhan khau hpc va cac dac digm ciia hing h6 gia dinh.
0 Viet Nam, Uong nhieu thap ky qua, nhieu chinh sach cai each ve y te duge thuc hien dan dgn chat lucmg djch vu y tg da cd cai tign vugt bac vg chat lugng. Siic khoe ciia ngudi dan Viet Nam duge cai thien dang kg va day ciing la yeu td quan trgng gop phan nang cao nang luc san xuat va tang tnrdng kinh te trong nhiing nam qua. Tuy nhien, dac thii ciia Viet Nam la mpt nudc dang phat trien vdi thu nhap So 136/2019
binh quan dau ngudi cdn thap, trinh dp phat trign xa hgi chua dong deu dan den viec tiep can vdi cham soc y te con gap nhieu rao can. Ngoai ra, tinh trang moi tnrdng d Viet Nam tir nguon nudc, khong khi, thitc an, tieng on hay dat dai dang bj d nhiem d miic bao dpng, de dpa true tiep den siic khoe con ngudi va lan rpng trong nhieu khia canh sinh hoat ddi sdng. Cac nha khoa hpc chi ra rang mot trong so cac nguyen nhan dan den tinh trang ung thu ngay cang tang chinh la do moi trudng song ngay cang xu6ng cap tram trpng (Anh Tuan, 2017). So ngudi mac benh ung thu, benh nghe nghiep, anh hudng den than kinh va chiec nang ciia tuyen ngi tiet, con cai hi di tat bam sinh ngay mpt tang. Dieu nay gia tang ap lyc chi tieu y tl cho cac hp gia dinh. Khi hau nhiet ddi gio miia am ciing thuan lgi cho su phat trien nhiiu ngu6n benh, cimg vdi van de gia boa dan so ciing lam gia tang dang kg cau ve dich vu y te d nudc ta. Cau ve y te la mgt npi dung quan trpng dang duge nghien ciiu trong giai doan hien nay.
Tu cac ly do dl cap d Uen. chung toi tien hanh mpt nghien ciru thyc nghiem lugng hoa anh hudng ciia viec mua bao hiem y te (BHYT) va 6 nhiem
khoa hoc c3=
mai 11
KiaiH TE v A QUAIV I.Y
khong khi Ign chi tigu y tg cua cac ca nhan hien nay.
DiSu nay duge xera la mpt yeu ciu vd ciing quan trong khi vin de cai thien siic khoe con ngudi !a van de nong dang duge ca xa hdi quan tam. Bai viet duge bd cyc thanh 5 phin. Phan tiep theo se trinh bay CO sd ly thuyit. Phuang phap nghien ciiu duge trinh bay Uong phin 3. Phin 4 phan tich va thao tuan cac ket qua thu duge tii nghign ciru nay. Phan cuoi dua ra ket luan va cac khuyen nghj giai phap.
2. Cff Sff ly thuyit
2.1. Cff SO' ly thuyet cho nghien cieu Kinh te y te gia dinh rang cac ca nhan co thu nhap nhat dinh dg chi cho bao v? siic khoe va cac hoat dgng tieu diing khac. Cac ca nhan nhan duge Igi ich tir viec tigu dung ca dich vy y te va cac hang hoa khac (Santerre va Neun, 2010). Md hinh ciu sue khoe ciia Grossman (1972) cho rang ngudi tigu diing CO myc tigu t6i da hoa lgi ich vdi rang bupc ve ngan sach. Cac dich vu y te da duge dua vao ham lgi ich mpt each gian tigp thdng qua vdn sire khoe. Trong rao hinh nay, cham soc sice khoe la mot hang hda tieu dimg vi ca nhan thu duge lgi ich tir viec khoe manh va dieu dd cho phep mpt ca nhan tham gia cac hoat dpng kinli te, do dd tao ra thu nhSp cho hg.
Theo Grossman (1972), mot ca nhan ke thira mot kho siic khoe ban dau va site khde nay se giam dan theo dp tudi va eo the duge phyc hoi bang each dau tu moi. Ca nhan do do se yeu cau cham soc siic khoe dg tang cudng khoe manh miln la chi phi diu tu can bien trong sue khoe thap han ty le lgi nhuan can bien. Cau cham sdc siic khde se tiep tuc cho den khi dat duge Uang thai can bang (chi phi can bien cua khoan dau tu bang lgi nhuan can bien). Lgi nhuSn cSn bign d day la sire khoe t6t hem khi duge cham soc th6ng qua cac djch vu y te.
2.2. Bang chirng thuc nghiem
Cd rat nhigu nghien ciru tren the gidi de cap den cac yeu to anh hudng den cau ve cham soc y te. Anh hudng ciia thdng tin bat doi xiing trong cham soc sire khde den chi tieu cho y tg lin diu duoc Pauly (1968) dg cap bang each phan tich bang each su dung 2 cap dp khac nhau. Thu nhat, ngudi tieu diing kli6ng chae chan ve so lugng va loai dich vy y te can thiet ma ho can tham khao y kien bac si la ngudi cd nliigu th6ng tin ve van de nay nhat. Dieu nay lam giam dang ke quyen ciia ngudi tieu diing d6i vdi viec quyet djnh tieu dung dich vu y tg cua hp. Thii hai, BHYT, mpt cong cu cho tai trg chi phi y tg la
hhoa hoc = ^ = ^ ^ , = ^ ^ = ^ ^ ^ ; ^ ^ = ^ 12 thifdngmai
cin thiit dl giam sd tiln ma ngudi benh phai thanh toan bing tiln tiii ciia minh, Tuy nhien, cac khoan thanh toan ciia ben thii ba (bao hiim) cd thg lain tang ciu vl dich vu y tl. Bdi vi bao hiem lam giain gia cham soc site khde, benh nhan co the tiep tyc cau dich vu y tl miln la lgi ich can bign Idn han chi phi cSn bign va Uong trudng hgp nay ngudi tieu dung se ygu ciu cham soc nhieu hon ngu hp mua bao hiem (Kop, 2004). Hieu qua eiia bao hiim tdi cham soc y tl ciing CO the duge phan tich thong qua tac dpng thay thi va tac dpng thu nhap do bao hiem nhu la mpt hinh thiic lam giam chi phi y tg ma ngudi benh phai tra cho cac nha cung cap. Theo higu ling thay thi, chi phi cham sdc y tl do bao hiim khiln ngiroi tieu diing phai mua them djch vu y te va cau vg y te cao hon (Santerre va Neun, 2010).
Nghien ciiu eiia Lepine va Nestour (2008) cho thiy tinh ttang kinh tl hp gia dinh va chat lugng cham sdc siic khde la cac nhan td quan Upng tac ddng tdi xac suat tim kiem djch vy dieu tri tir cac trune tam y tl cd chat lugng. Ngoai ra, ehi phi di lai la yeu td quan trgng tac dpng tdi kha nang tim kiem djch vu cham sdc siic khde. Abdullah ciing cac cpng sy (2016) xem xet chat lugngmdi tnrdng va yeu to kinh te xa hpi cho chi tieu y te tai Malaysia. Nghien ciru cho thay tong san pham qu6c npi, cac ^eu to moi trudng co mdi quan he vdi chi tieu y tg trong thdi gian dai d Malaysia. Miic sinh va ty le tir vong d tre sa sinh cho thay mirc anh hudng dang ke trong chi tieu y te cila dat nudc nay.
3. Phuong phap nghien ciru 3.1. Md hinh ly thuyet
Theo Grossman (1972), cac ca nhan tdi da hoa lgi ich cua hg doi vdi siic khde va cac m^t hang khac CO ygu td thi trudng va phi thi trudng. Cac yeu to thj trudng bao gdm su san co ciia cac dich vu cham soc sue khde va gia ca, bao hiem va thu nhap hp gia dinh. Cac yeu td phi thj trudng bao gom dac diem cua hp gia dinh, dja digm hoac khoang each tdi bgnh vien va cac dac diem ca nhan nhu tudi tac, giao due, tinh trang siic khoe va nhan thiic raa hp co vg chSt lugng djch vy y tl (Ajakaiye va Mwabu, 2007;
Jowett Cling cong su, 2004). Gia su ring cham soc sue khoe la rapt hang hoa tieu dimg, ngudi tieu diing tdi da hoa loi ich duge bieu thi bing:
MaxU- U(H.Z,X,Y) (1) Uong do U la lgi ich co duge tir viec tieu diing cac hang hda khac nhau; H la ham san xuit siic So 136/2019
KKfiH T6' T A qjsAsi iS
khoe; Z la viet tat ciia cae ygu td dau vao sue khoe nhu cham s6c sdc khde, X dai dien cho tat ca hang hda va dich vu khac va Y la hang hoa sire khoe lien quan mang lai lgi ich cho ngudi benh va cai thien tinh trang siic khde. Ham Igi ich duge tdi da hoa theo cac phuang trinh sau:
H= H(Z,l,S,C,A,hs,Pfj,N^ (2) Vdi rang bupc: B = XP^ + YPy + ZP.^ (3) Trong phucmg trinh (2), Z duge djnh nghTa nhu trong phuang frinh (I) va I la dac diem cua hg gia dinh bao gom bao hiem; S la bign so nhan khau hpc xa hpi bao gdm tudi tac, gidi tinh va giao dye; C la viit tat cda dac diem cpng dong bao gom khoang each dgn ca sd y te; A la tai san hg gia dinh; h^ la quy md ciia hp gia dinh; P;, la gia cua viec cham soc siic khoe, trong khi NQ la cac dac diem kh6ng quan sat duge cua hp gia dinh. Trong rang bupc d phuang trinh (3), B la thu nh|p ngoai sinh va P^,
?y va P^ lan lugt la gia cua hang hda trung tinh vdi sue khoe (nhu quan ao), hang hoa tieu dimg co lien quan den siic khde Z (chang han nhu cham sdc siic khoe) va hang hda dau tu cho siic khde nhu tap the dye. Giai quygt van dg tdi da hoa lgi ich sinh ra mpt ham cau cho cham sdc siic khde duge xac dinh nhu sau:
i ) j = /(I.B,A,S,C.h,,P,,,N^ (4) Trong d6 D^ de cap den nhu cau cham sdc sue khoe; I la BHYT; B la ngan saeh hoac thu nhap; A dai dien cho gia trj ciia tai san hd gia dinh va S la viet tat cita cac bien nhan khau hgc; C dai dien cho cac dac diem cdng ddng bao gdm khoang each dgn ca sd y te; h^ la thanh phan hp gia dinh; P^^ la gia cham soc sue khoe vit N^ la dac diem hd gia dinh khong the quan sat duge.
3.2. Mo hinh ir&c luffng
Nghien ciiu nay xuat phat tir mo hinh ly thuygt cita Grossman (1972), ciing vdi do san cd cua dir lieu, nghien ciru bo sung them yeu td 6 nhiem moi tmdng anh hudng den chi tieu y te ciia cac hg gia dinh d Viet Nam. Mo hinh duge de xuat nhu sau;
^h = f(^lt^2t'^3t'^4P^5t^6t'^7f^8t^ (^) Trong do:
Dj^. chi tieu cho y te cua cac ca nhan cho dieu trj npi tni va ngoai tni dai dien cho cau ve y te. Chi tigu y te khong bao g6m mua BHYT.
Xji: viec mua BHYT cita ca nhan, nhan gia tri = I ngu ca nhan mua bao hiem va = 0 neu khong mua.
Bigu kien sii dung bao hiem y te chi tieu y te la phai So 136/2019
dm dau/thuang tat Uong 4 min hoac 12 thang qua va CO diing the khi kham chiia benh.
Xji: tan suat dieu tri ndi tni va ngoai tni X j j : miic chi tigu hang hda binh quan cita cac ca nhan trong hg gia dinh theo nam
X^l^ : bien tuong tac giiia trinh dp hpc van va rauc thu nhap cua thanh vien trong gia dinh (hgc vin
* thu nhap). Trinh do hpc van = 1 niu co bing tiiu hoc, = 2 niu cd bing THCS va THPT, = 3 niu hpc nghi, = 4 neu co bang cap cao han THPT).
Xj(: nai cu tni_ (biln gia nhan gia tri =1 niu d thanh phd va = 0 neu d nong thon)
X^l: gidi tinh cac thanh vien (biln gia nhan gia tri == 1 neu la nii gidi va = 0 neu la nam gidi)
Xjf: tuoi cac thanh vien
Xgi: ty lg mice thiet hai khi thai d Vigt Nam den GNI (tong thu nhap quoc dan) theo thdi gian, dai dien cho mirc do 6 nhiem mdi trudng
3.3 Mo td dulieu
Nghien ciiu nay sit dung dii lieu tic cu6c dieu tra khao sat miic song hd gia dinh Viet Nam (VHLSS) duge tien hanh 2 nam mpt lan ciia T6ng cue thong kg tic nam 2010 den 2016. Dii' heu chua cac bien ve nam sinh, tudi, quan he vdi chii hd, tinh Uang bao hiem, thu nhap cac thanh vien trong hp, tinh frang kham chiia benh npi tni, ngoai tni, ehi cham soc siic khoe, trinh dp hpc van, nai cu tni, dan tpc, viing mien, gidi tinh va cac dac diem ca nhan khac cd thg cd tac ddng dgn vigc su dyng cac dich vu cham soc Stic khoe. Nghien,ciru loai bd nhu."ng ngudi duac bao higm mign phi (bao gdm ngudi ngheo, han 90 tudi va cuu chien binh). Chi phi kham chiia benh va thu nh|p da duge giam phat ve nam 2010 de Ioai bo ygu t l lam phat. Dir lieu ciia Ngan hang thi gidi (2018) ve miic khi thai tnmg binh tii cac nguon khac nhau d Viet Nam theo thdi gian tic nam 2010 din 2016 duge kit hgp vao bo dieu tra khao sat mice song h6 gia dinh Vigt Nam.
4. PhSn tich va thao luan kit qua nghien ciiu 4.1. Thuc trgng su dung bdo hiim y te cua cd nhdn, muc dQ 6 nhiem mdi truoitg vd chi tieu y te cua cdc hp gia dinh tgi Viet Nam
Nam 1992 lit raOt d§u moc trong dich vy cham soc siic khoe tai Viet Nam khi chinh sach BHYT tai Viet Nam ra ddi. Digu do co nghTa dich vu cham sdc siic khde khdng cdn duge cung cap mien phi cho tat ca ngudi dan. BHYT la mpt trong nhirng tru cot ciia he thdng an sinh xa hgi, mang y nghia nhan dao
khoa hoc ^^
thifdng'mai 13
,^JagH TE vA ftuAjg ht
cpng dong sau sac, gdp phan quan frgng thyc hien c6ng bang xa hpi trong cham soc va bao ve sue khoe nhan dan. Bgn canh viec gidp dd ngudi dan Viet Nam tiip can cac djch vu y tl, BHYT giiip tranh nhung cii sic tai chinh hoac ngheo doi do dot ngot benh nang (Wagstaff, 2007). Trai qua 26 nam thuc hien, vdi nhieu lin thay ddi, BHYT da tao ngn nliiing thay d6i quan Upng khong chi vg co chg, chmh sach tai chinh y te ma con tac dpng den nhigu mat cua hoat d^ng kham chiea b.enh cho nhan dan va da dat duge nhiing kit qua nhat dinh. Cu the, kgt qua tir mau dieu tra muc s6ng hp gia dinh Viet Nam cho bilt ban dau co 61 % ngudi dan tham gia BHYT nam 2010, sau dd tang len 66% nam 2012 va 71% nam 2014. Den nam 2016, ty le ngudi dan tham gia BHYT la 79%. Ty le tham gia BHYT Uong ca giai doan 2010-2016 dat 69%. Kit qua nay ciing kha sat vdl ket qua diSu tra dan so fren pham vi ca nudc tham gia bao hiem y te vdi ty le la 66,7% nam 2010 len 77,6% nam 2016 (T6ng cue thing ke, 2016).
Hign nay, chi phi kham chira benh cua doi tugng tham gia BHYT chilm 70-90% nguin thu cua cac benh vien, co ban bao dam cac chi phi true tigp dg phuc vu ngudi benh va hoat dpng cua benh vien (Thanh Huong, 2016). Dk tiln tdi BHYT toan dan vao nam 2020, Viet Nam da to chiic nhieu hoat dong, tuyen truyen, van dgng ngudi dan tham gia BHYT trgn mpi viing mien ciia td quoc.
Viec xem xet tuong quan ty le ngudi dan tham gia BHYT theo co cau gidi tinh, cu tni va trinh do hoc van se co cai nhin bao quat va ro rang hem vg thuc trang tham gia BHYT theo nhan khau hoc tai Viet Nam hien nay. Cu the, neu phan chia theo gidi tinh thi ty le tham gia bao hiem cua nir gidi (77,4%) cao hon ciia nam gidi (70,2%). Khac vdi nam gidi, nu: gidi can duge cham soc sice khoe sinh san. Viet Nam duge danh gia thupc nhom qudc gia eo ty le phu nii tham gia lyc lucmg lao dong cao nhat the gidi. Dg dang nhan thay phu nir sii dung bao higm y te pho bien hon so vdi nam gidi. NIU phan cliia theo trinh do hpc van thi ty le tham gia bao higm cua d6i tugng cd frinh dg cao dang, dai hpc khoa hoc ^ ^ ^ ^ ^ ^ ^ ^ 14 thifdng'mai
va fren dai hpc lit cao nhit va ty IS tham gia bao hiem thip nhit la hpc smh tiiu hgc, trung hgc ca sd (THCS) va frung hpe phi thong (THPT), Hoc sinh la nhiing d6i hrgng bit bupc ddng BHYT. Tuy nhien, kit qua frc miu dilu tra cho thiy viec cham soc siic klide cua thi he tuang lai van can sy quan tam han nua khong chi phia phu huynh hpc sinh ma cdn ca xa h6i. Phan loai theo nai cu tni thi ty le tham gia BHYT tai cac thanh phi Idn cao hem n6ng th6n do thu nhap va kha nang tiep can thong tin tdt hon. Tuy nliien, khoang each giiia 2 khu vyc nay frong viec tiip can BHYT dang nhd din lai do cdng tac tuyen truyin, phi biln phap luat, chinh sach, chg dp BHYT nhiing nam gin day hieu qua nhu diing muc tigu ciia Chinh phii de ra den nam 2020 cd fren 90% dan so tham gia BHYT, tien tdi BHYT toan dan (Tong cue thing ke, 2016). Do ngudi Kinh chu yeu sdng d cac viing ding bing va thanh thi Uong ca nude nen kha nang tigp can thdng tin va dieh vu y tg tdt hon ngn ty le tham gia BHYT cita ngudi dan tpc Kinh cao hem cac dan tpc khae d Viet Nam lit digu dg hieu.
; Thuc trgng tham gia BHYT ciia nguai ddn giai dogn 2010-2016
Phan loai Ty le thara gia
BHYT (%)
Trinh do hpc van
Nam Nu Trinh do tieu iipc
Trinli do THCS Tnnh dp THPT va
hpc nghe
70,2 77,4 66,5 67,6 68,6
Cao hon THPT Thanh thi Nong thon Kinh Dan tgc khac
70,7 68,1 87,8 64,1 Ngudn: Tdng cue thdng ke (2010-2016)
So 136/2019
KSSH V^ vA ^V&S lS
Trong nhung nam qua, vdi xu thg d6i mdi va hpi nhap, Viet Nam la diem sang ve phat trien kinh te trong khu vuc D6ng Nam A. Tuy nhign, Viet Nam van dang phiti doi mat vdi rat nhieu thach thiic, trong do CO van de 6 nhiem moi trudng. 0 nhiem moi trudng duge xem la m$t trong nhiing tac nhan hang diu CO tac dpng tigu cyc doi vdi siic khde cpng d6ng dac biet tap trung d cac dd thi phat trien, cac khu, cym cong nghiep. Do anh hudng cita cac yeu td khi hau va thdi tigt (bao g6m chg dp bite xa, nhigt dp, lugng mua), tinh trang 6 nhiem moi trudng, dac biet 6 nhiem khong khi d nudc ta dang anh hudng nghiem Upng doi vdi siic khde ngudi dan va gia tang dang ke ap luc len chi phi y te ciia cac hg gia dinh hien nay. Ho^t ddng xay dyng, cai tao va xay mdi cac khu chung cu, khu do thi, sira chira cau dudng, nha d, van chuyen vat ligu va phe thai xay dung dien ra 0 khap nai, lam phat tan khoi hyi vao mdi trudng khong khi xung quanh. Do tinh san cd cita dii lieu, nghign ciiu nay su dung tinh Uang d nhiem khdng khi dai dien cho miic anh hudng ciia 6 nhiem moi tmdng den cau y te ciia cac hg gia dinh tai Viet Nam.
< ~;'n; tit:tHiti sii>> r » n i i h i c i i i k h *
Ngudn: Ngdn hdng The giai (2010-2016) Hinh 1; Tinh trgng d nhiim khi thdi a Hinh 1 cho thay cac nguon chinh gay ra 6 nhiem khong khi bao g6m: khi thai hi giao thdng (23%); tii nganh che biln, che tao va xay dung (34%); tic san xuat dien va nhiet (34%); tic cac tda rihk dan cu va djch vu thuang mai (8%i) va cac ngudn khac (1%).
Trong do, lugng khi thai nhieu nhat den tir nganh chg tac va xay dyng, tic san xuat dien nang va nhiet nang. Nganh che bien, che tao duge coi la tru cpt chinh cua nen kinh te vdi mii'c rieu thy nhien vat lieu So 136/2019
cung nhu lugng khi thai ra moi frudng rit Idn. Hoat dgng tai chi ciing tao sue ep dang kl len moi trudng va pho bien d khu vyc miln Bic. Nganh xay dyng gay ap luc m6i trudng khong khi chu yiu do cac dan vi thi c6ng chua thyc hien day du va nghiem ngat cac bien phap bao ve moi tru'dng tai cong frudng xay dung. Hoat dpng dan sinh tap trung d khu vuc nong thon, noi nguyen lieu dun nau vit san xuit vin chii yeu dua vao nhign lieu hda thach, ciii va cac chit thai chua duge kigm soat ciing nhu viec sir dyng nang lugng ciia cac doanh nghiep lit nguyen nhan gay ra miic khi thai tu san xuat dien nang va nhiet nang tang cao. Lugng khi thai din tic giao thong (CO, VOC, TSP til- xe may va S02, N02 tir 6 t6) chiem mdt ty Ie kliong nho d mdc 23% do si iugng phucmg tien giao thdng gia tang manh me qua cac nam gdp phan suy giam dang kg chat lugng m6i tru'dng khdng khi. Do ap lyc hi qua trinh do thi hoa, lugng khi thai tic cac toa nha dan cu vit djch vu thuang mai ciing gay ra 6 nhigm khdng khi, chiem ty le 8%>. Nganh chan nudi vdi quy m6 vit s6 lugng tang nhanh chdng liim phat sinh cac loai khi thai nhu C02, CH4, NOx, H2S va
"^ ''•''' NH3. Lmh vyc tring Upt ciing gay ra van dg moi trudng do tang luang phan bon hoa hoc, thu6c bito ve thuc vat va lugng chat thai sau thu hoach (gom ram ra, cay kh6) thieu kiem soat.
Lugng khi thai chiem 1%
den tir cac nguon nay. O nhiem khdng khi rd rang dang d muc bao dong tai cac kliu do thj, kliu c6ng nghiep va thitnh pho Idn.
Dieu nity gop phan tao ra Viit Nam ^^ ^^^ ^'^^^ ^° ^^^ ^^'^ ^'^'^
chi tieu y te cac hp gia dinh giiia khu vyc nong thon va thanh dii.
Hinh 2 cho thiy mice thiet hai 6 nhiem khong khi din ting thu nhap qu6c dan GNI rat cao mice 3,39%
nam 2010, giam nam 2012 va co xu hudng tang trd lai tic 2,82% nam 2012 Ign 3,3% nam 2016, Trung binh ca giai doan, miic thiet hai ctia 6 nhigm kh6ng khi din GNI la 3,1%.
Kit qua bang 2 cho thay muc chi tieu y te trung binh cita hp gia dinh tai Viet Nam d ca thimh thj va
hhna hoc •^
— thifdfig'mai 15
KjnSII TE VA QUAK i t
I y
Ngudn: Ngdn hdng The gi&i (2010-2016) Hinh 2: Mice thiit hgi
nam 2012 la 1,94 trieu dong, cao gip 1,4 lin so vdi_ nam 2010. Nam 2014 con sd nay tang Ign 2,35 trieu dong. Nam 2016, chi phi kham chiia benh frung binh ciia mot ca nhSn tang gip doi so vdi nam 2010 d muc 2,76 Uieu dong.
Trong khi dd, thu nhap trung bmh hd gia dmh d Viet Nam tang dang kl tir khoang 74 trieu nam 2010 len gip d6i la 148 frieu ding nam 2016. Ddi sing tit hem ciing lit ly do klii en ngudi o nhiim khong khi din tdng thu nhgp quoc ddn ^^ gin sang ehi tigu nhiiu hon (GNI) cho cac djch vy y te. Muc chi Bang 2. Chi tiiuyticiia cdc ho gia dinh d VietNam giai dogn 2010-2016
Dan vi: nghin ddng
tieu y te trung binli hp gia dinh /nam
Nong thon
Thu nheip binh Chi tieu y te quan hd gia ca nhan trung dinh/nam binh/nam
2010 2012 2014 2016
3804,26 4983,74 5557,76 5854,43
2757,24 3285,79 4260,75 4397,22
3043,55 3764,94 4642,65 4831,71
74.528 105.225 126.456 148.260
1385 1940 2350 2760
Ngudn: Tong cue thdng ki (2010-2016) n6ng thon dgu co xu hudng tang dang ke rtc nam 2010 dgn nam 2016. Chi phi kham chiia benh tai thanh thi cao ban ndng thdn do thu nhap, Uinh dp giiio due ciing nhu kha nang tiep can vdi dich vu y te tot ban. Tai khu vyc thimh thj, trung binh mpt hp gia dinh chi tieu cho y te 3,8 frieu ddng nam 2010 thi den nam 2016, chi phi y tg la 5,9 trieu d6ng.
Trong khi dd, tai khu vyc nong thon con sd nity la 2,8 trieu dong nam 2010 tang len 4,4 tri^u dong nam 2016. Mice chi phi cho y tg cho ca nudc tang gap hem 1,5 lan trong vong 6 nam tic 3,04 trieu ddng nam 2010 Ign 4,83 trieu dong nam 2016. Theo ket qua khao sat miic song dan cu trong giai doan 2010- 2016, chi phi binh quan I ngudi kham chiia benh
hhoa hoc = ^ = = ^ ^ = ^ = ^ ^ , , , ^ , = ^ 16 thifffng mai
tieu y te frong giai doan nay chigm khoang 3-4% tong thu nhap cua cac hd gia dinh. Ket qua Ngan hang The gidi nam 2018 danh gia thi muc chi phi y te hien tai ciia Viet Nam viio khoang 6%o GDP va cd the duy tti tang on dinh Uong vong hai thap ky tdi.
4.2. Banh gid tdc dgng cua bao hiim y ti vd cdc yeu td mdi trudng lin cau y te tgi Viet Nam
Bang kilm djnh Hausman, kit qua tie bang 3 chi dinh md hinh_ si ligu mang vdi tac ddng cd djnh ciing vdi hg so cua cite bign uong m6 hinh diu co y nghia cao d muc \%. Ket qua cua biln X! dai dien vigc mua BHYT cua ca nhan duong phim anli ring viec mua BHYT gia tang chi tigu y tl ciia ngudi mua
So 136/2019
vaxa T& vk Qnisr vr
Bang 3; Anh hudng cua BHYT vd yeu td mdi tmdng len
Cac bien dpc lap Xi
X2 X3 X, Xs Xs X^
Xa Se quan sat
Hausman Test
Mo hinh tac dong co dinh (FE) He so 197,23***
(58,40) 96,48***
(47,24) Q Q3***
(0,00) 0,001***
(0,00) 993,70**
(396,50) 316,34***
(120,61) 20,12***
(2,644) 79,72***
(27,10) 145467 P-value=0,00<a= =0,05
cdu y te tai Viet Nam Mo hinh tac dpng ngau nliien
(RE) He so 92,02***
(26,12) 81,08***
(24,39) 0,04***
(0,00) 0,001 (0,00) -11,76 (28,71) 44,55 (29,93) 22,76***
(0,58) 89,10***
(18,92) 145467
Sai sd tiiu chudn dd duac hiiu chinh trong ngogc dan
***: mdc y nghia 1%; **.• mice y nghta 5%; *. miecy 1 Nguon: If&c luang cua cdc tdc gid
bao hiem. Nguyen n h ^ co thg dgn tir ttm ly e ngai den benh vign ciia ngudi benh dac biet d vimg ndng thon. Khi khQng may gap rui ro ve siic khde, rit nhigu ngudi chi din cac phdng kham hoac cac bac sT tu vdi tt^inh dp chuygn mon han che. Khi bgnh trd nSn nang hon, ngudi benh mdi sii dung BHYT de den cac co sd kham chiia benh uy tin thi chi phi y te lai trd ngn vd ciing dit d6. Ngoii ra, chi tieu y tl
:hia 10%
So 136/2019
ngoai kham chua bgnh thi con bao gom nang cao siic khoe va phdng tranh benh tat. Tai cac thanh phi Idn vdi miic thu nhap cao, nhieu ngudi con quan tam tdi gdi djch vu cham soc sue klide rieng ben canh BHYT dl giam thilu nii ro vl sue khoe trong tucmg lai. Dilu nity ciing gdp phin gia tang chi tieu y tl ciia ca nhan. Kit quit nay cung c6 diem tucmg dong vdi nghien ciiu cua Santerre va Neun (2010). Bdi vi
khoa hoc c^
thifdng'mai 17
KINIH TE VA QUAPir LT
BHYT lam giam gia cham sdc siic klioe, benh nhiin CO thg tiep tiic cau dich vu y te mign la lgi ich can bien Idn hon chi phi can bien va Uong trudng hgp nay ngudi tigu dung se yeu cau cham soc nhieu han ngu hp mua bao hiem.
Kit qua ciia cac he si biln X2 va X3 duang iing hp viec neu tan suat digu tri npi trii vit ngoai tni cita ngudi dan tang len cung vdi miic chi tieu cho han|
hoa vit dich vy khac tang len thi chi cho dich vu y tg se cao hon. He s6 cita bien tuang tac giiia trinh do hpc van va mdc thu nhap cua thanh vien trong gia dinh X4 duang cho thiy sy hiiu biet xa hpi cita ca nhan can di kem miic thu nhap cao thi chi tieu cho y te se nhieu hem so vdi nliicng ngudi co Uinh dp hpc van cao ma miic thu nhap thap hoac nhiing ngudi co trinh d6 hoc vin va thu nhap thip, Ro rang, thu nhap vin lit yiu tl tien quyet anh hudng dgn chi tieu sue khoe vit hang h6a dieh vu cua cac ca nhan. Daucua biln noi cu tni X5 duong cho biet chi Ueu y te tai khu vyc thiinh thj dang cao ban nong thdti. Ket qua nay phii hgp vdi phan tich mice chi tieu y tg theo kliu vuc tai bang 2. Biln gidi tinh X6 duong phan anh miic chi tigu y tl cua nii gidi dang nliieu hoti nam gidi. Khac vdi nam gidi, nir gidi can duge cham soc sii'c klioe sinh san. Ngoai ra, tuoi tlip trung binh ciia phu nir cao hon so vdi nara gidi. Do dd, viec giii gin sue khoe de co the frang Uai cho ciic chi phi y te la nhiing mdi quan tam hang dau doi vdi phu nii. Bien bien tuoi thiinh vign X7 chi ra rang ngudi cang cao tuoi thi miic chi tieu y te cang Idn. Theo cac danh gia gan day, ngudi cao tuoi d Viet Nara co chi phi y te cao gip 7-10 lan ngudi Ue. Viet Nam nam trong danh sach cac nudc c6 l6c dp giit hoa dan so nhanh nliat vdi ti le ngudi tren 60 tudi ngay cang gia tan^, Ngudi giit thudng dg mac cac benh nhu tang huygt ap, dai thao dudng, ung thu, suy giam nhan thiic, roi loan van dpng, lii lan, tram cam, tai bign,,. co thg phai dieu fri suot ddi cung nhu tang nguy ea tan phe.
Bien X8 the hien mice thigt hai khi thai d Viet Nam anh hudng den t6ng thu nhap quoc dan mang dau duang. Ket quit nay chi ra khi mirc dp 6 nliiem kh6ng khi cao, chi tigu y te cua ngudi dan ciing Idn.
6 nhiem kliong khi khong chi la van de nong tap trung d cac d6 thj phat frien, ciic khu, cum cong nghiep raa da Ud thitnh mdi quan tam ciia toan xa hpi. 6 nhigm kli6ng khi duge xem la mot trong nliung tac nhan hang dau cd nguy ca tac dpng nghicra trgng doi vdi sue khoe cdng d6ng nhu day khoa hoc ^ = = ^ ^ ^ ^ ^ ^ ^ ^ . . ^ = 18 thifting'mai
nhanh qua frinh lao hda, suy giam chirc nang ho hap, gay cac benh hen suyln, ho, viem mui, viem hgrtg, viem phi quan, viem phii, tim mach va lam giam tuli thp eon ngudi. Nguy hiira nliit la co the gay ra cac benh ung thu. Dilu nay gia tang ap luc chi tieu y te eho eac hp gia dinh.
5. Kit luan va khuyin khi giai phap 5.1. Kit luan
Cac kit qua phan tich d fren da cho thay ba diem quan Upng, Thd nhit,_ thong qua du ligu ting hg[D tii si heu dilu Ua miic sing dan cu ciia T6ng cyc thong ke va si heu lugng khi thiti 6 nhigm tir nam 2010- 2016 cua Ngan hang thi gidi, chi phi danh cho y te eua ciic hp gia dinh Uong mau dieu tra tang tic 3,04 Uieu ding nam 2010 len 4,83 Uieu ddng nam 2016.
Chi phi kham chira berth tai thanh thi cao hem nong th6n do thu nhap, frinh dp gmo due cung nhu kha nang tiip can vdi djch vu y te tot han. Mure chi tieu y tl Uong giai doan nay chilm khoang 3-4% tong thu nhap cita cac hp gia dinh. Chi phi binh quan 1 ngudi CO kham chiia benli nam 2010 la 1,36 trieu dong tang len gap ddi lit 2,76 frieu ddng nam 2016.
Thir hai, nghien cicu tim thay anh hudng ciia viec mua BHYT gia tang chi tieu y tl. BHYT lam giam gia cham sdc sue khoe co the khign ngudi tieu diing yeu ciiu chain sdc nhieu hem mien lit Igi ich can bien Idn ban chi phi can bien. Thic ba, 6 nhiem kliong khi duge xem la mot frong nhirng tae nhan hang dau tac dpng nghigm trpng d6i vdi sue khoe cpng dong vit gia tang ganh nang chi phi y te cua cac ca nlian noi rieng va hd gia dinh noi chung theo thdi gian. Mpt s6 bign khac dai dien cho dac digm ciia hp gia dinh (viec kliam npi tni/ngoai tni, chi tieu binh quiin ciia ca nhan cua ho, thu nhap) va nhan khau hpc (hpc van, nai cu tni, gidi tinh, tudi tac) ciing tac dpng den chi tigu y te.
5.2. Khuyen nghi gidi phdp
Nhu vay, dg giam chi tieu y te Uong tuong lai can cd sy vito cupc cua rat nhieu bp, ban ngitnh va dia phuong. Dg hudng tdi BHYT toan dan, chinh sach BHYT cin phai nghien eiiu ky cang dl BHYT thuc sy bao dam quyen lgi cho ngudi tham gia. Bp Y te can citi thien chat lugng dich vu tham kliam chiia benh cua eac ca sd cham sdc, chiia benh tir trung uang tdi dja phuong, ding thdi cin diy manh triin khai ling dung cdng nghe thong tin trong quan ly kliam chiia benh vit cai each thit tuc hiinli chinh; bao dam cong khai, minh bach Uong cung ung dich vu y So 136/2019
KESH T& T A QJUAN hf tl, tt-ong giam dinh chi phi va thanh toan BHYT va
gop phin tang do chinh xac vii hieu qua frong quan ly Nhit nudc vg BHYT. Bp Tai nguyen vit Moi ttuimg cin phdi hpp vdi Bg Giao thong van tai tiep tuc hoim thien hanh lang phiip Iy vg bao ve m6i tnrdng, that chat tigu chuan khi thai tu cac phuong tien giao th6ng dudng bp va tang cudng chat lugng phuang tien giao thdng cdng cpng, thu nghiem nhien lieu sach thiin thien vdi mdi tnrdng tai mpt s6 do thi. B0 Ke hoach vit Diiu tu can kiem soat cac nguon phat thai tir hoat dgng san xuat cong nghiep, chii trgng dSu tu' c6ng nghe xu ly khi thai phu hpp vdi timg loai hinh san xuat; uu diii, ho trg hoat dgng bito ve moi trudng trong san xuat kinh doanh; tiet kiem nang lugng, giam phat thai cac loai khi nhit kinh va day manh frien khai nhdm giiti phap xanh (tang tnrdng xanh, phat trien phat thai cac bon thap, chi tra dich vu moi trudng). Cac dja phucmg dac biet tai cac thanh pho Idn can xay dung cac chuotig frinh, ke hoach vit frien khai giai quyet hieu quit van de 6 nhiem khong khi tai cac d6 t b j . ^
Tdi lieu tham khdo:
1. Abdullah, H., Azam, M & Zakariya, S, (2016), The impact of environment quality on pub- lic health expenditure in Malaysia, Asia Pacific Journal of Advanced Business and Social Studies, 2 (2), 365-379.
2 Ajakaiye, O. & Mwabu, G. (2007), The demand for reproductive health services: an appli- cation of control function approach, AERC Working Paper Series, Nairobi
3. Anh Tuin (2017), 6 nhiim khong khi: Nguyen nhdn hdng ddu gdy ung thu, Truy cap ngay 13 thang 1 nam 2019, tir:
http:llvea.gov. vn/vn/quanlymt/suckhoe- moitruong/Pages/d-nhiim-khong-khi—Nguyin- nhdn-hdng-ddu-gdy-img-thu.aspx.
4. Grossman (1972), On the Concept of Health Capital and the Demand for Health, The Journal of Political Economy, 80 (2), 223-255.
5. Jowett, M., Deolalikar, A., & Martinsson, P.
(2004), Health Insurance and Treatment Seeking Behavior: Evidence from a Low-Income Country, Health Economics, 13, 845-857.
6. Lepine, A. & Nestour, A. (2008), Health care utilization in rural Senegal: the factors before the
extension of health insurance to farmers. Research Paper, International Labour Office,
7. K09 (2004), The productivity of health care and health production functions. Health Economics
13 (8), 739-747.
8. Pauly, M. (1968), The Economics of Moral Hazard: Comment, American Economic Review, 58 (3), 531-537.
9. Santenre, R, & Neun, S. (2010), Health Economics: Theories, Insights, and Industry Studies. Cengage Publishing, USA.
10. Thanh Huong (2016), 77.1% ddn so tham gia bdo hiem y ti, Truy cap ngay 13 thang 1 nam 2019, tCt: https://baomoi.com/77-l-dan-so-tham-gia-bao- hiem-y-te/c/19638677.epi.
11. Tong cue thing kg (2016), Yti. Truy cap l&n cudi ngdy 13 thdng 1 ndm 2019, tir:
http://www,gso.gov.vn/defauit.aspx?tabid=629&id mid=&ItemID=18531.
12. Wagstaff, A. (2007), The economic conse- quences of health shocks: Evidence from Vietnam, Journal of Health Economics, 26, 82-100.
Summary
The study looks at the spending on health in Vietnam from 2010 to 2016 and the influence of health insurance taking and air pollution on respon- dents' medical needs in the survey. Inidal results show that the individuals' average medical spending increased from VND1,36 million in 2010 to VND 2.76 million in 2016. The medical spending level of households in the research period accounted for 3- 4% of their total income. Secondly, the study finds that taking out health insurance heightens the buyer's medical spending. Thirdly, air pollution has serious effect on public health and causes sUess on the current medical spending.
SrnSTTOT^
.khoa hoc 'thifdns'ma
