Thirc trang ch^t lirpng kham chua bfenh bSng bao hiem y te tai cac b6nh vifen cong tuyen huyen tr6n dia ban tinh Thai Nguyen NguygnThiThu Truong Dai hoc Kinh te & Quan tri Kinh doanh-
Trang 1Thirc trang ch^t lirpng kham chua bfenh bSng bao hiem
y te tai cac b6nh vifen cong tuyen huyen tr6n dia ban
tinh Thai Nguyen
NguygnThiThu
Truong Dai hoc Kinh te & Quan tri Kinh doanh- Dai hoc Thai Nguyen
Th9ch van Chung
Ban Tuyen giao Tinh iiy B^c Giang
Bai vidt phan tieh, danh gia thyc hang ehdt lugng khdm ehua bdnh bang Bao hldm y td tai cdc bdnh vl^n cdng tuyen huydn tren dja bdn tinh Thai Nguydn giai doan 2017-2019, tii dd de xudt mdt sd gidi phdp nhdm nang eao ehdt lugng khdm chOa benh bdng Bdo hidm y td tai cdc benh vien ndy trong giai doan 2020 -2025, gdp phdn nang cao sy hai Idng cfla ngudi benh nhdm gidm tdi cho cdc bdnh vidn tuyen trdn
1 Mffdau
Ctiinh sach Bao hidm y td la mdt bg phdn cdu
Uidnh vd Id bd phdn quan hgng nhdt hong chinh sdeh
xS hdi cfla m6i qudc gia Bdo hiem y te mang y nghia
nhdn dao vd cd tinh chia se edng ddng sdu sde Xudt
Bdo hidm y td d nude ta dd dugc Ddng vd Nha nude ta
quan tam thyc hidn ngay tu ddu Tai bdo cdo tdng kd't
cdng tdc y td ndm 2014, mdt sd nhidm vg va gidi phdp
hgng tam nam 2015, giai doan 2016-2020 cua Bd Y td
nam 2015 da chi ra rdng "Viec dam bao cdng bdng va
chia se hong cham sde sue khde bdng bdo hidm y td
bang bdo hidm y td hong didu kien nen kinh td thi
trudng Id mdt van dd cdp bdch, thdch thiic, viia la mdt
chinh sdch lau dai"
Tinh nay ty Id ngudi ddn cd thd BHYT trdn dia ban
tinh Thdi Nguydn chiem 98,1% ddn sd Ket qua ndy dd
dua Thdi Nguydn trd thanh 1 trong 3 tinh cd ty Id ngudi
dan tiiam gia BHYT cao nhdt ea nude"
Vide "Uidng tuydn" KCB BHYT, khidn eho bdnh
vi$n tuydn huydn trd thanh co so KCB ban ddu cho
ngudi ddn cd tiid BHYT, da mang lai dieu kien thudn
Igi tdi da eho ngudi ttiam gia BHYT trong viec tidp can
tai cac bdnh vien cdng tuydn huyen tren dia ban tinh
Thdi Nguyen cdn khd nhidu tdn t^ii cdn phdi khdc
phuc nhu: Ddi ngfl bac y, bde si thidu cd ve sd lugng
vd chdt lugng; trang thidt bi y td cdn tiiidu va ydu, edn
xdy ra tinh hang tryc Igi quy BHYT tu nhidu phia, thdi
dd phyc vy, y due cfla ddi ngfl cdn bd y td cdn edl
tiiien, chinh sdch thfl tyc khdm chua benh BHYT cdn
rudm rd, hidu qud thdp
Ddnh ddnh gia thyc hang chdt lugng khdm ehiia benh bdng Bdo hidm y te tai cac bdnh vien cdng tuydn huydn hdn dia ban tinh Thai Nguydn giai doan
2017-2019 tii dd dd xudt dd xudt mdt sd gidi phdp nhdm n&ng cao ehdt lugng khdm, ehua bdnh bang Bao hiem y td tai cdc bdnh vien tuydn huydn hen dia ban tinh Thai Nguyen hong giai doan tidp theo Id viec ldm cdn thidt
2 Tliuc trans cliat lugng KCB bang BHYT tai cac benli vien
2.1 Thuc trang chdt lugng cac yeu td' ddu vao
- Thuc trgng nhdn luc chuyen mdn cua cdc benh
viin: Nhdn lye chuyen mdn efla eac benh vidn khdc
nhau cd vd sd luong vd co edu tuy thudc vao quy md giudng benh vd phan tuydn ky thuat Thgc trang vd nhdn lue y td eua 9 bdnh vien trong nam 2019, duge thd hien hong bang dudi ddy
Bang 1: Tinh binh nhin lljrf rhuyen mdn tai tac b nh dnh din 31/12/2019
Tmng lam y te IT Thai Nguyeit
BV da kiioa TX Pho Yen
BV da khoa huyen Phvi Binli
BV da khoa huygn ve Nbai
BV da khoa buyea Binh Hoa
m y te TP Song Cong
BV da khoa hiiy^g Phii Luong
BV da khoa huyen Boag Hy
BV da khoa huy^u B31 Tir
So lirflTig tan b5 chuj'fn loBn TJ If <Bta
(Ngudn So V le Imli Thdi Ngiiym
Trong 9 bgnh vien, chi cd 2 benh vidn cd ty le co cdu chuyen mdn giiia bde si vd cdc chflc danh y te chuydn mdn khae (bao gdm dieu dudng, hd sinh, ky thudt vidn) dat theo quy dinh tai Thdng tu lien ticb sd 08/2007yTTLT-BYT-BNV: BV da khoa huyen Ddng Hy (1 bde si/3,0 dieu dudng, ky thuan vien (KTV), y td), BV
Trang 2NGHIEN CUU
da khoa huydn Dai tii (1/3,5) Cdn IEU 7 benh vien ed ty
Id ea cdu chuyen mdn giiia bde si va cdc chiie danh
chuydn mdn khae thdp hem nhieu so vdi quy dinh, mdi
chi dat hi 1,9 den 2,7
Trong thye te, hogt dgng khdm ehiia benh tai cdc
benh vien khdng cd su tham gia day dfl nhu sd can bd
chuydn mdn duge thdng kd hong bang so lieu hen do
thudng xuyen ed mdt sd ngudi dugc cii tham gia eac
khda dao tcio, tap huan, v.v Vi vdy cae ehi sd ndy hdn
thuc td cd the chl dcit 2/3 sd nhan luc dugc tiidng ke
tham gia KCB thudng thdp hon so vdi sd lidu Uidng ke
- Thuc trgng ca sd vdt chdt, ky thudt ciia cdc benh
Dien: Giai doan 2017-2019, cdc benh vien da trang bi
thdm nhieu trang thidt bi y te phuc vy cdng tac chuyen
mdn nhu: He thdng may chup X- quang Endograph DC
cua Italia; He thong ndi sol da day, td trang, dai hdng
ECG • 1250K eua Nhat Ban; May sieu am dieu tri da tdn
efla Italia; May phdn tieh huydt hgc tg ddng 18 thdng
lung KTS cua Italia Cd the ddnh gia rdng trang bi ca sd
vat ehdt ky thuat eua ede benh vien hien nay da dugc
quan tdm ddu tu them, co bdn ddp ling dugc nhu cdu
KCB eua ngudi ddn
Tuy nhidn, hidn nay hdu het cae benh vien van edn
thidu nhidu thidt bi hidn dai, ddt tidn, nhidu thidt bj cu
ky 161 thdi Tdt ed ede benh vien d^u chua cd mdy
chup citi vd may chup cat Idp vi tinh da Idt edt moi khi
bdnh nhdn cd ehi djnh phdi chup citi hay cdt ldp lai
ly cdc he thdng thidt bi trong cdng trinh nhu: he thdng
didn, he thdng oxy tmng tam, he thdng phat thanh ngi
bd, chua aam bdo tdt Chua cd du phdng de bd tri
noi thu vi^n phi thudn Igi cho ngudi benh Mdt sd khoa
phdng d cdc benh vien cdn chua bd tri eho ngdi dgi
khdm cho benh nhan (nhu phdng sidu dm, khoa xet
nghidm CDHA, )
- Thii tue hdnh chinh khdm chiia benh bdo hiem y
te: Thfl tgc hdnh ehinh kham ehua benh bdng BHYT
bdnh Bdnh nhan edn phai chd dgi lau kJii dang ky
kham va ehd khdm: 64,3% bdnh nhan dugc hdi cho
rdng thfl tue hanh chinh khdm ehua benh BHYT va
tiianh toan bdo hidm tai Benh vien ehua rd rdng, edng
khai, thuan tien, chinh xae, ddm bao tinh edng bang
vd muc dd uu tidn; 63% benh nhdn duge hdi chua hdi
long vd vide cdng khai va cap nhat thdng tin ve dung
thudc va chi phi dieu hi; 59% bdnh nhdn eho rdng thfl
lue chuydn khdng tiiuan Igi
92 7% bdnh nhan duac khao sdt cho rdng d^ nang
eao chdt luong dich vy KCB bdng BHYT can phdi cdi
cdch thu lue hdnh ehinh KCB bdng BHYT
- Chi phi khdm chua b^nh BHYT: Cdc benh vien
edng tuydn huydn hdn dia ban tinh Thdi Nguyen tiiyc
hien miic gia dieh vy KCB BHYT bao gdm ca chi phi tidn luong theo quy dinh tai khodn 2 Di^u 5 Thdng tu
37 td ngay 12/8/2016, da Uiuc ddy ndng cao CLDV vd cai thien rd ret ttiai dd phyc vg Tuy nhien viec tiigc hien nay lam eho ty tn?ng chi thudc giam tii 41,69% xudng 36,01%, chi tidn khdm vd tidn giudng tii 2,3% tang len 21,1% 15], Gia tien giudng tang eao la nguyen ndi tni, hoac keo dai ngay ndm vien qua mflc cdn Uiiet Tai bang 2 eho tiidy tdng sd benh nhan didu trj ndi trfl thgc td tai ede bdnh vien giam qua cdc nam (nam 2017 la 122.922 lugt ngudi ddn nam 2019 giam xudng cdn 105.847 lugt ngudi) tuy nhidn chi phi KCB ndi trfl tang qua eae nam (binh quan cfla giai doan tai cae bdnh vien la tu 0,8% - 46,07%)
3.2 Thijc h-ang chdt luong d^u ra va qua trinh
- Bdnh gid chdt luang KCB bdng BHYT theo tuyen
chuyen mdn ky thudt: Trong ba nam tu' nam 2017 ddn
2019, sd giudng benh thye kd tai cae benh vien ddu dat tren 100% theo kd hoach dat ra Cdng sudt su dyng giudng benh gidm dan, tuy nhien 6/9 benh vidn cd edng suat sii dyng giudng bdnh tren 100% trong cd 3 nam, trong do cd 4 benh vien cd cdng suat sii dyng giudng bdnh tmng binh vugt tii 20% trd ldn (BV DK Phd Yen, Phu Binh, Djnh Hda, Vd Nhai) Didu nay chung td mac dfl giudng thuc ke eao hon giudng kd hoach nhung vdn ehua dap ling duge nhu cdu di^u tri ndi trfl cua benh nhan BHYT
Bang 2 Ket qna dien Ir
I.TSng so BN dien n\ nql
till thirc te B^nh uMn khoi
^nh nhac dfl giam B^nb nhdn khong tbay doi
enh nhan nacE T^a ve
Benh chan chuyen vien Til vong
cho b^nh nhan BHYT (ni cAc bSnh
2017
So l\i(pig
112911
91224
26154
1305
1818
2387
34
T\le
<%)
100 74.21 21.28 1,06 1.48 1.94 0.03
2018
So
111388
82124
21717
1940
1962
3620
25
1%)
100 73.73 19.50 1.74 1.76 3.25 0.02
l<0 2017-2019 Z019
S6 hrpng
105847
75437
17225
4302
3861
5001
21
100 71.27 16,27 4.06 3.65 4.72 0.02
'i Thdi Ng\n
Qua bdng 2 cho ta thdy, kdt qua dieu trj theo BHYT cfla cdc benh vien tai dia ban nghien eiiu, hong ba nam tii nam 2017 ddn 2019, ed bien ddng theo chidu hudng khdng tdt, eu thd:
Thii nhdt, sd benh nhdn dieu tri theo BHYT dugc ehiia khdi ehiem ty le cao nhat nhung cd chidu hudng 2019)
Thii hai, sd benh nhan dieu tri theo BHYT do gidm chidm ty Id cao thii 2, eung chidu hudng giam (tu 21,28% nam 2017 xudng cdn 16,27% nam 2019) Thir ba, nhdm benh nhan duge didu tri theo BHYT nhung khdng thay ddi vd tinh trang benh t^l: c6 ty ie tang qua cac nam (nam 2017 chidm 1,06% nhung ddn nam 2019 la 4,06%)
38
Trang 3v6 va nhdm b^nh nhan chuydn vidn cOng ed chieu
hudng tang qua cac nam ca vd sd lugng va ty Id %
Cudi eflng la nhdm hi vong mac du eon sd thdng
ke cho Uidy, nhdm nay chidm mdt ty trgng rdt nhd
hong kdt qua di^u hi bdnh nhan ndi hu BHYT cua ede
b$nh vi^n (giao ddng tii 0,02-0,03%), tuy nhidn eac
bdnh vi0n cdn cdi thidn chi tieu ndy sao cho ehi tidu
nay thdp hon nOra
- Banh gid chdt lu^ng KCB bang BHYT theo chuc
ndng
Bang 3 Tbflng kS mirc dO hai Ibog cua bfnh ohko ve CLDV KCB bang BHYT
t jl fljn bin i q ^ t i cflu
E)9tincjy
Dp dap ung
NSng liTC ph(ic vv
E)Q dong cam
Phirong lifn h&u hinh
Hiilong
Valid N(hstwisel
N
eo(
600
600
600
Mm
100
100
1 00
2.00
t.!a.l
500
5,00
5.00
5 00
Gia in trung bUih 3.6314
3 3711
3 1071
3 4629 3.7942
3 3506
D g l ^ b -92388
63921
,97768
,74590
ugBa Tot Tmng binh
Tot Tot Tmng binh
Ngvdii • Kel qiiapMn ticli b6ng SPSS 'if sd im ftiiii i
Bang sd lieu 3 cho thay chdt lugng chiie nang tai
cac benh vien da khoa tuydn huyen tren dia tinh Thdi
Nguyen duge benh nhan ddnh d miic tmng binh Dieu
nay th^ hien 3/5 thanh phan chdt lugng djch vy KCB
BHYT benh nhdn danh gia d mflc hai Idng (quan
hong) dd la miic dp tin cay ed gia tri tmng binh la
phuong tien huu hinh: 3,7942 Tuy nhidn 2/5 thanh
phdn chdt lugng dich vy KCB BHYT benh nhdn chi
danh gid d muc hung binh dd la: Mflc dd dap ung cd
gid tn tiling binh 3,3711 (thd hidn miic dd mong mudn
va sdn sang phyc vy benh nhan BHYT mgt edch kjp
thdi Nd eflng dugc phdn dnh vd m$t sdn sang giup dd
benh nhan BHYT va cung cdp djch vu nhanh chdng)
va nang lye phuc vy ed gia tri tmng binh 3,1071 (trinh
do chuydn mOn va cung each phye vy lieh sy, niem nd
cfla nhan vidn y td cfla bdnh vien vdi benh nhan
BHYT) V4 miie do hai Idng chung chdt lu(?ng dich vg
KCB BHYT cfla bdnh nhan ehi dat miie tmng binh vdi
gia tri hung binh la 3,3506
4, Giai phap nang cao chat linmg dich vu KCB
hang BHYT tai cac benh vien cong tuyen huyen
tren dja ban iinh Thai Nguyen
Dd nang cao CLDV KCB bdng BHYT tai cac benh
vien edng tuydn huyen tren dia ban tinh Thdi Nguyen
trong giai doan tidp theo, mdt sd gidi phdp sau dugc
dd xuat:
- Thii nhdt, cac bdnh vidn can cd chinh sdch thu
hut nhdn tdi de cd \hi tuyen dung va giu chdn dugc
nhung bde si gidi, cd trinh dp cao cdng hien lau ddi
tdc vdi ede benh vien tuyen tren dd tranh thfl sg hd trg
chuydn mdn ky thudt, hd trg dao tao
day du theo Danh mye trang thiet bi y te eua benh vien tuydn huydn Tranh thfl eac ngudn vdn hgp phap de thidt bi De nghi UBND tinh, UBND huyen va cac ban nganh lidn quan hd trg kinh phi de benh vien mua mdt
sd trang thiet bi can thiet Ddy manh ling dung cdng tao ddi ngfl sii dyng, bd phan di^u hanh va quan tri mang IAN cfla bdnh vien
- Thii ba, giam thieu cdc thu tue hanh chinh theo xu huting gon nhe Tin hgc hda cdc khdu hong qua tiinh hudng ddn, tiep ddn va kham eho ngudi benh j ^ dyng hinh thlic tu vdn, kham benh hoac dat lich kham benh cho benh nhan qua didn thoai, tang sd phdng kham, bdn kham, tang sd phdng sieu am Nghiem tflc thye hien edng khai minh bach quyen loi cfla benh nhan BHYT theo tiing ngay de hanh tinh trang t)dt thude, djch vy y
td, ky thuat nhdm tme Igi BHYT tii phia tiidy tiiudc, dnh hudng den ket qud didu til
- Thii tu, ap dung mdt cdch Iinh hoat quy djnh v^ chuydn tuydn Tang cudng giao dye nang eao dao dflc nghe nghiep de thay thude khdng cd thai do phan biet hong ling xii vdi ngudi KCB bdng BHYT
5 Ket Iuan
Nhu vay chdt lugng KCB bdng BHYT tai eac benh vidn da khoa tuyen huydn tren di^ ban tinh Thai Nguyen thdi gian qua bdn eanh nhuno I'ldnh tgu dat dugc dang khich Id thi vdn cdn nhiin'^ —", tai, han che can cai tien va hoan thien nhu chdt lugng yeu td dau vao: nhan lue y te cdn thidu va yeu; vdn cdn thieu nhidu thiet bi y te hien dai, ddt tien, nhieu thiet bi eu
ky Idi thdi; thu tue hanh ehinh KCB BHYT cdn rudm ra; Chi phi KCB BHYT ngay cdng tang cao anh hudng den can ddi quy KCB BHYT Ve chat lugng dau ra va qua
trinh can cai tien 6& nang cao hon nO'a ehdt lugng theo
tuyen chuydn mdn ley thuat tii do nang cao sy hai Idng eua ngudi benh./
Tai iieu tham Ithao
Bg Y td (2016), Bd tieu chi chdt lugng benh vien Viet Nam ban hdnh theo quyet dinh sd 6858/QD-BYT ngdy 18/11/2016 cfla Bd tnrdng Bd y td
Bg Y Te, Bd Ndi Vy (2007), Thdng tu lidn tjch sd 08/2007/TTLT- BYT-BNV hudng ddn dinh muc bien chd sy nghiep trong cdc co sd y td nha nude, ban hdnh 05/06/2007
Bd Y Te (2015) Bao edo tdng kel cdng tac y te nam
2014, mdt sd nhiem vy va gidi phap trgng tdm ndm
2015, giai doan 2016-2020
Bd Y Te (2016), Cdng van sd 6188/BYT-KH-TC ngay 12/8/2016 cua Bd y td "V/v Uigc hien gia djch vu KB, CB bdo hie,., y te bao gdm cd chi phi tien luong cua mdt
sd tinh/TP"