Song vifc thirc hien ASXH con bgc lp nhifiu hgn che nhu: mfic df bao phCi cua hf thing bao hiem xa hgi BHXH, bao hifim y tl BHYT con thap, chinh sdch BHYT con nhieu bat cgp, quy BHXH chu
Trang 1Thyc hien an sinh xa hoi
is Viet Nam vi muc tieu cong bSng
Nguyen Tfaanfa Ogt'
' Tnrtmg Dai hgc San khiu - Difn inh Tp Hfi Chf Minh
Email: dattriethoc@gmail.com
Nhin ngiy 26 thing 8 nim 2016 Chdp nhgn dang ngiy 6 thing 10 nim 2016
T6ra tat: An sinh xa hfi (ASXH) la mft trong nhihig hinh thdc phan phoi co bdn Trong nhiing
ndm qua, vifc thuc hifn ASXH da d?it dugc nhihig thanh tuu nhit djnh, vi da gop phin cai thifn ddi sfing ngudi ngheo, gidm bit binh ding vd bat cong, gop phan thuc day sir phat trien xa hgi Song vifc thirc hien ASXH con bgc lp nhifiu hgn che nhu: mfic df bao phCi cua hf thing bao hiem
xa hgi (BHXH), bao hifim y tl (BHYT) con thap, chinh sdch BHYT con nhieu bat cgp, quy BHXH chua quan ly hifu qua, chua can doi ttong phdn bo tai chinh thyc hifn ASXH NhSm thyc hifn tot hon ASXH va qua do thyc hifn cong bang xa hgi tot hon, cin phai: ndng cao muc df bao phu cda
hf thing ASXH; nang cao nang lire quan ly nha nude, hoan thifn hf thong phdp ludt doi v6i h? thong ASXH; can bdng ttong phan bo ngufin I\rc tai chinh; co chinh sach c\i thfi doi vdi nhom phi chinh thirc; tdng cudng tuyfin truyin, ndng cao nhgn thi;c cua ngudi dan ve cdc chinh sach ASXH
Tfi khod: Cfing bdng xa hfi, an sinh xd hfi, Viet Nam
Abstract: Social security is one of the basic forms of disttibution In recent years, the
implementation of social security has received certain achievements, for its conttibutions to improving the lives of the poor, reducing inequality and injustice, and to the social development Yet, the implementation also revealed many things to be improved such as the low coverage of the social and health insurance systems, inadequate heahh insurance policies, ineffective management
of the social insurance iiind, and the imbalanced financial allocation In order to better implement social security to better perform social equity, we need to improve the coverage of the social security system, the capacity of state management, and the legal homework on the social security system It is necessary to balance the allocation of financial resources, promulgate specific policies for the informal sector and sttengthen the sensitisation to and raising the awareness by the people
of social security policies
Keywords: Social equality, social security, Vietnam
Trang 21 Mddau
Hf thdng ASXH la mft ttong cdc phuemg
thfic phan phdi cua cai eua xa hfii cho cdc
ca nhdn Mgt ttong nhung ngudn thu nhdp
ma moi ngudi nfadn dugc tfi xd hfi Id thu
nhdp qua hf thdng ASXH Vi vdy, khi xem
xet su pfadn phdi cd cdng bdng hay khfing,
chfing ta can phdi xem xfit sy hudng thy cfia
mdi ngudi khfing ehi qua sy phdn phdi trye
tilp tfi qud trinh sdn xuit (ehdng hgn tu
luong md ngudi lao dfng dugc hudng), ma
cdn qua su pfaan phfii d hf tfafing phfic Igi
xa hpi vd ASXH Vdy d Viet Nam hifin nay,
fafi thfing ASXH cd tfadnfa tuu va hgn chfi gj,
lara the ndo de thye hifin tdt facm ASXH, qua
dd bao dam tdt hom cfing bdng? Dd la vdn dfi
md bdi vifit dfi c ^ tdi
2 Thanh tuu trong thijTc hifn ASXH
He thdng ASXH d nude ta ttong nhiing
nam qua da dgt duge tfadnh tyu ttfin tdt ed
cac try cdt eua hf thdng ASXH
Vfi BHXH: theo thfing kfi cfia Bg Lao
ddng Thuang binh va Xa hdi, dfii tugng
tham gia BHXH tinh dfin thdng 10 nam
2015 dgt ttfin 12,07 trifu ngudi, chilm tten
23% lyc lugng lao dgng (trong dd, tham gia
BHXH bit bude tren 11,85 trieu ngudi,
tdng ttfin 2,25 trifiu nguoi so vdi cudi nam
2010; tham gia BHXH ty nguyfin ttfin 223
nghin ngudi, tdng ttfin 148 nghin nguoi so
vdi cuoi nam 2010) [9] Sd lifu thdng kfi
cfao thiy ty If ngudi dan tham gia BHXH
ngdy cang tdng; quyen lgi ngudi lao ddng
ngay cang dugc ddm bdo; edng tdc chi ttd
da CO sy phdi hgp ttdeh nhifm nfaip nhdng
giiia CO quan BHXH vd edc nganh Lao
ddng Tfauong binfa va xa fadi, Kho bgc Nhd nude Vifc phdi hgp gifia ngdnh Lao dgng Thuong binh vd xa fadi va ca quan BHXH ngdy cdng cfadt cfafi Difiu do gifip tdng cudng han cdng tdc kilm tta, giam sdt vifc thi hanh Bg ludt Lao dgng vd thuc hifn cdc chfi df BHXH cho ngudi lao dgng d khu vyc kinh te ngodi qudc doanh; tang eudng qudn ly nha nude vfi vifc ky kit hgp ddng lao ddng, dang ky thang luong, bdng luang, thda udc lao ddng tdp thfi; xfi ly vd ngan chgn nhifiu doanh ngfaifp kfau vye ngodi qudc doanh cd hanfa vi vi pfaam v l pfadp lu|it BHXH ddm bao cdng bdng xd hgi (CBXH) Vfi BHYT: "Dfin cudi 2015, cd 64,6 trifu ngudi tham gia BHYT, dgt ty le bao pfafi 71,4% ddn sfi Trong 6 thang diu ndm
2016, dd ed ttfin 70,8 trifiu ddi tugng tham gia, tang khodng 0,83% vd vdn dang tieh cyc trien khai cdc gidi phdp de dat mue tifiu 78% dan sfi cd BHYT cufii nam nay" Ty lfi nay cho thdy vific trien khai cdc ehinh sdch BHYT dd dgt nhifiu kfit qua thugn lgi, ndng dan do bao phfi toan dan Dgi hgi Dang XII nhdn dinh: "Chdt lugng khdm, chiia bfinh dugc nang len, iing dyng nhifiu tfaanfa tyu kfaoa hpe ky tfauat cao Dd tich eye trien khai nhieu gidi phap giam qud tdi bfnh vien
vd dgt kfit qud budc ddu Tap tnmg xay dyng hf thong cdc bfnh vifin tuyfin huyfin, tuyfin tinh vd tuyen cudi Dpi ngu can bf y tfi phat trifin ca v l sfi l u g i ^ vd chdt lugng Ddy mgnh cai each hanfa cfainh, nang cao y dfic va dfii mdi ca cfafi tdi chinfa dfii vdi ede dan vi sy nghifp y te cfing lap, budc dau thyc hifn 16 trinh tinh dfing, tinh du gia tri dicfa vu y tfi cung vdi hd ttg cho ddi tugng chinh sdch, ngudi ngheo Cac co sd y tfi tu nhan, y hpc cfi truyfin va cdng nghifp dugc dugc kfauyfin khich phat trien Tdng cudng
Trang 3qudn ly chat lugng va gid thudc chfia bfinfa"
[3, tt.239-240]
Vfi fafi thdng bao hilm thdt nghifp
(BHTN): dfin nam 2015 ed tten 9,9 ttifu
ngudi tfaam gia BHTN, tang 3,6 trifu ngudi
so vdi cuoi ndm 2010 Tinfa tfi tfadng
01/2011 dfin cufii nam 2015 cd trfin 2,07
trifiu lugt ngudi dugc hudng trg cap tfadt
nghifip Tfing 5 ndm 2011-2015 ca nude dd
tao vifc ldm cho khodng 7.827 nghin ngudi;
tuyfin mdi dgy nghe gdn 9.171 ngfain ngudi,
tdng trfin 20% so vdi giai doan 2006-2010;
ty lfi fagc cd vifc ldm sau khi tfit nghifip dgt
khoang 70% [9] Sfi lugng ngudi tham gia
BHTN nhu ttfin cho thiy tinh uu vifit cfia
tru cpt ndy ttong hf thfing ASXH, gdp phdn
ddm bao CBXH Thuc hifn edc quy dinh vfi
BHTN cho ngudi lao ddng nhdm giai quyfit
kip thdi nhfing khd khan eho ngudi lao
dfng bi mdt vific lam, i ^ i vifc Id ca sd
quan ttgng dfi ngudi lao dgng hod nhap vdo
tfai trudng lao ddng va cd sinfa k l Ngodi ra
vific trifin kfaai pfaoi fagp vdi edc trung t§m
va trudng day ngfafi tu vin vific lam, gidi
tfaieu vific lam, ho ttg fagc ngfal cfao ngudi
tfait ngfaifp cQng tgo ra sy cdng bdng dfii
vdi nhom can ttg gifip ndy
Ve trg giiip xd fafi, uu ddi ngudi cd
cdng: tinh dfin ndm 2015, ca quan BHXH
dd ttg cip thudng xuyen eho khoang 2,643
trifiu dfii tugng, tdng gin 1,8 lin so vdi cufii
ndm 2010 Ngdn sacfa trung uong chi ttg
cdp xd hfii hang thdng cho dfii tugng bao trg
xd hfi tgi cgng ddng tdng nhanh, ndm 2015
khodng tren 11,6 nghin ty ddng, tdng gin
gap 3 Ian so vdi ndm 2010 Tinh dfin nay cd
nude ed 408 co sd ttg gifip xd hdi, nudi
dudng, chdm sdc trfin 41,4 nghin dfii tugng
bdo trg xd hdi (trong do, sd dfii tugng ngudi
56,5%) [9] Co quan BHXH chi tta diy dii, kip thdi ttg cip uu ddi thudng xuyen eho tren 1,4 trifiu ngudi cd cfing; thyc hifn day dfi cdc chinh sach vfi cfadm soc sfic kfade, im ddi gido dye vd cde chinh sdch uu ddi khdc ddi vdi nguoi cd cdng Cdc phong ttdo "dfin
on ddp nghia", "uong nude nfad ngudn",
"xa, pfauong ldm tdt cdng tdc tfauong binh, lift sy, ngudi cd cdng" dugc phdt trifin sdu rfng d tat ca cdc dia phuomg; huy dfng nhifiu ngufin lue ttong xd hgi, cfng dfing de ehdm sdc ddi sfing vgt chat, tinh thdn cho nguoi cd edng vdi cdch mgng Giai doan 2011-2015, ca nude dd huy ddng tten 1.250
ty dfing xdy dyng Quy den om dap nghTa; xdy mdi khodng 46 ngfain nfad tinfa ngfaTa; sfia chiia ttfin 43 nghin nhd vdi tten 10,6 nghin ty dong; cd gan 11 nghin ba me Vifit Nam anh hung cdn sdng dugc edc co quan, dan vj nhgn cham sde, phung dudng Den cufii nam 2015 cd 98,5% hf gia dinh ehinh sach ed mfic s6ng bdng ho^e cao han mfic sfing trung binh hd dan nai eu tni, tdng thfim 8,5% sd hg so vdi nam 2010; 98% xd, phudng lam t i t cfing tde thuang bmh, lift sT
vd ngudi cd cdng, tang them 6% sfi xa/phudng so vdi nam 2010 [9] Cdc kfit qua tfayc hifn chinh sdcfa ttg giiip xa hfi, uu ddi ngudi ed edng thfi hifn tinh nhan vdn sau sde trong sy trg gifip eua xa hfi Ddy dugc xem la nhdm yfiu the, de bj tfin tfauong vd tfaifit tfadi can sy bdo ttg va cfaia sfi nfait
Ve gidm ngheo: vdi hifu qud tfi ngufin lyc ddu tu cua cdc chinh sdch, chucmg trinfa,
dy an ve gidm ngfaeo, ty If hfi ngfafio ea nude dd gidm tfi 14,2% cu6i ndm 2010 xufing cdn 5,97% cudi ndm 2014 (ttong do edc huyfn ngheo giam cdn 32,59%); cufii
Trang 44,5%, gidm binh quan 2%/iidm (cdc huyfn
ngfaeo gidm binh qudn 5%/nam, con khodng
28%) [9] Kfai ty lfi faf ngheo giam thi su
gidn each vfi thu nhdp gifia cdc ting ldp ddn
eu dugc tfau hep CJ ndng thfin cdc xa ngfaeo
duge edi thifn ro rft Ngudi ngheo dugc ho
trg cdi thifin mfit bude vfi difiu kifin sdng;
dugc tifip can tdt horn cdc chinh sdch vd
ngudn luc ve vdn fafi trg cfia Nfad nude va
cfng dfing; nfad dd ddi sdng cfia hg dugc
ndng lfin
Nhin ehung, ede chinh sdch ASXH dd
hudng dfin nhifiu dfii tugng hom Dfii vdi
ehinh sdch BHXH, ddi tugng tham gia ngdy
cdng duge md rfing dfin cdc thanfa pfain
kinfa tfi faudng den bao pfafi toan dan Cdc
cfafi do huu tri^ thai sdn, dm dau, tfi tuit
dugc quy dinh cu thl Tdi cfainh cfia quy
BHXH vfi thu, ciii va ddu tu dugc quan ly
tap trung, chat che, cfing khai, minfa hgcfa,
hgcfa todn dfic i^ vdi ngdn sdcfa nfad nude
Cdc quy dinfa cua Lugt BHXH da dugc sfia
ddi ngay cang pfafi hgp vdi Bg ludt Lao
ddng vd nguyfin vgng cfia nguoi lao dgng
Chinh sach BHYT dd timg budc md rgng
cac ddi tugng va ddm bdo quyfin lgi cfia
ngudi tham gia BHYT, thl faifn tinfa cdng
bdng hem Vific td chue khdm chfia bfinh
eho ngudi ed the BHYT duge quy dinh cy
thl vdi chit lugng djch vu tot horn BHYT
dd that sy ttd thanh try cdt quan ttgng trong
faf thdng ASXH, tgo thudn lgi cho ngudi
ngheo va ngudi tfau nh|ip thdp ttong vifc
tifip can cae dicfa vu y tfi Cac cfainh sach
BHTN dugc trifin kfaai cd faifu qua tren todn
qudc Ca quan BHTN cd sy phfii hgp ch^t
chfi vdi cdc trung tdm va trudng dgy nghe
de trifin khai cdng tdc tu van vifc ldm, gidi
thifu vifc lam, fao ttg fagc ngfae cho ngudi
thit ngfaiep Cfal dQ cfao ngudi lao dgng tfaat
ngfaifp dugc gidi quyet ddy dfi, dfing tfadi gian Cac cfainfa sdcfa bao ttg thudng xuyfin
va dot xudt dd cd nhung tdc dgng hfit sfic to ldn dfin nhdm ngudi ylu thl Cac cfainfa sdcfa nay tfai faifn qua cdc ehl df ttg gifip khdc nhau (vfi tdi ehinh, ehdm sdc sfic khoe, phuc hfii chfic ndng, hgc van faod, fagc ngfal, tgo vific ldm ) Nfaa nude dd ed nfaifiu ehinh sdch tao dieu kifin thudn lgi d l cde tfi chfic xa hpi va ed nhdn (tfi chfic phi chinh phfi, cae doanh nghifp) tifin hanh hogt dgng tfi thifn gifip do cde dii tugng kfad khdn Cde chinfa sdch uu dai ddi vdi ngudi cd edng vdi dit nude thfi hifn duge tinh thin
"ufing nude nhd ngufin", "dfin on dap nghia"; gdp phin dn dinh, ndng cao ddi sfing vdt cfadt vd tinfa thdn eho gia dinh ngudi ed cfing; ddm bdo mfic sfing cua gia dinh ngudi cd cdng cd mfic sdng bdng hode cao ban mfic sfing cfia cgng ddng nai cu tni Cae chinfa sach giam i ^ f i o duge thuc hifn theo faudng diu tu cd ttgng tdm, ttgng difim nfadm giam ngheo nhanh vd bfin vihig, nhdt la doi vdi nhihig dia bdn khd khdn, viing ddng bdo ddn tdc vd mifin nui Cdc cfainfa sach ASXH tilp tue duge hodn thifn ttfin edc ITnfa vye lao dgng, vifc ldm, BHXH, BHYT, bdo ttg xd fadi; dd gdp phin cdi thifin ddi sdng ngudi ngheo; gidm bat binh ding vd bit cfing; gdp phdn 6n dinfa, tfafic day sy phdt ttien xd hfii
3 Han che trong thyc faien ASXH
Thu nhdt, mice dg bao phu cua h^ thdng BHXH, BHYT cdn thdp
Dfii vdi BHXH, ty If tham gia (kl cd hinfa thfic bit bugc d khu vuc ehinh thuc va
Trang 5cd tang len nhung cdn thdp Theo bao cdo
giam sat thyc hifn Ludt Bao liifim xd hfii
nam 2015 cua Tdng Lifin dodn Lao dgng
Vift Nam, d 6 tinh Hd Nam, Nam Dinh,
Phil Yen, Khanh Hda, Ddng Thdp vd An
Giang, ty If bao phfi BHXH binh qudn cfia
6 tinh dugc gidm sat la 13% luc lugng lao
dfng tham gia BHXH (chi khodng 6,9%
ddn sfi ttfin dia bdn tinh); cfi 100 doanh
nghifip hoat dfing tfai chi cd 40 doanh
nghifip dang ky ddng BHXH [10] Ty If bao
phfi thap ndy do nhifiu nguyfin nhdn khae
nhau, ttong do nguyfin nhdn ldn nfaat la cdc
doanh nghifp ehua thue hifn tdt nghia vu
ddng BHXH eho ngudi lao dgng Ben cgnfa
dd, cdc ehinh sdeh eho ddi tugng phi ehinh
thfic tham gia BHXH cdn hgn chfi Mgt bf
phdn ldn lao dfng phi chinh thfic (nhu lao
dgng thdt nghifp, lao dfng ttong cae hfi gia
dinh, lao dfng ttong nfing nghifip, lao dfng
ty do, lao dgng ldm tfaue, ngudi cao tudi )
khfing tham gia cdc quy BHXH; khi ggp rfii
ro hp chu yfiu dua vao gia dinh faogc ty lo
Nfaa nude khdng co khd nang chi tta cho tat
cd cac nhdm ddi tugng ndy nhung nfadm ndy
lgi ein nhit sy trg gifip ciia xd hfi thfing qua
hf thfing ASXH Ddi vdi BHYT, theo bdo
cao cfia BHXH Vift Nam 2015, ty lfi bao
phu BHYT cde dia phuang khdng dfing
dfiu, nhifiu tinh, thanh pho cd ty lfi tham gia
BHYT thdp hom mfic binh qudn chung cita
cd nude Dfin hit thang 5 nam 2015, co 31
dia phuong cd ty if bao phfi BHYT dgt
dudi 70% dan sd todn tinh, ttong do cfi din
15 tinh, thdnfa phfi mdi bao phfi dugc dudi
60 % dan sd Vdi mye tifiu din cufii nam
2016 ndng mfic do che phfi lfin 78% thi vin
chua thfi bao phfi dugc todn ddn tham gia
BHYT BHYT la cho dya an sinh thilt ylu
ddi vdi ngudi ddn, vifc cfaua bao phu hit
BHYT toan ddn Id han ehl ddng kfi ttong thye faifin CBXH
Thu hai, chinh sdch BHYT cdn nhieu bdt cap
Hifn nay, tinh ttgng qud tdi d cdc bfnh vifn tuyin qugn/huyfn va cde bfnh vifin chuyfin khoa da dugc cdi thifn tot ban nhung chua dap iing nhu cau eiia nhdn ddn trong khdm cfaiia bfnfa Sfi ngudi khdm chfta bfnh tang nfaanh so vdi mfic phdt triln cfia cac bfnh vifn Trong khi mgng ludi y tl phudng, xa tgi vin chua khdng djnh dugc vai trd co sd mft each diy dfi Tinfa trang qua tdi pfa6 bien d cdc bfinh vifn ldn Ngudi
cd the BHYT khi chiia bfnh van phdi ddng mdt sd khodn ehi pfai kfafing hgp ly (nhu cdc dich vu ky thugt mdi, edc chi phi do bfnh vifn thyc hifn ty chfi tdi chinh ) Van con
su phdn bift ddi xfi gifia dfii tugng thu hudng BHYT voi cde doi tugng khac tai he didng edc bfnh vifin dugc ddng ky tfaam gia khdm chfia bfnh Chat lugng kham cfafia bfnfa cho nfadm tfaam gia BHYT tfaudng kem hom so vdi nhdm sfi dung dich vu y tfi Nhihig ngudi tham gia BHYT khi khdm chfia bfnh d cde bfnh vifn tu nhan tid khfing dugc chdp nhdn cung cdp dich vy theo thfi Mdt khdc, do cd quy dinh thanh todn cde chi pfai tgi tuyen tten dugc tru vdo cae bfnh vifn nhgn ddng ky khdm chiia bfnh ban dau, nfin ede bfinh vifn cd ddng ky ban ddu thudng mudn giu bfnh nhan lai (khfing cho hodc gdy khd khdn cho bfnh nhdn chuyen lfin tuyfin khae) Bfinh nhdn cd nhu ciu dieu tri tgi tuyin kfadc noi dang ky ban ddu do kfao xin duge giiy chuyen vifn bode ngai phai chd dgi lau nfin cd xu hudng di khdm chfta bfnh vugt tuyen, ttdi tuyfin Vifc ho ttg kinh phi cho dfii tugng hgc sinh, sinfa vien tfaudng rit ehdm va nhifiu khfi Vdi
Trang 6nhiing bat cap trfin, cfing vdi su tdc dfng
cua ea chfi kinh te thi trudng vdo ITnh vyc y
tfi, neu cdc chinfa sdcfa BHYT kfadng duge
cdi tfaifin tfai sS khd thuc hifn tdt facm cdng
bing xd fagi (CBXH) trong BHYT
TTiu ba, giip BHXH cfnca qudn ly hieu qud
Hifn nay quy BHXH dang cd nguy ca vd
trong edn dii tfau ehi ma nguyfin nfadn cfainfa
la cfai nhieu faon tfau Sfi thu chfi yfiu cdn cfi
vao sfi luang dugc ky ttong hgp dfing lao
dgng (cfafi kfafing can cfi vdo sfi luomg tfauc
hnh) Mgt bf phan ldn doanh nghifp cfi tinh
ng dgng BHXH hodc trdn ddng BHXH ciing
Id bieu hifn yeu kem cua qudn ly quy
BHXH Theo sd lifu tfadng kfi 2014, "cfai cd
150.000 doanfa ngfaiep (DN) tfaam gia
BHXH, ttong kfai ea nude cd 300.000 DN
dang faogt dgng Sd ngudi tfaudc difn pfaai
nop BHXH bit bugc khodng 16 trifiu nhung
chi cd gin 11 trifiu nguoi ddng BHXH, ldm
cho sd thit thu len den 56.000 ti ddng"
Mac dfi trong ndm 2015, tinh trang ng, ttdn
ddng BHXH giam dang ke nhung vin edn
ty lfi ldn khfing ddng BHXH Tfaeo bdo cao
cfia Tdng Lifin dodn Lao dgng Vift Nam,
nam 2015 cd 6 tinh giam sat tinh ttang ng
dgng, ttdn ddng BHXH, BHYT cfia cde DN
dien ra phd bien d tat ca cdc tinh, thanh
pfad Tdng sfi ng cua 6 tinh gidm sat la ttfin
433 ti ddng Ti lfi trung bmh sd DN ddng ky
tham gia BHXH ttfin tfing sfi DN ddng ky
hogt dfing chi chifim 40% vd ti If DN ng
BHXH trfin sfi DN tham gia ddng BHXH Id
44,9% Nhu vdy, cu 100 DN hoat ddng thi
cd gin 80 DN vi pham phdp ludt ve BHXH
(60 DN khdng ddng va 18 DN ng BHXH)
Ngoai ra, ttong nfaifiu trudng fagp edc cfainh
sach tai cfainh cung bi Igi dung "dn chdn"
ngudn ngan sdeh nha nude ddnh cho an sinh
ttong difn duge hudng ttg cap nhung khai bdo tfaat ngfaifp dfi fauomg trg cdp; mft sd ngudi di ldm de kifim tfau nhdp d noi khac nhung khfing bao cao thufi; mgt sfi ngudi sfi dung lao dgng khdng ddng cdc khodn bao hifim cho ngudi lao dfing
Thu tu, chua cdn ddi trong phdn bd tdi chinh thue hi?n ASXH
Dfii vdi nhiing hf ngheo, vimg ngheo, vung khd khdn, ddn tgc thifiu sfi, hg kfad tun kifim vific ldm faodc ty sdn xudt ldnh doanh Tdi chinh dugc pfadn bd cfao dfii tugng nay cfafi yfiu la ttg cip tfaudng xuyen nen kfadng cdi thifin duge nhifiu mfic sfing cua mft bfi phan dan cu ndy Doi vdi nhdm ddi tugng lao dfing phi cfainfa tfafic vd nfadm cgn ngfafio hifn nay, edc chinh sacfa tai cfainh van cfaua khdc pfauc duge ttnfa trang ddi sdng bdp bfinfa eua fag, \a hg de tdi ngheo Theo Bdo cdo Piiat trien con ngudi Vift Nam ndm 2015 cua td cfauc UNDP, Vift Nam da phdt trifin faf thfing ASXH ea bdn dua tten "quyen" va theo "vdng ddi", hf tfadng nay cfaia thdnh hai nhdnh ro rang vdi BHXH tuomg ddi hdo phdng cho nhihig ngudi ldm vifc ttong khu vyc chinfa thfic vd ttg giiip xa hfi rdt fagn chfi eho nhung ngudi ngheo nfait Trong kfai cfai tifiu edng cfia Vift Nam cho ASXH ndi chung bdng 2,8% tfing sdn phim qude nfi (GDP), thi rieng pfadn trg gifip xd fafi cfai chilm 0,4% GDP (2013) Tmh ttgng ndy vd difn bao phfi hgn chfi cfia ttg gifip xd hfi dd ddn tdi sy "bo sdt nhdm d giiia" (gfim nfadm can ngfaeo va nfadm trung luu ldp dudi thudng lam vifc d khu vyc pfai cfainfa tfauc, nhdm nhiing ngudi chua dfi tifiu chuan dfi dugc nhdn trg gifip xd hgi hode ehua ed khd ndng tifip can bao hiem xa fadi) Do khdng thudc difn bao phfi ciia eac he thdng ASXH
Trang 7dl bi tdn thuang khi phdi ddi phd voi edc cfi
sfic vd cd khd ndng rit faan che dfi dau tu eho
tuong lai Mfic df ttg c ^ xd fadi ciing qud
tiiip nen khd tgo ra sy khdc bift ttong cufc
song cua nhiing nguoi cd dfi tifiu chudn thy
hudng vd din dfin mft sfi hf qud, ttong do cd
tinh trgng cdi phfi bien d ttfi em thudc cae hf
gja dinh ngheo va cd mue thu nhdp thip
4 Mgt s i giai phap
Thu nhdt, ndng cao mue do bao phti cua hi
thdng ASXH
Bk ndng cao mfic dp bao pfafi ciia fafi
tfaong ASXH cin tgo tfaudn lgi cfao ngudi
dan tham gia BHXH; chfi ttgng dfin md
rfng cdc ddi tugng tfaam gia BHXH ty
nguyfin; fa§ ttg mdt pfain pfai ddng BHXH
ty nguyfn cho cde ddi tugng cd thu nhdp
thdp; khuyen khich phdt trifin bdo hifim xa
fadi ty nguyfn dya tren ca sd xa fadi faoa nfau
bao faifim nhdn thg Cin hodn thifn cac co
cfae fao ttg pfai tham gia BHYT mdt each
hgp ly ddi vdi ede nfadm dfii tugng ddn cu
kfadc nfaau; kfadng dugc pfaan bifit doi xfi
giiia ngudi cd the vdi ngudi khong ed the
trong khdm chfia bfnh dich vy; trien khai
dfing bf edc gidi pfadp ndng cao chdt lugng
kham cfafia bfinh BHYT, ndng cao chat
lugng khdm bfinh chfia bfnh tgi cde ca sd y
te, dde bift la tuyfin y tfi ea sd, d cdc vung
kho khan, vung ddng bao dan tfc, huyfn
ngfafio; day mgnh phdt trien co cfafi kfadm
chfia bfnh cua khu vyc y tfi tu nhdn cfao ddi
tugng BHYT (dieu nay se gdp phdn gidm
thifiu tinh trgng qua tdi d cae bfnh vifn
tuyen trung uong)
Thu hai, cdn md rgng cdc chinh sdch icu
dai, xod ddi gidm ngheo (diiu ndy gdp phdn
gidm ngheo bin vdng vd bdo vi cdc nhdm ddi tugng di bi tdn thuang)
Cdn ddy mgnh thyc hifn chmh sdch uu dai ddc bifit ddi vdi ngudi ed cfing, thuong binfa, gia fflnfa lift sT, Bd me Vift Nam anh hung, cfainfa sdcfa ttg cap xd hfi eho cdc dfii tugng ylu thl; diy manh phdt triln nhifiu hinh thfic boat dgng dfin on ddp nghia; dfii mdi phuang phap tiep cdn xdy dyng ehuang trinh gidm ngfaeo vd ho ttg hg ngheo mgt each ddng bg hom; hodn thifn va
da dgng hda cde cfauang trinfa hd ttg dde thii cfao cde nhdm doi tugng yeu the, d6ng thai kfauyfin khich sy tham gia ciia cdc to chuc
xd hfi vdo cdc chuong trinh bdo ttg
Thu ba, ndng cao ndng l\cc qudn ly nhd nude, hodn thien he thdng phdp ludt ddi vdi
he thdng ASXH Cac tinh, thanh phd ein phdi cfafi dfng
xdy dyng va ban fadnh ke faoacfa ttiln kfaai tfayc hifn eac chinh sach ASXH tgi dia phuomg vdi nhiing chi tifiu, gidi pfadp cy the tfaeo timg nhdm ddi tugng Cin minh bach
va dom gidn hda cde thu tyc hdnh chuih Cdn fing dyng edng ngfaf thdng tin, hodn chinh edc phdn mem dang trifin kfaai ttong qud trinfa quan ly hf thong ASXH C§n thudng xuyfin thanfa tta, kifim tta vd ed bifn pfadp ciing rdn vd trift dfi ttong vifc xfi ly edc vi phgm vfi BHXH, BHYT, BHTN, bdo ttg xa hfii, xda ddi gidm ngheo Cin diy mgnh chfing tham nhiing, tf ngn mit dSn
chu ttong qudn ly nha nude v l ASXH Cha huy dfing su tham gia cfia cac th cfafic xa
hgi ddn sy khde ttong viec theo doi, danh gia thyc hifn chinfa sach ASXH Day mgnh cfauang trinfa BHTN, faudng ngfaifp, ddo tao
va day ngfae Tgo ea fagi va h6 ttg nhieu hom cho eac nhdm yeu thfi, ngudi dan d vtmg sdu, vung xa
Trang 8Thd tu, cdn bdng trong phdn bd ngudn
luc tdi chinh
Vifc phdn bfi tdi chinh phdi can cfi vdo
edc dicfa vy ASXH cung iri^ cdc dilu kifin
sdng kfadc v l vung mifin vd mfic thu nhap
cfia ddn sd Nfiu cung fing cdc dicfa vu eho
vfing giau vi sfic mua cde dich vy ASXH ldn
ma bd qufin ede viing ngheo, ngudi ngheo thi
se dan dfin bat binh ddng Thyc hifn cfing
bang ttong phan bfi ngan sdch thfi hifn qua
su minh bach ttong chi ngan sdeh eho cdc try
cgt ciia hf tfafing ASXH Vi v^y, can tiep tue
ehinh sdch tin dung uu dai dfii vdi nhihig hf
ngfaeo cd kfaa ndng lao dgng nfaimg thifiu
vdn vfi dau tu sdn xuit kinh doanh Ap
dung linh hogt edc phuomg thfic cfao vay tin
dung, c i n tfau BHXH cdn cfi vao mfic tien
luomg, tien edng thye t l cfia ngudi lao ddng
(dieu nay mgt mat se tdng nguon thu cho
quy, ddm bdo dugc quyen lgi cfia nguoi lao
ddng; mat khae tao ra sy binh dang gifia ede
ca quan, dom vi nhd nude vd cde co quan
dan vi khfing phdi cfia nhd nude)
Thic ndm, cd chinh sdch cu thi ddi vdi
nhdm phi chinh thuc
Can ed ehinh sdch giai quyfit hgp ly mfii
quan hf gifia nhu cau va khd ndng tham gia
faf tfafing ASXH cua nfadm pfai chinh tfafic
Nhu cdu tfaam gia bdo biem xa hdi tu
nguyen ciia lao ddng nhdm nay rat ldn, hg
ciing mudn ddng cao de hudng mfic eao
nhung khd ndng ddng gdp lgi rit hgn chfi
Day lai la ddi tugng dang dugc hudng rit it
eac ehuang trinh pfafic lgi xa hgi Vi vay,
cdn edi edeh manh me thfi tyc tham gia vd
thanh toan BHXH (difiu dd sfi tao difiu kifn
thuan lgi hem cho ngudi lao dfng nhdm nay
dfi dang tilp can vd tham gia) Chang han,
chi sfi dung mgt giiy td duy nhdt Id cfaiing
minh nfadn ddn (theo mau mdi) hodc hg
chilu (cip ddi hgn) dfii vdi nhiing ngudi
tham gia BHXH ty nguyfn Ian ddu; bd qua cdng doan tham tra ngudn tfau nfadp vdi nfaiing ngudi tfaam gia; ddy mgnh edc chucmg trinh vifc lam, tiep can cac ngudn lyc phdt trifin kinh t l , xa hdi
Thu sdu, tdng eudng tuyen truyen, ndng cao nhdn thuc cua ngudi ddn vi cdc chinh sdeh ASXH
Tang cudng cfing tdc phoi hgp vdi Bf Thdng tin vd Truyfin thong, cac co quan bdo chi; cd kfi hogch tuyfin truyfin, phfi bifin sdu rdng cae ehinh sach, vdn bdn quy pfaam phdp ludt ASXH din ngudi dan Tuyfin truyen chfi ttgng dfin cdc nfadm ngudi ngheo, nhdm ddn sd trfi, nfadm lao dgng di
eu, nhdm dan sd co trinh do nhdn tfafic thip
d nhimg vung nfing thdn vd vfing kem pfadt trifin Can giiip ngudi ddn nhdn thfic duge ring, tiiam gia BHXH, BHYT, BHTN la lgi ich tuong lai cua chinh minh; vifc khflng ky kit hgp ddng lao dfing vdi chfi sfi dyng lao dpng sfi gay thift hgi eho chinfa minh, ddng thdi tiep tay cfao chfi sfi dung lao dgng vi pfagm phdp lugt Cdn gifip ngudi ddn nhgn thfic dugc ring, nfiu pfadt faifin nfaung bit cap trong cac cfainh sdeh ASXH, nguoi lao ddng cd the thfing qua cdc kfinh khdc nfaau dfi dfi dgt nguyfn vgng cua minh (nhu gap tryc tifip dai difn co quan cfafic ndng, qua bdo ddi ) Suphdn hfii tryc tiep eua ngudi lao dgng Id yeu td quan ttgng dfi cdc co quan qudn ly tien hanh tim cde gidi phdp khic phuc kip tfadi pfau fagp Cin gifip
nguoi ddn thay ddi y thfic f lai, ttdng chd
vao nha nude
5 Ket luan Trong he thdng cac hinh thfic pfadn pfadi hifn nay, phan phdi thfing qua ASXH dd
Trang 9dat dugc nhung k i t qud tfailt tfayc gop phan
thyc hifn CBXH Tuy nfaifin, trong giai
dogn tiep tfaeo edn tfayc hifin nhifiu gidi phdp
dfi hodn thifin hf thfing ASXH Cfi nhu vgy
thi ehung ta mdi dam bdo CBXH tot ban,
qua do mdi gift dugc fin dinh vd phdt trien
ben vflng xa hgi
Tai lifiu tfaam khao
[1] Mai Nggc Cudng (Chu bien) (2009), Xdy dtmg
vd hodn thiin hi thdng chbth sdch an sinh xd hgi
a Viit Nam, Nxb Chfnh iri qu6c gia H i Nfli
[2] Bill D^i Dung (2012), Cong bdng trong phdn
phdi - ca sd de phdt triin bin vang, Nxb
Chfnh tq qudc gia H i Ngi
[3] Ding Cfing sin Vi^t Nam (2016), Vdn kiin
Dgi hpi dpi biiu todn quoe ldn thir XII, Nxb
Chfnh tri quic gia, H i Nfli
[4] Hfli ding Ly luin Trung uong - Nhi xuat bin
Chfnh tri q u i c gja (2013), Nhimg thdch thuc
vd gidi phdp ddi vdi ehinh sdeh an sinh xd hpi ben vOng eho tdt cd mpi ngudi tgi Viit Nam vd Diic, Nxb Chfnh trj qudc gia H i Nfi [5] Lfi Quoc Ly (Chii bifin) (2012), Chlnh sdch xod ddi gidm nghio thuc trgng vd gidi phdp,
Nxb Chinh tri q u i c gia H i Nfli
[6] Vu v a n Phdc (ChCi bifin) (2012), An sinh xa hdi d Viit Nam hudng tdi 2020, Nxb Chfnh tri
quic gia, H i Ngi
[7] Thu tudng Chinh phii (2013), gwyeV dinh sd 12i5/QD'TTg ngay 23/07/2013 vi chiin luge phdt triin ngdnh Bdo hiim xd hgi Viit Nam din ndm 2020 Hk}<^i
[8] Ph^m Thi Nggc T r ^ (2009) Nhiing vdn di ly lugn ca bdn vi cong bdng xa hgi trong diiu kiin nude ta hiin nay, Nxb Khoa hgc x i hfi
H i Ngi
[9] http://www.molisa.gov.vn/vi/Pages/chitie ttin.aspx?IDNews=24363
[10] http://www.baohaiquan.vn/Pages/Do-bao-phu-ve-bao-hiem-xa-hoi-con-thap.aspx