nhirng mgt hgn che va di xuat gidi phdp nhdm ddy nhanh Ip trinh thuc hien bdo hiem y te todn ddn tai tinh Khdnh Hda: i Cdi tien vd thay doi mgidi me tu duy qudn ly dieu hdnh ciia ca qua
Trang 1KET QUA NGHIEN CQU D A O TAO SAU DAI HOC
MOT SO GUI PHAP NHAM DAY NHANH LO TRINH THy^C HIEN BAO HIEM Y TE TOAN DAN TAI TINH KHANH HOA
SOME SOLUTIONS TO ACCELERATE IMPLEMENTATION ROUTE
OF POPULA TION HEALTH INSURANCE IN KHANH HOA PRO VINCE
Dqng Thi Kim Loan', Pham Xudn Thuy', Thdi Ninh'
Ngay nhfln bai: 23/7/2013; Ngiy phan bi^n thdng qua; 21/8/2013; Ng^y duyet dang 10/3/2014
TOIM TAT
Nghien cuu ndy nghien ciru thuc trgng th^c hien Bdo hiem y te todn ddn tgi tinh Khdnh Hoa bdng cdc phirang phdp tdng hop, phdn tich, so sdnh Nghien cdu da dua ra cdc nhgn djnh ve nhirng mgt dgt dug'c nhirng mgt hgn che va di xuat gidi phdp nhdm ddy nhanh Ip trinh thuc hien bdo hiem y te todn ddn tai tinh Khdnh Hda: (i) Cdi tien vd thay doi mgidi
me tu duy qudn ly dieu hdnh ciia ca quan Bdo hiem xd hpi; (li) Ndng cao ehdt lupng vd ddp dng nhu cdu khdm chda benh BHYT; (id) Tdng cudng cong tdc tuyen truyen vdn dpng tham gia BHYT vd Idem tra
Tir khda: bdo kiem yte, bdo hiem xd hpi, tinh Khdnh Hoa
ABSTRACT
This study research of the status of population health insurance in Khanh Hoa province in the synthesis, analysis comparison, The study has made comments about the gain result, the restrictions and proposed solutions to accelerate impementation route of population health insurance in Khanh Hoa province: (i) Improvement and powerful method
to change management mindset of social insurance agencies: (li) Improve quality and meet the needs of health care insurance; (iii) Enhance the propagation insured motor and testing
Keywords: health insurance, society murance Khanh Hoa province
I OAT V A N D £ dygc myc tieu BHYT todn ddn vdo ndm 2014 thi cdn Sau gan 20 nam thye hipn chi'nh sdeh, phdp lugt rlt nhilu thdeh thuv, dd id vipe bao phd BHYT cho
v l Bao hilm y t l (BHYT) vd 03 nam Lu|t BHYT cd khu vye lao d0ng t y do, ngydi lao d$ng Uong cdc hieu lye, BHYT da bao phd 63.7% dan so d nude [1] h$ gia dinh, ndng nghipp, ngy nghi|p, Idm nghidp
vd tai tinh Khdnh Hda Id 58% dan s6, trong dd ngydi edn rlt thap Cung vdi do, khd ndng tdi ehlnh ciia ngh^o vd d c d i i tygng ehinh s d d xa hOi da dirge qu? BHYT d i i vdi nhu d u ehi phi y t l cdng Id vin Nha nydc ho trg hodn todn mde ddng BHYT [2] d l Idn Do vdy, viec nghidn cii'u: "IVl$t s i gidi phdp Mge du tinh Khdnh H6a da ban hanh nhieu nham d l y nhanh Ip trinh thyc hipn Bdo hilm y tl van bdn hydng d i n , d c djnh hydng chinh sdch tdi todn ddn tgi tinh Khdnh HIa" Id d n thilt d l ddm bdo chinh y te dygc xdc djnh nhat quan va ro rang, eong cdc quy djnh cda Ludt Bao hilm y t l , gdp phln giO tac tuygn truyln da dygc d l y mgnh vd tang cydng, virng an ninh chinh trj, dam bdo tr|t ty an todn vi song ndm 2010 t j l§ tang tham gia BHYT ehi thdm I n d|nh an smh xa hpi trdn dja bdn tinh Khdnh H6a 1,17% so vdi nam 2009; ndm 2011 t? I§ tham gia Hi#n nay d mpt so d n g trinh nghifin cdu v l Bdo BHYT chf th6m 1.04% so vdi nam 2010, vdn cdn hilm yte tai Viet Nam Diln hinh trong s i d d Id nghi§n nhieu kho khdn thdeh thire li^n quan d i n vi^c tham cdu d a d e tdc gia d Vipn chiln iyge ehinh sdeh y te gia BHYT cda d e d l i tygng theo quy djnh, eung (2006) [5) Nhin chung nghiln cdu d i tiln hdnh phdn nhy ngydi ty nguypn tham gia BHYT [2] O l dgt t i d , ddnh gid kit qua thyc hi#n chinh sdch BHYT,
' D§ng Thj Kim Loan: Cao hoc Qudn trj kinh doanh 2009 - Trydng Ogi hpc Nha Trang
^ TS Phgm Xudn ThOy, ^ ThS Thdi Ninh' Khoa Kmh t l - Tafdng Ogi hpc Nha Trang
Trang 2nhirng khd khdn, virdng mde trong qua trinh thyc hi|n
diinh sdch BHYT, khd ndng ddp dng eua d i n h sdch
BHYT d l i vdi anh hydng phdt triln mlt nIn y te d n g
bing, hipu qua vd phdt triln, nhung bat d p v l mdt
chinh sdch B H Y T d n sira doi, 1)1 sung
Nghign ciru d a Phgm Dinh Thdnh (2004) [3]
dya ra cdc gidi phdp de tyng byde md r|ng phgm
vi ^am gia bdo hilm y t l theo dilu kien vd kha ndng
d a timg nhdm doi tygng t i l n tdi bao phd tdi mpi
ting Idp ddn ey, vd d l xult d c (Keu kipn c^n thilt
nhign vai trd chd d$ng eua BHXH cdn lu md, tac gia
cung da chya dya ra mpt giai phap cy t h i cho doi
tygng la nong ddn chiem 70% ddn so Vipt Nam
NghiSn d u cua Nguyin Thj Ty (2006) [4] Idm
ro sy d n thilt, ban chat, vai tro d a BHYT, tim
hilu kinh nghipm eua d c nydc tren t h i gidi tir dd
xdy dyng t i t hon chinh sdch BHYT tgi Vi§t Nam,
ddnh gid thyc trang thye hi^n BHYT tgi Viet Nam
thdi gian qua vd cull cdng Id mt ra nhyng giai phdp
nhdm hodn thipn chinh sdch BHYT Nghidn cdu ndy
eh[ ddng igi d mde d$: kiln nghj, de xult xdy dyng
ehinh sach bao hilm y te tai Vipt Nam Nd chi gidi
hgn hodn flii§n chinh sdeh n6n thilu tinh chit thyc
t l vd khd cd the tien tdl bao hilm y t l todn ddn Hipn
chya d tde gia ndo nghien cdu thyc trgng vd ede
gidi phdp d l y nhanh 1$ trinh thye hipn Bdo hilm y t l
todn dan tgi tinh Khdnh Hoa
IIL K^T QUA NGHIEN CLPU VA T H A O L U A N
1 Thyc trgng thyv hi$n Bao h i l m y t l tgi tinh Khdnh Hda
1.1 Thi/ctr$ng
-Tmh hinh thu, ehi BHYT
Bdng 1 So thu, chi va can d l i quy BHYT tgi tinh Khdnh Hda
II D 6 | TITONG VA PHUaNG P H A P NGHIEN CLTU
1 Doi ti/pmg va phgm vi nghien eChi Doi tirgng eua nghien ciru: Cong tde thye hipn bao hilm y t l todn dan tgi tinh Khdnh Hda Phgm vi: Cdng tdc bao hilm y t l todn ddn tgi b'nh Khanh Hda tir ndm 2009 - 2011 tgi Bao hilm xa hOi tinh Khdnh Hoa
2 Dir Ij^u va phipcng phdp nghiSn ciru Nghien cdu ndy sir dgng dong thdi so li^u thy
d p Dy li^u thy d p dygc thu thap thdng qua bdo
d o d a Bdo hilm xa hgi tinh Khanh Hda, d e thing tin qua mang Internet
PhiFong phdp nghien edu: Sd dgng phyong phdp so sdnh, phdn t i d , ting hgp dya tren d e
sd lipu thu th^p dygc lay ty ede bao cdo thydng nien
d a Bao hilm xa h^i tinh Khdnh HIa d l phdn tfch thyc trgng cdng tdc ^ y c hipn bdo hiem y te todn ddn tinh Khdnh Hda Ben cgnh dd, phyong phap ph6ng
v i n ehuy§n gia dyge thyc hipn nhdm ddnh gid nhu'ng mgt dgt dygc, ehi nguyen nhdn ciia k i t qud ndy, cung nhy phan t i n tai trong thye hi|n bao hilm y t l todn ddn tai Bao hiem xa h|i tinh Khdnh Hda Cdc ehuydn
gia dyge mdi pi^ong v i n bao gIm ehuydn gia n$i b^:
Ban Gidm doc, Tardng, Phd phdng thulc Bdo hilm
xa hpi tinh Khanh H6a, ehuydn gia ngodi: nguydn lanh dao Bdo hiem xd hpi Khdnh Hda
(Bon VT tlnti: tn$u dSng)
NAm
2009
2010
2011
SA thu BHYT
169.124
299.405
356.562
S& quy BHYT air d^ng KCB (90% s6 thu)
152.211 269.464 320.906
S6 chi BHYT
190.047
218 020 266.412
S6lt6tdir
- 37.836 + 51.444 + 64.494
(Ngu6n: [21)
Ty nam 2009 trd v l tnrde, nhd nydc thye hi^n
chi tra 100% ehi phi khdm ehCra benh BHYT theo
danh mye cua BO Y t l quy djnh, n§n quy BHYT ludn
2009 quy BHYT tgi tinh Khdnh Hda bj dm 37.836
tn$u ding, cd nghTa Id BHXH Vi^t Nam phai dilu
tilt vd bd
Nam 2010 thyc hi§n quy ^ n h eda Lu^t BHYT
ngydi tham gia BHYT ciing ehi trd d i phf khdm chira
b|nh BHYT theo d c mde khdc nhau, tdng nhdm
dli tygng d d c mde d n g chi t r i khdc nhau nhy:
hyu tri 5%; ngydi ngheo 5%; d " nghdo 20%, ngydi lao dpng 20%; hpc sinh - smh vien 20%; ngydi cd edng, tham gia khdng chiln, tre em dirdi 6
tuli khong edng ehi trd V\^c quy ^nh edng chi tra
da han c h i Igm dyng quy BHYT nen quy BHYT d
k i t dy la 51.444 tripu dong
D i n ndm 2011, do dp dgng quy djnh thanh toan ehi phf khdm chda bpnh BHYT eho ede ea
sd khdm chira benh theo khodn dinh suit ngn cdc rlt nhieu d c khdu ky thu§t khdng d n thilt ho$e
Trang 3tinh trgng d p thuoc, chi djnh chin dodn trdn Ian
nIn quy BHYT ed k i t d y la 64.494 tripu dong, co
sd y t l thi chd d§ng trong viec sy dgng nguon quy,
b|nh nhan thi dam bao dygc quyln Igi kham chya
bpnh Mdt khdc, theo quy djnh cda Lugt BHYT
so k i t dy quy BHYT trln mOt d|a bdn d p tfnh sS dygc trich Igi de d i u t y co sd vgt c h i t eho ngdnh
y t l trong tinh d l phye vg Igi cho d e d l i tygng tham gia
- Tinh hinh thu vd phdt hdnh t h i BHYT Bang 2 Tmh hinh thu va phat the bao h i l m y t l tai tinh Khdnh Hda nSm 2009 - 2011 Ooi t i r i n g
1 N g i f o i L D v a N S D L O d o n g
2 Hi^u tri, t r a cap BHXH
3 NSNN ho t r g 100%
- Ngi^crj CO cong, CCB
- Dai bleu quoc tioi, HDND
- Bao t r g xa tloi, ngtfcri cao tuoi
- Ngwai ngh^o, dan toe thieu s6
Than nhan quSn dOi, c6ng an
- Tre em d u g i 6 tuoi, Ithac
4 N S N N h 6 t r g m p t phan
- C | n ngh6o
- Hoc sinh-sinh vien
5 Nliom t^F nguydn Hiam gia BHYT v4 tv dOng
Nam 2Q09
So the BHYT /Tong so doi t i w n g 94.176/103.467 15.585/15.585
7.019/7.019 1.511/1.511 5.667/6.514
163 077/163.077 28.262/28.262 91.372/92.767
30 339/85 343 160.531/208.670 58.728/447.247
TjIfH
91
100
100
100
87
100
100 98,5
35,6 76,9 13,1
Nam 2010
So the BHYT
ning sd ddi t i r ^ g
113.869/124.667 15.907/15907
6.992/6.992 1.449/1.449 6.629/6.976
145 259/147.456
6 072/6.072 106.937/109.016
40.801/114877
176 267/214.824 72.918/419.045
Tilft
91
100
100
100
95 96,5
100 98,1
35,5 82,1 17,4
Nim 2011
St> t h i BHYT /Ting s6 ail tut^g
119.040/133.812 16.853/16.853
6.566/6.566 1.615/1.615 16.248/17.196 104.826/106.299 4,071/4.071 103.740n 07.484
57.779/124/430 185.202/209.653 80.642/446.123
' * m
69
100
m
100 94,5 96,8
100 9e,a 46,4 88,3
18
(Ngudn: [2])
B d n g 2 c h o t h i y v i e c t o c h i r c t h y c hien t h u v d
p h d t h d n h t h 6 B H Y T n h i n c h u n g la t h u d n Igi 6 c a e
n h 6 m d o i t y g n g d y g e n g a n s d e h n h a n y d c d o n g
1 0 0 % k i n h p h i N h o m d l i t y g n g d y g c hS t r g m o t
p h l n h o d c m u a t y n g u y p n co t y le t h a m gia B H Y T
t h a p n h a L N h d m d o i t y g n g bdt b u d e c d t y le t h a m
gia B H Y T t r e n 8 0 % q u a d e n a m , n h y n g t h y d n g
c h | m trS t r o n g v i | c p h d t h d n h t h i B H Y T c h o n g y d i
n g h i d p n g d p n g B H X H , B H Y T
1.2 NhOng kit qud da d^t du^
- N d m 2 0 0 9 t o n g s o t h u b a o h i l m y t l t o d n
t i n h K h d n h H d a d g t 1 6 9 1 2 4 t r i e u d o n g ; n a m 2 0 1 0
2 9 9 4 0 5 b i p u d o n g , t a n g h o n 1 3 0 2 8 1 trieu d o n g
s o v d i n d m 2 0 1 0 , t t r a n g d y o n g t a n g 7 7 , 0 3 % ; n a m
d g t 3 5 6 5 6 2 tai^u d o n g , t a n g 5 7 1 5 7 t r i p u d o n g s o
v d i n a m 2 0 1 0 , t y a n g d y a n g t a n g 1 9 , 0 9 %
- N h d m d o i t y g n g t i l t b u p e e d t y le t h a m gia
B H Y T t r e n 8 0 % q u a d e n a m ; h p e s i n h s i n h viSn d g t
t r e n 8 8 %
1.3 NhOng mdt han dii
- Ngdnh BHXH chya ddp yng kjp thdi vdi yeu
d u nhipm vg
Ngdnh BHXH dam nhgn khoi lygng eong vile
Idn do d l i tirgng tang nhanh Viec phan d p cong tdc
gidm djnh y t l v l huy^n chya dygc kjp thdi, miS'i phdn d p hodn todn cho t i t d cdc huy§n td' ndm
2009 Dpi ngu gidm djnh vidn y t l edn thilu vd yli|t chya CO co c h i kilm sodt chi KCB BHYT d tuy^n
xa, chya kilm sodt dygc gid thule, gid v§t ty ti6u hao Uieo quy djnh, nen chya ddp dng dygc nhl^A
vg kiem sodt chi phi KCB BHYT Bidn ehi, co clu l i ehye cdn bp thu hi#n nay cdn thilu, chya phd hpp vdi ySu d u nhi|m vy
- He thong y t l vd nhdn lye chya ddp dng y&u
d u khdm chira b$nh H^ thing ca sd khdm chira b$nh chya ddp i>ng ygu d u khdm chOa b$nh, chit lygng d a djch vy KCB thap, chya ddp dng ySu d u eda ngydi b^nh
vi v^y tinh h i p d i n cda vipc tham gia BHYT Uilp, ngydi dan khong muln tiiam gia BHYT Vdi \ri§c m* rdng dilu ki§n tham gia BHYT ty nguy§n, nen da si
Id d l i tirgng cd nguy ca hogc dang mie b|nh mdi tham gia BHYT, nhdn ddn chya d y thyc tham gH
vi ^ nghTa chia se mi ro trong d n g ding Co s6
KCB qud tai d t i t d d e tijyIn ndn hgn ehi dih
d I t lirgng khdm chu>a b|nh, Idm gidm tinh thu hOl cda ehinh s d d
- Cdng tdc tuydn truyln v l BHYT vd d n g tdc
d i cath hdnh d f n h hgn c h i
Cdng tdc Uidng tin, tuydn tmyln chya ddp i>ng dirge y l u d u nhi^m vy, ddc bi$t Id d t i m vT mO
Trang 4Cdi cddrx Uid tgc hdnh ehinh chya th|t sy hi|u qud,
chya gidm philn hd cho ngydi b$nh, viec dp dgng
cln vydng mIe chya triln khai dyge, khdng t$p
trung dyge nhdn lye d o viec gidm sdt thanh t d n
ehi phi KCB
- Khd Uiu hdt d l i tygng tham gia
Mde ho trg ddng BHYT d l i vdi d e doi tygng
c$n nghio, hpc sinh, ngydi thupc h | ning Idm ngy
nghipp Id thap so vdi dilu kipn hoan d n h song cda
hp n#n chn tang them ty Ip ho trg Tuy nhiln vdi
trxiic ho trg hi^n hdnh thi d c dja phyang da gap
khi khan trong vipc can doi ngdn sdeh
1.4 Nguydn nhdn
- Nguyen nhdn chd quan
+ B | may dilu hdnh thye hi§n ehi dO BHYT
Bp mdy hogt d$ng, ca d u to chdc hipn nay
cda CO quan BHXH da rlt Idn, nhan sy khdng phdi
It nhyng d l triln khai hipu qua sdu sat d i n nhdn
ddn thi chya dd Ca quan BHXH cdc d p Igi edng
Ide trien khai nhilu cdng tae nhipm vy tir che d$
tygng, 10 trinh, cdch thd'c t l chtpc triln khai thyc
hi$n khdc nhau, ty nguypn d , bat bupe ed, eung
dnh hydng rlt nhieu d i n hi#u qud hogt d|ng cda
CO quan BHXH, ding nghTa vdi dnh hydng d i n s i
lygng tham gia BHYT cda nhdn dan
Co ehi tuyln dgng, sy dgng nhdn tdi, co ehi
lyang thydng, khuyin khich d|ng viln d l i vdi d|i
chya ddp Crng dygc vdi yeu d u , chya that sy dygc
quan tdm, thay d l i , d n qud ngng v l co che bao
dyge cdc chien Iyge, k l hogeh nhdn sy, quan tn
dilu hdnh, d n phy thu^c vd dp dyng mOt each
nguyen tie Idm vipe chya dygc d$i ngu nhdn vien
thyc hi$n mOt edeh nghiem tde, tuan thd, d n d ty
chdc ky lu§t chya dygc de cao vd dyge thye hipn
m|t cdch nghifim minh
+ Cdng tdc BHYT vd tuyfin truyln chya dap
yng yeu d u
Hipn nay mdi d i dirng Igi d mye sao gdi van
bdn, ban hdnh vdn ban, td chdc so kit, tdng kit nhy
gin nhy Id nhi|m vy ehlnh, trpng tdm vd duy nhat
d a ngdnh BHXH, ty tuydn truyln, phd biln, triln
mIe, nlu cd cda cac co quan chdc ndng ed tham
quyln thi hogc chya kjp Uidi ho$e d n ehung d u n g
d n g tdc tuyen truyln hipn nay chya dyge quy djnh
rd rdng vd chya dd UBND tinh thye hipn chire nang
quan lif' nha nydc v l BHYT tgi dja phyang nhyng vipc t)6 tn' kinh phi eho edng tae tuyen truyen ehinh sach BHYT tgi dja phirang d n gap nhieu khd khdn
- Nguyen nhan khach quan + Chinh sdch d l i vdi ngydi d " ngheo chya thuc d l y vipc tham gia bdo hilm y t l : Dieu ki|n kinh
t l d a nhdm doi tirgng egn nghIo thye sy khong khde bi$t nhilu so vdi nhdm d l i tygng ngh6o nhyng
d c chinh sdeh yu dai eho nhdm doi tirgng d n ngheo Mac du da dygc h i trg den 85% nhyng s i tham gia van d n thip, dieu ndy d t h i d n lien quan
d i n nhdn thdc ve Igi ich eda viee tham gta BHYT chya day du, eung vdi d c h t l chdc khdm chira bpnh BHYT chya thudn Igi cho ngudi tham gia Mgt eao tdi 20% nhy quy djnh hi$n nay vd khdng cd trln gidi han mde eung chi trd trong mOt nam eung dyge xem Id mpt rdo d n hgn che sy tiep cdn cda ngirdi
d n ngheo d l i vdi d e djeh vy y t l , ddc bi^t id d e dieh vy ky thu|it eao, ehi phf Idn
+ Nh$n thdc cda ngydi tham gia bao hiem
Dii voi nguoi lao ddng trong cdc doanh nghi$p:
Cdc doanh nghipp khdng ddng, trdn ddng hodc ddng khdng day dd BHYT eho ngirdi lao dpng do nh|in thde eda ehd sd dung lao d|ng ve ehinh sdch BHYT chya dly dd, trdch nhi|m thye Uii phap lu§t quyen Igi BHYT hogc bj han che trong vipc doi hli
quyln Igi ndy khi kjf hgp ding lao dpng Trong khi
tdi XLF ly' vi phgm d n hgn ehi, d y a dd mgnh
DSI vcn hQC sinh, smh vidn: Chya cd sy phdi
hgp ch^t che giira ngdnh gido dye - ddo tgo vdi ca quan BHXH ndn d n g tde ehi dao, hydng din triln khai Lu|t BHYT trong d e nhd trydng chya kip thdi tham gia nhieu loai hinh bao hilm thyang mgi khde ndn dnh hirdng den viec tham gia BHYT
Doi vOi trd em duifi 6 tu6i: Cdng tdc Igp danh
sdch, bdn giao danh sdeh trd em dydi 6 tuli giCra
vd CO quan BHXH d n eh§m Chya thdng nhat quy hgp till BHYT da dygc ca quan BHXH phdt hdnh, chuyen eho dia phyang nhyng Igi khdng d i n dyge
d p phdt the BHYT
Oil vai nguoi tw nguy$n tham gia BHYT: S i
ngydi ty nguydn tham gia BHYT cdn thip, da s i ngirdi tham gia Id ngydi mde bdnh man tfnh, benh vipc td ehye, vdn dpng tuyen tnjyIn cho ngydi ddn hilu rd chinh sdch BHYT, tich eye tham gia BHYT
Trang 5•*• Khd ndng dap irng va tilp d n djeh vy y t l
Chya d sy d i u ty Uifeh dang eho d e ca sd y
te tyong t h f d vdi so lirgng ngydi tham gia BHYT,
yeu kem, hgn ehi ve d eon ngydi, co sd vat chit,
phyong tidn V.^ UiugL Ca che Uid tgc hdnh chfnh
d n rydm rd phde tgp, gay khd khan, phde tgp
Quy trinh chuyin tuyen edn nhilu philn ha hogc the
BHYT chi d gid tii tgi d c co sd y te d ky hgp ddng
KCB BHYT da Idm gidm di phan ndo y nghTa vd gid
tq khi tham gia BHYT
Tinh ti-gng Igm dyng quy BHYT tai co sd y te
v i n diln ra khd phuc tap nhy; ehi djnh thye hien
djeh vg ky thudt, sir dgng may mde thiet bi dygc
b^ng bj ti> nguIn xa hpi hda rdng rai, qua md-e d n
thilt vdi tinh tigng bpnh ly, Igp h i sa bpnh an khong
thudc phgm vj Uianh todn d a BHYT; thdng ke so
lygng thudc vdt ty y t l tieu hao nhieu han sd
khdng ed ehi djnh sir dyng U^ng ho sa bpnh dn dp
gid thude, djeh vy ky thugt, vat ty yte tidu hao d l
nghj ea quan BHXH thanh t d n cao hon mde gid da
dirge d p d thIm quyen phd duypt, hogc dp theo
mire gid dygc phd duydt sai quy dinh
2 M^t s6 gidi phdp gdp p h l n hoan thipn cdng
tdc BHYT tgi tinh Khanh Hda
2.1 Cdi tiin vd thay dii m^nh me phuong thuv vd tw
duy qudn /j^ diiu hdnh cua co quan BHXH
• Xdy dung ki ho$ch ddo t^o phu hop va hieu qua
Cd k l hogeh dao tgo ngay td khi mdi dyge
tuyen dgng, d l nlm bat dyge mot sd edng vide
ehlnh, ting Uil d a eo quan dan vj tnj'de khi vdo
vdi t i t d nhdn vidn, di nhidn ia tgp bung dao tgo
ede nOi dung lidn quan den nghe nghidp chuyen
mdn, b i n cgnh vipe td d d e ddo tgo d c ITnh vye
theo quy djnh cda nhd nirdc
- Xdy dgng mdi tnfdng ldm vi^c
l^di tnrdng Idm vipe d i md, kieh thich sy nang
d$ng phdt huy dirge hidu qua hogt ddng cda nhan
ngydi dung vide Cdc van d l lyang, thydng, hirdng
d c c h i dd dge thu d a nganh nen xay dyng mpt
ea c h i thich hgp, ti'dnh chu nghTa binh qudn, cdo
bang, kh&ng dya tren mire lyang md dya vdo hidu
Tgo eg h^i thang tien vd phat tnen vdi tat ca mpi
nhdn vidn Ca ehi bo nhipm vd d t nhle vdo d c vi tri
qudn 1;^ trdn ea sd ddnh gia ddng hipu qud, nang lye
Idm vide, khd ndng quan ly, lanh dgo eda nhan vidn,
tgo eho nhdn vidn sy tin tydng vd d m nhdn dyge
thdnh qud lao ddng d a minh ludn dygc ghi nhgn
vd ed gid trj vdi ban thdn hp trong vide thdng tiln
ve sau khi hdi dd d c dieu kipn, tranh tinh trang dt nhIc nhdn vidn vdo d c vi tii qudn ly khdng dung ngydi, ddng vipc, van de ndy se d i n d i n nhirng h^u qud khd lydng vd d tdc dpng x l u tnj-c tiep din hipu qud hogt dpng d a dan vj
- Xdy dgng h0 thing danh gid hieu qua ldm vfft;
c l n thyc htpn Idp bdng tidu ehuln nghidp vij cho h>ng logi nghipp vy, lidt ke dygc tat d nhOng ydu d u ehd y l u ddi vdi ngydi lao dOng, npi dung ddnh gid d n g chfnh xac, do d n g viee tiiydng tiiay
d l i , bd sung, nen bdn tidu chuan cung d n dygc c|p nhgt bd sung v l ndi dung cdng vide cho phd hgp
- Xdy dgng chiin iu^c phdt triin ngudn nhin li/c ngdnh BHXH
Theo dd phdi t l chirc dygc mgng lydi tgi co s6
ft nhlt Id d i n d p xa, hodc d d n b$ ehuyen Idm edng tdc qudn l<^ d p xa de ehi dao, hydng dan dOi ngu dgi ly, d n g tdc vidn tijyen xa lam tot d n g tdc tuyen truyln, thyc hipn chfnh s d d bao hilm y te
- Tdng cuimg diu tw co so vdt chit, dac bi$t li h$ thdng cdng nghd thdng tin
Cdng tac tiiyc hipn BHYT ddi hdi eao vide irng dyng cdng nghd thing tin trong vide quan ly doi tygng vd qudn ly quy BHYT Hien nay, da dygc diu
ty ndng d p d e thilt bi tin hpc cdng nhy d e phln mim qudn ly, tuy nhien v i n cdn chua ddp dng dypc vdi yeu d u Trong ngudn kinh phi dygc d p cln phdi t|ip trung dau ty han nu'a trang thiet bi lam vl$c cho nhdn vidn, dau ty, nghien cdu vd ndng d p cdc phan m i m qudn ly, dge bipt Id ket ndi dyge du' li§u trong hp thdng ea quan BHXH, giiJa ca quan BHXH vdi ea sd khdm ehira bpnh BHYT
2.2 Ndng cao chit Iwgng va dap ung nhu ciu khdm c/juB b$nh BHYT
Tilp tgc thye hipn dau ty md rpng mang lirdi khdm di>a bdnh dap img yeu d u ve cham sdc sire khde vd chit lygng kham ehd'a bpnh, dde bipt Id y
te ea sd thdng qua thye hipn D l dn gidm tdi bdnh Hda d i n ndm 2020 Tang cydng thye hidn x§ h^ hda d n g tde y te, da dgng cdc logi hinh khdm chua bdnh d l tilde d l y ndng eao chat lugng khdm chira bpnh BHYT
Xdy dyng vd tiiln khai chyang ti-inh ndng cao chit lygng khdm chira bdnh BHYT Vide trien khai chinh sdeh BHYT phai thyc hidn tCrng byde vd d6ng
bp vdi vide edng cd ndng eao chat iygng khdm chiia bdnh BHYT, d i d c h thu tyc hdnh chinh, nang cao dgo ddc nghl nghidp Cd gidi phdp thiet Uiyc ndng eao y ddc chinh la ndng cao chit lygng khdm ch&a bdnh, d l y mgnh tuydn truyen han n&a trong dOi ngu d n bd ngdnh y t l ve y ddc, dgc bipt Id d n b^
Trang 6bd, d l y mgnh cdng tac nghien cdu khoa hgc, sdng
kiln d i tien ky thu$t, thye htpn nghiran d c quy d e
ehuydn mdn, dgc bidt chu y den tiidi dp giao tilp vdi
ngirdi bdnh vd ngydi nha bpnh nhan Xdy dyng gdi
djch vy cham sdc sdc khde ban d i u , gdi quyen Igi
CO ban Xdy dyng ede vdn bdn vd tidu d u a n eg t h i
d& vdi ea sd kham d u ^ bdnh BHYT d l dam bdo
chit lygng vdi ca sd cung d p djeh vy y te, ehinh
s d d eung d p thudc cho ngydi bdnhh BHYT
2.3 Tdng cuong cdng tdc tuydn truyin van dgng
tham gia BHYT vd kiim tra
- Tuyen tmyen v$n ddng
Ngdnh BHXH d n tang cydng han nira eong
tde tuydn truyln v|n dpng, vdi nhilu hlnh thdc
phong phu vd da dgng, ndng cao nhdn thdc eda
ngydi ddn Cdng tdc tuyen truyen phdi dgt v l d
diieu r$ng lin chieu sdu Khdng chi ndng cao nhan
ti> chinh edn b^ qudn ly, d c d p ede ngdnh vd d
cdn bp thyc hien lien quan den BHYT Phil hgp lidn
t l chut: phi chfnh phd trong ddng gdp, thuc day sy
Uiam gia BHYT Ben canh dd, ngdnh BHXH trong
dnh, nhirng khd khdn virdng mde, kip tiidi de xult,
kiln nghj cae d p ngdnh thdo gd, dieu ehlnh, t]d
sung, sira doi d e quy djnh cho phu hg^ vdi thye te
TSng cydng d i u tir xdy dyng mgng lydi cdng
tdc vidn BHYT, Uidng qua ddi ngu dgi IJ d i ba BHXH,
dgi ly thu BHYT, thudng xuydn p h i biln, tgp huan
nghipp vy, ehi dp chinh sdch cho dpi ngd cdng tae
vidn Phdi hgp ehdt d d vdi tat d cdc d p , ngdnh,
d c CO quan thdng t i n , bdo d i , tnjyen thdng trong
cdng tde tuydn truyen van d$ng, t$n dyng dpi ngu
cdn t>d din tuyln ea sd d a ede hOi, dodn Uie d l Idm
d n g vidn tuydn buyin d l dp BHXH, ding Uidi d
chi dd ddi ngd thich ddng nham ddng vidn khuyin
khfeh ddi ngd ndy thyc hidn chdc nang tuyen truyln
vgn ddng bdn cgnh nhidm vg chinh tii eua hp
Cdng tde buyen thdng, tiiyen truyln d n dygc
tiln hdnh vdi tat d d c nhdm d l i tygng, bao gom
d i bp, ddng vidn vd thyc hien tiiydng xuyen, lidn
Kic vdi nhilu hinh thire phu hgp, bdo ddm d e ddi
tygng d a truyln tiling tiep d n dly du vdi thdng tin
v l ehinh sach BHYT va d c h Uidc tham gia
- Tdng cirdng cdng tdc thanh tra kilm tra vide thye hipn BHYT d o ngydi lao dpng
Dya bdu chi tham gia BHYT cho ngirdi lao dpng nhy Id mot ydu d u b i t bupe trong vipe d p phep hogt dpng san xuat kinh doanh, tiiydng xuyen kiem tra, ddn doc nhac nhd, xd phat nghiem minh d e hdnh vi tron ddng, ne banh vide tham gia BHYT, ede hanh vi vi phgm v l quyln vd nghTa vg d a d c bdn tham gia vd lien quan den vipc thyc hipn BHYT Phan djnh rd t r a d nhidm vd tang cydng d n g tdc thanh tra, kilm tra thyc hidn chinh sdch BHYT cua trd d a UBND tinh trong vide ehi dgo ede sd, ngdnh ehinh sdch BHYT tren ^ a bdn finh
IV K^T LUAN Cai thipn cdng tdc bao hem y t l todn ddn tgi tinh Khanh Hda se gdp phan quan trpng trong d n g cupc d l i mdi sy nghidp chdm sdc vd bdo vp sd-c khde nhdn ddn bong tinh O l khai thde nhyng k i t
d l xuat mpt sd giai phdp gdp phln nang eao edng tde bdo hilm y t l todn dan tgi tinh Khdnh Hda: Cdi tiln vd thay d l i manh me phirang thde va ty duy quan ly ^eu hdnh cua ea quan BHXH, nang eao chit lygng vd ddp dng nhu d u khdm chira bdnh BHYT, tdng eirdng edng tde tuyen tmyen v | n ddng tham gia BHYT vd kilm tra Trong do gidi phap d i tien vd thay d l i mgnh me phyang thirc vd ty duy qudn ly dilu hdnh d a eo quan BHXH ed y nghTa rat quan trpng, cd t h i coi nhy d m nang thye hien y te todn ddn tgi tinh Khdnh Hda
Vdi nhirng kit qud nay, nghidn ed'u dd giai quylt
t i t mgc tieu nghien cdu da d l ra Tuy nhidn nghidn ddng Igi d phdn tieh thyc trgng, phdng v i n ehuydn gia chi ra dilm hgn che vd de ra mdt s6 kiln nghj gidi phap d l gdp phln nang eao d n g tde bdo hilm y
t l toan ddn tai tinh Khdnh Hda Trong nhirng nghidn phdn tich cac nhan td dnh hydng d i n cdng tdc bdo Idn de d mot md hinh hodn tiiipn han
TAI L i f u TH.4\1 KHAO
1 Bao hiira xa hpi Vi?t Nam, 2010 Ky yiu nghien ciiu khoa hoc Ha Ngi
2 Bao hifem xa hpi KhSnh H6a, 20 U Bao cao danh gia 3 nam thyc hi?n Lu|t Bao hiem y le tren dja ban tinh Khanh Hoa
3 Ph^m Dinh Thanli, 2004 Bao hilm y ti va tien trinh t h ^ hi?n bao hiem y tk toan dan 6 Vift Nam Lu^n vSn Thac sT Kinh t6
Trudng Dai hpc Kinh tl TP.HCM
4 Nguyen Thi Tii, 2008 Phit triln va hoan thi?n h? th6ng y td t?i Viet Nam Luan v5n Thac sT Kinh tl Truemg D91 hpc Kinh
tl TPHCM
S Vifn Clucn lu<7c chinh sich y tl, 2006 Bio cao dinh gia vi thuc hipn chinh sach BHYT 6 Viet Nam