Vien Kinh te Y te va Cdc vdn de xa hoi - Dgi hgc Thai Nguyen TOM TAT Nghien ciru dya Uen phan tich sd Ii?u thii cip ciia bao hiim y tl, bao cao JAHR 2013 va kit qua ngudi ngh^o, DTTS ke
Trang 1GIAI P H A P HirOfNG T O I BAO PHII C H A M SOC SlfC K H O E TOAN DAN
1.^.1 CAC T I N H T R U N G DU M I E N NUI PHIA BAC
Nguyin Dire Lux'', Pham V5n Linh^, Pham Hong Hai"'
'Ban to chuc tinh Hy Thai Nguyen, ^Ban Tuyen gido TW Vien Kinh te Y te va Cdc vdn de xa hoi - Dgi hgc Thai Nguyen
TOM TAT
Nghien ciru dya Uen phan tich sd Ii?u thii cip ciia bao hiim y tl, bao cao JAHR 2013 va kit qua
ngudi ngh^o, DTTS ket du; Ty le chi cho y te binh quan dau ngudi cao nhit ca nude; nhung mgt
chii yeu la chua bao ve tai chinh va bao phii dich vu chua hieu qua, chua minh bach; Van hanh he
thong y te con bat cap, chua phoi hop dong bg KHUYEN NGH|: Nang cao nang lire quan ly
ding bg giaa c4c nginh
Til-khda: Trung du miin nui chdm sdc siic khde todn ddn, chi phi ngheo hda, chi phi tham hga
DAT VAN DE
Theo Td chiic y te The gidi (WHO): Bao phii
cham sdc siic khde toan dan la dam bao cho
tat ca mgi ngudi dan khi can den deu cd the
sti dung cac dich vu nang cao siic khde, du
phong, dieu trj va phuc hdi chirc nang cd chat
lugng va hieu qua ma khdng gap phai khd
khan tai chinh [9]
Ty le bao phu bao hiem y te (BHYT) d cac
tinh Trung du mien niii phia Bac dat tren
80% Ngan sach nha nude (NSNN) ddng cho
ngudi ngheo, dan tgc thieu sd (DTTS) chiem
khoang 20% tdng thu BHYT Quy kham chira
b$nh (KCB) cho ngudi ngheo kit du tdi 33%
va mirc ket du ciia quy KCB cho ngudi ngheo
cdn cao hon miic ket du chung (15%) ndi len
kit du quy BHYT ciia ngudi ngheo dugc sir
dung dl bao cap ngugc cho cac viing giau
[1],[2] Theo Bao cao JAHR 2013, chi NSNN
cho y tl binh quan dau ngudi tai Trung du va
mien mil phia Bac dinh miic cao gap 1,7 - 2,4
lan viing dd thj va cao nhit ca nude [2] Mac
Bang l.Ty li ngudi khdm chiea binh
dil dugc ngan sach nha nude hd trg 100% cho kham chii-a benh BHYT, nhung ngudi ngheo, DTTS van phai chi phi tien tui cao (OOP -Out of Pocket money), chi phi y te tham hga cao (CATA - Catastrophic) va tinh trang ngheo hda do chi phi y te cao (IMPOOR Impoverished) [2], [5]
Vay, de hudng tdi bao phil cham sdc sii'c khde (CSSK) toan dan cdn cd cac rao can gi va giai phap nao cho van de nay d cac tinh Trung du mien mil phia Bac?
Muc tieu: Md ta thuc trang BHYT, phan tich
mdt sd rao can hudng tdi bao phii CSSK toan dan tai cac tinh Trung du mien niii phia Bac
va de xuat giai phap
PHU'ONG P H A P NGHIEN CUU Phuang phap md ta dya tren sd lieu thir cap ciia bao hiem xa hgi (BHXH) Viet Nam, bao cao JAHR 2013 va ket qua dieu tra mirc sdng
hd gia dinh giai doan 2000 - 2014 [1 ], [2]
KET QUA NGHIEN CUU
tgi tru, ngogi tru cd BHYT (%)
2004
2006
2008
2012
' Tel 0983 317197
37,4
57,4
66,7
72,1
43,0 62,1 65,0 72,6
71,2
80,2
86,8
91,8 92,0
Trang 2Ty le lugt ngudi K C B B H Y T d khu vuc D o n g B i c va T a y B i c c a o hem ca n u d e va c a o h o n thanh thj, xu h u d n g K C B tang d t i t ca cac khu v y c
Bang 2 Mot sd kit qud CSSK cho tre em khu vice Trung du mien ndi phia Bdc (%)
Khu vuc
Thanh thi
Trung du MN phia Bac
DTTS
Ngheo nh5t
Suy dinh dvQng
(Nhe can) 6,0 15,4 22,0
Suy dinh dtfOng (thap c6i) 11,8 31,4 40,9 40,9
Suy dinh duo-ng (gay cdm) 3,9 4,4 5,7
(Ngudn; Tdng cue Thong ke Bdo cdo M1CS20I1)
Ty le tre em bj suy dinh d u d n g d khu vyc Trung du mien nui phia B a c c a o h o n khu v y c thanh thj,
n h i t la d n h d m tre em D T T S va nhdm ngudi ngheo
Bang 3 Ngudi chdm sdc SKSS trudc sinh cho phu nie (%)
, , - ^ , Khong di k h a m Outre cham soc
K h u v m B4CS, Y t a , n u h o s n h ^^^ | , „ h i t l l i n
Thanh thi
Trung tlu MN phia Bac
DTTS
Ngheo nhat
94,7
60 44,5 51,1
3,3 22,2
28 25,5
2,1 16,2 24,9 19,9
97,9 82,8 73,2 78,4
(Ngudn: Bdo cdo MICS Viet Nam 2011)
Ty le phu nir d m i l n niii khdng di kham thai n h i l u g i p 9 - 10 lan so v d i t h a n h thi
Bang 4 Ngudi da de vd chdm sdc SKSS trong vd sau smh cho phu nie (%)
„ , , Nii'ho sinh, „ , j - - Nhan vien y t e
Khu vuc Bacsy •., Ba off, mu v u o n , ,-'
• ^ i_{A • then b^n
Thinh thi
Trung du MN phia Bac
DTTS
Ngheo nhat
90,9 62,2 44,8 49,3
7,9 15,1 0,9 1,6
0 4,7 10,8 8,3
0,1 3,5 4,2 3,4
(Ngudn: Bdo cdo MICS Viit Nam 2011)
Ty le phu ntr D T T S d u g c Bac sy d d de t h i p b a n d thanh thj; d u g c m y v u d n d d d e ( 4 , 7 % ) , dugc nhan vien y te thdn ban d o de (3 - 4%)
Bang 5 Nai sinh con cua phu nie (%)
Khu vuc ** T ^ '^ Co- so- y t l t u Tai n h i K h i c
; cong ^ ;
Thanh thi
Trung du MN phia Bac
DTTS
Ngheo nhat
94,6 76,5 60,8 67.2
3,6 1,5 0,9 3,2
1
22 38,3 29,5
0,8
0
0 0,1
(Ngudn: Bdo cdo MICS Viet Nam 2011)
Ty le de tai nha ciia khu v u c T r u n g du mien niii phia Bac r i t c a o 22%i, ty le p h u nir D T T S de con tai nha chiem tdi 3 8 , 3 % , ty le d e con tai nha ciia n h d m phu nii n g h e o c u n g c h i e m tdi g i n 30%)
Bdo vi rill ro tdi chinhy ti cho chdm soc sii-c khoe dong bdo DTTS
Trang 3S - —-
0:15 T y le l<et dir Quy BHYT nguoi ngheo
- T y le k i t d u Quy BHYT Chung
2010 2011 2012
(Nguon: Bdo cdo sd 1161/BC-BHXH ngdy 29/3/2011 da BHXH Viel Nam) Bigud6 1 Ty le kit du quy BHYT ngudi nghiio, DTTS vd quy BHYT ndi chung
Ty le ket du quy BHYT cho nguai ngheo cao hon kat du quy tai chinh chung, chung to quy BHYT nguqi ngheo da dugc bao cap ngugc cho cac quy khac bi bpi chi
Chl NSNN
DB Sdng Ciiu long
Tay Nguyen
DBSdngHdng
Chung ca nude
1
^ ^ H
C^^H
^^^"
I
!
i
- V
406
;8
7
1
72
(Ngudn: Bd Tdi chinh thdng ke ve chi ngdn sdch nhd nude) Bieu do 2 Chi ngdn sdch choy te binh qudn dau ngudi giUa cdc viing ndm 2012
Chi NSNN binh quan dau ngudi cho CSSK viing Trung du mien niii phia Bac cao nhit ca nude Mirc chi nay bao gdm chi sy nghiep y te va chi hd trg mua BHYT cho ngudi ngheo va tre em dudi 6 tudi
Bang 6 Chi philhdm hga vd chi phi ngheo hda do chi phi y te tie 2002 - 2010 (%)
Chiph
Ty le chi ph
Thanh thi
Nong thon
Ngheo nhat
Giau nhat
Ty If ngh^o
Thanh thj
Nong thon
Ngheo nhat
Giau nhSt
cho y te
th^m hoa
li(ia
2002
1,9 5,6 5,5 3,6 0,7 4,3 4,6 0,1
2004
3,1 6,6 5,5 4,9
1,2 5,2 6,2 0,0
2006 3,0 5,9 6,9 4,3 0,9 4,0 5,1 0,2
2008
3,1 6,4 7,8 3,6
1,1 4,5 7,5 0,0
2010 2,7 4,4 4,7 2,5
0,8 3,3 5,4 0,1
(Ngudn: WHO, Dgi hoc Y Hd Ndi 2002)
Trang 4Ty le chi phi tham hga d nhdm ngudi ngheo
nhit va khu vyc nong thdn cao hon so vdi khu
vuc thanh thj va nhdm giau nhit Ty 18 ngheo
hda d nhdm ngudi ngheo rit cao (5,4%) so
vdi nhdm ngudi giau nhat (0,1 %), a doi tugng
ndng thdn (3,3%) so vdi thanh thj (0,8%)
DANH GIA
Ndi din bao phii dich vu CSSK la ndi den kha
nang ngudi dan nhan dugc cac can thiep
CSSK cd hieu qua khi hg can Dd khdng chi
don thuan la viec cung ung djch vu ma cdn la
mgt qua trinh bao gdm tir phan bd ngudn luc
din ket qua thyc hien muc tieu dl ra Bao phii
CSSK can dugc do ludng mgt each toan dien
dudi nhieu gdc do khac nhau, ca ve tinh san
cd ciia djch vu, kha nang tiep can, kha nang
chap nhan, viec sir dung dich vy va tinh hieu
qua cua viec cung irng djch vu Phan tich rao
can bao phu CSSK toan dan tai cac tinh
Trung du mien niii phia Bac theo ba chieu
(chieu rdng ve bao phii, chieu sau ve djch vu
vii chieu cao ve bao ve tai chinh) cua CSSK
toan dan thay rang, hien nay hau het cac tinh
Trung du mien niii phia Bac da dat mice do
bao phii ve chieu rgng nhd cd NSNN hd trg
cho nhdm ngudi ngheo, DTTS, quy BHYT
ngudi ngheo, DTTS cdn du tai chinh den 1/3
quy [1], NSNN chi cho y tl viing Trung du
mien nui cao nhat ca nude [2], vay ma cac chl
sd ket qua CSSK ngudi dan mien mii deu thap
hon ddng bang; ty le suy dinh dudng tre em
cao, ty le CSSK ba me trudc, trong va sau
sinh thap [3], ty le chi phi ngheo hda va chi
phi tham hga do chi phi y te cao [5] Ty le chi
tien tiii d Viet Nam tucmg duang cac nude cd
thu nhap trung binh thap ia 52,1%; va thap
hon so vdi Cgng hda dan chii nhan dan Lao
61,7% va Campuchia 60,1% [5] Chi tir tiln
till cLia hd gia dinh cho y te chiem khoang 8
-11% kha nang chi tra ciia hg gia dinh
(OOP/kha nang chi tra) va 4,6 - 6% tdng chi
tieu cua hd gia dinh (OOP/chi tieu) Theo bao
cao ciia WHO va trudng Dai hgc Y Ha Ndi
(2012) thi ty le va sd lugng cac hd gia dinh tai
Viet Nam phai chju chi phi y t l tham hga (3,9
5,5%) va ngheo hda do chi phi y te (2,5 -4,1%) tir cac nam 2002 - 2010 la tuang ddi cao so vdi cac nude trong khu vyc Nam
2008, tai Viet Nam chi sd CATA la 5,5% va IMPOOR la 3,5% thi Philippin CATA 1,2%
va IMPOOR 1%, Lao CATA 1,7% va IMPOOR 1,1%, campuchia CATA 4,3% va IMPOOR 2,5% Phan tich ty le chi phi tham hga theo mot sd dac tinh hg gia dinh cho thiy:
CJ ndng thdn la 4,4%i (thanh thi 2,7%), nhdm ngheo nhat 4,7%) (giau nhat 2,5%); ty le ngheo hda do chi phi y te d ndng thdn 3,3% (thanh thj 0,8%), nhdm ngheo nhit 5,4% (giau nhat 0,1%)
Nhu vay, cd the thiy buc tranh toan canh ve CSSK cho ngudi ngheo, ngudi DTTS chua dat hieu qua vdi sy dau tu va hd trg NSNN Ben cgnh cac nguyen nhan khach quan nhu yeu td van hda, dia ly, giao thdng cdn co cac nguyen nhan chu quan dan den v|in hanh
he thdng y te cho khu vyc Trung du mien nui phia Bac ndi rieng chua hieu qua Phan tich 6 cau phan cua he thdng y te theo WHO [8], cd
le nguyen nhan chii quan dau tien la van de quan ly, nang lye quan ly dieu hanh he thdng cdn ban che, chua minh bach; nguyen nhan thir hai la mdi trudng cung cau chua thuan Igi (ngudi dan thieu thdng tin ve dich vu, thieu thdng tin de tim kilm dich vu, cung chua dap ung dung ciu ciia ngudi dan vl CSSK ca ve
sd lugng va chit lugng dich vu, gdi djch vu chua rd rang ); nguyen nhan thir ba la phdi hgp trien khai cac chuang trinh, cac van ban, cac thdng tu, nghj dinh giUa cac nganh Y
te, Kinh te, Ndng nghiep, vien thdng cdn bat cap va chua linh hoat doi vai khu vyc Trung du mien niii phia Bac Cac chuang trinh xay dung ndng thdn mdi, xda ddi giam ngheo, phdng chdng benh djch thudng khdng cd sy phdi kit hgp giira cac ben, cac nganh lien quan, khdng phat huy dugc sue manh tdng the cua cac ngudn luc GlAl PHAP
Qua phin danh gia d tren, cd thi thiy kha ro van de ciia cham sdc sue khde cho ddng bao
Trang 5mien nui dd la van d e van hanh he thdng y te
He t h d n g y t e van hanh c h u a hieu q u a cd ly
do ciia s u c h u a t h u c s u coi trgng cac gia trj va
nguyen tac, trong dd phai nhan manh tdi tinh
minh bach, trung t h u c va chat lugng D o vay,
giai phap dau tien dd la Cham sdc s u e khde
toan dan cho khu v y c trung du mien mil phia
B i c phai d u a tren B H Y T toan dan, theo
nguyen tac minh bach v a trung thyc Giai
phap tiep theo la viin h a n h he thdng y t l d y a
tren nguyen t i c C o n g b i n g , hieu qua, chat
lugng, minh bach, trung t h y c v a phat trien
K H U Y E N N G H I
Can phai nang c a o n a n g luc quan ly nganh y
te; Xac dinh gdi djch vy y te c a ban va phii
hgp vdi dac thii viing mien; X a y d y n g c a che
phdi hgp d d n g bd giiJa cac nganh
K E T L U A N
Tai cac tinh T r u n g du mien mil phia Bac, bao
phu B H Y T dat g i n 100%; chi cho y te binh
quan dau ngudi c a o nhat ca n u d e , quy B H Y T
van ket du hang tram ty ddng mdi nam; nhmig
chi sd C S S K ba me va tre em thap va chi phi
ngheo hda, chi phi tham hga do y te cao
Rao can tien tdi C S S K toan dan chinh la c h u a
bao ve tai chinh, bao phu djch vy c h u a hieu
qua, chua minh bach, van hanh he t h d n g y te
con bat cap, c h u a d o n g bd
TAI L I E U T H A M K H A O
1 Bao hiem xa hgi Viet Nam (2013), Bao c^o so ngay 2 9 / 3 / 2 0 1 3 v l tinh hinh thuc hien chinh sach phap luat bao hiem y te giai doan 2009-2012
2 Bao cao chung tong quan nganh y te nSm 2013 (JAHR 2013)
3 Nghj quylt s6 46 - NQ/TW cua Bp Chinh tri ng^y 23/2/2005 v^ cong t^c bao ve, chSm s6c va nang cao siic khoe nh3n dan trong tinh hinh mdi
4 Nghi quylt s6 21-NQ/TW ngay 22/11/20I2 cua
Bg Chinh tri ve tang cudng sy I3nh dao cua Dang giai doan 2012-2020
5 Hoang Van Minh v^ CS, Research report: Assessment of financial protection in the Vietnam health system; Analyses of Vietnam living standards survey data 2002 - 2010
6 Quylt djnh s l 538/2013/QD-TTg ngay
29/3/2013 ciia Thii tudng chinh phii ve viec phe duyet di dn thuc hien Id trinh bdo hiem y ti todn ddn giai dogn 2013-2015 vd 2020
1 Tangcharoensathien, et al, Health financing
reform in Southeast Asia; Challenges in achieving universal coverage Lancet, 2011 377(9768); p.863
8 WHO (2007), Strengthening health systems to improve health outcomes
9 WHO 2000, Health Systems Improving Perfomiance Geneva, Switzerland 2000
WHO (1993 - 1997), Measuring overall health
system perfonnance for 191 countries
Trang 6S U M M A R Y
T O W A R D U N I V E R S A L H E A L T H C O V E R A G E IN M I D L A N D
A N D H I G H L A N D P R O V I N C E S O N T H E N O R T H E R N M O U N T A I N O U S
R E G I O N : B A R R I E R S A N D S O L U T I O N S
Nguyen Due Luc^', Pham Van L i n h \ Pham Hong HaP
Organizing Department of Thai Nguyen province Central Propaganda Department,
•* Institute of Health Economics and Social Issues - TNU
The Study is based on analysis of secondary data from Vietnam Health Insurance, JAHR 2013 and VLSS RESULTS: The coverage is almost 100% for the poor; the share ofthe State for health per capita is highest; however, some health indicators are lower than those in the plain region; IMPOOR and CATA rate from OOP for health are higer Financial risks are not yet protected and the service package is not yet effective and accountable; Health system performance is in management and administration of the health sector; To define the basic health care package appropriate for the region; And to establish coordination mechanisms among sectors for health care
Keywords: mid and high land region, universal health coverage, CATA, IMPOOR
Ngdy nhdn bdi 14/12/2014; Ngdy phdn bien-28/12/2014, Ngdy duyet ddng; 30/01/2015
Phdn biin khoa hoc: PGS TS DdAnh Tdi- Dai hoc Thai Nguyen
' Tel: 0983 517197