BH20

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam
Li m u
Mt x hi pht trin trc ht phi c nhng con ngi kho mnh. C sc kho con ngi mi c th thc hin cc hot ng sng phc v cho chnh bn thn mnh v cho cng ng. Nhng khng phi lc no con ngi cng kho mnh v khng phi ai cng c kh nng chi tr chi ph khm cha bnh khi khng may gp ri ro bt ng nh m au, bnh tt Chnh v vy hu ht cc quc gia trn th gii u trin khai BHYT nhm gip v to ra s cng bng trong chm sc sc kho i vi ngi bnh. nc ta BHYT c thc hin t nm 1992, tuy t c nhiu kt qu nhng cn rt nhiu kh khn do nhiu nguyn nhn khc nhau. Mc d vy ti i hi ng IX, Nh nc ta quyt tm n 2010 nc ta s tin ti BHYT ton dn, to iu kin chm sc sc kho cng ng m khng phn bit a v, gii tnh, ni c tr Mun t c mc tiu ny phi tng bc tng nhanh i tng tham gia, c bit l tr trng BHYT t nguyn bi l din bt buc tham gia BHYT ca nc ta cha nhiu. Hn 80 triu dn mi ch c trn 30 triu ngi c th BHYT bt buc, cn li u thuc din t nguyn, trong hc sinh - sinh vin chim hn 20% dn s khong 23 triu ngi vn ch nm trong din vn ng tham gia.
L Thu Dung Bo him 43A
L th h tr ca t nc, hc sinh; sinh vin cn c quan tm chm sc sc kho ca c cng ng sn sng gnh vc trch nhim ln lao trong tng lai. Ngay t khi thnh lp, Bo him Y t Vit Nam quan tm n vic trin khai BHYT HS-SV. Sau hn 10 nm thc hin, BHYT HSSV chng t c vai tr khng th thiu ca mnh, em mun nh gi chnh xc nhng g t c trong 10 nm qua v nhn nhn nhng mt cn hn ch trong vic trin khai. Chnh v vy em chn ti: nh gi thc trng trin khai BHYT HS - SV ti c Nam Em chn ti ny vi mc ch nghin cu t kt qu thc t v thc trng trin khai a ra cc gii php nhm thc y s pht trin ca BHYT HS-SV gp phn thc hin thng li mc tiu tin ti BHYT ton dn m ton ng, ton dn t ra. Ni dung chuyn ca em gm 3 chng: Chng I : L lun chung v BHYT HS-SV Chng II : Thc trng trin khai BHYT HS-SV Chng III : Gii php pht trin BHYT HS-SV ti Bo him x hi Vit Nam. quan Bo him x hi Vit
Chng i C s l lun ca BHYT HS - SV
I. S cn thit khch quan ca BHYT i vi hc sinh sinh vin. 1. S cn thit phi trin khai BHYT HS SV. Ra i t cui th k XIX, BHYT l mt trong nhng bin php hiu qu nht nhm gip mi ngi khi gp ri
ro v sc kho trang tri phn no chi ph khm cha bnh gip n nh i sng gp phn bo m an ton x hi. Ngy nay, BHYT c ngha quan trng hn khi chi ph y t v nhu cu khm cha bnh ngy cng tng. khng ai c th ph nhn nhng thnh tu ca ngnh y hc m ra cho con ngi nhng hy vng mi , nhiu bnh him ngho tm c thuc phng v cha bnh. Nhiu trang thit b y t hin i c a vo chun on v iu tr. Nhiu cng trnh nghin cu v cc loi thuc c tr thnh cng. Tuy nhin khng phi ai cng c th tip cn vi nhng thnh tu c bit l nhng ngi ngho. i a s ngi dn bnh thng khng c kh nng ti chnh khm cha bnh, cn nhng ngi kh gi hn cng c th gp by i ngho bt c khi no. BHYT l s san s ri ro ca mi ngi trong cng ng, l gii php hu hiu mi ngi vt qua bnh tt. Theo ngi kho mnh gup ngi b bnh v mt ti chnh h c s dng thuc men, trang thit b y t sm bnh phc sc kho. Trn th gii, khng mt quc gia no c th khng nh ngn sch nh nc chm lo sc kho cho ton cng ng m khng c s huy ng ca cc thnh vin trong x hi. Cng ngy BHYT cng khng nh vai tr khng th thiu ca mnh trong i sng con ngi.
BHYT l cn thit vi tt c mi ngi do n c tc dng rt thit thc. Hu ht cc quc gia trn th gii u trin khai BHYT di nhiu hnh thc t chc khc nhau. Tuy nhin d trin khai di hnh thc no th BHYT cng c chung nhng tc dng sau: Mt l gip nhng ngi tham gia BHYT khc phc kh khn v kinh t khi bt ng b m au, bnh tt. Chi ph khm cha bnh l mi lo rt ln i vi mi con ngi. Khi b m au, h khng th tham gia lao ng hoc lao ng vi hiu qu thp dn n thu nhp b mt hoc gim. Trong khi chi ph y t ngy cng tng gy kh khn, nh hng n ngn sch ca mi gia nh. Nh c BHYT m ngi bnh yn tm cha bnh v kh khn ca h c nhiu ngi san s. T h sn sng cha bnh cho n khi khi hn. Tham gia BHYT s gip ngi bnh gii quyt c mt phn kh khn kinh t v chi ph khm cha bnh c c quan BHYT thay mt thanh ton vi cc c s khm cha bnh. H s nhanh chng khc phc hu qu v kp thi n nh cuc sng, to cho h s yn tm, lc quan trong cuc sng. Vi ngi lao ng th h yn tm lao ng sn xut to ra ca ci vt cht lm giu cho h t lm giu cho x hi. Hai l lm tng cht lng khm cha bnh v qun l y t.
BHYT v vn chm sc sc kho cng ng lun c mi lin h cht ch vi nhau. Cht lng khm cha bnh nh hng trc tip n vn chm sc sc kho cng ng, tng cht lng khm cha bnh l mc tiu hng u ca BHYT. Trong cc khon chi th chi cho hot ng khm cha bnh, nng cp v m rng c s khm cha bnh l mt trong nhng khon chi thng xuyn , chim t trng ln nht. Cht lng khm cha bnh c tt th mi thu ht c cc i tng tham gia BHYT. Ngc li, nh c BHYT mi c ngun ti chnh u t cho cng tc khm cha bnh. Mt trong nhng nguyn tc ca BHYT l s ng nn s ng gp ca mt ngi l nh b nhng ca c cng ng th rt ln nn ngun ti chnh l rt ln. Tng cht lng khm cha bnh ch c th bn vng v lu di th phi da vo ngun kinh ph t s ng gp ca ngi tham gia thng qua ph bo him. Qua cng tc qun l y t cng n gin v d dng hn. Ba l to ra s cng bng trong khm cha bnh. BHYT l phn phi li thu nhp gia nhng ngi tham gia. Tham gia BHYT, ngi bnh c chi t theo phc iu tr ring ca tng ngi ch khng phn bit a v giu ngho. BHYT hot ng theo nguyn tc c ng c hng v mang tnh nhn vn su sc. Ai cng c m bo quyn li khi tham gia trnh tnh trng tiu cc v b c quan BHYT gim st cht ch.
Bn l gp phn lm gim gnh nng cho ngn sch Nh nc. Ngun thu ch yu ca ngn sch Nh nc l t thu nhng c rt nhiu khon chi cn n ngun ngn sch ny. Trong xu th hi nhp kinh t quc t, hng ro thu quan dn c gim bt thm ch l bi b. V vy chm sc y t khng th da vo nhn vin tr ca Nh nc. Mt trong nhng phng php em li hiu qu cao nht l BHYT, Nh nc v nhn dn cng chi tr. Nh vy, BHYT c hch ton thu chi c lp vi ngn sch Nh nc s lm gim c gnh nng rt ln cho ngn sch trong vic m bo hot ng cho ngnh y t. Nh vy, mi la tui u c th tham gia BHYT bo v sc kho cho mnh. Tui hc sinh l mt qung thi gian di khng th thiu trong s pht trin ca mi con ngi. tui ny c th cc em pht trin cha hon chnh, cc em cn rt hiu ng, cha nhn thc v cc nguy him c th xy ra v vy rt d gp ri ro c th dn n hu qu nng n sau ny. Nu khng c s quan tm ng n i vi vn chm sc sc kho ngay t khi cn nh th cc em s khng c iu kin tt tip thu kin thc lm hnh trang bc vo i. C sc khe tt cc em mi pht trin mt cch ton din, mi c th tip thu ht khi kin thc m cc thy, cc c truyn t khi cn ngi trn gh nh trng. Nh vy th h tr s c nng lc
gnh vc trng trch ln l cho li con tu t nc trong tng lai. Nu cc em khng may mc bnh phi nm vin iu tr th cha m cc em khng yn tm lm vic v phi ngh vic chm sc cho cc em. Nh vy cha m cc em mt phn thu nhp cng thm chi ph KCB s lm cho kinh t gia nh gp nhiu kh khn. C BHYT th chi ph KCB ny s c chia s vi nhiu ngi do vy cha m cc em s gim c gnh nng kinh t rt ln. Cha m cc em cng khng phi mt thi gian a cc em i khm sc kho nh k v yn tm khi cc em khng may gp ri ro trong khi ang hc tp ti trng v c y t trng hc m nhn. Con em mnh c chm lo sc kho th cha m s ton tm ton tham gia lao ng sn xut gp phn n nh kinh t gia nh v lm giu cho x hi. BHYT HS-SV l mt gii php c bn chm sc sc kho cho hc sinh - sinh vin. y l i tng gn lin vi trng hc nn cng tc chm sc sc kho cho cc em cng gn lin vi cng tc YTH. Hin nay nhiu nc trn th gii, cng tc chm sc sc kho hc sinh ti cc trng hc rt c ch trng. Mt s nc nh: Anh, M, Nht, Philippinh thng YTH pht trin mnh v hot ng rt c hiu qu trong vic chm sc sc khe cng nh gio dc kin thc sc kho cho hc sinh. BHYT HS - SV l chm lo cho th h tr mt cch ton din, khng nhng chm lo v mt sc kho m cn gio dc
nhn cch v li sng nhn i. Tham gia BHYT
cc em s
thy c tc dng ca BHYT i vi mi ngi xung quanh, vi bn b mnh v chnh bn thn mnh. Thng qua BHYT cc em s hc c cch chia s kh khn, ng cm vi ngi khng may gp ri ro. Nhn cch sng tt p y s hnh thnh trong cc em, theo cc em i ht cuc i v truyn t i ny sang i khc. Ni tm li, cng nh s cn thit phi thc hin BHYT ni chung, BHYT HS-SV cng rt cn thit phi trin khai v tng lai ca cc em v v mt x hi pht trin. II. Ni dung c bn ca BHYT. 1. Ni dung c bn ca BHYT trn th gii. 1.1. i tng tham gia BHYT. i tng ca BHYT l sc kho ca con ngi, bt k ai c sc kho v c nhu cu bo v sc kho cho mnh u c quyn tham gia BHYT. Nh vy i tng tham gia BHYT l tt c mi ngi dn c nhu cu BHYT cho sc kho ca mnh hoc mt ngi i din cho mt tp th, mt c quan ng ra k kt hp ng BHYT cho tp th, c quan y. Trong thi k u mi trin khai BHYT , thng thng cc nc u c hai nhm i tng tham gia BHYT l bt buc v t nguyn. Hnh thc bt buc p dng i vi cng nhn vin chc nh nc v mt s i tng nh ngi v hu c hng lng hu,nhng ngi thuc din chnh sch x hi theo qui nh ca php lut ... hnh thc t nguyn p dng cho mi
thnh vin khc trong x hi c nhu cu v thng gii hn trong tui nht nh tu theo tng quc gia. 1.2.Phm vi BHYT. Mi i tng tham gia BHYT khi khng may gp ri ro v m au, bnh tt i KCB u c c quan BHYT xem xt chi tr bi thng nhng khng phi mi trng hp u c chi tr v chi tr hon ton chi ph KCB, BHYT ch chi tr trong mt phm vi nht nh tu iu kin tng nc. BHYT l hot ng thu ph bo him v m bo thanh ton chi ph y t cho ngi tham gia bo him. Mc d mi ngi dn trong x hi u c quyn tham gia BHYT nhng thc t BHYT khng chp nhn bo him thng thng cho ngi mc bnh nan y nu khng c tho thun g thm. Nhng ngi tham gia BHYT khi gp ri ro v sc kho u c thanh ton chi ph KCB vi nhiu mc khc nhau ti cc c s y t. Tuy nhin nu KCB trong cc trng hp c tnh t hu hoi bn thn trong tnh trng khng kim sot c hnh ng ca bn thn, vi phm php lut th khng c c quan BHYT chu trch nhim. Ngoi ra, mi quc gia u c nhng chng trnh sc kho quc gia khc nhau. C quan BHYT cng khng c trch nhim chi tr i vi ngi c BHYT nu h KCB thuc chng trnh ny. 1.3. Phng thc BHYT.
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Cn c vo mc thanh ton chi ph KCB cho ngi c th BHYT th BHYT c nhiu phng thc thanh ton khc trong c nhau, c th l: - BHYT trn gi l phng thc BHYT quan BHYT s chu trch nhim v mi chi ph y t thuc phm vi BHYT cho ngi c BHYT. - BHYT trn gi tr cc i phu thut l phng thc BHYT trong c quan BHYT s chu trch nhim v mi chi ph y t thuc phm vi BHYT BHYT - BHYT ( theo quy nh ca c quan y t). thng thng l phng thc BHYT trong trch nhim ca c quan BHYT c gii hn tng xng vi trch nhim v ngha v ca ngi c BHYT. i vi cc nc pht trin c mc sng dn c cao , hot ng BHYT c t lu v pht trin c th thc hin BHYT theo c ba phng thc trn. i vi cc nc ang pht trin, mi trin khai hot ng BHYT BHYT thng thng. i vi phng thc BHYT thng thng th BHYT c t chc di hai hnh thc l BHYT bt buc v BHYT t nguyn. BHYT bt buc c thc hin vi mt s i tng nht nh c qui nh trong cc vn bn php lut v BHYT. D mun hay khng nhng ngi thuc i tng ny u phi tham gia BHYT, s cn li khng thuc i tng bt thng p dng phng thc cho ngi c , tr cc chi ph y t cho cc cuc i phu
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buc tu theo nhu cu v kh nng kinh t c th tham gia BHYT t nguyn. 1.4. ph BHYT ph BHYT l s tin m ngi tham gia BHYT phi ng gp hnh thnh qu BHYT. Ph BHYT ph thuc vo nhiu yu t nh: xc sut mc bnh, chi ph y t, tui tham gia BHYT ngoi ra c th c nhiu mc ph khc nhau cho nhng ngi c kh nng ti chnh khc nhau trong vic np ph la chnTrong chi ph y t l yu t quan trng nht v n ph thuc vo cc yu t sau: tng s lt ngi KCB , s ngy bnh qun ca mt t iu tr, chi ph bnh qun cho mt ln KCB, tn sut xut hin cc loi bnh Ph BHYT thng c tnh trn c s cc s liu thng k v chi ph y t v s ngi tham gia BHYT thc t trong thi gian lin ngay trc . Ph BHYT bao gm c chi ph qun l cho c quan, t chc ng ra thc hin v thng tnh cho mt nm. Vic tnh ph khng h n gin v n va phi m bo chi tr chi ph KCB ca ngi tham va phi m bo quyn li ti thiu vi mc ph tng ng. 1.5. qu BHYT. Tt c nhng ngi tham gia BHYT u phi ng ph v Qu BHYT c hnh thnh t phn ng gp ny. qu BHYT l mt qu ti chnh tp trung c quy m ph thuc vo s lng thnh vin ng gp v mc ng gp
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vo qu ca cc thnh vin . Thng thng, vi mc ch nhn o, khng t mc ch kinh doanh ln hng u, Qu BHYT c hnh thnh ch yu t hai ngun chnh l do ngi s dng lao ng v ngi lao ng ng gp, hoc ch do s ng gp ca ngi tham gia BHYT. Ngoi ra Qu BHYT cn c b sung bng mt s ngun khc nh: s h tr ca Ngn sch Nh nc, s ng gp v ng h ca cc t chc t thin, li do u t t phn qu nhn ri theo qui nh ca lut bo him hoc theo qui nh trong cc vn bn php lut v BHYT. Sau khi hnh thnh qu, qu BHYT c s dng nh sau: - Chi thanh ton chi ph y t cho ngi c BHYT - Chi d tr, d phng dao ng ln - Chi phng hn ch tn tht - Chi qun l T l v quy m cc khon chi ny thng c qui nh trc bi c quan BHYT v c th thay i theo tng iu kin c th. 2. Ni dung c bn ca BHYT Vit Nam. Vit Nam, BHYT c t chc thc hin t nm 1992 theo Ngh nh 299/HBT ( nay l Chnh ph) ngy 15/8/1992 ban hnh iu l BHYT. Sau mt thi gian thc hin sa i, b sung theo Ngh inh 58/CP ngy 13/8/1998 ca Chnh ph ban hnh v iu l BHYT, BHYT Vit Nam v c bn cng thng nht vi cc nc. 2.1.i tng tham gia.
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Theo Ngh inh 58 th BHYT Vit Nam cng c thc hin di hai hnh thc l bt buc v t nguyn. * i tng tham gia bt buc gm: - ngi lao ng Vit Nam lm vic trong: + cc doanh nghip nh nc, k c cc doanh nghip thuc lc lng v trang. + cc t chc kinh t thuc c quan hnh chnh s nghip, c quan ng, cc t chc chnh tr x hi. + cc doanh nghip c vn u t nc ngoi, khu ch xut, khu cng nghip tp trung, cc c quan, t chc nc ngoi, t chc quc t ti Vit Nam, tr trng hp cc iu c quc t m Vit Nam k kt hoc tham gia c qui nh khc + cc n v, t chc kinh t ngoi quc doanh c t 10 lao ng tr ln. - cn b, cng chc lm vic trong cc c quan hnh chnh, s nghip, ngi lm vic trong cc c quan ng, cc t chc chnh tr - x hi, cn b x, phng, th trn hng sinh hot ph hng thng theo qui nh ti Ngh nh s 09/1998/N - CP ngy 23/1/1998 ca Chnh ph, ngi lm vic ta cc c quan dn c t Trung ng n cp x, phng. - ngi ang hng ch hu tr, hng tr cp bo him x hi hng thng do suy gim kh nng lao ng. - ngi c cng vi cc mng theo qui nh ca php lut
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- cc i tng bo tr x hi c Nh nc cp kinh ph thng qua bo him x hi. * i tng tham gia BHYT t nguyn gm: tt c mi i tng trong x hi, k c ngi nc ngoi n lm vic, hc tp, du lch ti Vit Nam. Chnh ph khuyn khch vic m rng v a dng ho cc loi hnh bo him y t t nguyn, ng thi khuyn khch Hi ch thp , cc Hi t thin, t chc qun chng, t chc kinh t ca Nh nc v t nhn ng gp mua th BHYT cho ngi ngho. U ban nhn dn cc cp c trch nhim quan tm, to iu kin thun li nhn dn a phng c tham gia BHYT t nguyn. 2.2. Phm vi BHYT Ngi c th BHYT bt buc c hng ch BHYT khi KCB ngoi tr v ni tr gm: - khm bnh, chn on v iu tr - xt nghim,chiu chp X quang, thm d chc nng - thuc trong danh mc theo qui nh ca B Y t - mu, dch truyn - cc th thut, phu thut - s dng vt t, thit b y t v ging bnh Ngi c th BHYT t nguyn c qu BHYT chi tr cc chi ph KCB ph hp vi mc ng v loi hnh BHYT t nguyn la chn. Nu mc ng BHYT t nguyn tng ng mc ng BHYT bt buc bnh qun trong khu vc
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th ngi c th BHYT t nguyn s c hng ch BHYT nh ngi c th BHYT bt buc. Trong trng hp bnh vt qu kh nng chuyn mn ca c s KCB ngi c th BHYT trng hp sau: - iu tr bnh phong, s dng thuc iu tr cc bnh lao, st rt, tm thn phn lit, ng kinh, dch v k hoch ho gia nh ( v y l chng trnh sc kho quc gia c ngn sch Nh nc i th) - phng v cha bnh di, phng bnh, xt nghim, chn on v iu tr nhim HIV AIDS, lu, giang mai - tim chng phng bnh, iu dng, an dng, khm sc kho iu tr v sinh - chnh hnh v to hnh thm m, lm chn tay gi, mt gi, rng gi, knh mt, my tr thnh, thu tinh th nhn to, khp nhn to, van tim nhn to - cc bnh bm sinh v d tt bm sinh - bnh ngh nghip, tai nn lao ng, tai nn giao thng, tai n chin tranh v thin tai - t t, c gy thng tch, nghin cht ma tu, vi phm php lut 2.3.Phng thc BHYT BHYT Vit Nam c thc hin theo phng thc BHYT thng thng, chi ph KCB cho ngi c th BHYT bt buc c c quyn chuyn vin ln tuyn trn. Tuy nhin Qu BHYT khng thanh ton trong cc
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thanh ton theo mc: 80% chi ph KCB s do Qu BHYT chi tr cn 20% ngi bnh t tr cho c s KCB. i tng thuc din u i x hi qui nh ti Php lnh u i ngi hot ng cch mng, lit s v gia nh lit s, thng bnh binh c qu BHYT chi tr 100% chi ph KCB Nu s tin m ngi bnh t tr 20% chi ph KCB trong nm vt qu 6 thng lng ti thiu th cc chi ph KCB tip theo trong nm s c qu BHYT thanh ton ton b. i vi ngi tham gia BHYT t nguyn th mc hng s do Lin B Y t Ti chnh qui nh p dng cho tng a phng sau khi c s tho
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thun ca U ban nhn dn tnh, thnh ph trc thuc Trung ng. 2.4. Ph BHYT . Ngi c tham gia BHYT bt buc c mc ng bng 3% lng lm cn c ng qui nh cho tng trng hp c th trong c nhn tham gia ng 1% cn ngi s dng lao ng, c quan s dng cng chc, vin chc, c quan cp sinh hot ph ng 2%. i vi ngi hng sinh hot ph l i biu Hi ng nhn dn ng nhim cc cp khng thuc bin ch Nh nc mc ng l 3% mc lng ti thiu hin hnh do c quan cp sinh hot ph ng. i vi ngi c cng vi cch mng, i tng thuc din bo tr x hi th mc ng bng 3% mc lng ti thiu hin hnh do c quan trc tip qun l kinh ph ca i tng ng. Ngi ang hng tr cp hu, hng cc ch BHXH th mc ng bng 3% tin lng hu, tin tr cp BHXH hng thng v do c quan BHXH trc tip ng. Ngi tham gia BHYT t nguyn c mc ng do Lin B Y t - Ti chnh qui nh p dng cho tng a phng. 2.5.Qun l v s dng qu BHYT 2.5.1. Ngun hnh thnh qu BHYT . Qu BHYT c qun l tp trung, thng nht trong ton b h thng BHYT Vit Nam, hch ton c lp vi Ngn sch Nh nc v c Nh nc bo h.
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Qu BHYT c hnh thnh t cc ngun sau: - thu t cc i tng tham gia BHYT theo qui nh. - cc khon vin tr t cc t chc Quc t - cc khon vin tr t cc t chc t thin trong v ngoi nc. - ngn sch Nh nc cp - li do hot ng u t - cc khon thu khc ( nu c ) Qu BHYT t nguyn c hch ton v qun l c lp vi Qu BHYT bt buc nhm phc v cho cng tc trin khai BHYT t nguyn. 2.5.2. Qun l v s dng qu BHYT. Hng nm qu BHYT bt buc dnh 91,5% cho qu KCB trong dnh 5% lp qu d phng KCB. Qu KCB trong nm khng s dng ht c kt chuyn vo qu d phng. Nu trng hp chi ph KCB trong nm vt qu kh nng thanh ton ca qu KCB th c b sung t qu d phng. Dnh 8,5% cho chi qun l thng xuyn ca h thng BHYT Vit Nam theo d ton hng nm c cp c thm quyn ph duyt v ch chi tiu ca Nh nc qui nh. Tin tm thi nhn ri ( nu c ) ca qu BHYT c mua tn phiu, tri phiu do Kho bc Nh nc, ngn hng thng mi quc doanh pht hnh v c thc hin cc bin php khc nhm bo tn v tng trng qu nhng phi m bo ngun chi tr khi cn thit.
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Ngun thu BHYT t nguyn c hch ton ring v s dng chi cho cc ni dung sau: - chi tr chi ph KCB cho ngi c th BHYT t nguyn theo qui nh - chi cho cc i l thu, pht hnh th BHYT t ngun - chi qun l thng xuyn ca c quan BHYT BHYT Vit Nam chu trch nhim qun l thng nht qu BHYT t nguyn. Lin B Y t Ti chnh qui nh chi tit v hng dn s dng qu BHYT t nguyn. Lin B Y t Ti chnh ban hnh quy ch qun l ti chnh i vi BHYT Vit Nam. 2.6.Quyn v trch nhim ca cc bn tham gia BHYT 2.6.1. i vi ngi tham gia BHYT a. Quyn li Khi tham gia BHYT ngi c th BHYT c bo m cc qun li sau: - c KCB theo ch BHYT qui nh - chn mt trong cc c s KCB ban u thun li ti ni c tr hoc ni cng tc theo hng dn ca c quan BHYT qun l, chm sc sc kho v KCB - c thay i ni ng k KCB ban u vo cui mi qu. - c thanh ton vin ph theo ch BHYT khi sinh con th nht v th hai
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- yu cu c quan BHYT nh ca iu l BHYT
bo m quyn li theo qui
- khiu ni vi cc c quan nh nc c thm quyn khi ngi s dng lao ng, c quan BHYT , cc c s KCB vi phm iu l BHYT dn n vic quyn li ca h khng c m bo. b. Trch nhim Khi tham gia BHYT ngi tham gia cng phi c cc trch nhim sau: - ng BHYT y v ng thi hn - xut trnh th BHYT khi n KCB - bo qun v khng cho ngi khc mn th BHYT 2.6.2. i vi c quan, n v v ngi s dng lao ng a. Quyn li - t chi thc hin nhng yu cu ca c quan BHYT v cc c s KCB khng ng vi quy nh ca iu l BHYT. - khiu ni vi cc c quan Nh nc c thm qun khi c quan BHYT v cc c s KCB vi phm iu l BHYT. Trong thi gian khiu ni vn phi thc hin trch nhim ng BHYT theo qui nh ca iu l BHYT. b. Trch nhim. - ng BHYT theo ng qui nh ca iu l BHYT . - cung cp cho c quan BHYT cc ti liu v lao ng, tin lng, tin cng, ph cp lin quan n vic ng v thc hin ch BHYT.
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- chp hnh s kim tra, thanh tra v thc hin ch BHYT ca c quan Nh nc c thm quyn. 2.6.3.i vi c quan BHYT. a. Quyn li. - yu cu c quan, n v, ngi s dng lao ng ng v thc hin ch BHYT, cung cp cc ti liu lin quan n vic ng v thc hin ch BHYT. - t chc cc i l pht hnh th. - k hp ng vi cc c s KCB hp php KCB cho ngi c BHYT. - yu cu c s KCB cung cp h s, bnh n, ti liu lin quan n n thanh ton chi ph KCB BHYT. - t chi thanh ton chi ph KCB khng ng qui nh ca iu l BHYT hoc khng ng vi cc iu khon ghi trong hp ng c k gia c quan BHYT vi c s KCB. - thu gi cc chng t v th BHYT gi mo chuyn cho cc c quan iu tra x l theo qui nh ca phpt lut. - kin ngh vi cc c quan c thm quyn x l cc n v, c nhn vi phm iu l BHYT.
b.Trch nhim. - thu tin BHYT, cp th v hng dn vic qun l, s dng th BHYT - cung cp thng tin v cc c s KCB v hng dn ngi tham gia BHYT la chn ng k.
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- qun l qu, thanh ton chi ph BHYT ng qui nh v kp thi. - kim tra, gim nh vic thc hin ch BHYT. - t chc thng tin, tuyn truyn v BHYT. - gii quyt cc khiu ni v thc hin ch BHYT thuc thm quyn. 2.6.4. i vi c s KCB a.Quyn li. - yu cu c quan BHYT tm ng kinh ph v thanh ton chi ph KCB theo qui nh ca iu l BHYT ng KCB c k kt. - KCB v cung cp dch v y t theo ng nguyn tc chuyn mn. - yu cu c quan BHYT cung cp nhng s liu v th BHYT ng k ti c s KCB. - t chi thc hin cc yu cu ngoi qui nh ca iu l BHYT v hp ng k vi c quan BHYT. - khiu kin vi cc c quan c thm quyn khi c quan BHYT vi phm hp ng KCB BHYT. b.Trch nhim. - thc hin ng hp ng KCB BHYT. - thc hin vic khi chp v cung cp cc ti liu lin quan n KCB cho ngi c BHYT, lm c s thanh ton v gii quyt cc tranh chp v BHYT. - ch nh s dng thuc, vt phm sinh hc, th thut, phu thut, xt nghim v cc dch v y t an ton, hp l theo qui nh v chuyn mn k thut ca B Y t. v theo hp
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- to iu kin thun li cho cn b c quan BHYT thng trc ti c s nhm thc hin cng tc tuyn truyn, gii thch v BHYT, kim tra vic m bo quyn li v gii quyt nhng khiu ni lin quan n vic KCB cho ngi c th BHYT. - kim tra th BHYT, pht hin ch BHYT. 2.7. T chc, qun l BHYT. Trc nm 2002, Bo him y t Vit Nam c thnh lp trn c s thng nht h thng c quan BHYT t Trung ng n a phng BHYT ngnh qun l v thc hin chnh sch BHYT. Tuy nhin ph hp vi thc t v thc hin ci cch th tc hnh chnh, ngy 24/01/2002 Th tng Chnh ph ban hnh Quyt nh s 20/2002/Q- TTg chuyn Bo him y t Vit Nam sang h thng Bo him x hi Vit Nam. V vy, hin nay Bo him x hi Vit Nam l c quan t chc v qun l BHYT. Mi iu l v c bn vn c thc hin theo Ngh nh 58 v c vn bn sa i hng dn c th km theo tng phn cho ph hp. trung ng: Bo him x hi Vit Nam l c quan s nghip trc thuc Chnh ph. cp tnh: Bo him x hi tnh, thnh ph trc thuc Bo him x hi Vit Nam. v thng bo cho Bo him y t Vit Nam nhng trng hp vi phm v lm dng
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cp huyn, qun, thnh ph, th x thuc tnh t chc chi nhnh bo him y t trc thuc Bo him x hi tnh, thnh ph trc thuc Trung ng. Bo him x hi Vit Nam l c quan s nghip c chc nng thc hin chnh sch, ch BHXH, BHYT theo quy nh ca php lut. Bo him x hi Vit Nam qun l v i tng tham gia BHXH, BHYT cp s BHXH, cp th BHYT, qun l h s hng ch BHXH i vi tng ch v thc hin ch BHXH, qun l i tng hng tr cp hng thng, qun l qu BHXH, qu BHYT t nguyn. III . Ni dung c bn ca BHYT HS - SV Vit
Nam. 1.i tng tham gia BHYT HS-SV l loi hnh BHYT t nguyn c i tng tham gia l tt c hc sinh t bc tiu hc tr ln ang theo hc ti cc trng quc lp, bn cng, dn lp, cc trung tm gio dc thng xuyn tr cc trng hp thuc i tng chnh sch u i x hi ca Nh nc c Nh nc cp th BHYT. BHYT HS-SV c trin khai theo Thng t 14/1994/TTLT BGD T BYT ngy 19/9/1994 v c sa i b sung bng Thng t 40/1998/TTLT BGD T BYT ngy 18/7/1998. Theo cc Thng t ny th BHYT HS-SV c ni dung chnh l chm sc sc kho hc sinh - sinh vin ti trng hc v KCB khi m au, tai nn, tr cp mai tng trong trng hp t vong.
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2. Phm vi ca BHYT HS-SV Theo Thng t 40/1998/TTLT BGD T BYT th hc sinh - sinh vin c th BHYT c: a.Chm sc sc kho ban u: - hc sinh c qun l sc kho v hng dn phng chng cc bnh hc ng, c th: + gi gn v sinh c nhn, v sinh dinh dng, v sinh mi trng + phng chng cc dch bnh + cc bin php phng, cha mt s bnh v triu chng thng thng nh: au u. + phng chng bnh cong vo ct sng + v sinh rng ming, bo v th lc ( trnh cn th) + phng chng cc bnh x hi, cc t nn x hi ( ma tu, HIV AIDS ) + phng chng tai nn giao thng, tai nn lao ng + khm sc kho nh k vo cc thi im: u nm lp 1, cui mi cp hc ph thng v u kho hc ca cc trng i hc, chuyn nghip - thc hin s cu tai nn, m au t xut - m bo v sinh n ung ti trng cho hc sinh - sinh vin - v sinh hc ng: gm cc hot ng c th sau: + gio dc sc kho ( l mt mn hc trong nh trng) + tuyn truyn chm sc bo v sc kho a chy, au bng, au mt,
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+ m bo cc tiu chun v sinh hc ng: nh sng, nc ung, nc ra hp v sinh phong tro xy dng trng xanh - sch - p v sinh an ton thc phm - qun l v chm sc sc kho hc sinh ti trng hc gip hc sinh x l kp thi bnh tt ng thi nh trng t chc thc hin hc tp, lao ng, rn luyn thn th ph hp vi sc kho, mt khc vic qun l sc kho hc sinh tt s to iu kin, c s cc nh qun l v m c th hoch nh chnh sch quc gia. b. Khm, cha bnh - c khm, cha bnh ti cc c s KCB ( gi chung l bnh vin) c ng k trn phiu KCB bo him y t. Trong trng hp cp cu c KCB ti bt k mt bnh vin no. - KCB ngoi tr ( trong trng hp cp cu v tai nn nhng cha phi nm vin) c chi tr cc chi ph dch v y t nh tin cng khm, xt nghim, X quang, ring tin thuc hc sinh - sinh vin t tc. - Hc sinh - sinh vin c hng chi ph trong iu tr ni tr ti cc c s KCB gm cc ni dung sau: + khm bnh, chn on v iu tr + xt nghim, chiu chp X quang, thm d chc nng + thuc trong danh mc theo qui nh ca B Y t
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+ mu, dch truyn + cc th thut, phu thut + s dng vt t, thit b y t v ging bnh c. trng hp m au, tai nn dn n t vong c tr cp tin mai tng ph. 3. Ph v qu BHYT HS-SV 3.1. Ph BHYT HS-SV Ph BHYT HS-SV cng da trn cc nguyn tc v ph BHYT ni chung v c qui nh theo tng vng, tng cp hc v tng a phng nh sau: Bng 1: ph BHYT HS-SV Mc ng khu vc ni thnh ( /hs) 25.000 40.000 Mc ng khu vc ngoi thnh ( /hs) 20.000 40.000
i tng 1. Cc trng tiu hc, THCS, THPT 2. Cc trng H, THCN, dy ngh
(Ngun: Phng Khai thc BHXH VN)
T nm hc 2003 2004 mc ng BHYT HS-SV c thc hin theo Thng t lin tch s 77/2003/TTLT BTC BYT ngy 07/8/2003 hng dn thc hin BHYT t nguyn. Bng 2: Ph BHYT HS-SV
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i tng Thnh th ( / ngi) Nng thn ( / ngi) Hc sinh - sinh vin 35.000 70.000 25.000 50.000 Dn c theo a 80.000 140.000 60.000 100.000 gii HC Hi, on th 80.000 140.000 60.000 100.000
( Ngun: Ban t nguyn BHXH VN)
khuyn khch nhiu ngi tham gia BHYT trong mt h gia nh, k t thnh vin th 2 tr i, c thm mi thnh vin tham gia BHYT t nguyn th mc ng ca ngi c gim 5% so vi mc ng BHYT qui nh ti Thng t ny, trn c s ngh ca BHXH tnh, thnh ph trc thuc Trung ng, BHXH Vit Nam s quyt nh mc ng c th sau khi c kin tho thun ca B Ti chnh. Ph BHYT c thu np vo 1 hoc 2 ln trong mt nm ti cc thi im thch hp theo qui nh ca a phng. i vi hc sinh tiu hc v trung hc c s, vic np BHYT HS - SV do ph huynh hc sinh np cho t chc thu BHYT ca nh trng. i vi hc sinh sinh vin trng ph thng trung hc, i hc,cao ng, trung hc chuyn nghip v dy ngh do hc sinh, sinh vin t np cho t chc thu BHYT ca nh trng. 3.2 Qu BHYT HS-SV BHYT HS-SV l mt phn ca BHYT t nguyn nn c hch ton
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ring, t cn i thu chi. Ngun thu ca Qu BHYT HS-SV c phn b nh sau: + 35% chi cho chm sc sc kho ban u cho hc sinh sinh vin ti trng, trong : 30% chi tr ph cp cho cn b YTH, mua thuc v dng c y t thng thng s cu v chm sc sc kho ban u cho hc sinh - sinh vin ti y t trng hc. 5% chi cho c nhn, n v tham gia tuyn truyn v t chc thc hin cho cng tc thu np BHYT ( gm: c quan gio dc, o to cp qun, huyn, th trn v tng ng) + 60% chi tr chi ph ni tr v cp cu tai nn, tr cp t vong 1.000.000/1 trng hp. + 4% qu dng cho chi qun l ca c quan BHYT tnh, thnh ph + 1% qu np cho BHYT Vit Nam( nay l BHXH Vit Nam), trong : 0,8% trch lp qu d phng 0,2% chi qun l Cui nm phn kt d ca qu BHYT HS-SV c trch mt phn nng cp trang thit b y t trng hc, to iu kin chm sc sc khe ban u cho hc sinh - sinh vin ngay ti trng hc. Theo Thng t 40/1998/TTLT BGD T BYT th phn qu kt d c trch 80% vo qu d phng,
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20% mua BHYT cho nhng hc sinh - sinh vin c hon cnh qu kh khn. Trong trng hp thu khng chi v d s dng ht qu s phng, c quan bo him bo co ln linS Gio dc v o to Y t v Ti chnh thm tra, kt lun, sau trnh U ban nhn dn tnh, thnh ph trc thuc Trung ng xem xt gii quyt, khng xy ra tnh trng mt kh nng chi tr ca qu BHYT HS - SV ng thi c k hoch xin iu chnh mc ng BHYT HS - SV m bo an ton qu. 4. Quyn li v trch nhim ca cc bn tham gia BHYT HS-SV 4.1. i vi hc sinh - sinh vin. a. Quyn li. - c cp th theo mu qui nh thng nht ton quc - c ng k KCB ban u ti c s kx gn ni c tr theo hng dn ca c quan BHYT - c bo him 24/24 gi trong ngy theo thi hn s dng th Trong trng hp cp cu ti bt k c s y t no ca Nh nc cng u c hng ch BHYT. - c chm sc sc kho ban u v s cu t y t trng hc - c KCB ngoi tr (c chi tr cc chi ph dch v y t nh tin cng khm, xt nghim, X quang, th thut. Ring tin thuc hc sinh - sinh vin t tc)
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- c chi tr trong trng hp tai nn m au, ni tr ti cc c s ca Nh nc theo quy nh chuyn mn v cc quy nh BHYT - cc chi ph KCB c c quan BHYT thanh ton vi bnh vin nu hc sinh - sinh vin i KCB c trnh th ti: bt k c s y t no ca Nh nc trong trng hp cp cu bnh vin ng k trn phiu KCB BHYT ca hc sinh - sinh vin bnh vin theo giy chuyn vin ph hp vi tuyn chuyn mn k thut ca B Y t - trng hp KCB khng ng quy nh, KCB theo yu cu ring, hc sinh - sinh vin s phi t tr cc chi ph cho bnh vin. Sau trn c s ho n, chng t hp l c c quan BHYT thanh ton li mt phn chi ph KCB theo gi vin ti vin ph ti tuyn chuyn mn k thut ph hp theo quy nh ca B Y t - trng hp khng may b t vong c c quan BHYT chi tr tr cp mai tng ph 1.000.000ng/hc sinh Theo Thng t 77/2003/TTLT BTC BYT quyn li ca hc sinh - sinh vin khi i KCB BHYT nh sau: - c chm sc sc kho ban u ti phng y t trng hc. Trng hp khng c phng y t ti trng th c quan BHXH c trch nhim hp ng vi c s y t gn nht m bo vic chm sc thun tin v ph hp
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- hc sinh - sinh vin khi i KCB BHYT ng tuyn theo quy nh, iu tr ngoi tr v ni tr c hng cc quyn li sau: + khm v lm cc xt nghim, chiu chp X quang, cc thm d chc nng phc v cho vic chun on v iu tr theo ch nh ca bc s + cp thuc trong danh mc quy nh ca B Y t, truyn mu, truyn dch theo ch nh ca bc s iu tr, s dng cc vt t tiu hao thng dng, thit b y t phc v KCB + lm th thut, phu thut + s dng ging bnh Chi ph mt ln KCB t 20.000 tr ln th ngi c th phi np 20% - hc sinh - sinh vin tham gia BHYT lin tc t 24 thng tr ln c c quan BHXH thanh ton chi ph KCB i vi mt s trng hp c bit nh sau: + phu thut tim: khng qu 10 triu ng/ ngi/ nm + chy thn nhn to: khng qu 10 triu ng/ ngi/ nm + tim phng un vn, sc vt cn ti a l 300.000 ng/ ngi/ nm + tr cp t vong: theo mc 1 triu ng/ trng hp * C quan BHYT khng thanh ton cho cc trng hp sau:
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- cc bnh c Nh nc i th, s dng thuc c tr nh: phong, lao phi, st rt, tm thn phn lit, ng kinh - phng v cha bnh di, xt nghim HIV, lu, giang mai - tim chng m rng, iu tr, an dng - cc bnh bm sinh, d tt bm sinh - chnh hnh, thm m nh: mt gi, rng gi, chan tay gi - dch v k hoch ho gia nh - tai nn chinh tranh, thin tai - KCB cp cu do t t, c gy thng tch, nghin cht ma tu, vi phm php lut Theo Thng t 77 th sung nh sau: - k thut h tr sinh sn - ghp c quan ni tng - iu tr phc hi chc nng ngoi danh mc B Y t quy nh - bnh ngh nghip - tai nn giao thng, k c di chng tai nn giao thng - xt nghim, chun on thai sm, iu tr v sinh - chi ph vn chuyn ngi bnh, khu phn n trong thi gian iu tr b.Trch nhim. cc trng hp khng thuc trch nhim chi tr ca Qu KCB t nguyn c quy nh b
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- ng ph BHYT y theo quy nh - t tc tin nh v tin s KCB - xut trnh ngay th hoc giy t tu thn c nh hp l v phiu khn cha bnh khi KCB ni v ngoi tr, nu nhp vin th phi xut trnh trong vng 48 gi k t khi nhp vin. - khng cho ngi khc mn th - thc hin ng quy nh ca Nh nc v s hng dn ca c quan BHYT. 4.2. i vi nh trng. a. Quyn li. Nh trng c trch mt khon kinh ph t tng thu BHYT s dng cho cng tc YTH. b. Trch nhim. - Trch nhim chnh i vi cng tc bo v chm sc, gio dc sc kho cho hc sinh trong thi gian trng thuc v lnh o nh trng. - Mi trng hoc cm trng b tr y t trng hc theo qui nh v m bo cc iu kin cho YTH hot ng theo chc nng, nhim v qui nh ca lin B Gio dc - o to B Y t v cng tc YTH - Nh trng c trch nhim: t chc tuyn truyn, thc hin ng k, k khai, thu tin ng BHYT ca hc sinh v s dng ng mc ch, c hiu qu ngun kinh ph BHYT HS - SV li nh trng. 4.3. i vi cc c s khm cha bnh.
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a. Quyn li. - c c quan BHXH tm ng kinh ph t chc khm cha bnh cho hc sinh sinh vin c th BHYT. - c thanh ton mi qu mt ln cc chi ph KCB cho hc sinh sinh vin tham gia BHYT. b. Trch nhim. - thc hin KCB ng hp ng vi c quan BHXH cho hc sinh sinh vin tham gia BHYT, m bo cha bnh hp l, an ton theo ng qui nh ca B Y t. - thc hin vic ghi chp v cung cp cc ti liu lin quan n KCB BHYT HS - SV lm c s thanh quyt ton ti chnh. - kim tra th v phiu KCB BHYT, pht hin kp thi nhng trng hp vi phm v lm dng vic s dng th, phiu KCB BHYT, thng bo ngay cho c quan BHYT gii quyt. - cc bnh vin cng c quan BHXH k kt hp ng trch nhim, tm ng kinh ph v nh k quyt ton chi ph KCB theo qui nh v hp ng KCB c k. - t chc tip n hc sinh sinh vin khi n KCB, c thi phc v tt trnh phin h. - gii thiu hc sinh sinh vin ln ng tuyn chuyn mn k thut iu tr bnh nu vt qu kh nng ca tuyn mnh. 4.4. i vi c quan BHXH.
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a. Quyn li. - c trch lp v s dng qu BHYT HS - SV theo ng qui nh. - kim tra, gim st thu hi th trong trng hp pht hin ra vic lm dng th, cho ngi khc mn th - iu tit, cn i qu KCB BHYT HS SV, s dng qu kt d theo qui nh. - kim tra, gim st vic tip nhn v thc hin ch BHYT HS - SV ti cc bnh vin, bo v quyn li chnh ng cho hc sinh tham gia BHYT, t chi chi tr tr cp BHYT i vi nhng trng hp KCB khng ng theo qui nh ca php lut. b.Trch nhim. - k kt hp ng trch nhim vi nh trng t chc thu BHYT ca hc sinh sinh vin. - k hp ng KCB vi cc bnh vin m bo vic tip nhn v KCB cho hc sinh sinh vin tham gia BHYT c thun tin, hp l. - t chc pht hnh th v phiu KCB BHYT HS SV. Chi ph in v pht hnh th, phiu bng kinh ph qun l ca c quan BHXH. - c quan BHXH no pht hnh th v phiu KCB BHYT HS - SV th c quan c trch nhim tm ng kinh ph v thanh ton chi ph theo qui nh. Vic thanh ton c thc hin theo cc phng thc:
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+ chi tr cho c s KCB theo hp ng k. + chi tr qua thanh ton a tuyn ngoi a bn c giao qun l. + chi tr trc tip cho ngi bnh BHYT trong cc trng hp c th khc. 5. In n v pht hnh th. Th v phiu KCB BHYT HS - SV c qui nh thng nht theo mu trong c nc c gi tr s dng trong thi hn ghi trn phiu v tng ng vi s tin ng BHYT. Th BHYT gip nhn ng ngi c BHYT c thi hn s dng ti a l 5 nm, trong trng hp hc sinh c cp giy t tu thn c nh hp l th khng nht thit phi cp th BHYT. 6. T chc thc hin. Bo him x hi cc cp phi hp vi c quan gio dc o to y mnh cng tc tuyn truyn,gii thch v BHYT ni chung v BHYT HS - SV ni ring trong cc trng nht l i vi cha m hc sinh. C quan gio dc - o to, c quan y t cng cp v c quan bo him x hi phi hp xy dng, duy tr v pht trin y t trng hc, trin khai tt ni dung hot ng ca cng tc y t trng hc. C quan bo him x hi tnh, thnh ph trc thuc Trung ng xy dng n BHYT HS - SV bo co vi Gim c S Y t, Gim c S Gio dc - o to xem xt v
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trnh Ch tch U ban nhn dn tnh, thnh ph ph duyt v t chc thc hin a phng khi n c ph duyt. Cc S Y t ch o cc bnh vin thuc S phc v tt ngi bnh c th BHYT HS - SV khi n KCB ngoi tr v ni tr. Nh trng chu trch nhim theo di, thanh quyt ton phn kinh ph BHYT HS - SV li nh trng, bo co c quan ti chnh ng cp ph duyt C quan gio dc - o to, y t v c quan BHXH cng cp phi hp t chc cc hi ngh lin ngnh t chc trin khai thc hin BHYT HS SV, nh gi, tng kt v ra cc bin php y mnh cng tc BHYT HS - SV cho tng giai on c th. 7. Mi quan h gia BHYT HS-SV v YTH YTH l mt cng tc quan trng nhm bo v v chm sc sc kho cho hc sinh, l mt trong nhng mc tiu pht trin s nghip bo v sc kho nhn dn. Ngay t nhng nm u xy dng XHCN min Bc, B Y t c nhiu cuc iu tra ln v tnh hnh pht trin th lc v bnh tt hc sinh ti 13 tnh, thnh ph pha Bc. T nhng kt qu iu tra Th tng Chnh ph ra ch th 48/TTg ngy 02/06/1969 v vic gi gn nng cao sc kho hc sinh v giao nhim v cho cc B Ngnh phi hp thc hin. Trong sut mt thi gian di cng tc y t trng hc khng c quan tm ng mc v thiu kinh ph cng nh bin ch cn b nn vic trin khai chng trnh cn gp rt
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nhiu kh khn. Sau 5 nm thc hin BHYT HS-SV, ngy 01/03/2000 lin B Gio dc o to B Y t ra thng t lin tch s 03/2000/TTLT BYT BGD T hng dn thc hin cng tc y t trng hc. Mt trong nhng ni dung ch yu ca Thng t ny l cng c v pht trin cng tc y t trng hc trong qui nh r trch nhim ca cc ngnh c lin quan nh sau: a. i vi ngnh Y t T chc qun l, ch o cng tc YTH, c s ch o thng nht t B Gio dc - o to n S Y t cc tnh, trung tm y t d phng cc tnh, trung tm y t huyn, trm y t x phng, th trn. b. i vi ngnh Gio dc - o to T chc qun l ch o cng tc y t trng hc, c s ch o thng nht t B Gio dc - o to n cc S Gio dc - o to, Phng Gio dc v h thng trng hc. c. S phi hp lin ngnh Y t v Gio dc - o to Hai ngnh phi c s phi hp cht ch v c s thng nht ch o v: - cng tc phng v cha bnh - cng tc cng c v pht tin c s YTH - cc iu kin m bo hot ng YTH 7.1. BHYT HS-SV tc ng n YTH Cng c v pht trin h thng YTH l mt nhim v quan trng v cn thit, l trch nhim ca ngnh Gio dc v ngnh Y t. Trc nm 1998, khi cha c Thng t lin tch s
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40/1998/TTLT BGD T BYT trch 35% s thu li nh trng th ch c s t trng hc c t thuc y t, cn b lm cng tc YTH thng l kim nhim. T khi c vn bn php l qui nh r chi ph ginh cho YTH th h thng YTH bt u c khi phc. Thc hin BHYT HS-SV l mt gii php tt khc phc hn ch trn, a hot ng YTH vo n np. BHYT HSSV thc hin cng bng trong chm sc sc kho v chng trnh YTH khng ch c cc em tham gia BHYT mi c hng quyn li chm sc sc kho m c nhng em cha tham gia BHYT. 7.2. YTH tc ng n BHYT HS-SV Thng qua hot ng ca h thng YTH ph huynh hc sinh va hc sinh sec nhn thc c tc dng, vai tr v ngha ca YTH, t s nhn thc c tc dng, vai tr, ngha ca BHYT. H s tch cc tham gia BHYT v nh c BHYT con em hc mi c chm sc sc kho ngay ti trng. BHYT HS-SV v YTH c mi quan h cht ch, tc ng qua li thc y nhau pht trin. Thng qua hot ng YTH nhm nng cao kin thc sc khe gip hc sinh - sinh vin t phng chng dch bnh, bo v sc kho cho chnh mnh. Qua hot ng YTH rn luyn cho cc em bit chia s, tham gia BHYT nh mt thi quen. Ngc li BHYT gip hot ng YTH c duy tr v ngy cng hon thin p ng nhim v chm sc sc kho cho cc em ngay ti trng cng l gii php
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tt gim chi ph tng t cng tc phng hn ch ri ro ca bo him thng mi. III. So snh BHYT HS - SV ca BHXH Vit Nam vi bo him hc sinh ca cc Cng ty Bo him thng mi. 1.Ging nhau. X hi cng pht trin, i sng con ngi cng nng cao th nhu cu v bo him li cng ln. BHXH, BHYT hay bo him nhn th, bo him con ngi phi nhn th u l bo him con ngi nn n c nhiu c im ging nhau. Hin nay, bn cnh vic thc hin BHYT cho i tng hc sinh sinh vin ca BHXH Vit Nam th cc Cng ty bo him thng mi cng c cc sn phm bo him dnh cho i tng ny. Chng u c i tng chung l sc kho v tnh mng ca hc sinh sinh vin. i tng tham gia l hc sinh cc cp ang theo hc ti cc m hnh trng lp c nhu cu tham gia. C hai u hot ng da trn nguyn tc s ng v t nguyn. Khi tham gia bt k loi hnh no th ngi tham gia cng phi ng ph v t ngun thu ny hnh thnh nn qu phc v cho mc ch chung l tr gip cho hc sinh v gia nh cc em mt s tin nht nh nhanh chng khc phc kh khn, phc hi sc kho gip cc em sm tr li trng lp khi khng may cc em gp ri ro. Thng qua cc hnh thc bo him ny to lp nn mi quan h cht
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ch gia nh trng, cha m hc sinh v nh bo him cng chm lo sc kho cho cc em. Tuy nhin c hai loi hnh bo him ny u khng nhn bo him cho nhng ri ro chc chn xy ra, bnh tt bm sinh, hnh vi c gy thng tch ca ngi c bo him v nguyn tc chung trong bo him l ch nhn bo him cho nhng ri ro bt ng khng lng trc c. 2. Khc nhau. C th ni s khc nhau c bn gia BHYT HS - SV ca BHXH Vit Nam v bo him hc sinh ca cc Cng ty Bo him thng mi c phn bit r nt nht l mc ch thc hin, n chi phi ni dung ca cc nghip v ny. Nu BHYT HS - SV mang tnh cht nhn o, hot ng khng v mc ch kinh doanh, da trn nguyn tc cn bng thu chi v khng phi ng thu th bo him hc sinh ca cc Cng ty thng mi li c mc ch chnh l kinh doanh v mc tiu li nhun v phi ng thu cho Nh nc. i tng tham gia ca BHYT HS - SV do BHXH Vit Nam t chc c phn hp hn, khng c cc em la tui nh tr, mu gio v y l i tng c Nh nc chm sc sc kho hon ton, khng phi chi tr tin KCB khi i khm cha bnh ti cc c s y t theo qui nh. Nhng bo him hc sinh ca cc Cng ty thng mi bao gm c i tng ny.
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V phm vi bo him, do c s khc nhau gia mc ph ng nn hai loi hnh bo him dnh cho hc sinh ny c phn m rng hoc hn ch hn nhau,tu thuc vo tng loi sn phm m cc nh bo him a ra s c phn loi tr tng ng. Quyn li ca hc sinh khi tham gia c s khc nhau l do mc ph ng khc nhau. BHYT HS - SV do BHXH Vit Nam c mc ph ph hp v ging nhau theo tng a phng v mi cp hc nhng bo him hc sinh ca cc Cng ty bo him thng mi li khng phn chia theo tng a phng v la tui m da vo kh nng kinh t ca ngi tham gia theo s tho thun t trc.T dn n mc hng l kh khc nhau. Tu theo tng iu kin v mc ph tham gia m mc hng ca bo him thng mi l khc nhau. Cn BHYT HS - SV thc hin ti BHXH Vit Nam u chi tr 80% s tin iu tr khng c gii hn v s ngy iu tr v s tin ti a ca mi t iu tr. BHYT HS - SV do Nh nc qun l thng nht v h tr nu thu khng chi, c s vt cht h tr cho vic thc hin c Nh nc u t v cung cp. BHYT HS - SV khng chu s iu tit ca Lut Kinh doanh bo him v c ch qun l ring. Ngc li nghip v bo him hc sinh ca bo him thng mi nu hot ng khng c hiu qu dn n vic thua l th cc cng ty phi t chu, hng nm chu s qun l ca Nh nc theo php lut v phi thc hin
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cc cng vic theo ng trnh t kinh doanh bo him m lut qui nh. Tuy c s khc nhau nh vy nhng chng khng h mu thun m ngc li chng b sung cho nhau. BHXH, BHYT thc cht l bo him con ngi v xut hin t lu, song phm vi m bo cho cc ri ro vn cn hn hp. Con ngi vn quan tm n nhng vn khc ny sinh trong cuc sng, m BHXH, BHYT cha m bo v Nh nc khng th thc hin tt c nhu cu ca con ngi do iu kin v kinh ph cn hn ch. Mi ngi c iu kin kinh t l khc nhau v nhu cu v bo him l khc nhau nn bo him thng mi l cch tt nht gip con ngi tho mn nhu cu ca mnh. Cng mt lc hc sinh sinh vin c th tham gia nhiu hnh thc bo him bo v sc kho cho mnh mt cch tt nht c th.
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Chng II Thc trng trin khai BHYT HS-SV ti c quan Bo him x hi Vit Nam
I. Cc qui nh php l v BHYT HS SV. Thng t lin B s 14/TTLB ngy 19/9/1994 ca B Gio dc - o to v Y t hng dn BHYT t nguyn cho hc sinh l vn bn php l cao nht nh du s ra i ca loi hnh bo him ny, to iu kin thc y s pht trin ca cng tc BHYT HS-SV. T Thng t ny chnh sch BHYT HS-SV bt u c thc hin trong phm vi c nc. Cn c vo Ngh nh 58/CP ngy 13/8/1998 ban hnh km theo iu l BHYT v Ngh quyt 37/CP ngy 20/6/1996
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v nh hng chm sc v bo v sc kho nhn dn. Ngy 18/7/1998 Lin B Gio dc - o to v B Y t ban hnh Thng t lin B s 40/TTLB hng dn thc hin BHYT HS-SV. Ngy 18/6/1999 B trng B Y t Nguyn Phng c t trnh s 3980/TTr BYT ln Chnh ph bo co kt qu ng khch l ca vic thc hin BHYT HS-SV trong nhng nm qua v ngh Ph Th tng Chnh ph Phm Gia Khim xem xt v cho kin ch o t nm hc 1999-2000 ch cho php thc hin mt loi hnh bo him trong h thng trng ph thng cc cp. B Y t cho rng to ngun lc cho chm sc sc kho ban u, ng thi trnh tnh trng cnh tranh trong cc trng hc gia cc t chc bo him, cn thit phi c s nh hng ca Nh nc. thc hin mc tiu x hi ho s nghip chm sc bo v sc kho nhn dn, gim bt gnh nng v ti chnh cho cha m hc sinh, B Y t ngh Bo him y t Vit Nam l t chc duy nht thc hin BHYT HS-SV trong cc trng ph thng cn BHYT trong cc khi hc khc th tu s la chn ca hc sinh v nh trng. Ngy 13/7/1999, B Gio dc - o to c vn bn s 6436/GDTC ng vi kin ca B Y t ch cho php thc hin mt loi hnh BHYT HS-SV trong trng ph thng v Bo him y t Vit Nam l t chc duy nht m nhim. Ngy 12/8/1999 Th tng Chnh ph c Thng bo s 3645/VPCP VX v vic thc hin BHYT HS-SV ni r: t nm
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hc 1999- 2000 tr i B Gio dc - o to phi hp vi B Y t hng dn, tuyn truyn, vn ng hc sinh trong h thng trng ph thng cc cp tham gia BHYT HS-SV do Bo him y t Vit Nam thc hin. Tuy nhin, B Ti chnh l c quan ch qun ca Tng cng ty bo him Vit Nam, c cng vn khng ng vi kin trn gi ln Th tng Chnh ph nn vic thc hin BHYT HS-SV vn c thc hin theo Thng t 40/1998/TTLT BGD T BYT. Ngy 01/3/2000 Lin B Gio dc - o to B Y t ban hnh Thng t lin tch s 03/2000/TTLT BGD&T BYT hng dn thc hin cng tc y t trng hc. Thng t nu r rng: sc kho tt l mt mc thiu quan trng ca gio dc ton din hc sinh - sinh vin trong trng hc cc cp. Chm sc, bo v v gio dc sc kho cho th h tr cc trng hc l mi quan tm ln ca ng, Nh nc, ca mi gia nh v ton x hi. B Y t, B Gio dc v o to phi hp ch o BHYT HS-SV trong ngnh Gio dc - o to phi hp vi c quan BHYT cng cp tuyn truyn vn ng c nhiu hc sinh - sinh vin tham gia BHYT HS-SV. Cc c quan y t d phng, c s khm bnh, cha bnh v BHYT phi hp cht ch qun l ch o, nng cao cht lng phng bnh, KCB cho hc sinh. Ngun kinh ph ch yu t chc cng tc y t trng hc l t BHYT HS-SV. Cng vi Thng t lin B s 40/1998 hng dn thc hin BHYT HS-SV, Thng t lin B s 03/2000 khng nh vai tr quan trng ca BHYT HS-SV trong vic khi phc v pht
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trin mng li YTH. l nhng vn bn php l quan trng thc y chnh sch BHYT HS-SV pht trin mnh m hn. tng tnh hp dn v khc phc nhng tn ti ca BHYT HS-SV, cn phi iu chnh mt s ni dung khng cn ph hp ca Thng t lin tch s 40/1998/TTLT. T nm hc 2003 2004, BHYT HS-SV c thc hin theo Thng t lin tch s 77/2003/TTLT BTC BYT ngy 07/8/2003 hng dn thc hin BHYT t nguyn. y l vn bn php quy mi nht hng dn t chc thc hin BHYT HS-SV c hiu lc t ngy 2/9/2003. II. Cc yu t nh hng n nhu cu v kh nng tham gia BHYT HS-SV 1. Nhu cu BHYT HS-SV Nhu cu l mong c c c nhng t liu vt cht no ngy cng tng ln theo pht trin ca lc lng sn xut. l nh ngha v nhu cu ni chung mt cch khi qut nht m cc nh kinh t hc pht biu. Nhu cu v bo him cng khng nm ngoi khi nim . Khi con ngi t c nhu cu ny th xut hin ngay sau nhu cu mi cao hn. Maslow l nh kinh t hc a ra bc thang nhu cu ca con ngi trong nhu cu v an ton, tc l nhu cu c bo v xut hin sau khi con ngi t c nhu cu v n, , i li . .. Tuy nhin, nhu cu v cu l hai khi nim c s khc bit. Nhu cu ch tr thnh cu khi con ngi c kh nng chi tr cho vic tho mn nhu cu ca mnh. Nhng y chng
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ta ch ni n nhu cu v BHYT ca hc sinh sinh vin khng nh BHYT c cn thit phi tip tc trin khai hay khng cn cu v BHYT HS - SV vn ph thuc bi rt nhiu yu t v chng ta phi a ra cc gii php chuyn nhu cu thnh cu v BHYT HS - SV thc s. T khi thc hin BHYT t nguyn th hc sinh - sinh vin l nhm i tng chim 99% s ngi tham gia BHYT t nguyn hin ti. S hc sinh - sinh vin tham gia BHYT nm sau lun cao hn nm trc. Tuy nhin din bao ph cha ln, c nc c khong 23 triu hc sinh - sinh vin nhng mi ch c hn 5 triu hc sinh tham gia BHYT t nguyn, nh vy cn gn 17 triu hc sinh cha tham gia, y l nhm i tng tim nng. Hc sinh - sinh vin l nhm i tng c trin khai 10 nm tr li y nn chng ta rt ra c nhiu kinh nghim qu bu trong vic thc hin, qua thi gian ny chng ta u thy cn thit phi tip tc trin khai BHYT cho i tng ny. C th ni vic trin khai BHYT t nguyn cho hc sinh - sinh vin rt thun li v hc sinh sinh vin l i tng kho mnh, t m au li tp trung theo trng, lp. Mt khc cha m u lo lng cho sc kho ca con em mnh nn vic tuyn truyn hiu qu s thu ht c ng o hc sinh tham gia. Nh vy nhu cu v BHYT ca i tng hc sinh - sinh vin l rt ln bi l hc sinh sinh vin no cng mong mun c bo v sc kho ca mnh trong thi i ngy nay.
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2. Cc nhn t nh hng n kh nng tham gia BHYT HS-SV 2.1 Kh nng ti chnh. Mt trong nhng nhn t quan trng nht nh hng n kh nng tham gia BHYT l kh nng ti chnh ca ngi dn. Ti chnh c vng mnh con ngi mi c nhu cu bo v mnh chnh l nhu cu v bo him. Theo Maslow, nhu cu v bo him ng th hai sau cc nhu cu thit yu hng ngy, mt khi nhu cu v n, c p ng th ngi ta mi ngh n cc khon bo him. Sau mt thi gian di b chin tranh tn ph t nc ta i vo con ng xy dng t nc v t c nhng thnh tu rt ln. Tc tng trng GDP qua cc nm lun mc cao v n nh Bng 3: Tc tng trng GDP qua cc nm Nm Tc tng trng GDP 2000 6,8% 2001 6,89 % 2002 7,04% 2003 7,24 % 2004 7,7%
( Ngun: Thi bo kinh t Vit Nam)
Vit Nam lin tc gia nhp cc t chc APEC ( din n hp tc kinh t chu thi Bnh Dng), AFTA ( khu vc mu dch t do ng Nam ), tng lai nc ta s sm gia nhp t chc WTO. Di s dn dt ca ng v Nh nc, nn kinh t Vit Nam lun pht trin bn vng, i sng nhn dn
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ngy cng c ci thin. Nhn chung, ngi dn c iu hinv mt kinh t hn sn sng tham gia vo cc loi hnh bo him cng l p ng nhu cu bo v cho chnh mnh. 2.2. Kh nng tip cn cc dch v y t Hin nay, x hi ho cng tc KCB ngy cng c m rng, huy ng mi ngun lc ca x hi tham gia cng tc chm sc sc kho cho nhn dn. Mng li bnh vin t Trung ng n a phng c cng c, nm 2000 c nc c trn 895 bnh vin, trong c 12 bnh vin t nhn, n nm 2003 c 1.028 bnh vin trong c 36 bnh vin t nhn, gn 50 nghn c s hnh ngh y hnh ngh dc, hnh ngh y hc c truyn. c bit hnh thnh cc bnh vin chuyn khoa tuyn tnh nh bnh vin lao, tm thn p ng yu cu chm sc sc khe nhn dn.
Bng 4: S lng c s KCB qua cc nm Nm C s KCB 1995 12.97 2

(Ngun: Nin gim thng k nm 2004)
1999 13.264
2000 2001 2002 13.117 13.172 13.095
2003 13.16 2
Trong nhng nm qua, hu ht cc bnh vin c tng cng u t ci to, nng cp c s h tng, mt s bnh vin c xy dng mi vi trang thit b hin i. nhiu 52 L Thu Dung Bo him 43A
thnh tu khoa hc cng ngh hin i c p dng trong chun on v iu tr, gp phn nng cao cht lng KCB. Nh c BHYT nn h thng y t ngy cng pht trin, c bit l y t c s, vng su, vng xa. Hin ti ton quc c trn 97% x, phng c trm y t, 60% trm y t c bc s. Bng 5: S bc s bnh qun trn 1 vn dn Nm
S bc s/ 1 vn dn ( Ngun: Nin gim thng k nm 2004)
1995 4,3
1999 4,8
2000 5,0
2001 5,2
2002 5,6
2003 5,8
S lng bc s bnh qun trn 1 vn dn lin tc tng nhanh, ngi dn c chm sc bi cn b y t c trnh chuyn mn nhiu hn do cng tc cha tr c hiu qu hn. Nh vy, kh nng tip cn dch v y t ca ngi dn ni chung v hc sinh sinh vin ni ring l rt ln, to iu kin thun li mi ngi cng tham gia BHYT. 2.3. Dn s Mt trong nhng nguyn tc hot ng ca BHYT l ly s ng b s t. Dn s nc ta ng v c c cu dn s tr, ch yu nm trong tui lao ng. y l mt trong nhng iu kin thun li thc hin BHYT HS-SV.
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Bng 6: Qui m dn s Vit Nam giai on 1998 2003 Nm Dn s(triu ngi)
1998 1999 2000 2001 2002 2003 75.4 76.59 77.63 78.68 79.72 80.9 56 1,55 4,8 6 1,51 4,7 5 1,36 4,5 5 1,35 4,5 7 1,32 4,4 02 1,47 4,4
T l tng (%)
Quy m h gia nh (ngi)
(Ngun: Nin gim thng k nm 2004)
D bo trong nhng nm tip theo dn s nc ta tip tc tng v nh vy dn s trong tui n trng vn tng vi qui m ln. Hin nay dn s nc ta l kh ng v hc sinh sinh vin chim t l ln. Tt c cc em u c quyn c tham gia BHYT c chm lo sc kho cho mnh. Mt khc quy m dn s trong mt gia nh c xu hng ngy cng gim, chng ta phn u mi gia nh trung bnh ch c t 1 n 2 con nn cha m c iu kin chm sc cho con ci mnh hn. H sn sng to iu kin tt nht cho con em mnh trong hc tp c bit l chm lo v sc kho bi h thc c rng sc kho l quan trng nht. II. Thc t thc hin BHYT HS-SV ti bo him x hi vit nam trong giai on 1998 2004 1.Thun li v kh khn trong vic thc hin. 1.1.Thun li.
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Trong qua trnh thc hin BHYT HS - SV c rt nhiu iu kin thun li c th tn ti v pht trin. thc hin tt cn khai thc trit cc iu kin thun li ny tng din bao ph th BHYT v trin khai mt cch c hiu qu cao. Cc iu kin thun li c th l: Mt l, i tng hc sinh sinh vin chim t l cao, hn 20% dn s c nc. Hc sinh sinh vin li hc tp v sinh hot ti trng lp nn thun li cho vic trin khai. Cng tc thng tin tuyn truyn tp trung ti trng hc c th thng qua cc gi hc, hot ng ngoi kho tuyn truyn v ni dung, li ch ca BHYT HS SV. Thng qua nh trng vic thu ph cng tr nn d dng hn, cn b BHYT c s ch cn n trng thu ph ca cc em tham gia sau khi c cc thy c tp trung thu theo lp, theo trng. So vi i tng t nguyn khc, y l yu t ht sc thun li trnh cho vic tng chi ph, cng sc khi vn ng i tng tham gia v cng tc thu ph cng nh vic nm bt cc thng tin v i tng. Hai l, vic trch li % s thu li theo n v trng hc s d dng hn v to iu kin cho nh trng chm sc sc kho hc sinh. Bi l nu khng c ngun kinh ph t BHYT th nh trng vn phi trch mt phn tin xy dng hng nm ca hc sinh ng gp duy tr phng y t ca trng. Nh 35% s thu li trng hc m nh trng chm sc sc kho cho hc sinh ca mnh tt hn, t ph huynh
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hc sinh yn tm cho con theo hc ti trng v hiu bit hn v BHYT. Ba l, tuy din bao ph cha cao nhng BHYT HS - SV m bo nguyn tc s ng b s t. Hc sinh sinh vin l i tng kho mnh, t m au nn mc d mc ng thp nhng cho n nay v c bn qu vn m bo nguyn tc t cn i thu chi v quyn li c hng kh ton din. y cng l iu kin thun li tip tc t chc thc hin thnh cng BHYT HS - SV trong thi gian ti. Bn l, so vi cc loi BHYT dnh cho i tng khc th quyn li ca hc sinh sinh vin khi tham gia rng hn, khng hn ch trn ti a chi ph KCB mt t iu tr s to ra s yn tm cho ngi nh hc sinh sinh vin khi khng may gp ri ro m au. Hn na bc s cng khng phi lng tng trong vic iu tr cho bnh nhn. Mt thc t cho thy bc s nhiu a phng cha thc s hiu ht v trn chi ph KCB nn rt lng tng khi bnh nhn cn phi iu tr di ngy hn s vi s ngy qui nh, s ln KCB c chi tr BHYT Do khng c s phc tp nh BHYT bt buc nn mi ngi d dng hiu v ni dung cng nh quyn li khi tham gia BHYT HS - SV do thun li hn trong vic trin khai. Nm l, BHYT HS - SV c s quan tm ng h ca ng, Chnh ph, B, cp u ng, chnh quyn, s, ban ngnh s phi hp v ng h ca cc ngnh Y t Gio dc. iu c th hin qua cc Thng t, vn bn, cng vn hng
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dn ch o. Ngay trong Thng t hng dn thc hin BHYT HS - SV ca lin B, t tng ch o xuyn sut l ngun ti chnh thu c t s tham gia BHYT ca hc sinh c s dng ch yu phc v hc sinh, ngay c vic nu qu BHYT HS SV cha s dng ht trong nm ti chnh cng c chuyn vo qu s phng KCB v u t tr li phc v hc sinh. Khi nghin cu cc quy nh v BHYT HS - SV nhiu ngi khng nh y mi ng l loi hnh bo him ton din cho hc sinh. 1.2.Kh khn. Khng phi tt c u thun li cho vic t chc thc hin BHYT HS SV. Bn cnh nhng iu kin ht sc thun li trn vn cn mt s kh khn cn phi khc phc nhm gim bt nh hng khng tt ca n n qu trnh thc hin. Mt s kh khn l: Mt l, kinh t ca ngi dn cn nhiu kh khn. Nc ta mi chuyn i kinh t t kinh t k hoch ho tp trung sang nn kinh t th trng nh hng XHCN c s qun l v iu tit ca Nh nc. C cu kinh t cn nng v nng nghip, ngnh dch v mi pht trin nn bo him mi ch l khi nim mi. Kinh t gia cc a phng c s cch bit ln, la tui hc sinh cn tp trung nng thn nhiu hn do s phn b dn c khng u v thi quen sinh ng con t th h trc cn li. Hin nay, s con trong mt h gia nh nng thn vn cn ln v ph bin do cng tc dn s thi k trc cn nhiu hn ch. Thm vo kinh t
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nng thn cn nhiu kh khn nn vic tham gia BHYT cho con em mnh l iu rt kh. Hn na, cch nhn sai lch v BHYT ca ph huynh v hc sinh. V hc sinh sinh vin c sc kho tt, t m au nn nhiu ngi tnh ton thit hn, cn cha tht hiu v ngha ca BHYT HS SV. y cng chnh l nhn thc sai tri ca ngi dn v BHYT ni chung v BHYT c thc hin nc ta cha c bao lu nn kin thc ca ngi dn v bo him cha nhiu. H cha hiu nguyn tc s ng b s t, san s ri ro trong bo him v cha c thi quen d phng ti chnh trong cuc sng. Tuy s tin b ra hng nm l rt t so vi chi ph KCB c thanh ton nu khng may b m au, bnh tt nhng khng phi ai cng nhn ra c iu ny. Bo him l sn phm dch v nn ngi tham gia s khng thy c tc dng ca n nu cha t tiu dng. H thy s tin b ra hng nm mua BHYT nh b mt i mt cch lng ph m khng bit rng n cu sng bao nhiu em khc, gip bao gia nh khc n nh v mt ti chnh. Thi quen khng tham gia v so o tnh ton s gy cn tr rt ln n vic y mnh s pht trin ca BHYT HS SV. Hai l, s cnh tranh gay gt trn th trng bo him dnh cho hc sinh. Nm 1999 do s phn i ca B Ti Chnh v vic Th tng Chnh ph ng cho php Bo him y t Vit Nam l c quan duy nht t chc thc hin BHYT HS SV. Do vy cc Cng ty bo
58
him cng c quan BHXH Vit Nam u trin khai nghip v bo him cho hc sinh sinh vin. So vi BHXH th BHTM cng c rt nhiu li th, phn hoa hng trch cho gio vin, trng hc ln (thng gp i so vi BHXH ) do khng phi trch % s thu cho YTH nn c mt thc t cho thy cc thy c gio thng nh hng cho hc sinh tham gia cc nghip v BHHS do cc Cng ty bo him thc hin. Thm ch c trng cn chia 50% s hc sinh tham gia BHYT v 50% hc sinh tham gia BHTM. Cc sn phm bo him dnh cho hc sinh ca cc Cng ty bo him thng mi thng c mc hng ln, hp dn tu thuc vo iu kin kinh t ca ngi tham gia, th tc chi tr khi xy ra s kin bo him nhanh chng khng rm r nn thu ht c khch hng. BHTM khng lin quan n dch v y t nn khch hng tham gia khng phi chu cnh i x phn bit gia bnh nhn KCB theo th v bnh nhn tr vin ph. Ngoi cc sn phm chnh, cc cng ty cn a ra cc sn phm ph tu thuc vo iu kin ca khch hng nn quyn li cng c m rng lm cho ph huynh thy BHTM c tnh u vit hn. BHTM vi mc ch kinh doanh l li nhun nn h sn sng b ra mt khon chi ph ln dnh cho qung co cc sn phm ca mnh cn BHXH, BHYT ch l chnh sch ca Nh nc thc hin v mc ch chung ca Nh nc nn t c tuyn truyn trn cc phng tin thng tin i chng m thin v vic ch o cc cp, cc t chc c trch nhim thc hin hn. Nhn chung, BHYT c sc cnh tranh yu hn so vi BHTM, iu ny gy
59
s tr ngi ln cho vic m rng din bao ph th BHYT cho hc sinh sinh vin v y mi ch l i tng t nguyn cn vn ng tham gia. Ba l, c s vt cht ca cc c s KCB cn ngho nn v trang thit b y t cn thiu thn dn n tnh trng cht lng KCB cha cao. i sng ca cn b y t cn thp dn n mt s tiu cc trong vic n tip bnh nhn c th BHYT n khm v iu tr. T thc t trin khai BHYT bt buc ngi tham gia thng phn nn v cht lng dch v KCB dn n vic c thnh kin vi BHYT v h cho rng th BHYT khin h b phn bit i x. Nh vy h s kh ng cho con ci mnh tham gia v y ch l loi hnh BHYT t nguyn tham gia tu thuc vo kin c nhn m khng phi chu s g p no. 2. Tnh hnh hc sinh - sinh vin tham gia BHYT. Trn y l mt s yu t tc ng, cc iu kin thun li v kh khn cho vic thc hin BHYT HS SV. Trong thc t liu chng ta c khai thc ht c nhng iu kin thun li hay khng v thc t c hn ch c kh khn trn hay khng v nh hng ca cc yu t tc ng nh th no chng ta cn nh gi vic trin khai nghip v bo him ny trong giai on t nm 1998 2004 bit r hn. Tnh hnh hc sinh tham gia BHYT trong nhng nm qua c th hin qua bng s liu sau:
60
Bng 7: S lng hc sinh sinh vin tham gia BHYT ti c quan Bo him x hi Vit Nam Nm hc 1997 1998 1999 2000 2001 2002 2003 1998 1999 2000 2001 2002 2003 2004 S HS SV tham gia(ngi) 3.460.540 3.396.400 2.955.160 3.101.123 4.201.514 4.910.640 5.078.730 % bao ph th 18,8 18,2 16,7 20,9 22,4 22,45 22,9
( Ngun: Ban T nguyn BHXH VN)
Nhn c s ch o ca B Gio dc - o to, B Y t, BHXN Vit Nam, BHXH cc tnh, thnh ph, cc cp u ng v chnh quyn a phng cho n nay c 64 tnh thnh trong c nc trin khai BHYT HS-SV. Nhn chung, s lng hc sinh sinh vin tham gia BHYT c xu hng tng qua cc nm. Din bao ph tng t 18,8% nm 1997 1998 ln 22,9% nm 2003 2004. Tuy nhin nm hc 1998 1999 v 1999 2000 s hc sinh sinh vin tham gia BHYT gim l do hai nguyn nhn ch yu sau: Mt l, nm 1998 lin B Gio dc - o to v B Y t ban hnh Thng t s 40/1998/TTLT BGD T BYT hng dn thc hin BHYT HS-SV thay th Thng t lin B s 14/1994/TTLT BGD T BYT. iu ng ni nht Thng t 40/1998 l mc ph tng lm nh hng trc tip n nhu cu tham gia BHYT ca hc sinh sinh vin. Khng t ph huynh hc sinh t chi tham gia BHYT cho con em mnh 61 L Thu Dung Bo him 43A
bi mt l h cm thy t hn cho d quyn li ca con em h c m rng. Hai l vic B Ti Chnh l c quan ch qun ca Tng cng ty Bo him Vit Nam khng ng vi kin ca Vn phng Chnh ph cho php BHYT Vit Nam t chc thc hin duy nht BHYT HS-SV. Cng vn s 3645/VPCP VX ngy 12/8/1999 ch r BHYT Vit Nam l c quan duy nht thc hin BHYT HS-SV trnh tnh trng lm tng thm gnh nng ng gp cho cc bc cha m trong khi iu kin kinh t cn nhiu kh khn v hin nay c nhiu loi hnh bo him cho hc sinh ang c t chc thc hin trong nh trng. Nhng B Ti Chnh cho rng, BHYT HS-SV l loi hnh BHYT t nguyn thc hin da trn nguyn tc vn ng nn cng khng khc bit so vi cc sn phm bo him dnh cho hc sinh m cc cng ty Bo him thng mi cng ang trin khai. Chnh v vy nn cho ph huynh v hc sinh t la chn nh bo him cho mnh hn na m bo tnh cnh tranh trong thng mi trnh tnh trng c quyn. Nh vy th cng mt lc ph huynh v hc sinh c quyn la chn nh bo him cho mnh nn dn n vic gim s lng hc sinh tham gia. Hn na cc cng ty Bo him thng mi c hnh thc khuyn mi v hoa hng ln cho thy c v nh trng nn c phn hng sang bo him thng mi. Chnh v hai l do trn m s lng hc sinh tham gia gim, c bit l nm hc 1999 2000, gim t 3.460.540
62
hc sinh nm 1997 1998 xung cn 2.955.160 (gim 505.380 hc sinh tng ng gim 14,6%). T nm 2000 2001 s lng hc sinh sinh vin tham gia li tip tc tng v nm sau s em tham gia lun cao hn nm trc. Nm 2000 2001 s hc sinh tham gia l 3.101.123 em tng 145.963 hc sinh tng ng tng 4,94% so vi nm 1999 2000. Nm hc 2001 2002 s hc sinh tham gia l 4.201.514 em tng 1.100.391 em tng ng tng 35,48% so vi nm 2000 2001. Nm hc 2002 2003 s hc sinh tham gia l 4.910.640 em tng 709.126 em tng ng tng 16,88% so vi nm 2001 2002. Nm hc 2003 2004 s hc sinh tham gia l 5.078.730 em tng 168.090 em tng ng tng 3,43% so vi nm 2002 2003. Nm hc 1994 1995, nm u thc hin BHYT HS-SV ch c 600.000 em tham gia th n nm 2003 2004 s em tham gia tng 4.478.730 em. Ngay t nhng thng h, th trng bo him hc sinh sinh vin dn nng ln vi s tip cn ca cc t chc Bo him. Cc hnh thc khuyn mi, chm sc khch hng, chng trnh u i, nhiu hnh thc tuyn truyn qung co c thc hin. Tt c u vo cuc v hc sinh sinh vin l i tng tim nng vi tt c cc nh bo him. Trong iu
63
kin cnh tranh gay gt gi vng th phn khng phi l chuyn n gin. BHYT c nhiu bt li c th l BHYT HS-SV hot ng khng v mc tiu li nhun, l mt chnh sch x hi ca ng v Nh nc nn khng th c k hoch khuyn mi, khuych trng nh BHTM. Mc ph thp nn quyn li ca hc sinh sinh vin cn hn ch, cha hp dn vi i tng ny. lm r vn ny chng ta cn xem xt qua bng s lng hc sinh tham gia vo BHTM. Bng 8: S lng hc sinh tham gia bo him ti cc cng ty BHTM S HS SV tham gia (ngi) 7.560.000 8.000.000 8.800.000 9.860.000 11.140.000 12.700.000 T l c bo him (%) 39,78 41,03 42,18 45,86 50,31 57,07
Nm hc 1998 1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 2004
(Ngun: Chin lc pht trin th trng bo him Vit Nam t nm 2003 n 2010)
Qua bng s liu trn ta thy s lng hoc sinh tham gia cc nghip v ti cc cng ty Bo him thng mi l rt ng, lun gp i s lng hc sinh tham gia BHYT ti Bo him x hi Vit Nam. S lng hc sinh tham gia tng u
64
qua cc nm v tc tng lun t mc n nh t 10 15% mt nm. Nh vo nhng c im thun li ni tri nh vic tuyn truyn qung co, mc hng ln, mc ph a dng ph thuc vo iu kin kinh t tng gia nh, phm vi bo him rng, phng thc thanh ton nhanh chng m t l hc sinh tham gia nghip v bo him hc sinh ln, c bit nm hc 2003 2004 c 57,07% hc sinh tham gia bo him thng mi gp 2,5 ln s hc sinh tham gia BHYT ti Bo him x hi Vit Nam. Nm hc 1999 2000 s hc sinh tham gia bo him thng mi tng 440.000 em tng ng tng 5,82% v nhiu hn 5.044.840 em gp 2,71 ln s hc sinh tham gia BHYT ti Bo him x hi Vit Nam so vi nm hc 1998 - 1999. Nm hc 2000 2001 s hc sinh tham gia bo him thng mi tng 800.000 em tng ng tng 10,00% v nhiu hn 5.698.877 em gp 2,84 ln s hc sinh tham gia BHYT so vi nm hc 1999 2000. Nm hc 2001 2002 s hc sinh tham gia bo him ti cc cng ty bo him thng mi tng 1.060.000 em tng ng tng 12,05% nhiu hn 5.658.486 em gp 2,35 ln s hc sinh tham gia BHYT so vi nm hc 2000 2001. Nm hc 2002 2003 s hc sinh tham gia bo him thng mi tng 1.280.000 em tng ng tng 12,98% nhiu hn 6.229.360 em gp 2,27 ln s hc sinh tham gia BHYT so vi nm hc 2001 2002.
65
Nm hc 2003- 2004 s hc sinh tham gia bo him thng mi tng 1.560.000 em tng ng tng 14,00% nhiu hn 7.621.270 em cao gp 2,50 ln s hc sinh tham gia BHYT so vi nm hc 2002 2003. Mi mt cng ty bo him khi trin khai nghip v bo him cho hc sinh u xy dng v thc hin cc chin lc kinh doanh ca mnh nng t l tham gia ti cng ty mnh ln cao, chnh v qua. Trong iu kin cnh tranh gay gt nh hin nay, cc nh bo him lun phi c gng gi vng kt qu m mnh t c v tm mi bin php tng s lng ngi tham gia bo him ti cng ty mnh. iu ny cho thy BHYT HSSV do Bo him x hi Vit Nam thc hin c c nhng kt qu trn l mt n lc rt ln ca i ng nhng ngi lm cng tc BHYT, l s quan tm ch o ca cc cp u ng, chnh quyn, l s phi hp cht ch ca cc ngnh Gio dc - o to, ngnh Y t v chnh quyn a phng. 3. Tnh hnh thu, chi Qu BHYT HS-SV qua cc nm. 3.1. Tnh hnh thu BHYT HS SV. Qua bng s liu v s lng hc sinh tham gia qua cc nm chng ta thy s hc sinh tham gia tng khng u, thm ch c nm cn gim nhng tng thu Qu BHYT HS - SV vy t l hc sinh tham gia bo him thng mi tng ln nhanh chng trong nhng nm
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u tng, iu liu c mu thun vi nhau khng? tr li thc mc chng ta cng xem xt qua bng s liu thu sau: Bng 9: Bng thu BHYT HS - SV S hc sinh tham gia(
ngi)
Nm hc 1997 1998 1999 2000 2001 2002 2003 1998 1999 2000 2001 2002 2003 2004
S thu ( triu ng) 47.963 58.933 61.044 66.337 89.987 114.842 170.781
3.460.540 3.396.400 2.955.160 3.101.123 4.201.514 4.910.640 5.078.730
( Ngun: Phng K hoch tng hp Ban T nguyn BHXH Vit Nam )
Nhn vo bng s liu trn ta thy tuy hai nm hc 1998 1999 v 1999 2000 s hc sinh tham gia gim nhng s thu vn tng nguyn nhn chnh l do mc ng c iu chnh tng do Thng t 40/1998 qui nh m bo vi quyn li hng c m rng cho ph hp vi nhu cu ca cha m hc sinh v ph hp vi chi ph y t trn thc t tng nn tng thu vn tng u. Biu 1:
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Bi doanh thu u
200000
Tri u ng 170781
150000
114842
100000 50000 0
47963 58933 61044
89987 66337
1997 - 1998 1998 1999
1999 - 2000 - 2001 - 2002 - 2003 2000 2001 2002 2003 2004 Nm hc
Nhn vo biu ta thy s thu ca nm hc 2003 2004 tng cao (gp 3,56 ln ) so vi nm hc 1997 1998. T nm hc 2001 2002 s thu tng nhanh mt phn l do s hc sinh tham gia tng ln rt nhanh, hn na c nhiu mc ng tng ng vi quyn li m hc sinh c hng khi tham gia mc , v vy hc sinh c quyn la chn mc tham gia. Mt s tnh, thnh ph ln ngh mc ng cao hn so vi mc ng m Bo him x hi Vit Nam a ra ch ng m rng mc hng cho ph hp vi a phng mnh nh: H Ni, thnh ph H Ch Minh. Hn na, s hc sinh tham gia cc khu vc ny ng chim t l ln trong tng s hc sinh sinh vin tham gia ca c nc, c th s thu ca cc nm c s bin ng nh sau: Nm hc 1998 1999 s thu tng 10.970 triu ng tng ng tng 22,9% so vi nm hc 1997 1998.
68
Nm hc 1999 2000 s thu tng 2.111 triu ng tng ng tng 3,6% so vi nm hc 1998 1999. Nm hc 2000 2001 s thu tng 5.293 triu ng tng ng tng 8,7% so vi nm hc 1999 2000. Nm hc 2001 2002 s thu tng 23.650 triu ng tng ng tng 35,7% so vi nm hc 2000 2001. Nm hc 2002 2003 s thu tng 24.855 triu ng tng ng tng 27,6% so vi nm hc 2001 2002. Nm hc 2003 2004 s thu tng 55.939 triu ng tng ng tng 48,7% so vi nm hc 2002 2003. Do BHYT hot ng theo nguyn tc t cn i thu chi nn tng thu tng l iu kin tt duy tr cc khon chi m bo quyn li cho ngi tham gia. BHYT hot ng khng v mc tiu li nhun nn thu chi l mt nt in hnh ring bit ca BHXH, y cng th hin tnh nhn vn v nhn o su sc m bo him thng mi khng th c, chnh v vy ch c Nh nc mi ng ra t chc c. Tuy nhin so vi s thu ca bo him hc sinh ti cc cng ty bo him thng mi th s thu ca BHYT HS - SV qu l rt thp.
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Bng 10: So snh s thu BHYT HS - SV v s thu bo him hc sinh S thu bo him hc sinh
(triu ng)
S thu BHYT HS - SV Nm hc 1999 2000 2001 2002 2003 2000 2001 2002 2003 2004
(triung)
61.044 66.337 89.987 114.842 170.781
132.096 180.000 200.000 230.000 270.000
( Ngun: Ban t nguyn BHXH Vit Nam v chin lc pht trin th trng bo him Vit Nam t 2003 2010 ca B Ti chnh)
Qua bng so snh trn ta c th thy s thu ca hn s thu ca BHYT HS SV.
bo
him hc sinh ti cc cng ty bo him thng mi lun cao Nm hc 1999 2000 s thu ca bo him hc sinh cao gp 2,16 ln so vi BHYT HS SV. Nm hc 2000 2001 s thu ca bo him hc sinh cao gp 2,71 ln so vi BHYT HS SV. Nm hc 2001 2002 s thu ca bo him hc sinh cao gp 2,22 ln so vi BHYT HS SV. Nm hc 2002 2003 s thu ca bo him hc sinh cao gp 2,00 ln so vi BHYT HS SV.
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Nm hc 2003 2004 s thu ca bo him hc sinh cao gp 1,58 ln so vi BHYT HS SV. S d s thu ca bo him hc sinh cao hn l do s hc sinh tham gia bo him ti cng ty bo him thng mi lun cao hn BHYT HS - SV v mc ph ca cc cng ty ny cng kh cao. Bng11: Ph bo him hc sinh
n v: ng
Nm Ph bo him
1999 131.29 5
2000 132.096
2001 180.000
2002 200.000
2003 230.000
(Ngun: chin lc pht trin th trng bo him Vit Nam t 2003 2010 ca B Ti chnh)
So vi mc ng ca BHYT HS - SV ch t 25.000 70.000 th mc ph ca bo him hc sinh qu l rt ln, iu ny nh hng trc tip n quyn li ca ngi tham gia. 3.2. Tnh hnh chi BHYT HS SV. BHYT HS - SV l chnh sch x hi vi mc ch l chm sc v bo v sc kho hc sinh sinh vin, l loi hnh BHYT t nguyn nn qu c hch ton ring v t cn i thu chi. V vy vic s dng qu c hiu qu l vic lm rt kh trong khi chi ph y t u c xu hng tng cao. nh gi vic chi ca qu BHYT HS - SV chng ta xem xt qua cc
71
bng s liu sau bit thm tnh hnh chi qua cc nm ra sao:
Bng 12: Tnh hnh chi BHYT HS SV Chi YTH (triu Nm hc 1998 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003 2004
Vit Nam )
ng) C 5% hoa hng
Chi KCB
( triu ng)
Tng chi
(Triu ng)
20.626 21.365 23.218 30.457 33.800 37.082
35.360 36.626 39.802 51.927 67.898 116.644
55.986 57.991 63.020 82.384 101.698 153.726
( Ngun: Phng K hoch tng hp Ban t nguyn - BHXH
72
B 2 Tn hn c i q ac n . i u : h u c m h h
100 800 100 600
t u ri ng
100 400 100 200 100 000 800 00 600 00 400 00 200 00 0
19 98 19 99 19 99 20 00 20 00 20 01
C i YT h H
nm hc
20 01 20 02
20 02 20 03
20 03 20 04
CiK B h C Tn ci h g
Qua bng s liu trn ta thy tng chi qua cc nm u tng mt phn l do chi ph y t tng nhanh v do vic Nh nc ch nng cao cht lng tt c cc tuyn c bit l tuyn c s. Nm 1998 1999 tng chi KCB cho i tng hc sinh sinh vin l 35.360 triu ng trong chi cho YTH l 20.626 triu ng chim phn ln trong tng s chi ca qu. Trong cc nm hc sau qu li nh trng phc v cho YTH tng ln theo tng nm gp phn chm sc sc kho ban u cho hc sinh tt hn. c bit nm hc 2002 2003 chi cho cng tc YTH chim mt na s chi ca c nm. iu cho thy khng phi ch cc em tham gia BHYT HS - SV mi c hng li ch t cng tc YTH, hn na nu lm tt cng tc ny th s hn ch c cc
73
khon chi cho KCB v cc em c KCB ti trng nn sm pht hin ra bnh kp thi ngn nga v cha tr. C th: Nm hc 1999 2000 tng chi tng 2.005 triu ng tng ng tng 3,58% trong chi cho YTH tng 739 triu ng v chi cho KCB tng 1.266 triu ng cng tng tng ng l 3,58% so vi nm hc 1998 1999. Nm hc 2000 2001 tng chi tng 5.029 triu ng trong chi cho YTH l 1.853 triu ng v chi cho KCB tng 3.176 triu ng cng tng tng ng l 8,67% so vi nm hc 1999 2000. Nm hc 2001 2002 tng chi tng mnh l 19.364 triu ng tng ng tng 30,73% trong chi cho YTH tng 7.239 triu ng tng ng tng 31,18% v chi cho KCB tng 12.125 triu ng tng ng tng 30,46% so vi nm hc 2000 2001. Nm hc 2002 2003 tng chi tng 19.314 triu ng tng ng tng 23,44% trong chi cho YTH tng 3.343 triu ng tng ng tng 10,98% v chi cho KCB tng 15.971 triu ng tng ng tng 30,76% so vi nm hc 2001 2002. Nm hc 2003 2004 tng chi tng t bin 52.028 triu ng tng ng tng 51,16% trong chi cho YTH ch tng 3.282 triu ng tng ng tng 9,71% cn phn ln l chi cho KCB tng 48.746 triu ng tng ng tng 71,79% so vi nm hc 2002 2003. iu ny cng ph hp vi thc t
74
bi l y l nm chi ph y t c bin ng ln c bit l vic tng gi cc loi thuc do B Y t qun l khng nghim. T nm hc trc gi thuc v chi ph y t khc tng cao lm cho nhiu a phng b bi chi do phn chi tng t bin trong khi mc ph ng iu chnh cha tng kp so vi mc tng ca chi ph. Tuy nhin cng tc y t trng hc vn m bo n nh, nh kinh ph li nh trng t s thu BHYT m cng tc YTH nhiu ni c khi phc. Ti cc trng hc c ngun kinh ph t BHYT , hc sinh c thc hin cc ni dung chm sc sc kho ban u, chi muc thuc, cc dng c y t thng thng, tr lng v cc khon ph cp khc cho cn b YTH. y chnh l im u vit khc bit mang tnh x hi ring c ca BHYT so vi cc sn phm bo him hc sinh ca cc cng ty Bo him thng mi nh Bo Vit, PJICO, Bo Minh Ti trng hc cc em c khm sc kho nh k, nhiu em c pht hin bnh kp thi v c thng bo ti gia nh c hng iu tr. Theo mt cuc iu tra nghin cu 23.833 hc sinh H Ni, Hi Phng, Tha Thin Hu, Thi Bnh v Ho Bnh v cc bnh thng gp hc sinh - sinh vin l: nhim k sinh trng ng rut ( 78,9%), bnh tiu ho ( 47,6%), bnh thiu mu ( 21,5%), bnh v mt v phn ph ca mt (18,5%), bnh h hp (15,25%) Nhng cho n nay hu ht hc sinh
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mc cc bnh ny gim ng k v c phng trnh c thng qua chng trnh YTH.
Bng 13: Chi tit chi ph KCB cho hc sinh sinh vin trong 5 nm 1998 - 2003
Nm hc 1998 1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 2004
KCB ni tr
( s lt)
KCB ngoi tr
( s lt)
Chi KCB
( triu ng)
232.630 179.160 146.972 195.097 230.546 285.769
1.213.000 450.204 352.400 525.189 892.843 1.305.432
35.360 36.626 39.802 51.927 67.898 116.644
( Ngun: Ban t nguyn BHXH Vit Nam )
Cng vi s tng ln v s lng hc sinh tham gia BHYT th s tin chi cho KCB c ni tr v ngoi tr u tng ln ng k. Nm 1998 1999 do b sung thm quyn li chi tr iu tr ngoi tr nn s lt em i KCB ngoi tr tng ln t bin v c s lt ngi i KCB cao nht trong cc nm qua.
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Hng nm c hng trm nghn lt hc sinh c chm sc sc kho, KCB ngoi tr v iu tr ni tr. Do nh hng bi s hc sinh tham gia nm 1998 1999, 1999 2000 nn s lt em i KCB cng gim so cc nm trc . Nm hc 1999 2000 s lt iu tr ni tr gim 53.470 lt tng ng gim 23%, s lt iu tr ngoi tr gim 762.796 lt tng ng gim 62,8% so vi nm 1998 1999. Nm hc 2000 2001 s lt iu tr ni tr gim 32.188 lt tng ng gim 18%, s lt KCB ngoi tr gim 97.804 lt tng ng gim 21,7% so vi nm hc 1999 2000. Nm hc 2001 2002 s lt KCB ni tr tng 48.125 lt tng ng tng 32,7%, s lt KCB ngoi tr tng 172.789 lt tng ng tng 49,03% so vi nm hc 2000 2001. Nm hc 2002 2003 s lt KCB ni tr tng 35.449 lt tng ng tng 18,17%, s lt KCB ngoi tr tng 367.654 lt tng ng tng 70% so vi nm hc 2001 2002. Nm hc 2003 2004 s lt KCB ni tr tng 55.223 lt tng ng tng 23,95% cn KCB ngoi tr tng 412.589 lt tng ng tng 46,21% lm cho tng chi KCB tng 48.746 triu ng tng ng tng 71,76% so vi nm hc 2002 2003. III. nh gi kt qu v hiu qu hot ng BHYT HS - SV ti BHXH Vit Nam. Sau 10 nm thc hin BHYT t nguyn ( 1994 2004) cho i tng hc sinh sinh vin Bo him x hi Vit Nam gt hi c nhng kt qu kh quan ng mng. S lng hc
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sinh tham gia BHYT nhn chung tng dn qua tng nm. Nm hc 2003 2004 c s hc sinh tham gia l 5.078.730 em cao nht trong 10 nm qua. Cho n nay tt c cc tnh, thnh ph trong c nc thc hin BHYT HS - SV trong cc a phng c s hc sinh tham gia ng l thnh ph H Ch Minh, H Ni, Thi Bnh, Ngh An Cc a phng c t l hc sinh tham gia cao so vi tng s hc sinh trn a bn l Hu ( 67%), Thi Bnh ( 66%), Nng ( 63%). Hng nm c hng trm nghn lt em i KCB ngoi tr v iu tr ni tr. C th:
Bng 14: Bnh qun s lt KCB ca hc sinh sinh vin

S lt KCB ngoi tr bnh qun
(lt/h.s)
S lt KCB ni Nm hc tr bnh qun

(lt/ h.s)
Chi ph KCB bnh qun

(triu ng/h.s)
1998 1999 2000 2001 2002
1999 2000 2001 2002 2003
0,068 0.357 0,061 0.152 0,047 0.114 0,046 0.125 0,047 0.182 (Ngun: Tnh t bng 9 v bng 11)
0.010 0.012 0.013 0.012 0.014
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T nm 1999 2000 BHYT HS - SV thc hin theo Thng t 40/1998 th bnh qun s lt hc sinh c i KCB c ni tr v ngoi tr u n nh. Trung bnh c 21 em hc sinh sinh vin tham gia BHYT HS - SV th c 1 em i KCB v iu tr ni tr, trung bnh c 8 em tham gia c 1 em iu tr ngoi tr. Nh vy s hc sinh tip cn vi cc dch v y t l kh nhiu. Quyn li ca hc sinh c m bo, nhiu trng hp KCB theo yu c ring cng c thanh ton chi ph theo tuyn chuyn mn k thut ph hp vi qui nh ca B Y t. Cht lng KCB ngy cng c nng cao, nhiu thuc t tin v trang thit b hin i cng c a vo chun on v iu tr cho hc sinh sinh vin. S tin KCB bnh qun mt em hc sinh dao ng t 10.000 15.000 ng/nm/hc sinh ph hp vi mc ng hin hnh. Tuy nhin, nhn vo bng s liu trn ta thy chi ph KCB bnh qun ang c xu hng tng ln. Do khng hn ch trn ti a chi ph iu tr nn c nhiu em c c quan BHXH chi tr hng chc triu ng, nhng em khng may t vong u c tr tr cp theo ng qui nh v c cn b BHXH mang n tn nh. Bng 15: Hiu qu s dng qu BHYT HS - SV
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S hc sinh Nm hc 1998 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003 2004 tham gia( ngi) 3.396.400 2.955.160 3.101.123 4.201.514 4.910.640 5.078.730
S thu ( triu ng) 58.933 61.044 66.337 89.987 114.842 170.781
Tng chi (Triu ng) 55.986 57.991 63.02 82.384 101.698 153.726
Tng chi/ thu ( %) 95,0 95,0 95,0 91,6 88,5 90,01
(Ngun: Tnh t bng 9 v 10)
Nhn vo bng s liu trn ta thy t l tng chi/ thu ca qu BHYT HS - SV u t mc cao cng chng t mc ch BHYT HS - SV hot ng khng v mc ch kinh doanh. S tin thu c u phc v cho mc ch chm sc sc kho cho hc sinh sinh vin. iu khng nh quyn li ca hc sinh rt c m bo, tuy nhin c th thy mc thu cn thp trong khi chi ph y t ngy cng tng cao v khng phi a phng no cng cn i c qu. S tin kt d cui nm ca nhiu a phng c chuyn sang mua th cho hc sinh ngho nm sau, nh
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nhiu em c hon cnh gia nh kh khn c tham gia vo BHYT HS SV gip cho cc em yn tm hc tp. C th ni mng li y t trng hc c khi phc v xy dng mi trn kinh ph li nh trng. Hng nm s tin li nh trng l rt ln chim hn 1/3 s thu khng nh mt iu l Nh nc ta quan tm n cng tc chm sc sc kho ban u cho hc sinh sinh vin hn cc i tng khc. Cc trng c YTH hot ng u thc hin tt vic chm sc sc kho cho cc em, phng trnh kp thi cc bnh v mt, rng ming, cong vo ct sng hoc ti thiu cc em cng c ung nc sch, hc tp trong mi trng sch p. Ti nhiu trng hot ng YTH rt c hiu qu gy c thin cm nht nh i vi hc sinh v ph huynh nh m s lng hc sinh tham gia BHYT ngy mt tng. * Nhng kh khn, tn ti trong khi thc hin BHYT HS SV ti Bo him x hi Vit Nam. Mc d vy, bn cnh nhng kt qu t c khng phi l khng c nhng kh khn, hn ch, nhng mt cn tn ti trong qu trnh thc hin. Sau 10 nm thc hin, BHYT HS - SV mi ch t c kt qu ht sc khim tn l do nhiu nguyn nhn trong c nguyn nhn khch quan v nguyn nhn ch quan. C th ni c cc nguyn nhn khch quan ch yu sau: Mt l, nn kinh t mi chun i t kinh t k hoch ho tp trung sang kinh t th trng nn ph huynh hc sinh phi ng gp nhiu khon , nhiu gia nh khng kh
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nng tham gia. Nhng nm gn y, kinh t c pht trin kh song thu nhp bnh qun u ngi con thp. Do u t khng u nn kinh t gia cc a phng cn c nhiu khong cch, ch cc thnh ph ln nh Thnh ph H Ch Minh, H Ni khu vc tp trung nhiu dn c nh cc thnh ph, th x ca tnh trc thuc Trung ng mi c iu kin tham gia. Mc d a ra mc ph ring cho khu vc thnh th v nng thn nhng cha st thc t bi l mc ng ca khu vc nng thn khng thp hn nhiu so vi khu vc thnh th trong khi thu nhp ca ngi dn hai khu vc ny c s khc bit kh ln. Chnh v vy cha thu ht c ng o hc sinh nng thn tham gia. Hai l, vic t chc thc hin cha c tt. BHYT HS SV c trin khai sau 2 nm thc hin BHYT cho i tng bt buc nn cha c nhiu kinh nghim. Mt s ch trng a ra nhng cha thc hin c mt cch hon chnh. Cc vn bn hng dn cn thiu s ng b, s lng cc vn bn cn nhiu i khi b chng cho gy kh khn cho c ngi tham gia v ngi t chc thc hin. Cn b lm cng tc BHYT cha thc s mn m vi vic thu ht i tng tham gia bi h ch n lng Nh nc v ph cp cn thp. Ba l, s tip n hc sinh sinh vin n KCB cha thc s tt. Cng nh cc i tng c th BHYT khc, hc sinh sinh vin b i x khng cng bng do mt s cn b y t gy ra. iu ny li thnh kin khng tt cho ph huynh hc sinh cng nh chnh cc em hc sinh. Cha m hc
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sinh thng phn nn nhiu v nhng tn ti trong cng tc KCB c v cht lng iu tr cng nh tinh thn ti phc v i vi con em mnh, y l l do thng gp khi h t chi tham gia. Nu nh ngi ln thy bc mnh, khng hi lng v thi phc v ca nhn vin y t th hc sinh cn cm thy s v cc em cn b qut mng do nh tui. Trn thc t qua kho st thy ng l c tnh trng trn song khng phi l ph bin. Thm ch c ngi mi ch nghe ni nhng tr nn c thnh kin. V vy mt s t nhn vin y t khng lm theo ng o c ngh nghip gy cn tr trong vic vn ng mi ngi tham gia. Bn l, mt s a phng vn thng xuyn b bi chi trong mt thi gian di. L do chnh l cc a phng ny c t l tham gia thp nn t m rng quyn li thu ht i tng tham gia. Nhiu ni khng qun l cht v lm khng tt cng tc thng k nn n cui nm vn khng tng kt c tin thc hin k hoch m Bo him x hi Vit Nam giao kp thi bo co ln trn. Do vy c quan qun l khng nm bt c tnh hnh thc t thc hin kp thi a ra phng n gii quyt cng nh nh hng hot ng cho nm tip theo. Nm l, phn trm trch li t s thu BHYT ( 35%) s dng cha c hiu qu. Vic hnh thnh mng li y t trng hc nhn chung cn chm v cn nhiu vng mc, khng t trng cha t chc c phng y t, cha c cn b y t trng hc v vy cn lng tng trong qun l v s dng phn kinh
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ph trch li. Nguyn nhn chnh l do s hc sinh sinh vin ca trng tham gia t cho nn phn trch li cha kinh ph t chc YTH. H Ni l thnh ph thc hin BHYT HS SV tng i tt. Nm hc 2002 2003, s tin trch li cho YTH l 3.535 triu ng, vi 657 trng tham gia BHYT th tnh bnh qun mt trng ch c trch li l 5,4 triu ng/nm. Ring tin tr cho cn b y t vi mc ti thiu l 300.000ng/thng th mt nm nh trng phi tr 3,6 triu/ nm. Nh vy ch cn li 1,8 triu ng/nm dnh cho cng tc chm sc sc kho cho hc sinh sinh vin. c nhng trng hc sinh tham gia t nn s tin li ch vi trm ngn ng. Vi chi ph y t nh hin nay th s tin khng th lm g ngoi vic mua thuc r tin thng thng, trang thit b y t th s nh bng, bng Vi s tin tr hng thng t i cho cn b y t th khng my ton tm ton vi YTH. a s l k hp ng ngn hn gia nh trng v cn b y t, thiu cn b y t c trnh chuyn mn, ch yu l kim nhim. Thm ch cha c ch BHYT , BHXH cho cn b y t v vy h ch lm tm thi trong thi gian ngn, khng khuyn khch cn b YTH gn b vi cng vic dn n tnh trng phc v cha c tt, nu tm c cng vic tt hn h s chuyn i ngay. Ban gim hiu nh trng hiu rt r v vn ny nhng do cha c c ch c th cho cn b y t nn mi trng p dng phng thc tr lng ring.
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Su l, cng tc thng tin tuyn truyn cn nhiu hn ch. Ngay c s cn b YTH c tuyn truyn v BHYT HS SV cn thp. BHYT HS - SV c c im l gn lin vi trng hc nhng cng tc thng tin tuyn truyn li xa ri vi mi trng ny. a s cc trng khng ph bin trc tip ni dung, quyn li, tc dng ca BHYT ti hc sinh sinh vin m thng qua bui hp ph huynh thng bo. Mt phn do thi gian c hn, mi nm ch hp ph huynh vi ln, ph bin v BHYT ch hai ln vo u mi hc k. Hn na ngay c gio vin cng cha nm r v BHYT HS - SV nn ch thng bo ti ph huynh mc ng. Tin hc ca hc sinh sinh vin cng rt ln nn khon ng gp v BHYT c coi nh gnh nng nn ph huynh khng my thit tha vi khon ng gp t nguyn ny. H ch thy khng bt buc phi mua nn h sn sng gt ra ngoi cc khon ng hc bt buc m khng ngh n quyn li ca con em mnh khi tham gia BHYT.
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Chng III Mt s kin ngh nhm pht trin BHYT HS - SV ti BHXH Vit Nam
I.Quan im nh hng ca ng v Nh nc ta trong vic t chc thc hin BHYT HS - SV t nay n 2010. 1. Quan im nh hng ca ng v Nh nc ng v Nh nc ta nhn nh rng con ngi l ngun ti nhuyn qu bu ca t nc. Mt x hi mun pht trin phi cn n nhng con ngi kho mnh, v vy cn phi u t cho sc kho ca nhn dn. u t cho sc kho l u t cho s pht trin ca kinh t x hi. Hc sinh sinh vin ang hc tp ti cc loi hnh trng hc l th h tng lai ca t nc, l ngi quyt nh vn mnh ca t nc nn chm lo cho th h tr ny chnh l chm lo cho t nc trong tng lai. Ti i hi ng IX ng ta ch r: thc hin ng b cc chnh sch bo v v chm sc sc kho nhn dn nhm gim t l mc bnh, nng cao th lc, 86
tng tui th v pht trin ging ni. Cng c v hon thin mng li y t, c bit l y t c s. Xy dng mt s trung tm y t chuyn su. y mnh sn xut dc phm, bo m cc loi thuc thit yu n vi mi a bn dn c. Thc hin cng bng trong chm sc sc kho, i mi c ch chnh sch vin ph, c chnh sch tr cp v BHYT cho ngi ngho, tin ti BHYT vy tin ti BHYT thc hin. Tin ti BHYT ton dn l hon ton ph hp vi bn cht nhn o v nh hng XHCN. t c mc tiu ny th mi ngi dn Vit Nam khng phn bit ngh nghip, giu ngho, gi tr, gii tnh, a v x hi u c chm sc sc kho. y l mc tiu cng bng, bnh ng m XHCN hng ti. Ti i hi ng ton quc ln th IX, ng ta mt ln na li khng nh con ng m ng chn l tin ln CNXH, thc hin cng bng, chm lo i sng cho nhn dn. Tuy nhin, chm sc sc kho nhn dn khng phi ch l nhim v ca Nh nc m l trch nhim ca mi c nhn, gia nh, cp u ng, chnh quyn, cc ban ngnh. Quan im ca ng l Nh nc v nhn dn cng lm, thng qua chnh sch thu mt phn vin ph, Nh nc h tr mt phn chi ph y t. Bi l khng mt quc gia no c th mt mnh chm sc sc khe nhn dn v ngn sch lun ton dn. Nh ton dn l mt trong nhng nhim v
chin lc quan trng m ton ng, ton dn phi phn u
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lun eo hp vi cc khon cn chi tiu ca Chnh ph. Mun thc hin tt quan im, nh hng ca ng th cn thit phi c s ch o phi hp cht ch gia cc ban ngnh v s ch o thng nht t trn xung. Hin nay, c nc mi ch c 21% dn s c th BHYT cho nn m rng i tng tham gia l nh hng ca ng tin ti BHYT ton dn, c bit l i tng hc sinh sinh vin. y mnh cng tc YTH c xc nh l phng thc thc hin c hiu qu nht v kinh t nht. nh hng chung cho cng tc YTH l tip tc m bo ti chnh cho hot ng ca h thng ny. Phn u nng cao c v s lng v cht lng y t trng hc d chm lo sc kho cho cc em ngay ti trng hc. 2.Phng hng chung v d kin k hoch t nay n 2010. Cn c vo kt qu t c v quan im ca ng, Nh nc v BHYT t nguyn ni chung v BHYT HS - SV ni ring, trong nhng nm ti cn tp trung vo mt s vn tin ti BHYT ton dn theo ng d kin. Mt l, khn trng t chc thc hin Thng t lin tch s 77/2003/TTLT BTC BYT ngy 07/8/2003 v BHYT t nguyn. Tip tc m rng cc i tng tham gia v xem xt vic b sung i tng bt buc trnh ln Chnh ph, nghin cu cc phng thc thanh ton chi ph cho c s KCB cho ph hp.
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Hai l tip tc phi hp cht ch gia ngnh Gio dc o to, B Y t v BHXH Vit Nam T trung ng n a phng thng nht chng trnh thc hin. c bit l s kt hp gia cc ban ngnh cng tc YTH thc s pht trin rng khp. H thng trng hc m bo iu kin thun li cho vic thc hin chng trnh BHYT . Nm 2003 2004 c nc c trn 22 triu hc sinh sinh vin, trong c trn 5 triu hc sinh sinh vin tham gia BHYT . Vi tc tng trng s lng hc sinh sinh vin tham gia nh my nm va qua th t nay n 2010 BHXH Vit Nam d bo mc tng l 0,5 triu hc sinh mt nm v n nm 2010 c trn 8 triu hc sinh sinh vin chim khong 40% hc sinh sinh vin c th BHYT. Mc d hin ti mc ng gp ca hc sinh kh thp nhng quyn li hng kh ton din lm cho khng t a phng thng xuyn xy ra tnh trng bi chi. Nhng nhn chung trong nhng nm qua BHYT HS - SV trn c nc vn cn i c thu chi. D kin trong nhng nm tip theo s phi khc phc tnh trng ny bng cch tng s hc sinh tham gia v tng ph cho ph hp vi gi chung. Tip tc thc hin cc bin php qu c cn i gp phn thc hin thng li cng tc BHYT HS SV. Nhng n nm 2010 tin ti BHYT ton dn m s hc sinh tham gia ch chim 40% th cha t mc tiu ra v vy cn phi c cc gii php thc y BHYT HS SV pht trin nhanh hn na.
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II. Mt s kin ngh i vi cc bn c lin quan. 1.i vi Nh nc. BHYT l mt chnh sch ln ca Nh nc nn n phi chu s iu tit trc tip ca Chnh ph. Nh nc thc hin iu tit v m i vi chnh sch ny. T khi thchin BHYT Vit Nam to ra s chuyn bin ln t c ch bao cp ton b sang c ch tr mt phn hoc ton b vin ph. Vi s thay i ln nh vy Nh nc phi ng ra hng dn, t chc v thc hin. Th nht l Quc hi, Chnh ph nn xem xt ban hnh Lut BHXH (v BHYT nm trong BHXH ), to c s php l cho BHXH ni chung, cho BHYT ni ring hot ng c hiu qu. Theo li ca ng Afsar Akal, mt trong nhng thnh vin ca chng trnh hp tc gia Vit Nam v t chc WHO mun thc hin c BHYT ton dn, Vit Nam phi c lut BHYT. Hin nay Vit Nam mi ch c Ngh nh v BHYT, nht thit phi xy dng c Lut BHYT, ng thi Lut hnh ngh cho cc c s KCB. Nu c lut ny th n s lm c s php l c bn tin ti BHYT ton dn, bi v ch c Lut BHYT th chnh quyn cc cp, cc ban ngnh c lin quan mi da vo iu chnh cc hot ng ca BHYT. Nh nc nn m rng quyn cho c quan BHXH trong vic nh ph cng nh phn loi cc i tng tham gia.
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Ngoi bin php v m ny Chnh ph cn c nhng bin php c th khc h tr, b sung cho lut. Hin nay BHYT HS - SV ang chu s chi phi chng cho ca nhiu vn bn php lut nn cc a phng gp kh khn trong vic thc hin. V vy gii php quan trng hng u i vi Nh nc l phi c lut v BHXH chi tit, r rng. Nh nc ta ang xy dng d tho lut BHXH v y l iu kin cn tin ti BHYT ton dn. Cn phi xy dng lut BHYT chi tit, bm st vo iu kin khc bit gia cc tnh, thnh ph p dng thng nht theo lut a ra trnh tnh trng cc tnh trnh vn bn ln BHXH Vit Nam xin kin ch o nh hin nay. Trc mt cn khn trng t chc thc hin nghim tc Thng t 77/2003 nhm tho g nhng kh khn vng mc v cho n nay trn c nc vn cha thc hin ng b theo Thng t ny. y l vn bn php lut mi nht iu chnh BHYT HS SV, mun thc hin c lut BHYT trong thi gian ti th phi thc hin tt cc lut hin ti. Th hai l Nh nc cn xc nh quyn li ca ngi tham gia bng gi dch v y t c bn do Chnh ph qui nh. Gi dch v ny phi m bo quyn li chung ti thiu m ai cng c th c hng, nu ai c iu kin v kinh t th tham gia thm vo cc t chc BHTM c chi tr nhiu hn. Lm nh vy va p ng c nhu cu chung ca ph huynh v hc sinh va pht trin c h thng BHTM gii quyt hi ho vn cnh tranh.
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Th ba l, Nh nc nn tng cng u t m rng v cng c mng li c s KCB. c bit l u t cho khu vc min ni, vng su, vng xa c ng dn c thuc din ngho v cn ngho nhm to iu kin cho h c bnh ng tip cn vi cc dch v KCB. Nh nc cn tng cng cng tc kim tra, kim sot cht lng dch v KCB ca cc c s KCB. Nh nc nn ku gi u t trong nc cng nh ngoi nc vo khu vc ny. C nhng chnh sch khuyn khch v vn, li sut, mt bng, c s h tng khi u t vo y. Th t l Nh nc to vic lm tng thu nhp cho ngi dn. y l bin php quan trng nht v thu nhp quc dn bnh qun u ngi l c s quan trng nht quyt nh s tham gia ca ngi dn. Thu nhp cao th ngi dn mi sn sng tham gia chng trnh BHYT cng nh cc loi hnh Bo him khc. Cha m hc sinh c thu nhp kh th h mi c iu kin chm lo cho con em mnh v sn sng tham gia BHYT cho cc em. Theo bc thang nhu cu ca con ngi th nhu cu v Bo him ng sau nhng nhu cu thit yu nh n, , mc, i li Vi thu nhp ca mnh ngi lao ng ln lt phn phi cho cc nhu cu thit yu y trc, nu thu nhp cn thp nh hin nay nc ta th cc nhu cu cn cha c p ng y th h cha th tch cc tham gia BHYT ngay. Hn th ch c b phn nh dn c l c thu nhp nhnh hn n phn nh ng t l tham gia BHYT ni chung v
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BHYT HS - SV ni ring nh hin nay. T l ngi lao ng c vic lm cn thp, trong khi t l ngi n bm cao th vic dnh mt phn thu nhp hng nm tham gia BHYT l cha th. tham gia BHYT cho ton b thnh vin trong gia nh l rt kh khn i vi h. Gii quyt vic lm l mt vn kh t ra i vi bt k mt Chnh ph no. gii quyt vic lm i hi phi thc hn nhiu bin php ng b km theo nh: gim tc tng dn s, thu ht u t nc ngoi, ci cch th tc u t, khuyn khch u t vo cc vng c kinh t kh khn, u i v thu, t ai Nh nc nn tip tc khuyn khch cc thnh phn kinh t pht trin c bit l thnh phn kinh t t nhn. To iu kin ngi dn t to vic lm cho mnh trn chnh qu hng mnh, Nh nc cho vay vn vi li sut thp v quan trng hn l trang b kin thc ngi dn s dng c hiu qu ngun vn y. iu kin kinh t l yu t nh hng kh quan trng n BHYT HS - SV bi l cc em cha lm ra tin h tr cho cha m trong khi cha m cc em cn phi chm lo rt nhiu th cho cc em. Th nm l vic Chnh ph nn nghin cu v mnh dn a i tng hc sinh sinh vin vo din bt buc. Theo kinh nghim cc nc t mc tiu BHYT ton dn th i tng no iu kin v thun li th a vo din bt buc. Nh phn trn ni, hc sinh sinh vin hc tp v sinh hot tp trung tng t nh i vi ngi lm cng n lng ( din
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BHYT bt buc) nn rt thun li cho cng tc qun l. Hn na mc ng BHYT ca hc sinh sinh vin so vi i tng bt buc l tng i thp nn nu a hc sinh vo din bt buc cng khng gy kh khn g ln cho cc bc cha m. Quan trng hn nu hc sinh l i tng bt buc th t mc ng thp ny s gy dng c qu ln, t % trn s thu li trng hc ln nn trng hc no cng c phng y t, c nhn vin y t. Nh nc cng cn u t v ku gi cc t chc quc t h tr cho chng trnh YTH xy dng y t trng hc vng mnh. Chm sc bo v sc kho l s nghip ca ton ng, ton dn. Nh nc vi vai tr l ngi iu hnh, lnh o, iu tit cc hot ng v m cn c nhiu bin php lin quan n nhiu lnh vc nhm y nhanh tin trnh thc hin BHYT HS - SV dn tin n BHYT ton dn. 2. i vi c quan Bo him x hi Vit Nam. Trc nm 2002, BHYT HS - SV l do Bo him Y t Vit Nam trc tip ch o. Ngy 24/ 01/2002 Th tng Chnh ph ban hnh Quyt nh s 20/2002/Q - TTg chuyn Bo him Y t Vit Nam sang h thng BHXH do BHYT l mt b phn ca BHXH. L c quan t chc v thc hin BHYT HS SV, c th ni Bo him x hi Vit Nam cn c nhiu gii php nht BHYT HS - SV gn lin vi mi hc sinh - sinh vin khi cn ngi trn gh nh trng.
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Vic lm u tin i vi Bo him x hi Vit Nam l vic nng cao nng lc qun l ca h thng BHYT. T khi chuyn sang h thng BHXH, vic thc hin BHYT cn nhiu vng mc. V i ng chuyn mn cn o to bi dng cho nhng cn b cha lm v BHYT bao gi theo chng trnh o to mi, o to li, o to nng cao v o to chuyn su. Trnh ca nhn vin khai thc cng l vn quan trng. Tuy khng c nh gi quan trng nh bn BHTM nhng nhng ngi lm cng tc tuyn truyn, hng dn lm th tc tham gia i vi nh trng, gii thch ch ca Nh nc khuyn khch mi ngi tham gia phi c nng lc chuyn mn, c trnh giao tip. C nh vy mi gii quyt c nhng kh khn cn tn ti ca BHYT ni chung v BHYT HS - SV ni ring. Bo him x hi Vit Nam cn nghin cu xy dng n trin khai BHYT HS SV, hp tc quc t hc hi kinh nghim ca cc nc. Bo him x hi Vit Nam cn nghin cu ng dng cng ngh thng tin vo vic qun l n gin ho quy trnh lm vic. Nn chng Bo him x hi Vit Nam cn c cc phn mm ring bit cho BHYT HS SV thng nht trn ton quc d dng cho vic qun l h s, cng tc thng k v truy cp tm ti thng tin. Th hai l vic y mnh ci cch th tc hnh chnh c bit l cng tc pht hnh th. Thng thng Bo him x hi Vit Nam hng dn cho cc c quan BHXH cp di khai thc v pht hnh th khong hai thng sau khi khai ging nm
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hc mi. Nh vy cc em c nhu cu tham gia sau khng c tham gia do ht t. Bo him x hi Vit Nam khng nn a ra mt khong thi gian nht nh nh vy m nn c b phn sn sng p ng nhu cu cho cc em v d nh phng ti chnh k ton ca nh trng. Phng ny c nhim v b sung cc em tham gia sau khi t pht hnh ht. Th ba l, nghin cu cng vi B Ti chnh, B Y t iu chnh mc ph cho ph hp, va m bo cho cng tc chi tr va m bo c s ng hc sinh u c th tham gia. y l mt vn kh bi l nc ta vn ang p dng mc ng cch y nhiu nm m thc t chi ph y t thay i thng xuyn nhng tm l ngi dn vn kh tip nhn s thay i. Mc ph l vn ln nht trong vic thc hin v hin nay mc ng hin ti khng p ng c cc nhu cu chi tr gy kh khn cho Bo him x hi Vit Nam. Tng ph s d dn n vic gim i tng tham gia nhng nu vn gi nguyn th tnh trng bi chi l khng trnh khi v nh vy BHYT HS - SV s tht bi. Khi mua mt loi hng ho ngi ta thng cn nhc mua hay khng l gi c cho d cht lng ca n nh th no. Tm l ngi dn l a gi r nhng i hi cht lng cng phi kh. V vy Bo him x hi Vit Nam nn a ra mc ng ring cho cc tnh, thnh ph ln nh H Ni, Thnh ph H Ch Minh Bo him x hi Vit Nam nn kin ngh vi Nh nc h tr mt phn ph cho khu vc nng thn, vng su, vng xa
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Th t l, cng tc thng tin tuyn truyn cn c ch trng c bit trong tnh hnh hin nay khi kin thc ca ngi dn v bo him cn hn ch. Hin nay Bo him x hi Vit Nam thng tuyn truyn v BHYT ni chung trn cc phng tin thng tin i chng nh: truyn hnh, tp ch, bo, p phch m t c chng trnh qung co ring cho BHYT HS SV, c chng ch l tranh c ng trn tp ch ca BHXH. Bo him x hi Vit Nam nn a dng ho cc knh truyn thng ring cho BHYT HS SV. C th l: - Tuyn truyn qua trng hc. C th ni y l mi trng thun li nht tuyn truyn BHYT HS SV ti hc sinh sinh vin. Bo him x hi Vit Nam nn c quan h tt vi cc trng hc h thng xuyn ch quan tm ti vn BHYT cho i tng ny. Hng ngy cc em dnh phn ln thi gian ca mnh hc tp v sinh hot ti trng nn lm tt cng tc thng tin tuyn truyn trng hc th bn thn cc em s nng cao nhn thc ca mnh v BHYT . Nu lm c nh vy th khng nhng cc em s tham gia tch cc hn m cn rn luyn cho cc em thi quen tham gia bo him, hnh thnh nhn cch tt p l lnh m l rch, bit chia s ri ro vi ngi khc. Tham kho kinh nghim cc nc c t l ngi tham gia BHYT ng ta thy cc tng lp dn c u c thi quen mua bo him nh phng v cho chnh mnh, h coi nh l mt khon chi tiu thit yu hng ngy nh n, mc. Thi quen tt p khng phi mt chc mt lt h
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c thi quen m phi tri qua mt thi gian hnh thnh rt di, t th h ny qua th h khc. Chnh v vy lm cho th h tr hiu bit v BHYT khng ch c ngha hin ti m cn hnh thnh cho cc th h ngi dn Vit Nam c thc hn trong vic tham gia. Ti trng hc Bo him x hi Vit Nam nn chng c cc cch tuyn truyn sau: + tuyn truyn qua hi ph huynh. Ph huynh hc sinh l ngi mang tnh cht quyt nh cho con em mnh tham gia BHYT HS - SV hay khng, c bit i vi cc em hc sinh cp hc di. cp tiu hc v THCS cc em hu nh khng hiu c tc dng v ngha ca BHYT nn cha m l ngi thay cc em quyt nh vic c tham gia hay khng. Hng nm Bo him x hi Vit Nam nn c vn bn hng dn, ch o cc c quan BHXH trc thuc cho ngi xung tn trng hc ph bin v tuyn truyn ti ph huynh hc sinh v chnh sch BHYT vo bui hp ph huynh u nm. C th kt hp cng cc thy c gio ch nhim hoc tp hun cho chnh cc thy c gio ny phi hp thc hin. BHXH cp c s cn c mi quan h tt vi cc trng nh trng dnh thi gian nhiu hn trong bui hp ph huynh tuyn truyn v BHYT cho hc sinh. Trong bui hp nhn vin bo him c th gii thch thc mc v BHYT, hng dn th tc v c bit coi trng vic tuyn truyn v ngha, tc dng ca BHYT HS - SV chm
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sc sc kho cho con em h, gip h khc phc kh khn v kinh t. i vi cc cp hc khc tuy cc em c nhn thc v BHYT hn nhng cng khng nn l l vic tuyn truyn ti cha m cc em. + tuyn truyn trc tip ti cc em. Cch lm ny nn p dng i vi cp hc t THCS tr ln v cc em c tm hiu bit nht nh. Mc ch ca vic tuyn truyn l cho cc em thy tc dng ca BHYT. C th tuyn truyn qua i pht thanh ca trng, qua bui cho c u tun, qua on thanh nin, t ri, , cng tc ny khng ch dng li u nm hc m cn phi lm thng xuyn trong sut nm v n cn c tc dng n c nhng nm sau. C th ngay ti nm hc cc em cha tham gia nhng do kin thc v BHYT c b sung nn cc em mi hiu ht c ngha ca n cc nm sau cc em tch cc tham gia. Qua bui tuyn truyn ny nn a ra cc v d thc t nh: vic chi tr chi ph KCB cho em hc sinh no trong trng, vic nng cao cht lng ca phng y t nh trng ( mi mua sm c trang thit b mi, chng trnh phc v ). Thng qua chng trnh hot ng ca on thanh nin, Hi sinh vin pht ng cc cuc thi tm hiu v li ch,tnh cng ng,tnh nhn vn ca vic tham gia BHYT ni chung v BHYT HS - SV ni ring , pht ng cuc thi sng tc tranh c ng, bi vn, th v BHYT, BHYT HS - SV.
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BHXH cp c s c th trch tin ti tr cho cc chng trnh ny t s tin li trng hc. - Tuyn truyn qua i truyn thanh, truyn hnh. y l cch tuyn truyn quen thuc v thng dng nht i vi mi sn phm m cc Cng ty quen dng qung co cho sn phm ca mnh. BHYT HS - SV cng l mt sn phm dch v nn khng c l g khng qung co qua knh truyn thng ny. Cc Cng ty Bo him thng mi v ang tn dng trit cch qung co ny gii thiu sn phm ca h n khch hng. i vi BHYT, c th thng qua knh tuyn truyn ny pht cc tin bi, phng s v nhng vic lm c nh: biu dng chng trnh YTH ca ni no , nh c BHYT HS SV m gia nh cc em mc bnh him ngho c iu kin cha bnh cho cc emV BHYT HS - SV l mt chnh sch ca Nh nc ta nn vic tuyn truyn qua i truyn hnh, i ting ni l ht sc thun li v chi ph b ra so vi cc Cng ty thng mi l nh hn. Chnh v vy cn tn dng trit knh truyn thng ny m hiu qu thu c li rt ln. Hin nay h thng loa truyn thanh ti cc x, phng rt phong ph v gn gi vi nhn dn. Hu ht cc x, phng ti cc tnh, thnh ph trong c nc u c h thng ny. Nu Bo him x hi Vit Nam thc hin vic tuyn truyn v BHYT ni chung v BHYT HS - SV ni ring trn knh ny s c hiu qu thit thc v thi lng pht sng nhiu hn v vic
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ng bi cng d dng hn. Thc t cho thy BHXH cha ch n ngun thng tin ph bin ny v vy trong nhng nm ti Ban Tuyn truyn ca Bo him x hi Vit Nam cn quan tm n knh thng tin ny hn. - Tuyn truyn qua knh thng tin khc. Ngoi cc knh tuyn truyn trn th c th tuyn truyn qua pa n, p phch ( cn t ti nhng ni thun li ngi c d nhn thy), qua tp ch chuyn bit nh tp ch BHXH, cc t bo khc nh bo a phng, bo Trung ng, cc tp ch khc Th nm l chm lo hn na n cng tc YTH. C quan Bo him x hi Vit Nam cn phi hp cht ch vi ngnh Gio dc - o to, ngnh Y t xy dng k hoch hng nm v vic hnh thnh YTH i vi cc trng cha t chc c phng y t trng hc. C k hoch t chc tp hun nghip v cho cn b YTH nhm nng cao kh nng chuyn mn cho i ng ny. Kim tra, gim st vic thc hin Thng t lin tch Y t Gio dc v o to s 03/2000/ TTLT BYT BDGT hng dn thc hin cng tc y t trng hc. Bo him x hi Vit Nam nn kin ngh vi Nh nc v vic bin ch v chc danh ca cn b YTH gip h yn tm cng tc v gn b vi vic lm ca mnh. T nm hc 2003 2004, s tin li nh trng cho cng tc y t trng hc c thc hin theo Thng t 77/2003. Nh vy phn kinh ph li cho nh trng l 18% s thu
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BHYT HS SV, t l li cho nh trng tuy gim nhng khng hon ton ng ngha vi vic gim gi tr kinh ph tng ng v mc ng gp ca hc sinh sinh vin tng so vi Thng t 40/1998. iu ny d gy hiu lm nn Bo him x hi Vit Nam cn c vn bn gii thch cho cc c quan BHXH trc thuc gii thch li vi trng hc. i vi cc trng xy dng c chng trnh YTH th s tin li nn giao trc tip cho trng sau khi quyt ton np ln c quan BHXH trc thuc ( c quan BHXH huyn) nh trng ch ng trong cng tc hot ng ca mnh. Cn i vi nhng trng cha c cn b y t cng nh cha xy dng c chng trnh YTH th c quan BHXH huyn c trch nhim phi hp vi cc trng hc k hp ng vi c s y t thun li v vic s dng kinh ph thc hin yu cu chm sc ban u cho hc sinh sinh vin. Th su l Bo him x hi Vit Nam cn kt hp cht ch vi cc c s KCB. Vng mc chung trong vic trin khai BHYT l vic ngi dn phn nn v cht lng KCB. Mt trong nhng l do ca vn cn tn ti trn l vic c quan BHXH v cc c s KCB cha phi hp cht ch vi nhau. BHXH ch l ni t chc thc hin vic thu ph ca ngi tham gia thay mt h chi tr chi ph y t cho h cn ngi cung cp dch v KCB li l cc c s y t. Chnh v vy cht lng phc v ca hai c quan ny khng my rng buc ln nhau. Do cha c quan h cht ch gia c quan BHYT vi c s
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KCB nn gy ra tnh trng hiu lm c quan BHYT ch bit thu tin. Bo him x hi Vit Nam cn kin ngh vi Nh nc v tiu chun la chn c s KCB cho bnh nhn c th BHYT . Cht lng phc v s l cn c ngi bnh nh gi v c s KCB . Nh nc, c quan BHXH ch l ngi iu hnh, qun l hot ng BHYT cn c s KCB l ni KCB cho ngi dn. Nn chng thit lp mi quan h rng buc gia c quan BHXH v c s KCB, c s KCB no c cht lng phc v ngi bnh tt hn th c c quan BHXH tip tc k hp ng vo nm sau v c chuyn giao mt phn tin chi tr chi ph y t ng trc ngay t u nm c s KCB c tin u t cho mnh. S tin ny c th tnh da trn chi ph m c quan BHXH tr nm cng vi phn trm d kin tng thm ca nm sau. Nu s lng ngi tham gia BHYT ng th s tin ny s rt ln nn cc c s c BHXH k hp ng s c tin m rng qui m, u t nng cp v mua mi trang thit b y t t nng cao uy tn cho c s mnh. iu ny c li cho c hai pha v cho ton x hi. 3.i vi B Y t. L c quan trc tip cung cp dch v y t cho hc sinh - sinh vin, B Y t cng cn phi hp vi c quan Bo him x hi Vit Nam gii quyt nhng kh khn cn ang tn ti. B Y t nn tham mu cho Bo him x hi Vit Nam v B Ti chnh v mc ng ca BHYT HS SV. Ch c B Y t
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mi nm r nht v chi ph y t i vi ngi bnh khi vo KCB. Bn cnh tham mu cho Bo him x hi Vit Nam c gi dch v y t c bn m hc sinh c hng tng ng vi mc ph lm sao tho mn nhu cu ca cha m hc sinh ng thi chi ph trang tri khi hc sinh c hng quyn li . B Y t nn qun l gi thuc bn trn th trng cht hn na v thc t trong thi gian qua gi thuc b tri ni gy kh khn khng ch cho bnh nhn m cn lm cho vic cn i qu BHYT gp tr ngi. B Y t cn c nhng bin php tch cc nh ng k gi thuc bn ti cc ca hng, tp trung u t sn xut thuc ni. Nghin cu v s dng thuc ni thay cho thuc ngoi v thuc ni c cht lng kh tt m gi thnh li r, t lm gim chi ph KCB. B Y t cn c cc bui hi ngh nhm cng c v nng cao y c ngi thy thuc, lm gim dn n xo b t nn i x khng bng gia bnh nhn tr vin ph v bnh nhn KCB bng th BHYT . Xy dng cc chng trnh v bnh vin vn minh, nhn vin y t nhit tnh, thi tip n nim n c kim im, tng kt hng nm cng tc phc v bnh nhn ti cc c s y t. Ch o thc hin, ku gi u t, bn vi Nh nc vic nng cao cht lng KCB v m rng mng li KCB n tng a gii hnh chnh nh nht. C s KCB a phng cn phi hp cht ch vi nh trng trong vic thu i ng y, bc s thc hin cng tc YTH sao cho t hiu qu cao nht.
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4.i vi nh trng. Nh trng chnh l c s chm sc sc kho ban u cho hc sinh - sinh vin. Cng tc YTH c thc hin tt th vic trin khai BHYT HS - SV mi thun li. Ban gim hiu nh trng cn t chc thc hin s dng phn kinh ph trch li c hiu qu thc s c ch cho cc em, cn quan tm n c s h tng, phng hc, gc y t ph hp vi iu kin ca tng trng, tu thuc la tui v s lng hc sinh sinh vin. Trang thit b v s thuc phc v chm sc sc kho ban u cng cn c b sung thng xuyn. Mt s trng vng su, vng xa, t l tham gia t cng cn phi c mt s trang thit b c bn nh: cn sc kho, thuc thng dng, dng c y t nh bng bng, kp Nh trng nn phi hp vi c s y t gn nht chuyn cc em ln tuyn trn trong trng hp vt qu kh nng iu tr ca cn b y t hc trng hc. Kin ngh vi BHXH c s, vi chnh quyn a phng v vic bin ch cho cn b y t trng hc v cch gi cn b c chuyn mn li trng lu di. Nh trng nn hng cho hc sinh - sinh vin tham gia BHYT trc khi tham gia BHTM v mc tiu ca ng v Nh nc t ra l an sinh x hi, m bo quyn li ti thiu ca mi cng dn v v chnh mc tiu tin ti BHYT ton dn. Nu gia nh no c iu kin th tham gia BHTM cho ph hp vi kh nng kinh t ca mnh.
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5.i vi chnh quyn cc cp UBND cc tnh, thnh ph cn c s ch o st sao cc ngnh, cc cp quan tm n BHYT HS - SV c s phi hp ng b v hiu qu. BHYT HS - SV mun thc hin thnh cng khng ch t c vi s c gng ca c nhn c quan no m l s phi hp cht ch, nhp nhng ca tt c cc c quan c lin quan. y mnh s tham gia ca cc c quan thng tn, bo ch vo vic tuyn truyn chnh sch BHYT HS SV. ng h nh trng, c quan BHXH trong vic tng s lng hc sinh tham gia, hng nm trc mi k hc cn c cng vn n c, hng dn thc hin xung cc trng t c kt qu m c quan BHXH giao. Trn y l mt s kin ngh c th ca em i vi tng b phn c lin quan n BHYT HS SV. Em hy vng nhng xut ny c ngha trong vic pht trin BHYT HS SV.
Phn kt lun
Sau 10 nm thc hin, c s quan tm ch o ca cc cp lnh o ng, Nh nc, ca cc B, Ban, Ngnh hu quan v ca UBND cc cp, s phi hp ca S Y t cc tnh, thnh ph, cc c s KCB, cc t chc on th, cc c
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quan truyn thng t Trung ng n a phng v s c gng ca cc cn b nhn vin trong ngnh BHXH, vic thc hin chnh sch BHYT HS - SV t c nhng kt qu quan trng, ng khch l to c s cho s pht trin v m rng BHYT HS - SV tin ti BHYT ton dn trong nhng nm ti. S lng hc sinh sinh vin tham gia lin tc tng, quyn li ca hc sinh tham gia BHYT c m bo v ngy cng m rng. Qu BHYT HS - SV lun n nh m bo chi tr cho vic chm sc sc kho cho hc sinh. Gim dn s bao cp ca Nh nc chuyn sang hnh thc Nh nc v nhn dn cng chi tr. Ngun thu t BHYT HS - SV h tr mt phn chi ph cho cc c s KCB, c bit l YTH to iu kin cho vic cng c v nng cao cht lng dch v. thc hin thng li BHYT HS - SV ni chung tng bc tin ti BHYT ton dn th cc cp cc ngnh phi chun b cho mnh cc gii php thit thc y nhanh s pht trin ca BHYT HS SV. Trn y em a ra mt s gii php c th cho tng c quan c lin quan nhm tng bc chm lo sc kho ton din cho hc sinh. Em tin tng rng vi s quan tm, gip nhit tnh ca cc c quan hu quan cng vi s n lc ca h thng BHXH v c s KCB th cng tc BHYT HS - SV ni ring v BHYT ni chung ngy cng pht trin sm thc hin thnh cng ngh quyt Trung ng l tin ti BHYT ton dn.
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Mc lc
Li m u................................................................1 I. S cn thit khch quan ca BHYT i vi hc sinh sinh vin.................................................................3 1. S cn thit phi trin khai BHYT HS SV. ..........3 II. Ni dung c bn ca BHYT...................................9 1. Ni dung c bn ca BHYT trn th gii. ..............9 1.1. i tng tham gia BHYT...................................9 1.2.Phm vi BHYT................................................10 1.3. Phng thc BHYT. ......................................10 1.4. ph BHYT ....................................................12 1.5. qu BHYT. ..................................................12 2. Ni dung c bn ca BHYT Vit Nam. .............13 2.1.i tng tham gia...........................................13 2.2. Phm vi BHYT .............................................15 2.3.Phng thc BHYT .........................................16 2.4. Ph BHYT ....................................................18 2.5.Qun l v s dng qu BHYT ......................18 2.5.1. Ngun hnh thnh qu BHYT . ...............18 2.5.2. Qun l v s dng qu BHYT..................19 2.6.Quyn v trch nhim ca cc bn tham gia BHYT ..............................................................20 2.6.1. i vi ngi tham gia BHYT .....................20 2.6.2. i vi c quan, n v v ngi s dng lao ng ..............................................................21 2.6.3.i vi c quan BHYT. .........................22 2.6.4. i vi c s KCB.....................................23 2.7. T chc, qun l BHYT.................................24 III . Ni dung c bn ca BHYT HS - SV Vit Nam. .............................................................................25 1.i tng tham gia.................................................25 2. Phm vi ca BHYT HS-SV....................................26 3. Ph v qu BHYT HS-SV ....................................28 3.1. Ph BHYT HS-SV ..........................................28 3.2 Qu BHYT HS-SV ..........................................29
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4. Quyn li v trch nhim ca cc bn tham gia BHYT HS-SV ..........................................................31 4.1. i vi hc sinh - sinh vin.............................31 4.2. i vi nh trng...........................................35 4.3. i vi cc c s khm cha bnh...................35 4.4. i vi c quan BHXH....................................36 5. In n v pht hnh th........................................38 6. T chc thc hin.............................................38 7. Mi quan h gia BHYT HS-SV v YTH ..............39 7.1. BHYT HS-SV tc ng n YTH ..................40 7.2. YTH tc ng n BHYT HS-SV ..................41 III. So snh BHYT HS - SV ca BHXH Vit Nam vi bo him hc sinh ca cc Cng ty Bo him thng mi.42 1.Ging nhau.........................................................42 2. Khc nhau..........................................................43 I. Cc qui nh php l v BHYT HS SV.................46 II. Cc yu t nh hng n nhu cu v kh nng tham gia BHYT HS-SV ............................................49 1. Nhu cu BHYT HS-SV .........................................49 2. Cc nhn t nh hng n kh nng tham gia BHYT HS-SV ..........................................................51 2.1 Kh nng ti chnh.......................................51 2.2. Kh nng tip cn cc dch v y t...............52 2.3. Dn s........................................................53 II. Thc t thc hin BHYT HS-SV ti bo him x hi vit nam trong giai on 1998 2004....................54 1.Thun li v kh khn trong vic thc hin. ........54 1.1.Thun li.......................................................54 1.2.Kh khn.......................................................57 2. Tnh hnh hc sinh - sinh vin tham gia BHYT. . 60 3. Tnh hnh thu, chi Qu BHYT HS-SV qua cc nm. .............................................................................66 3.1. Tnh hnh thu BHYT HS SV........................66 3.2. Tnh hnh chi BHYT HS SV........................71 III. nh gi kt qu v hiu qu hot ng BHYT HS SV ti BHXH Vit Nam............................................77 I.Quan im nh hng ca ng v Nh nc ta trong vic t chc thc hin BHYT HS - SV t nay n 2010.....................................................................86 109 L Thu Dung Bo him 43A
1. Quan im nh hng ca ng v Nh nc .......86 2.Phng hng chung v d kin k hoch t nay n 2010.....................................................................88 II. Mt s kin ngh i vi cc bn c lin quan.. . . .90 1.i vi Nh nc.....................................................90 2. i vi c quan Bo him x hi Vit Nam............94 3.i vi B Y t...................................................103 4.i vi nh trng................................................105 5.i vi chnh quyn cc cp...............................106 Phn kt lun........................................................106
110
Ti liu tham kho
1. 2. 3. 4. 5. 6. 7.
Gio trnh Kinh t bo him PGS. TS. H S S ch bin - Nh xut bn Thng K - 2000. Gio trnh Kinh t bo him TS. Nguyn Vn nh ch bin Nh xut bn Thng K - 2004. Gio trnh Thng K bo him - PGS. TS. H S S ch bin - Nh xut bn Thng K - 2000. Tp ch Bo him Y t Vit Nam t nm 2001 n nm 2002. Tp ch Bo him x hi t nm 2003 n nm 2005. Thng t lin tch s 40/1998/TTLT BGD T BYT ngy 19/8/1998 v BHYT HS - SV Ngh nh 58/CP ngy 13/8/1998 ban hnh km theo iu l BHYT
111
8.
Thng t lin tch s 03/2000/TTLT - BYT BGD T ngy 01/03/2000 hng dn thc hin cng tc y t trng hc.
9. 10. 11.
Thng t lin tch s 77/2003/TTLT BTC BYT ngy 07/8/2003 hng dn thc hin BHYT t nguyn. Chin lc pht trin th trng bo him Vit Nam t nm 2003 n nm 2010 ca B Ti chnh. Cc bo co tng kt nghip v BHYT HS - SV t nm 1998 n nm 2004 ca Ban T nguyn Bo him x hi Vit Nam.
12.
Nin gim thng k t nm 2001 n nm 2004.
112

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nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

Chng i C s l lun ca BHYT HS - SV

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

nhn cch v li sng nhn i. Tham gia BHYT

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

- yu cu c quan BHYT nh ca iu l BHYT

bo m quyn li theo qui

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

i tng 1. Cc trng tiu hc, THCS, THPT 2. Cc trng H, THCN, dy ngh

(Ngun: Phng Khai thc BHXH VN)

L Thu Dung Bo him 43A

nh gi thc trng trin khai BHYT HS - SV ti c quan BHXH Vit Nam

L Thu Dung Bo him 43A