Cac nhan to anh hu'dng den
Y djnh tham gia BHYT ho gia dinh tren dja ban thj xa Long My,
tinh Hau Giane
• * - ' BUI VAN TRINH' D 6 TH! THANH TGYEN"
Tom tat
Nghien cffu nham kiim dinh cdc nhdn td'dnh hudng de'n Y dinh tham gia bdo hiim y ti (BHYT) hg gia dinh trin dia bdn thi xd Long My, tinh Hdu Giang. Ki't qud phdn tich cho thdy. 6 nhdn td. gdm: Tuyin truyen; Thu nhdp; Sff hieu biet ve BHYT; Thdi do ve BHYT; Su quan tdm de'n sffc khoe; Ky vgng cua gia dinh co dnh hudng de'n y dinh tiiam gia BHYT hd gia dinh trin dia bdn thi xd Long My. tinh Hdu Giang.
Ttf khoa: bdo hiem y ti'. nhdn tddnh hudng, hg gia dinh. y dinh tham gia Summary
This study aims to assess determinants of the intention to participate in household health insurance in Long My town, Hau Giang province. The result identifies six influential factors, which are Propaganda; Income; Understanding of health insurance; Attitudes about health insurance; Attention to health; Family's expectation.
Keywords: health insurance, determinants, household, participation intention Giai THIEU
BHYT la ehinh sach quan trpng h^ng dau trong h6 tho'ng an sinh xa hoi cua quoc gia, mang y nghia nhan dao va cd tinh chia se cong dong sau s5c. Khong chi vay, BHYT con htfdng tdi ta't ca cac dd'i ttfdng khac la cd nhan trong xa hgi nham muc dieh ho trd trong cham soc stfc khoe tr6n nguydn tae "lay so'dong bu so' it". Van d l y t6' - stfc khoe lien quan de'n ta't ca cac ca nhan, la mdt vS'n de ma bat ky quo'c gia, dan lpc nao cung dat \tn vi tri hang ddu.
XuS't phat ttf nh§n thtfc v l tam quan trgng va y nghia to Idn cua chinh saeh BHYT, nhom tac gia thtfc hien nghien ctfu "Cdc nhdn to dnh hudng din y dinh tham gia BHYT hg gia dinh tren dia bdn thi xd Long My, llnh Hgu Giang ".
CO sd LY THUYET VA PHL/aNG PHAP NGHIEN CL/U
Cd sd ly thuy§'t va md hinh nghian ci}u Mathiyazhagan (1998) cho rang, hau het ngtfdi dan dac biet quan tam den stfc khde, sfn sang tham gia va tra tiln cho cac chtfdng trinh BHYT nong thon. Tuy
nhien, kha nang sl^n skng tham gia dtfdc tim tha'y la Idn hdn kha nang san sSng chi trd. Nhan to quan trpng quyet dinh stf san sang tham gia va tra tiln cho chtfdng trinh bao hiem la c5c nhan to kinh te, xa hoi va kha nang tilp eSn cdc dich vu y t l chatItfdng.
Theo Chu Thi Kim Loan va Nguyen Hong Ban (2013), sd' Itfdng ngtfdi tham gia BHYT ttf nguy6n cd xu htfdng tang len, nhtfng vin chiem mpt ty le khiem ton trong tong so' ngtfdi tham gia BHYT.
Ty le ngtfdi dan suT dung the BHYT khi di kham chffa benh \k khd cao. Song, ngtfdi dan vin gap nhffng philn ha khi khdm chifa benh b^ng the BHYT, dac bi6l li hien itfdng phai chd ddi lau, nhan viSn y te chtfa nhidt linh.
Nghien ctfu ciia Vu Ngpc Huyen vi Nguyln Van Song (2014) cho biet, s i nong dan tham gia BHYT lien tuc tSng trong nhtfng niim gan day. nhtfng vdi td'c do cham. Theo dd, hau hli nong dan (chiem 92,18%) cho ring, day m chinh
* PGS, TS., Trtfdng Dai hpc C i n Thd
" Bao hiem xa h6i thi xa Long My, Hau Giang
Ngdy nhdn bd,: 30/5/2020: Ngdy phdn bi^n: 18/6^020: Ngdy duy^t ddng. 24/6/2020
68
sdch rat cin thiet vdi hp. Mac du vay, ty le nong d3n khong cd nhu cau tham gia edn khd cao (dao ddng ttf 7%-31%) vi nhilu ly do.
Cdn theo Hoang Thu Thuy v& Bui Hoang Minh Thtf (2018), 5 nhan to', gom:
Thai do do'i vdi vide tham gia bao hilm xa hdi ttf nguyen; Cam nhan rui ro; Thu tuc tham gia bao hilm xa hpi ttf nguyen;
Trach nhidm dao ly; Hieu bill ve chinh saeh anh htfdng de'n Y dinh tham gia bao hilm xa hdi ttf nguydn ciia ndng dSn tai tinh Phu Ydn.
Xua't phat ttf cac cd sd ly thuye't tren, tdc gia hinh th^nh mo hlnb nghien cu\i bao gora cdc nhSn to anh htfdng den Y dinh tham gia BHYT hg gia dinh tren dia ban thi xa Long My, tinh HSu Giang nhtf Hinh.
Mpt so gia thuye't dtfa ra la:
Gid thuyi't H-. Thai dp ve BHYT cd
^nh htfdng cung chieu (+) de'n Y dinh tham gia BHYT hp gia dinh.
Gid thuyet H^: Ky vpng cua gia dinh cd anh htfdng ciing chilu (-I-) de'n Y dmh tham gia BHYT ho gia dinh.
Gid thuye't H^: Ckm nhSn rui ro tff benh tat cd dnh htfdng cffng chilu (+) din Y dinh iham gia BHYT hd gia dinh.
Gid thuyi't H^. Stf quan tam sffc khoe dnh hrfdng ciing chilu (+) de^n Y dinh tham gia BHYT h6 gia dinh.
Gid thuyi't H^: Stf hilu bie't ve BHYT cd anh htfdng cung chilu (+) den stf Y dinh tham gia BHYT hd gia dinh.
Gid thuyet H^: Tuyen truyin cd dnh htfdng ciing ehieu (+) din Y dinh tham gia BHYT h6 gia dinh.
Gid thuyet H7: Thu nhap cd anh htfdng ciing chilu (+) dd'n y dinh tham gia BHYT hd gia dinh.
PhtAAig phap nghidn cihi D l cd dff lidu nghien ctfu nhdm tac gia da khao sal 270 dai dien hp gia dinh chtfa thara gia BHYT tai phtfdng Vinh Ttfdng, phtfdng Trd Long va xa Long Phii tren dia ban thi xa Long My, tinh Hau Giang.
Ket qua khao sat thu v l 262 phieu hdp Id.
Thdi gian thtfc hidn khSo sdt la dixx nam 2020. Sd' mau hdp Id dtfdc tiln hdnh xff ly va phan tich vdi phan mim SPSS 23.0.
KET QUA NGHIEN CLfU VA THAO LUAN
Kilm dinh d$ tin c^y thang do b^ng Cronbach's Alpha
Ke't qu^ kilm dinh Cronbach's Alpha (Bang 1) cho thay, bie'n CNl hi loai do
HIMH: MO HJNH NGHIEN CCfU D I XOAT
BANG 1: KET QUA DANH GlA THANG DO BANG CRONBACH'S ALPHA Bifn
quan sdt
Trung binh tbang do nS'u loai bid'n
PbiftAig sai tiiang ilon^u loai bid'n
Ttfdng quan hiS'n
tiing
Cronbach's Alpha ndu Thai 1« v^ BHYT He s6'Cronhach's Alnha = O.KSr, TDI
TD2 TD3 TD4 TD5
14,66 14.64 14,67 14.69 14.70
5.942 5.741 5.670 5.848 6,357
0.686 0.673 0.706 0.669 0.620
0.822 0.8^5 O.S 16 0.826 0.839 Kv vonc ciia aia dinh He s6' Cronbach's Aioha = 0.879 KV!
KV2 KV3 KV4
10.94 11.02 10.86 10.96
4.505 4.379 4.349 4.247
0,731 0.748 0.761 0.718
0.849 0.842 0.837 0.855 Cam nhan riii ro H€ s6' Cronhach's Aloha = 0,807 CNl
CN2 CN3 CN4
11.20 11.45 11.25 11,17
7.501 6.401 6.174 5.928
0.414 0.839 0.631 0,667
0.851 0.673 0.754 0,736 Sir quan tSm den sifc khoe He sd' Cronhach's Alpha = 0,853 OTl
0T2 0T3 0T4 0T5
14.35 14.38 14.33 14.43 14,48
5.208 5.217 5.041 5.066 5.193
0,658 0,679 0,675 0,719 0,602
0.825 0.820 0.821 0.809 0,840 Sif hie'u bie't v^ BHYT He so Cronbach's Alpha = 0,825 HBl
H B : ' HB3 HB4
10.96 11.02 11.03 11.09
3.588 3.889 3.704 3.754
0,657 0,636 0,663 0,646
0.777 0.787 0.774 0,782 Tuydn truven Ha s6'Cronbach's Alpha = 0,744 TTI
TT2 TT3 TT4
10,49 10,74 10.55 10.53
2.849 3.099 2.853 3.307
0,573 0,552 0,588 0,442
0,665 0,678 0,656 0,736 Thu nhap He so Cronbach's Alpha = 0,829 TNI
TN2 TN3 TN4
10.35 10.37 10.33 10.45
3.295 3.391 3.456 3.452
0,645 0,666 0,665 0,650
0,791 0,780 0,781 0,787 Y dinh tham eia BHVT Hd sd'Cronbach's Alpha = 0,889 YDI
YD2 YD3 YD4
10.69 10.69 10.68 10,72
3.296 3.358 3.730 3.813
0,836 0,806 0,682 0,706
0,825 0,837 0,884 0,875
Economy and Forecast Review
69
BANG 2: KET QUA KIEM D[NH KMO VA BARTLETT BIEN DQC LAP KMO and Bartlett's Test
Kiem dinh Kaiser-Meyer-Olkin (KMO)
Kiem dinh Bartlett's
He so Chi binh phirong D6 tir do Mu'c y nghia (Sig.)
0,822 3412,824 406 0,000
BANG 3: KET QUA KIEM DINH KMO VA BARTLETT BIEN PHq THGpC Kiem dmh Kaiser-Meyer-Olkin (KMO)
Kiem dinh Bartlett's
He so Chi binh phiTcfng Do tir do MiJc y nghia (Sig.)
0,720 811,540 6 0.000
BANG 4: CHJ TIEG DANH GlA DO PHCI H^P CGA MO HINH Mdhinh
1 a Bien doc lap;
(Hang s6') TN, CN, TD, KV, HB, QT, TT b. Bi6'n phu thudc: YD
B 9,751-
R^
0.564 R*
hifu chinh 0.552
SaisfiT tfdc Itf^ig
0.41258 msfS Durbin-Watson
1,899
BANG 5: KET QOA PHAN TJCH HOI QUY BQI
1 Hang so TD KV CN QT HB TT TN
Hf s8'chifa chuin h6a B -1,004
0,180 0,107 0,045 0,166 0,173 0,367 0,238
Sai s6'chuS'n 0,267 0,047 0,039 0.029 0,051 0,045 0.052 0.047
Hf stf chuin hoa
Beta
0,172 0.119 0.066 0,150 0.175 0.331 0,231
t
-3.754 3.821 2.716 1.555 3.246 3.852 7.046 3.016
Miic y nghTa
0,000 0,000 0,007 0.121 0,001 0,000 0,000 0,000
Thtfngke c$ng tuyf'n Tolerance
0..822 0.900 0,808 0.835 0,794 0.819
VIF
1,217 1.111 1,237 1,197 1,260 1,220
Bie'n phu thupc: YD
CO he so tddng quan bien tdng la 0.414 > 0,3; gia tri Cronbach's Alpha if Hem Deleted cua CNl la 0,851 >
0,807 (Gia tri Cronbach's Alpha long the), cac bien con lai di/oc diTa vao phan tich nhan to kham pha (EFA).
PhSn tich EFA Ddi vdi bie'n doc lap
Ket qua Bang 2 cho thay, chi so KMO la 0.822 > 0,5 thoa man yeu ciu va kiem dinh Bartlett's la 3 412,824 vdi mu-c y nghTa Sig. = 0,000 < 0.05, nen cac bien quan sat c6 tiTdng quan vdi nhau trong tong the. Vi
vdy, phan tich nhan to trong tru'dng hdp nay la phu hdp.
Ddi vdi bii'n phu thuge
Ket qua Bang 3 cho thay, KMO = 0,720 (> 0,5); phUdng sai dich 1^ 75,037%
> 50%; Gid tri Sig. kiem dinh Bartlett la 0,000. Vl vSy, CO the khIng dmh rang, c^c miJc y nghia va phifdng sai dUdc dam bao cho budc phan tich hoi quy ke tiep.
Ke't qua phSn tfch hoi quy Ket qua phan tich Bang 4 cho thay, gia tri he so R- hieu chinh bang 0.552, c6 nghia la mo hinh hoi quy giai thich dugc 55,2% sd bien thidn cua sU hai long cua khach hang. Con lai 44,8% la do cdc bia'n ngoai mo hinh va sai so ngiu nhien. He so Durbin-Watson la 1,899, nkm d'ong khoang 1,5 den 2.5, nen khong co hien tUdng tUdng quan chuoi bac nhS't xay ra.
Ket qua Bang 5 cho tha'y, Sig. kiem djnh I he so hoi quy cua cac bie'n dpc lap c6 6 nhan to', gom: TD (Thai dp ve BHYT); KV (Ky vpng cua gia dinh); QT (Sir quan tam den siJc khoe); HB (SU hieu biet); TT (Tuyen truyen); TN (Thu nhSp) cho gia tri Sig. < 0,05, chiing td cac bien dpc lap nay deu tu'dng quan cd y nghTa thd'ng ke vdi bien phu thudc YD (Y dmh tham gia BHYT) d mUc y nghia 5%, con bien CN cd Sig. > 0,05, nen se du'dc loai ra khoi mo hinh.
Ke't qua hoi quy bpi sau khi loai bien CN cho thay, Sig. kiem dinh t he so hoi quy cua cac bie'n dpc TT; TN; HB; TD;
QT va KV deu nho hdn 0,05, chiing td cac bie'n dpc lap nay deu tu'dng quan c6 y nghTa thong ke vdi bie'n phu thupc YD (Y dinh tham gia BHYT) d mu'c y nghTa 5%, nen khong cd bie'n nao bi loai khdi mo hinh.
He so' phdng dai phUdng sai (VIF) deu nho hdn 2, do vdy khong c6 hien tifdng da cpng tuye'n xay ra.
Ket qua cung cho tha'y, cdc he sd'h6i quy deu ldn hdn 0. NhU vay, ta't ca cdc bie'n dpc lap (TD, KV, QT, HB, TT, TN) dUa vao phan tich hoi quy deu tac dong ciang chieu tdi bien phu thupc (YD). DUa vao do ldn cua he so hoi quy chuan hda Beta, thU tif mUc dp tac dpng tif manh nhat tdi yeu nhat cua cac bien dpc lap tdi bien phu thupc YD \h:
TT(0.33l} > TN(0.231) > HB(0.175)
> TD(0.172) > QT(0.150) > KV(0.l}9) Hay
Y dinh tham gia BHYT hg gia dinh
= 0.33l*TT + 0.231*T\ + 0.!75*HB + 0.!72*TD + 0,150*QT+0,I19*KV
70
KET LUAN VA HAM Y QUAN TRj Kg't mn
Ke't qud nghien ciJu cho thay, cd 6 nhan td' anh hUdng de'n y dinh tham gia BHYT hd gia dmh tai Bao hiem Xa hpi thi xa Long My, tinh Hau Giang, dUdc s^p x^p theo thiJ tu giam dan, gom:
Tuydn truyen; Thu nhap; Su hieu biet;
Thdi dd ve BHYT; Su quan tSm de'n sUc khde; KJ' vpng.
M$ts6'dlxu3't
Tren cd sd ke't qua nghien ciJu, nhdm tdc gia d l xuS't mpt sd khuyen nghi nham gia tang f dinh tham gia BHYT hp gia dinh tren dia ban thi xa Long My, tinh Hau Giang nhU sau:
Ve Tuyen truyen: Tid'p tuc v^ tang cUdng tuydn truyen thdng tin ve BHYT ho gia dinh tren he thd'ng bdo, loa phat thanh d to, thdn, xdm; dai phat thanh vd truyen hmh dia phUdng de nhieu ngUdi dan bie't dd'n BHYT ho gia dinh nhieu hdn, phd'i hpp vdi chinh quyen dja phUdng tuyen truyen ve BHYT hd gia dinh de'n ngUdi dan thdng qua nhieu hinh thitc nhU cac budi hpp hoi, doan the.
Ve Thu nhdp: Nha nudc ndn cd nhihig chinh sdch tang cUdng hd trp de ngUdi dSn, dac biet la nhffng hp gia dinh lam ndng, ISm, ngU nghidp cd thu nhap thap, khdng d'n dinh tham gia BHYT hd gia dinh. Do dd, trong pham vi cua mmh, nganh BHXH can thie't ke nhffng gdi hoac trien khai cdc mffc ddng, phUdng thffc ddng BHYT Iinh boat, da dang phu hdp vdi tifng nhdm dd'i tffdng khdc nhau.
Tuy nhidn, dd' lam dffdc dilu nay, can cd du ngudn nhdn life va nhifng chinh sdch ho dd khdc tff Nhd nUdc.
S^ hieu biet ve BHYT: Nganh bao hiem xa hdi ndn phd bid'n rdng rai de' ngffdi dan hieu rd ve quyen Idi cua viec tham gia BHYT hp gia dinh dd'i vdi hg va nhifng quy dinh ve mffc ddng BHYT hd gia dinh, nen cdng bd' day dii ndi dung, quy trinh thu tuc va quyen ldi tren website dd ngUdi ddn de ndm bdt. Cd the phdt trien he tho'ng dpi ngu nhan vidn tid'p can ngUdi dan de tuyen truyen phd bid'n kie'n thffc ve BHYT ho gia dinh.
Thai dg ve BHYT: Nganh bao hid'm xa hpi ndn thid't ke' nhidu dang lpi ich cho ngudi thu hudng phu hdp vdi nhu cau ciia nhieu dd'i tUdng khdc nhau va cdng khai rd rang dd'n ngUdi dan. NhiJng chinh sdch ve BHYT cua Nha nUdc can dupc thUc thi nghiem tuc, rd rang.
Ddng thdi, can nang cao dich vu khdm chffa bdnh tai cd sd khdm chifa bdnh dd'i vdi ngudi cd the BHYT nhdm dam bao chat lUpng td't nha't de tao niem tin cho ngUdi dan, thl mdi cd the tang them sU ha'p dan cua BHYT ndi chung va BHYT hd gia dinh ndi rieng.
Su quan tdm din sffc khoe: SU quan tam sffc khde cd tdc dpng tich cffc de'n y dinh tham gia BHYT hd gia dinh. Vi vay, de gia tdng sU ha'p dan cua loai hinh BHYT hp gia dinh dd'i vdi ngUdi dan, thi vide nang cao dich vu y te', cung nhu chat lupng ciia cdc cd sd kham chffa bdnh la mdt viec ta't yd'u va ndn tap trung cai thien, nang cao chat lUdng dich vu y te' tai cd sd y td' ed'p xa. Can cd bien phdp giai quye't hieu qud va'n de y dffc, cai thien to't hdn tinh th^n, thdi do va cung cdch phuc vu Clia nhffng nhan vien y te do'i vdi ngffdi sff dung the BHYT tai c d s d y te'tff Trung ffdng de'n dia phffdng nham phuc vu td't nha't cho ngudi ddn.
Ky vgng cda gia dinh: Nganh bao hiem xa hdi nen cd Uu dai, khuyd'n khich ngUdi da tham gia BHYT hd gia dinh tuyen truyen, van dpng ngUdi than cua hp va nhffng ngUdi xung quanh hieu va tham gia BHYT ho gia dinh. Bdi, thUc te' da minh chihig rang, sff ung ho cua ngUdi than trong gia dinh cd tdc dpng tich cUc den y dinh tham gia BHYT hd gia dinh cua ngUdi dan. Can quan tam tdi ky vdng cua ho, ciing cac mong mud'n ldi ich khi tham gia BHYT, dac biet la nhifng ldi ich thffc sff c^n thie't do BHYT hd gia dinh mang lai liic khdng may bi benh.Q
TAI LI^U THAM KHAO
1. Nguydn Dinh Thp, Nguydn Thi Mai Trang (2007). Nghiin cffu khoa hgc Marketing, Nxb Dai hoc Qud'c gia, TP. Ho Chi Minh
2. Hoang Trpng vd Chu Nguyln Mong Ngpc (2005). Phdn tich dff lieu nghiin cffu vdi SPSS, Nxb Thdng ke
3. Chu Thi Kim Loan va Nguyen Hong Ban (2013). ThUc d-ang tham BHYT tU nguydn cua ngudi ddn trdn dja ban TP. Ha TTnh, Tgp chi Khoa hgc vd Phdt triin. so' 1, 115-124
4. Vu Ngpc Huyen va Nguydn Van Song (2014). ThUc d-ang tham gia BHYT Wi nguyen cua ndng ddn tinh Thai Blnh, Tgp chi Khoa hgc vd Phdt trien, so 6. 853-861
5. Hodng Thu Thuy vd Biii Hoang Minh ThU (2018). Cdc nhan to' anh hffdng de'n y dinh tham gia bao hidm xd hpi tff nguyen ciia nong ddn: Trffdng hdp dia ban tmh Phii Yen, Tgp chi Phdt triin Khoa hgc vd Cdng nghi, so' 4, 54-62
6. Mathiyazhagan (1998). Willingness to Pay for Rural Health Insurance Through Community Participation in India, The International Journal of Health Planning and Management, 13(1), 47-67
