THUC TRANG THAM GIA BAD HIEM Y I E CUA N O N G DAN TAI TH! XA SON TAY, HA NOI NAM 2012 VA MOT SO YEU TO LIEN QUAN
TOM T A T
Bao hiim y td (BHYT) li mdt chinh sach xi hdi nhim huy ddng su ddng gdp cOa cdng ding nhim thuc hiin cdng bing va nhin dao trong linh vuc bio vi va chBm sdc sUc khde nhan din. Trong bdi canh Viit Nam hiin nay, do he thdng chinh sich ve BHYT cdn nhiiu han chd nen viec tham gia BHYT cQa nhdm ddi tuang ndng din vBn ehua cd vBn bin hudng dan thuc hiin. Su tham gia cda nhdm da tupng nay phu thude phin Idn via su tu nguyin vi bj anh hudng nhiiu bdi yiu td kien thUc vi thai dd cOa bin than ngudi ndng dan vdi BHYT. Nghiin cOu nay nhim tim hiiu thuc trang tham gia BHYT vi di xuat giai phap tBng cudng su tu nguyin tham gia BHYT cQa ngudi ndng din tai thj xa San Tiy, Hi Ndi vdi cic muc tiiu: (i) Md ti thuc tr^ng tham gia BHYT d ndng din thi xa Sdn Tay, Hi Ndi, nBm 2012; (ii) xac djnh cic ydu td lien quan tdi tham gia BHYT a ddi tuang ndng din tal dja bin nghiin cOU. Nghiin eUu Bp dung thiit ki nghiin cUu md ti cit ngang kit hpp nghiin cUu dinh lupng vi dinh tinh. Thdi gian nghiin cOu tit thing 12/2011 - 8/2012.
Kit qui nghiin eUu cho thdy: t^ li tham gia BHYT rat thip (20,4%). Ly do eda da sdnhOng ngudi chua tham gia BHYT chO yiu li: khd khBn vi mBt tii chinh (43,9%), thO tuc hanh chinh trang khim chOa binh (KCB) BHYT rudm ri (19,1%), khdng biet thCi tpc di mua thi BHYT (17.6%). Tp le ngUdi cd thi BHYT cd KCB BHYT trong vdng 1 nBm cao (78,7%). Sd dung thi BHYTtmn^ tat ei cic lin di KCB cao (87.5%). Sd dung dieh vp a benh viin cdng lap tuyin tinh va tuydn huyin chiim da sd (52.5% vi 33,3%). Dinh gia ehdt luang djch vu KCB BHYT td chua tdt (Thdi gian chd ddi di khim liu: 84,1%, chd dang ky: 55,6%, chd xit nghiem can lim sang liu: 40.3%). Thii dd cOa bic sy vi nhan viin y td la tot dpt thdp (25,4%,). SudaydOvi sd luang thudc dat thip (48,4%). GBp khd khBn tnjng thd tuc chuyin viin cao (90.5%,). Nam gidi cd xu hudng khdng tham gia BHYT nhiiu han nUgldi. Ngudi d nhdm tuii cao. hpc vdn thap, thu nhap thap, kien thuc vi BHYT thap khdng tham gia BHYTcaa han cac ddi tuang tr^ tuii, hpe \^n cao, thu nhip cao va kiin thUc vi BHYT cao. Khuydn nghi dua ra la can tBng cudng tuyen truyin, van ddng siu rdng trong nhin dan vOng ndng thdn vi lai ich - quyin lai va nghTa vu cQa ngudi tham gia BHYT tu nguyin dk ning t^ li ngudi dan tham gia BHYT cao han nOa tien tdi Id trinh dat t^
li 100% BHYT toan dan vio nBm 2015.'Nghien'cOu cung ta ca sd cho nhUng nghien eUu can thiip tidp theo nhim tBng Q? li tham gia BHYT d tat ca cic ddi tuang la ndng din tai thi xa San Tay, Ha Ndi.
Td khoa: Bao hiim y te, ndng din, kham ehUa binh.
SUMMARY
STATUS OF HEALTH INSURANCE PARTICIPATION AMONG FARMERS IN SON TAY TOWN, HANOI IN 2012 AND RELATED FACTORS
LE NGOC QUYNH - Vu Bao hidm Ytd,B^Y te Health insurance (HI) is a social policy aims to raise the contribution of the community to implement a fair and humane care and protection of people's health. In the current context of Vietnam, due to a limitation o/
health insurance system, the guidelines for the HI partidpation of the farmer group have not yet implemented. The participation of this group depends largely on their willingness and affected by fyt^ors of knowledge and attitude of the farmers themselves with health insurance. This study aimed to identify current status of HI participation and propose solutions to strengthen the voluntary of HI participation among farmers in Son Tay Town, Hanoi w'rth speciiic objedives: (i) to describe current status of HI participation among fanners in Son Tay Town, Hanoi in 2012; (ii) to identify fyctors related to the HI participation among farmers in the study area. The study employed a cross-sedional descriptive study design combined quantitative and qualitative methods.
Stijdy period dam 12/2011 - 8/2012. The study results showed that the HI participation rate is very low (20.4%,). The reason most people did not participate mainly: financial diWculties (43.9%), complicated administrative procedures in HI healthcare and treatment (19.1%), not know the procedures to purchase health insurance (17.6%). The proportion of people having health insurance cards within one year was high (78.7%). Using health insurance cards in all healthcare visits was high (87.5%). Using sen/ices In public provincial and districted hospitals accounts for the majority (52.5% and 33.3%,). Assessment of the quality of HI healthcare and treatment was not good (waiting period for long examination: 84.1%,, pending registration: 55.6%, pending laboratory long: 40.3%).
The attitude of dodors and medical staffs as well was low (25.4%). The adequation of dmg is low (48.4%).
Difficulties in referral procedures were high (90.5%).
Men tended to be more participate than women, People in the elderiy group, low education, tow income, low knowledge about health insurance paitidpated lower than the young group, highly educated, high income and knowledge about health insurance.
Recommendations are to put forward to strengthen advocacy and mobilization largely for people in rural areas about interests, rights and obligations of the voluntarily in HI participation to increase the percentage of health insured people, and further progress roadmap to achieve 100% universal health coverage in 2015. The study was also a ba^s for tiie sut}sequent inter/enb'on studies aimed at increasing partidpation rates of HI in all subjects including farmers in the Son Tay town, Hanoi.
Keywords: Health insurance, farmers, health care and treatment.
OAT VAN Di
BHYT la mpt cau p h i n trong h i tiling an sinh xa h6i va la chinh sach xa hdi Idn do Nha nude td chiJte thuc hien. nham huy dong sU ddng gdp eda eong ddng,
chia se nguy_ ca benh t i t va giam bdt g i n h nang t i i t^fnh cda mdi nguffi khi dm dau, binh tat, tao nguon tii chinh hd tra cho hoat ddng y t i , thiJC hiin cong bang v i nhan dao trong ITnh vUt bao ve va c h i m sdc sdc khoe nhan dan [15]. Theo B i o cao tdng quan nginh y te n i m 2009 cda Bp Y te, cdng vdi ngudn ngan sach nha nude, ngudn tiiu tU BHYT da trd thanh mpt bong ba ngudn t i i chi'nh chd y i u , chiim 29% tdng dii cho y te [1], [7]. De cdng cd vai trd cda ngudn tai chi'nh y t i niy, viec duy tri v i md ring ddi tuang tiiam gia BHYT rat quan trpng. Chien luac qudc gia bao v i , d i i m sdc va nang cao sdc khde n h i n dan giai doan 2011 - 2020, tam nhin den 2030 cung x i c djnh quan diem, muc tiiu v i giai phap ve thue hien BHYT t o i n dan [9).
Tinh den h i t 2011, tai Viet Nam mdi cd 57,8 trieu ngudi c6 ttie BHYT, ehiem 63% d i n sd Viet Nam [6].
Rat nhieu ddi tuang ed trach nhiem tham gia nhung tiiam gia khdng day dd: cd 22,4% tre em dudi 6 tudi;
46,6% ngu^ lao d i n g trong doanh nghiip; 24,1% hpc sinh, sinh viin; 86,9% ngudi thudc hd gia dinh can ngheo; v i 66,3% ndng dan, xa vien hap t i e xa hd kinh doanh ca the chua tham gia BHYT [8].
Viit Nam l i mdt nudc nong nghiip, tinh den tiling 7/2011 cd 15,35 trieu hp nong dan tren toan qudc, chiim khoang 70% d i n sd [2]. Ndng dan duac coi l i nhdm ngudi cd thu nhap thap v i khdng dn djnh n i n khdng duac bao phd BHYT cd the d i n tdi nhdiig nguy cd ddi nghio khi dm dau, b i n h t i t . De dam bao tinh cong bing trong cham sdc sdc khoe, viee quan t i m tdi phat triin BHYT eho nhdm dd'i tUdng nay la h i t sde cin thiet.
Jh\ xa Sdn T i y l i mdt vung b i n sdn dia, cd tong dien tich tu nhien la 183,46 km2, d i n sd khoang 181.381 ngudi, dUdc chia l i m 15 ddn vj hanh chinh gdm 09 phudng, 06 xa; c6 53 ed quan, doanh nghiep nhi nude, benh vien, trUdng hpc va 30 dan vi quan dpi ddng q u i n tren dia ban [17J. Nam 2011 sd ngudi tiiam gia BHYT t o i n thi x i l i 123,110 chiim khoang 58%, trong dd. tf le tham gia BHYT bat bupc la 94,7%, riing ngudi thuoc hd gia dinh nghio v i tre em dudi 6 tudi dat 100%, hpe sinh sinh v i i n l i 98%. Ty l i tham gia BHYT cda ddi tuang t u nguyen trong dd cd hp gia dinh ndng nghiep tai thj xa Sdn T i y n i m 2011 die biit t h i p chi chiim 5,3%, thap hdn ty le chung ciia ca nudc la 34% [3], [5].
Theo quy dinh cda Luit BHYT, tmdc 1/1/2012 ndng dan thuoc nhdm tiiam gia BHYT tu nguyen va sau ngay 1/1/2012 ndng dan thuoc nhdm ddi tupng tham gia BHYT bat bupc. Tuy nhiin, do chUa cd v i n ban hudng d i n thuc hiin nen viec tham gia BHYT eda nhdm dan sd n i y van mang tinh tu nguyen. Viec quyet djnh tham gia BHYT cda ngudi ndng dan bj anh hudng tidi cac y i u td kiin thdc, tiiai dp, niem tin eda ban t h i n hp ddi vdi BHYT. C i u hdi dUde d i t ra l i : ThUc trang tham gia BHYT cda ngudi nong d i n nhu tiii nao?
TTiuft trang sd dung tiie BHYT eda ngudi ndng dan borig k h i m chua b i n h nhu the nao? L i m the n i o d i tang cudng sU tu nguyen tham gia BHYT cda ho?
D 6 | TUONG VA PHUONG P H A P NGHIEN CLTU 1. Doi tuong nghien cUu
Ndng dan: L i ngUdi trudng thinh (^ 18 tudi) tiiupc ho gia dinh nong nghiip, lam nghiip, ngU nghiep, d i i m nghiip sinh sdng tai Uij x i Sdn Tay thuie ddi tuang 22 Dieu 12, Luat BHYT. K i t qua nghien cdu dUdc thu tiiap td viec phong v i n 390 ddi tuang ndng dan theo daiih sach da duac l i p trin i^a ban thi x i Sdn Tiy, Ha Npi.
Nhdm ndng dan sd dung the va khdng sd dung the BHYT.
Dai d i i n bao h i i m thj xa San T i y , dy ban nhan dan thi xa Sdn^Tay, Hoi ndng dan thj xa San Tiy.
Dja diem: Thj xa San T i y , thanh phd H i Ndi.
Tfidi gian: Td tiling 12/2011 den thing 8/2012.
2. Thiet ke n g h i i n cdu: Nghiin edU md ta cat ngang, k i t hdpjSnh luang va dmh tinh.
3. Chpn m i u va c d m i u
Chpn m i u dinh ludng: Cd m i u duac tfnh theo c i n g thdc ti'nh chon m i u n g i u nhien dan eho dieu tra 1 ty le
( l - a / 2 ) ^ 2
vdi p = 0,25 (theo tJ l i tham gia BHYT tu nguyen toan qudc nam 2011 [6]); 2 (1 - a / 2 ) = 1,96; a = 0,05;
d = 0,045 ^ T i n h duac n = 357, epng 10% du kien bd cudc tfnh dUde ed m i u tdi thiiu c i n phong v i n l i 390 ngudi.
Chpn m i u i^nh tinh: Chpn m i u chd dich eho c i c nhdm ddi tuang: nhdm ndng d i n sd dung the BHYT tiling KCB, nhdm ndng dan c h i ^ cd the BHYT, dai dien UBND thj xa phu trach cdng t i c y t i ; dai diin BHXH tiij xa, dai dien Hpi ndng d i n thj x i .
4. Phuong phap thu t h i p so lieu
Nghien cdu djnh luang: phong v i n true tiip ngudi d i n bang bp c i u hdi cd cau tmc ve kien thdc, thUe hanh, tinh hinh tham gia BHYT v i c i c yeu td liin quan NgUdi dUdc chpn la ngUdi thda man cac t i i u chi lua chpn cho doi tUdng nghien cdu thee c i c bude: 1) Lap danh sach hd gia dinh va danh sd thd tu eac thinh v i i n t r i n dja b i n ; 2) Chon h i gia dinh phdng van tu danh sach theo phuang phap chpn m i u n g i u nhiin dan cho d i n khi dd cd mSu; 3) Chpn ngau nhien 1 ngudi phdng van ^ 1 8 tuoi l i m n g h i ndng tai hd gia dinh. Bp cdng cu dupe thiit k i va thd nghiem trudc khi dieu tra.
Nghien cdu djnh tinh: Thao luin nhdm vdi ddi tUdng ed the BHYT (tim hieu tan suit, mdc do sd dung, mdc dp thda man vdi c i c djch vu KCB y te); thao luin nhdm vdi ddi tuang chua cd the BHYT (tim hieu nguyen nhan vi sao khdng tham gia, yeu td can trd); phdng v i n s i u dai d i i n UBND xa, BHXH thj xa, Hoi ndng d i n thj xa (tim hieu chii trUdng, hd trd ciia dia phUdng cho nong d i n trong tham gia BHYT, nhdng thuin lai, khd khan trong q u i trinh triin khai, cap phat ttie, cdng t i e phdi hap l i i n nginh trong tnen khai bao phd BHYT tai thj xa)!
5. Phuang phap xur ly so' lieu
So lieu dUdc nhip v i o phin mem Epidata 3.1 va duac phin tich bang phan mem SPSS 16 va Stata 9.0.
Y HOC THV'C HANH (953) - S6 3/2015
K l T QUA
Bang 1: Dae diem doi tUdng nghiin eUu Oacdi^
Nh6m tugi (x±SD)
18- 30-39
Thu nhap tmng binh Tdng
719.188 + 641.057
X
100Khi danh g i i v i chat luong djch vu tai cac ea sd KCB BHYT, da s d ngUdi tra ldi phong van cho rang cac djch vu n i y d mdc binh thuGng. Mot s d y kien cho rang : i e djch vu nay chua tdt vi thdi gian c h d ddi lau hoic :hd tuc m d m ra, v i du v e thdi gian chd kham (84,1%), thdi gian d i n g ky (55,6%) hay tiidi gian chd xet i g h i i m , chan doan hinh anh (40,3%). T i le ngudi b a ldi :;ho rang cac djch vu nay tdt kha thap. Khi danh gia ve :hai dd eda b i c sy v i n h i n v i i n y te, c d 25,4% ngudi tham gia phdng van cho rang thai dd cda cac bac sy ai ndi ho k h i m chda b i n h l i tdt, con s d nay ddi vdi i^ic n h i n v i i n y te khac la 20,6%. T i le danh g i i thai dd Dhue vu eda cac b i c sy khdng tdt (31,1%) hoac rat
<hdng tdt (7,3%) k h i cao. Con s d nay doi vdi c i c nhin /ien y te khac lan luat la 14,3% va 1,6%.
Trong cac ddi tuang nghien cdu la ndng dan, n d c h i i m t f l i cao hon so vdi nam (56,2% n d so vdi 43,8% nam); tudi tmng binh cda cac doi tuang la 43,9
± 10,7, trong dd nhdm tudi t d 40 - 49 chiem ty le cao nhat (39,6%) v i nhdm hjoi ti^ 60 trd len chiem ty le ttiip nhat (3,3%). Thu n h i p tmng binh cda m i t ngudi bx)ng ho gia dinh d m d t xap yd 720.0(X) dong/ngudi/tiiing vdi dp l i c h chuan l i khoang 642.000 ddng.
Thi/c t r a n g t h a m gia BHYT c u a n o n g dan Trong tong s d 390 ddi hJting tham gia n g h i i n cdU, cd 20,4% hien dang tham gia BHYT. S d nam bung binh ngudi tra Idi phdng v i n da tham gia kham chda benh BHYT l i 5,5 nSm, trong do ngudi tham gia tU 1-3 n i m c h i i m da s d (68,2%). B i n canh dd, ty ie cd kham chua benh BHYT trong vdng 1 nam gan n h i t chi c h i i m 16,2% (80 ngUdi). Qua tiiao luan nhdm, cd nhdng ngudi mua the BHYT nhieu n i m , t h i m ehi 10 nam nhuhg tan s u i t s d dung the d e k h i m c h i ^ benh BHYT cdn t h i p . C i c ly do dua ra la "ehi nhd ngudi mua gidp",
"thiy ngudi khie mua thi cung mua thd xem thi nio".
"mua liu riSi mi chua thdy cd Ipi ich" - ngudi ti'a Idi xa Thanh My.
Trong tdng sd 80 ndng dan cd the BHYT, chi cd 63 ngudi sd dung ttie BHYT de kham chda binh (KCB).
Hau het ngudi sd dung the BHYT deu dung trong tat ca l i n di KCB (87,5%), so con lai chi sd dung khi nam dieu tri ndi bd (7,5%) ho3c da tilmg dung nhung khdng dung nda. Tan suat KCB t r i n dau ttie la 2,3 lan/ttie. Ty l i sd dung djch vu KCB d b i n h v i i n cong l i p bjyin tinh (52,5%) v i binh v i i n b j y i n huyin (33,3%) chiem da sd. Chi phi tmng binh cho kham chua benh BHYT b'nh theo dau the cda ngudi di KCB xap xi 350 nghin ddng, do lich ehuln 256 nghin ddng. Trong sd nhimg ngudi da KCB BHYT, 23,8% phai tu tra tien ttiem.
Tmng binh sd tien phai tra them la 132 nghin ddng, sd tien cao nhit phai tra l i x i p xi 1 triiu ddng,
Bang 2: Chi phi kham chda t>enh bao hiem y t i (VND)
Chi phi theo Stflignphdi
trSttifim rathiSu
65.000 18.000
Tffida 1.400.00
0 1.000.00
0 Tmng
binh 353.784 131.333
Deiech chuan 256.012 278.186
Hinh 1: Nhan xet ve c h i t luang cac djch v u tai CSYT Khi danh gia ve tinh hinh c i p thuoc cda ea sd y t i , da s d ngudi duae hoi eho b i i t sU d i y dd v i s d ludng thudc (48,4%), tuy nhien v i s u t i i n lai, chdng loai hay tinh c i n g khai thong tin, da s d d i u d i n h g i i d mdc binh thudng ( 3 9 , 1 % ; 59,7% v i 57,7%) vdi lan lupt tCflig tiiu chi.
Bang 3: Nhin x i t v i tinh hinh cap ttiude ciia CSYT (n=63)
Cdctieuchf vesu tien loi
V6 chOng loai V^stfiuonq
Tfnh cAng Ithai thOng tin
Khdng tiSn loi(%)
24.2 Khdng divdS 24.2 16.7 Khdng cdng
lihal 27.0
8inh thudng 39,1 Binh thudng
59.7 26.1 Binh thudng
57.7 Tidn i(^
27,9
(%)
fiaydQ 9.7 48.4 Cdng Ithai 7,4
Khdng y kiSnN) 9,3 Khdng fid^n 6,S 9,3 Khdng$
l(i£n 7,4 Trong s d nhi^ig ly do nong d i n khong den c d sd kham c h i j ^ benh la ndi d i n g ky kham ehua benh ban dau, ly do khdng tin tudng v i o chat lUdng kham chijte binh d ndi d i n g ky v i tin ring chat luang bjyin tren tdt hdn chiim da sd (34,6%). Trong khi dd, ehi cd 9,5%
ngudi da tham gia kham chda binh BHYT cho biet ho gap khd khin trong thd tuc chuyen viin.
M^t so yeu to lien quan di'n quyet dinh tham gia BHYT cua nong dan
Trong cac ly do chua ttiam gia BHYT ddi tuang nghien e l ^ dua ra, ly do khd khan ve mat t i i chinh, khdng cd tien de mua, chiim ^ le cao ntiit (43,9%).
Tiep sau do la TTid tuc h i n h chinh tixjng KCB BHYT mdm ra (19,1%), khdng biet thd Uic de mua ttie BHYT
(17,6%). Cae ly do Wiac chiem ti' l i tiiip han (1,0- 8,7%).
Khi tiin h i n h thao luan nhdm doi tuong ndng d i n khdng tham gia BHYT, hau h i t ho deu d i o rang ho hjy hp Wit c i i Id cda BHYT nhung khong tiiam gia BHYT, mdt sd cho rang hp v i n chua den tudi can phai di kham ffinh ki bang the BHYT. Mpt sd ddi tiJOng phan nan v i chit ludng djch vu y te khi hp di kham sdc khoe bang the BHYT. Nguyin nhan dau tien can tid hanh vi thEun gia BHYT l i d i i u kien kinh te, ben canh do cdn Ion tai nhiJing b i t cap, thieu trach nhiem cda nhdtig can bd y t i , t i m m i t niem tin cda nguf^ ning d i n vao chat lifting DVYT. "Khdng tham gia dupc BHYT do diiu kien kinh ti khdng cho phip. Nhiiu ngudi phin nin li cho thudc ri tiin hoBc sip hit han. Di khim tu thi chat luang hdn. Chua di kham, ntiung ed nghe vi BHYT, thai dd nhan viin ddi vdi ngudi cd BHYT phin biit ddi xd. Di khim tu ngoii thi thai dd tdt hdn, nhanti khdi han"- ndng dan xa Thanh My eho bieL
Bang 4' Mdi l i i n quan gida tham gia BHYT v i kiin lhifcviBHYT(n=390)
KidnthUc Ithdngdat Kigh thl^ dat
Chua tham qia BHYT
n 1 %
219! 70.6 92 1 29.7
0 3 tham gia BHYT n 27 53
33.8
%
66.3
T } s 8 1 p chdnh 1
OR(KTC95%) 4.7 (2.7-8,21 <0,0001 N h d n g n g u d i c d k i i n t h d c k h d n g d a t v e B H Y T c d xu h u d n g k h d n g U i a m g i a B H Y T n h i e u g a p 4 , 7 l a n s o vdi n h d n g n g u d i c d k i i n U i d e d a t ( K T C 9 5 % : 2 , 7 - 8 , 2 ) . S i f k h a e b i e t n a y c d y nghTa t h d n g k e ( p < 0 , 0 0 0 1 ) .
B a n g 5: M d i lien q u a n g i d a t h a m g i a B H Y T v i s U san s i n g t h a m g i a ( n = r
Chira tham DS tiiam gia f T T T T T T T T SiaBHYT BHYT T y s g c h e n h | KhOng
183 59,0 24 C6sansang | 1 2 7 | 41,0 j 56
OR (KTC 95%) 3,4 70,0 I
N h d n g ngUdi t r a Idi k h d n g s i n s i n g t h a m g i a B H Y T c 6 x u h u d n g k h d n g t h a m g l a B H Y T n h i e u g a p 3,4 l a n so vdi n h d n g n g u d i t r a Idi s i n s a n g ( K T C 9 5 % : 1,9- 6,0). S U k h a c b i e t n a y c d y nghTa t h d n g k e { p < 0 , 0 0 1 ) . Ly d o s i n s i n g t h a m g i a B H Y T d u a c n g u d i t h a m g i a phdng v i n d u a ra n h i i u n h a t l i vi h p m u d n d e p h o n g se s d d u n g k h i d a u d m ( 4 4 , 9 % ) , n g o i i ra c i c ly d o khac n h u m u d n g i a m c h i p h i y t i ( 3 5 . 7 % ) , v i t h i y ldi i c h cCia B H Y T ( 1 5 , 4 % ) c h i e m t l l i e a o . T r o n g k h i d o , c a e ly do l ^ i i n n g u d i t h a m g i a n g h i e n c d u k h d n g s i n s a n g tiiam gla B H Y T b a o g d m : m d c d d n g q u i c a o c h i e m d a so ( 3 8 , 7 % ) . t h i e u t h d n g tin v e B H Y T ( 2 8 , 6 % ) , t h d t u c phdc t ^ p ( 1 7 , 8 % ) v a c i c l y d o k h a c . L y d o k h d n g t h i c h Oram g i a c h i i m 1 0 , 8 % ,
B S n g 6 : M d i l i i n q u a n g i d a t h a m g i a B H Y T v a t h a i a a v i m d c d d n o B H Y T ( n = 3 9 0 )
ThSiddvdmiJc ddng BHYT LChSpnhdndiroc
Cao
Chua tham aia BHYT
n 8 37
%
2.6 11.9
0 § tham gia BHYT
n 18 22
%
22.5 27.5
T9s8 chdnh ORdCTC
1.0 3,8 (1,3-11,7)
P 95%)
<0,01
Qudcao Khdng bilt/l(hdng
ykifin 29 236
9.4 76.1
24
15 30.0
18.8 2.7 (0.9-8.5)
35,4 (12,0- 107.6)
<0.05
<0.0O1 S o v d i n h u n g n g u d i c d n h a n x i t v e m d c d d n g B H Y T c h a p n h a n d u a c , n h d h g n g u d i c d n h i n x i t m d c d d n g B H Y T c a o c d x u h u d n g k h d n g tiiam g i a B H Y T n h i i u g a p 3 , 8 l i n ( K T C 9 5 % : 1,3-11,7; p < 0 , 0 1 ) ; n h d n g n g u f f i c d n h a n x e t m d c d d n g B H Y T q u i e a o e d x u h u d n g k h d n g t h a m g i a B H Y T n h i e u g a p 2 , 7 l a n ( K T C 9 5 % : 0 , 9 - 8 , 5 ; p < 0 , 0 1 ) ; n h d n g n g u d i k h d n g biet h o a c k h d n g c d y k i i n v e m d c d d n g B H Y T c d x u h U d n g k h d n g t h a m g i a B H Y T n h i i u g i ' p 3 5 , 4 l a n ( K T C 9 5 % : 1 2 ^ 0 - 1 0 7 , 6 ; p < 0 , 0 1 ) . C a c s U k h i c b i e t n a y c d y n g h t a thdng k i .
_ Khi duac hdi ve su t i i p n h i n cac hinh thdc hudng d i n , tuyen buyin lien quan d i n BHYT, da sd cho biet hp duac nhan thong tin td nhan vien y te hay can bo BHYT tai Cd sd BHYT (65,6%), c i e thdng tin td cac ngudn tai lieu khae chiem ti le thip, vf du thdng tin niim yet ve BHYT (23,4%), b i n g rdn, pa no ap phi'eh (9,4%) hay t i i lieu phat tay ve BHYT (7,8%).
Bang 7 Mdi lien quan gida tham gia BHYT v i viee cd nghe cac hinh thdc tmyen thong ve BHYT (n=390)
Khdng nqheA)idt Cd nqhe/bidt
Chua tham gia BHYT n 300
10 96.8
%
3.2 Oa tham gia
BHYT n 65 15
81.3
%
18.8
TJsd j p chdnh 1 OR (KTC 95%)
6.9 (2.8-17.9) <0.001 Nhdng ngudi khdng nghe hoac nghe khdng day du ve c i c hinh thdc tmyen thong BHYT cd xu hudng khong Uiam gia BHYT nhieu g i p 6,92 l i n so vdi nhdng ngudi cd tiiudng xuyen hoac cd nghe ve cac loai hinh tmyen thdng BHYT (KTC 95%. 2,75-17,94). SU khac biit nay cd y nghTa thdng k i (p<0,0001).
KET LUAN
Thuc trang tham gia BHYT cua nong dan thj xa Sdn Tay, Ha Noi
Trong 390 doi tuang dieu tra la la ndng dan, ty le tham gia BHYT rat thap (20,4%).
Ty l i nhdng ngudi cd the BHYT cd k h i m chua b i n h BHYT trong vdng 1 nam eao (78,7%). T j l i sd dung the BHYT trong tat ca cac lan di kham chda benh cao (87,5%). Ty l i sd dung dich vu d benh v i i n cdng lap tuyin tinh va tuyen huyen ehiem da sd (52.5%'vi 33,3%).
Mot so ye'u to lien quan den quyet djnh tham gia BHYT
- Kidn tfiuc ctia ndng din vdBHYT: 36,9% ngUdi tham gia BHYT dUdc danh g i i la ed kiin thdc dat v i BHYT. Ngudi cd kien thUC khdng dat cd xu hudng khong tham gia BHYT nhiiu gap 4,7 lan so vdi nhiJng ngudi cd kiin thdc dat (KTC 95%: 2,7-8,2; (p<0,0001).
- Thai dp cua nong din vd BHYT: 96,7% ngudi dUCic hdi ed quan t i m tdi BHYT. Ty l i tra Idi s i n sang tiiam gia (46,9%) thap hdn s d b a Idi khdng s i n sing (53,1%). Nhdng ngudi khdng s i n s i n g tiiam gia BHYT
Y HOC THVC HANH (953) - S6 3/2015
cd xu hudng it tham gia BHYT 3,7 lan so vdi ngudi s i n sang ttiam gia BHYT (KTC 95%, 1,9 - 6,0, p<0,01).
- W/«n tin cua nong din vd BHYT: 81,5% ngudi duac hdi tin vao BHYT. Nhdng ngudi khdng tin v i BHYT cd xu hudng khong tham gia BHYT nhiiu gap 3,3 lan nhdng ngudi cd tin ve BHYT. Su khac biit n i y CO y nghTa tiidng k i (KTC 95%, 1,4-9,8, p<0,01).
- Mpt sd ydu tdlien quan khac:
Nam gidi cd xu hUdng Idling tham gia BHYT nhiiu hon ndgidi 1,47 l i n (KTC 95%: 0,9-2,5; p>0,05).
Nhung ngudi d nhdm tudi eao va nhung ngudi ed hpc van thap cd xu hudng khdng tham gia BHYT nhiiu hdn nhdm tre tudi v i nhdng ngudi ed hoc van eao (p>0,05).
Ngudi cd thu nhap tmng binh cang thap cd xu hudng khong tham gia BHYT cang cao.
Nhdng ngudi khdng nghe hoac nghe khong day dd ve eac hinh ttidfc tmyin thong BHYT cd xu hudng khing tham gia BHYT nhieu gap 6,9 lan so vdi nhdng ngudi cd thudng xuyen hoac cd nghe ve eac loai hinh tmyin thing BHYT.
Ngudi cd nhan x i t mdc ddng bao hiem eao cd xu hudng khdng tham gla BHYT nhieu gap 3,8 lan (KTC 95%: 1,3-11.7; p<0,01) so vdi ngUdi cho rang mdt ddng BHYT la chap nhin dupe.
KHUYEN NGHj Dd'i vdi UBND thi xa
- Xay dung k i hoach bao phd BHYT v i ehi tiiu eho ddi tUdng ndng d i n tai ^ a ban, phu hap vdi de an BHYT toan dan ciHa thanh phd Ha Npi la cd sd de ea quan BHXH v i cae ban nganh khac phdi hap thuc hiin,
- Xay dung mdc sdng tmng binh cho ddi tuang ndng d i n tai thj xa trong khi chd ban hanh quy djnh ci^a Bp Lao dpng, thuang binh v i xa hpi de cd c i n ed thuc hien mdc h i tra mdc ddng BHYT
- Xem xit, tang mdc hd trd mdc ddng BHYT cho nhdm ddi tudng ndng dan t d ngan sach dia phuang, cac ngudn t i i tra di mile ddng phu hdp vdi kha nang ddng gdp ci^a ndng d i n
- Chi dao c i e cd quan chdc nang thuoc thi xa thUe hien nhiem vu tuyen t m y i n , phd b i i n chfnh sich phip luat ve BHYT nham nang cao kien thdc, thai dp, niim tin ve BHYT ddi vdi ndng d i n .
Doi vdi BHXH thj xa Sdn Tay
- L i d i u mdi, frfidi hap vdi phdng Lao ddng, thuang binh v i xa hpi tiii xa lap danh s i c h ttianh vieri hd gia dinh nong, lam, nguva d i i m nghiep ed mdc sdng bung binh tai dia ban;
- Xay dung ke hoach v i chi tieu hang n i m tnang van dpng nhdm ddi hJOng n i y tiiam gia BHYT;
- Li dau moi. phdi hap vdi c i c ban, nginh, td chdc k h i c de tuyen truyin chinh sach, phap luat ve BHYT cho ddi bjang ndng dan vcfi hinh ttidc fruyin thdng trifc tiep, qua td rOi, Ioa phat thanh xa/phUdng nham ting cudng kien tiidc, thai dd, niem tin cda nong d i n ddi vdi BHYT.
Doi vdi ngudi ndng dan
Tham gia BHYT theo hinh thdc hd gia iSnh d i duOc giam mdc ddng BHYT.
T A I L i e u THAM K H A O
1. Ban ehi dao lien nganh nghien cdu sda doi bo sung Nghj djnh 58/1998/ND-CP (7/2004), Bao cao dinh gla 5 nim thuc hien Dieu le BHYT tian hanh kem nghi dinh so 58/1998/ND<;P eda Chinh phi5.
2. Ban chi dao tong dieu ti^ nong thdn (2011), Bio eao Sd bd kit qua tdng dieu tra ndng thdn, ndng nghiap va thuy san nim 2011.
3. Bao hiem xa hpi ttij xa Sdn T i y (2011), Bio c^o tinh hinh tham gia BHYT nim 2011.
4. Bao hiem xa hpi Viet Nam (2008), Bio cao danh gi^
tinh hinh thUC hiin bao hiim tu nguyin.
5. Bao hiem xa hdi Viet Nam (2011), Cong vin sd 32/BHXH-CSYT ngay 06/01/2011 v l bio cio tinh hinh thUd hiin BHYT nim 2010.
6. Bao hiem xa hoi Viet Nam (2012), Cdng vSn 3447/BHXH-CSYT ve bio c i o sd liiu v i gdp y d l Sn BHYT toan dan.
7. Bp Tai chfnh va Bp Y te (2003), Thong tU lien tjch sd 77/2003/TTLT hudng d i n thuC hiin Bao hiim y te tU nguyin.
8. Bp Y te (2011), Bao cao Hpi nghj Tong kit thUC hiin Luat Bao hiem y te nim 2010.
9. Bp Y te (2011), Chiin luac bao v i , chim sdc v^
ning cao sUc khoe nhin d i n giai doan 2011 - 2020 vd tam nhin den 2030.
10. Bp Y te v i Tdng cue Thdng k i (2003), Dieu tra y te qudc gia 2001-2002, Bio c i o chuyin 6$ tinh hinh BHYT d Viet Nam.
TINH TRANG NHIEM CYTOMEGALOVIRUS OTRE DONG KINH
TOM TAT
DBt van de: Ddng lanh la mdt rdi loan thin kinh man tinh, anh hudng din nhiiu ngudi d mpi lUa tuoi trin the gidi. Mdt vii nghiin eUu gin diy da chira ring nhiem Cytomegalovirus (CMV) la mdt trong nhOng nguyin nhin giy ddng lanh tiim in. Trong nghiin cUu niy, Chung tdi diiu tra tinh trang nhiim CMV d tre ddng kinh vi mdt vii diim khac biit vi lim sing giSa nhdm cd huyit thanh CMV duang tinh va im tinh.
TdNNQvANANH Ddi tupng va phuang phip nghiin cUu: Chiing t^
chpn 72 binh nhi duac chin doan ddng kinh vio diiu tri iai Trung tim Nhi Khoa - Benh vien Tmng uang Hui va tiin hanh xit nghiim tim khang thi IgM, IgG cda CMV trong huyet thanh bing phuang phip EUSA.
Ching tdi diia thinh hai nhdm nghiin cUu (nh(m cd huyet thanh duang vi nhdm cd huyit thanh im tinh vdi CMV) va tim sukhic biit giOa hai nhdm vi mpt vii dSc diim lam sing da tri ddng kinh.
