B Y t Vit Nam

Nhm i tc y t

D tho 1

Bo co chung tng quan ngnh y t nm 2011

Nng cao nng lc xy dng chnh sch, i mi ti chnh y t v bao ph BHYT ton dn

H Ni, thng 9/2011

Ban bin tpPGS. TS. Nguyn Th Kim Tin - Trng ban PGS. TS. Phm L Tun TS. Nguyn Hong Long PGS. TS. Phm Trng Thanh ThS. Sarah Bales ThS. Dng c Thin

Chuyn gia bin sonTS. Nguyn Hong Long ThS. Sarah Bales PGS. TS. Phm Trng Thanh TS. Nguyn ng Vng TS. Trn Th Mai Oanh ThS. Phm Ngn Giang ThS. Nguyn Khnh Phng PGS. TS. Nguyn Th Kim Chc CN. Nguyn Th Linh H PGS. TS. Bi Thanh Tm ThS. Nguyn Trng Khoa BS. Nguyn nh Loan TS. Dng Huy Liu ThS. V Vn Chnh ThS. L Vn Khm TS. Trn Vn Tin PGS. TS. Bi Th Thu H TS. H Anh c

Li cm nBo co chung Tng quan ngnh y t (JAHR) 2011 l bo co th nm do B Y t cng vi cc i tc pht trin y t phi hp thc hin hng nm. Bo co JAHR 2011, c xy dng vo nm u tin trin khai thc hin Ngh quyt i hi i biu ton quc ln th XI ca ng v K hoch 5 nm v Bo v, chm sc v nng cao sc khe nhn dn 20112015, cp nht tnh trng sc khe v cc yu t nh hng; tng quan cc nh hng chin lc ngnh y t trong thi gian ti; cp nht thc trng h thng y t v phn tch su cc chuyn v ti chnh y t v qun tr h thng y t. Qu trnh thc hin bo co JAHR 2011 nhn c s h tr nhit tnh ca cc bn lin quan. Chng ti cm n v nh gi cao s h tr k thut t Nhm i tc y t (HPG), v c bit cm n s h tr v ti chnh ca WHO, t chc Atlantic Philanthropies, AusAID v USAID/PEPFAR. T th k ca bo co JAHR do TS. Nguyn Hong Long, Ph V trng V K hoch - Ti chnh ch o, cng cc iu phi vin gm PGS. TS. Phm Trng Thanh, ThS. Sarah Bales, ThS. Dng c Thin v ThS. Dng Thu Hng ng gp tch cc vo vic t chc qu trnh xy dng v hon thin bo co. Chng ti cm n cc chuyn gia trong nc tham gia phn tch cc thng tin c sn, thu thp kin ca cc bn lin quan d tho cc chng v b sung, sa i hon thin. Chng ti trn trng cm n nhng kin ng gp v t vn qu bu ca cc V, Cc, Tng cc, Vin, cc n v lin quan thuc B Y t, ca mt s b, ngnh, a phng, ca cc Nh ti tr v cc t chc, c nhn khc trong qu trnh xy dng Bo co ny.

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Vit ttADB ASEAN ATVSTP AusAID BHXH BHYT CSSK DALY DRG DS-KHHG GAVI GDP GLP GMP-WHO GPP GSP HIV/AIDS HPG HTA ICD IHP+ JAHR JANS KCB MDG NSNN OECD PEPFAR RIA SKSS UBND UNAIDS UNFPA UNICEF USAID WHO YTDP Ngn hng Pht trin Chu (Asian Development Bank) Hip hi cc quc gia ng Nam An ton v sinh thc phm C quan pht trin quc t Australia Bo him x hi Bo him y t Chm sc sc khe S nm sng iu chnh theo tn tt (Disability adjusted life years) Nhm chn on Dn s- K hoch ha gia nh Lin minh ton cu v vcxin v tim chng (Global Alliance on Vaccines and Immunizations) Tng sn phm quc ni Thc hnh tt phng kim nghim thuc Thc hnh tt sn xut tiu chun WHO Thc hnh tt nh thuc Thc hnh tt bo qun thuc Vi rt v Hi chng suy gim min dch mc phi Nhm i tc y t (Health Partnership Group) nh gi cng ngh y t (Health technology assessment) International Classification of Disease Nhm i tc y t quc t (International Health Partnership and related initiatives) Bo co chung Tng quan ngnh y t hng nm (Joint Annual Health Review) nh gi chung chin lc quc gia (Joint Assessment of National Strategies Khm cha bnh Mc tiu pht trin thin nin k (Millennium development goals) Ngn sch nh nc T chc hp tc v pht trin kinh t (Organization for Economic Cooperation and Development) K hoch Cu tr Khn cp ca Tng thng Hoa K v Phng, Chng (US Presidents Emergency Plan for AIDS relief) Phn tch tc ng ca vn bn quy phm php lut (Regulatory Impact Assessment) Sc khe sinh sn y ban Nhn dn Chng trnh phi hp ca Lin hip quc v HIV/AIDS (Joint United Nations Programme on HIV/AIDS Qu Dn s Lin hip quc (United Nations Population Fund) Qu Nhi ng Lin hip quc (United Nations Childrens Fund) C quan Pht trin Quc t Hoa K (United States Agency for International Development) T chc Y t Th gii (World Health Organization) Y t d phng

Mc lcGii thiu ................................................................................................................ 11Mc ch ca bo co JAHR ........................................................................................ 11 Ni dung v cu trc ca bo co JAHR ..................................................................... 11 Phng php ................................................................................................................ 13 T chc thc hin......................................................................................................... 15

Phn I: Cp nht thc trng h thng y t ........................................................... 17 Chng 1: Tnh trng sc khe v cc yu t nh hng ................................ 181. Tnh hnh thc hin cc ch tiu y t........................................................................ 18 Tui th trung bnh ..................................................................................................... 18 T sut t vong tr em di 1 tui .............................................................................. 18 T sut t vong tr em di 5 tui .............................................................................. 19 V t s t vong m .................................................................................................... 19 T l suy dinh dng tr em di 5 tui...................................................................... 19 2. C cu bnh tt v t vong v gnh nng bnh tt ............................................... 19 2.1. C cu bnh tt.................................................................................................... 19 2.2. Gnh nng bnh tt .............................................................................................. 20 3. Tnh hnh mt s bnh x hi ................................................................................... 21 3.1. Cm A(H1N1) ....................................................................................................... 21 3.2. St xut huyt (SXH) ............................................................................................ 22 3.3. Dch tiu chy cp nguy him (t)......................................................................... 22 3.4. Bnh si ............................................................................................................... 22 3.5. Bnh Rubella ........................................................................................................ 22 3.6. Bnh lin cu ln.................................................................................................. 23 3.7. Bnh tay-chn-ming ........................................................................................... 23 3.8. Bnh st rt .......................................................................................................... 23 3.9. Bnh lao ............................................................................................................... 23 3.10. Dch HIV/AIDS .................................................................................................... 24 4. Cc yu t nh hng n sc khe ...................................................................... 24 4.1. Kinh t - x hi ..................................................................................................... 24 4.2. Cc yu t lin quan n dn s .......................................................................... 24 4.3. Cng nghip ha, th ha, di c v thay i li sng........................................ 25 4.4. Bin i kh hu................................................................................................... 25 4.5. Nh v mi trng ............................................................................................ 25 4.6. Cc yu t lin quan n li sng ......................................................................... 26 5. Tnh hnh thc hin cc gii php khuyn ngh nm 2010................................ 27

Chng 2: Tng quan v cc nh hng ln trong lnh vc y t.................... 291. Bi cnh ..................................................................................................................... 29 2. Vn kin i hi XI ca ng v phng hng, nhim v ca ngnh y t ........ 30 3. D tho Chin lc chm sc, bo v v nng cao sc khe nhn dn giai on 2011-2020 v K hoch 5 nm ngnh y t 2011-2015 ................................................. 31 4. Tham kho v thc hin cc nh hng ca cc t chc quc t ...................... 32

Chng 3: Nhn lc y t ....................................................................................... 351. Cp nht cc chnh sch mi ................................................................................... 35 2. Tnh hnh thc hin nhng nhim v ra ........................................................ 35 2.1. Cc kt qu t c ...................................................................................... 35 2.2. Cc kh khn, bt cp .......................................................................................... 38

Chng 4: Ti chnh y t ....................................................................................... 42 5

1. Cp nht cc chnh sch mi ................................................................................... 42 2. Tnh hnh thc hin nhng nhim v ra ........................................................ 43 2.1 Kt qu t c .................................................................................................. 43 2.2 Kh khn, hn ch ................................................................................................ 45 2.3 Tnh hnh thc hin cc d n/ chng trnh c ti tr quc t ............................. 46

Chng 5: Dc, trang thit b v c s h tng y t........................................ 481. Cp nht cc chnh sch mi ................................................................................... 48 1.1. V lnh vc dc.................................................................................................. 48 1.2. V lnh vc trang thit b ...................................................................................... 49 1.3. V c s h tng y t ........................................................................................... 49 2. Tnh hnh thc hin cc nhim v ra ............................................................. 50 2.1. Lnh vc dc v sinh phm ................................................................................ 50 2.2. Lnh vc trang thit b ........................................................................................... 54 2.3. C s h tng y t............................................................................................... 55

Chng 6: H thng thng tin y t ....................................................................... 571. Cp nht chnh sch mi.......................................................................................... 57 2. Tnh hnh thc hin nhng nhim v ra ........................................................ 58 2.1. Hon thin chnh sch, k hoch pht trin h thng thng tin y t ..................... 58 2.2. Tng cng kh nng p ng nhu cu s dng thng tin, s liu ...................... 59 2.3. Tng cng ph bin thng tin, phn tch v s dng s liu thng k ................ 60

Chng 7: Cung ng dch v y t ........................................................................ 61 7(1). Chm sc sc khe ban u, Y t d phng v cc Chng trnh mc tiu y t quc gia .................................................................................................... 611. Cp nht chnh sch mi.......................................................................................... 61 2. Tnh hnh thc hin cc nhim v ra ............................................................. 62 2.1. Tng cng cng tc gio dc truyn thng gio dc sc khe........................... 62 2.2. Kim ch cc yu t ri ro i vi sc khe do mi trng, li sng .................... 63 2.3. Pht trin mnh y t d phng, hon chnh m hnh t chc v cng c mng li y t c s .................................................................................................................... 68 3. nh gi chung ......................................................................................................... 69

7(2). Khm cha bnh............................................................................................ 711. Cp nht chnh sch mi......................................................................................... 71 2. Tnh hnh thc hin nhng nhim v ra ........................................................ 72 2.1 Kt qu, tin b ..................................................................................................... 72 2.2. Kh khn, hn ch................................................................................................ 75

7(3). Dn s - K hoch ho gia nh v Chm sc sc kho sinh sn ............ 771. Cp nht chnh sch mi.......................................................................................... 77 2. Tnh hnh thc hin nhng nhim v ra ........................................................ 78 2.1. Kt qu t c.................................................................................................. 78 2.2. Kh khn, hn ch................................................................................................ 82

Chng 8: Qun tr h thng y t ......................................................................... 861. Cp nht chnh sch mi.......................................................................................... 86 2. Tnh hnh thc hin nhng nhim v ra ........................................................ 86

Phn II: Chuyn ti chnh y t .......................................................................... 88 Chng 9(1): i mi c ch ti chnh y t ....................................................... 891. nh gi thc trng .................................................................................................. 89 1.1. Nhng kt qu v tin b ..................................................................................... 89 1.2. Nhng kh khn, thch thc ................................................................................ 91 2. Cc vn u tin .................................................................................................... 94

Chng 9 (2): i mi phng thc chi tr dch v khm cha bnh ............ 961. Khi nim ................................................................................................................... 96 2. Thc trng phng thc chi tr dch v KCB Vit Nam................................... 102 2.1 Nhng kt qu bc u ................................................................................... 102 2.2 Nhng kh khn, hn ch .................................................................................. 103 3. Cc vn u tin .................................................................................................. 106

Chng 9(3): L trnh pht trin bo him y t ton dn ................................. 1081. Khi nim/ quan nim v bo him y t ton dn ................................................. 108 2. nh gi thc trng ................................................................................................ 109 2.1 Nhng tin b v kt qu .................................................................................... 109 2.2 Nhng kh khn, thch thc ............................................................................... 112 3. Cc vn u tin .................................................................................................. 116

Phn III: Chuyn qun tr h thng y t......................................................... 121 Chng 10(1): Xy dng chnh sch trong qun tr h thng y t .................. 1221. Khi nim/quan nim .............................................................................................. 122 1.1 Chu trnh chnh sch .......................................................................................... 122 1.2 Xy dng chnh sch da trn bng chng ....................................................... 124 1.3 Phn tch tc ng chnh sch ............................................................................ 125 2. Thc trng cng tc xy dng chnh sch y t .................................................... 125 2.1 Kt qu v tin b ............................................................................................... 127 2.2 Nhng vn cn gii quyt ............................................................................... 128 3. La chn nhng vn u tin ............................................................................ 132 3.1 Vn trong xy dng chng trnh hoch nh chnh sch ............................. 132 3.2 Vn trong phn tch chnh sch, tham vn chnh sch ................................... 132 3.3 Vn trong s dng ngun lc v xy dng quy trnh hoch nh chnh sch m bo s tham gia ca cc bn lin quan ..................................................................... 132

Chng 10.2: Nng cao nng lc qun l v hoch nh chnh sch ngnh y t ............................................................................................................................... 1341. Thc trng ............................................................................................................... 134 1.1 Kt qu v tin b ............................................................................................... 134 2.2 Kh khn, hn ch .............................................................................................. 135 3. Xc nh cc vn u tin ................................................................................... 137 3.1 Cng tc o to, bi dng nng cao nng lc xy dng chnh sch cho cn b qun l y t cha p ng yu cu ........................................................................... 137 3.2. Nng lc nghin cu, cung cp bng chng ca cc vin, trng v cc c nhn cho xy dng chnh sch cha p ng yu cu ...................................................... 138

Chng 11: Kt lun............................................................................................ 1391. Tng quan cc nh hng ln trong lnh vc y t.............................................. 139 2. Tnh trng sc khe v cc yu t nh hng ..................................................... 139 3. Nhn lc y t ........................................................................................................... 140 4. Ti chnh y t ........................................................................................................... 141 5. H thng thng tin y t ........................................................................................... 142 6. Dc, trang thit b v c s h tng y t ............................................................ 143 7. Chm sc sc khe ban u, y t d phng v cc chng trnh mc tiu quc gia................................................................................................................................. 144 8. Khm cha bnh ..................................................................................................... 145 9. DS-KHHG v Chm sc sc kho sinh sn ........................................................ 146 10. Qun tr h thng y t ........................................................................................... 147 11. i mi c ch ti chnh ngnh y t ................................................................... 148 12. i mi phng thc chi tr dch v khm cha bnh ..................................... 149 13. L trnh pht trin bo him y t ton dn .......................................................... 149 14. Hon thin qu trnh xy dng chnh sch y t .................................................. 150

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15. Nng cao nng lc xy dng chnh sch y t ..................................................... 151

Chng 12: Khuyn ngh .................................................................................... 1521. Nhng vn sc khe v dch bnh mi ni ..................................................... 152 2. Nhn lc y t ........................................................................................................... 152 2.1. Qun l pht trin nhn lc ................................................................................ 152 2.2. Nng cao cht lng o to, gio dc y hc .................................................... 153 2.3. S dng, i ng cn b y t vng kh khn ...................................................... 153 3. Ti chnh y t ........................................................................................................... 153 3.1 Huy ng kinh ph p ng nhu cu .......................................................... 153 3.2 S dng ngun lc ti chnh hiu qu ................................................................. 153 3.3 Kim sot x hi ha cht ch hn ..................................................................... 154 4. Dc, trang thit b v c s h tng y t ............................................................ 154 4.1 Lnh vc dc..................................................................................................... 154 4.2. Lnh vc trang thit b ......................................................................................... 155 4.3. C s h tng y t............................................................................................. 155 5. H thng thng tin y t ........................................................................................... 156 5.1. Hon thin chnh sch, k hoch pht trin h thng thng tin y t .................... 156 5.2 Tng cng kh nng p ng nhu cu s dng thng tin, s liu ..................... 156 5.3 Tng cng ph bin thng tin, phn tch v s dng s liu thng k ............... 156 6. Chm sc sc khe ban u, y t d phng v cc Chng trnh mc tiu y t quc gia ....................................................................................................................... 157 7. Khm cha bnh ..................................................................................................... 157 7.1 Bo m cng bng, hiu qu, tng kh nng tip cn ca ngi dn i vi dch v chm sc sc khe .............................................................................................. 157 7.2. Nng cao cht lng dch v khm, cha bnh ................................................. 158 7.3 Tng cng qun l, i mi c ch ti chnh bnh vin theo hng t ch, cng khai, minh bch ......................................................................................................... 158 8. Dn s- K hoch ha gia nh v Chm sc sc khe sinh sn........................ 159 9. Qun tr h thng y t ............................................................................................. 159 10. i mi c ch ti chnh ngnh y t .................................................................... 160 10.1. Tng chi cng cho y t thng qua tng chi NSNN cho y t v tng bao ph BHYT ........................................................................................................................ 160 10.2. i mi cch phn b ngn sch v tng chi NSNN nhm to thm ngun lc cho cng tc y t d phng ....................................................................................... 160 10.3. Thc hin tt vic chuyn cp kinh ph cho cc c s cung ng dch v sang h tr cho i tng th hng, i i vi tnh ng tnh chi ph dch v y t ........... 160 10.4. i mi c ch ti chnh y t to ng lc lm vic tch cc cho i ng cn b y t ....................................................................................................................... 161 10.5. Tng cng cng tc qun l nh nc v ti chnh cho y t .......................... 161 11. i mi phng thc chi tr dch v khm cha bnh ..................................... 161 11.1. Tng cng tho lun chnh sch, trao i thng tin, bng chng v xy dng ng thun trong i mi ti chnh y t v i mi phng thc chi tr ni ring ..... 161 11.2. Hon thin cc ni dung k thut cn thit cho pht trin v trin khai p dng cc phng thc chi tr tin b hn ......................................................................... 162 11.3. Tng cng vai tr ca c quan Bo him x hi trong xy dng chnh sch v thc hin i mi phng thc chi tr ...................................................................... 162 12. L trnh pht trin bo him y t ton dn .......................................................... 163 12.1 V trch nhim UBND a phng .................................................................... 163 12.2 C ch h tr mc ng v quyn li BHYT ngi cn ngho tham gia BHYT. .................................................................................................................................. 163 12.3 Thc y thc thi php lut v tham gia BHYT i vi ngi lao ng ti cc doanh nghip. ........................................................................................................... 163 12.4 M rng BHYT i vi i tng khu vc phi chnh thc .................................. 164 12.5 i mi m hnh qun l v BHYT .................................................................... 164

12.6 m bo bao ph theo chiu su v quyn li BHYT ....................................... 164 13. Hon thin qu trnh xy dng chnh sch y t .................................................. 164 14. Nng cao nng lc hoch nh chnh sch ngnh y t ...................................... 165 14.1. Tng cng o to, bi dng nng lc xy dng chnh sch ...................... 165 14.2. Nng cao nng lc cung cp bng chng cho xy dng chnh sch................ 166

Ph lc 1: Tm tt cc nhim v ra, cc vn u tin v gii php ... 168 I. Cc nhim v ra v gii php tip tc thc hin (cc chng tng quan) ..................................................................................................................... 1681. Nhn lc y t ........................................................................................................... 168 2. Ti chnh y t ........................................................................................................... 169 3. Dc, Trang thit b, c s h tng y t ............................................................... 170 4. Thng tin y t........................................................................................................... 171 5. Chm sc sc khe ban u, Y t d phng v cc Chng trnh mc tiu y t quc gia ....................................................................................................................... 173 6. Khm cha bnh ..................................................................................................... 175 7. DS - KHHG v chm sc SKSS ............................................................................ 177

II. Cc vn u tin v gii php (cc chng chuyn ) ........................... 1791. i mi c ch ti chnh y t ................................................................................. 179 2. i mi phng thc chi tr dch v khm cha bnh ....................................... 181 3. L trnh pht trin bo him y t ton dn ............................................................ 184 4. Hoch nh chnh sch trong qun tr h thng y t ............................................ 187 5. Nng cao nng lc qun l v hoch nh chnh sch ngnh y t ...................... 190

Ph lc 2: Cc ch s gim st v nh gi ....................................................... 193 Ti liu tham kho ................................................................................................ 198

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Bo co tng quan ngnh y t nm 2011

Danh mc BngBng 1: Kt qu thc hin cc ch tiu y t c bn ............................................................. 18 Bng 2: Bin ng nhn lc y t theo tuyn ton quc v mt s tnh, thnh ph, 2004~2009 .............................................................................................................................. 39 Bng 3: Gi tr sn xut thuc trong nc........................................................................... 50 Bng 4: S lng s ng k vc xin, sinh phm cn hiu lc ........................................... 51 Bng 5: Tm tt nhng im tin b, hn ch ca mt s phng thc chi tr ................ 100 Bng 6: S ngi tham gia BHYT theo nhm i tng, 2008-2010 ................................ 109 Bng 7: S ngi ngi tham gia BHYT theo vng, 2009-2010 ....................................... 110 Bng 8: Cn i thu chi qu bo him y t, 2008-2010 ..................................................... 110 Bng 9: Lt khm cha bnh BHYT v chi ph, 2010 ..................................................... 111 Bng 10: Khm cha bnh ca ngi tham gia BHYT theo tuyn, 20082010 ................ 111

Danh mc HnhHnh 1: S cu trc v ni dung chnh ca cc bo co JAHR ...................................... 12 Hnh 2: Bin i ba nhm bnh qua cc nm, 1976~2009 .................................................. 20 Hnh 3: Ch tiu o to bc i hc v sau i hc khi ngnh khoa hc sc khe, 2004 2010...................................................................................................................... 36 Hnh 4: S bc s, dc s, iu dng trn 10000 dn, 2005-2009 ................................. 39 Hnh 5: C cu cc ngun ti chnh y t, 2009.................................................................... 44 Hnh 6: Ngn sch nh nc cho y t, 20072009 ............................................................. 89 Hnh 7: T l chi y t so vi GDP v t l chi y t t ngn sch nh nc so vi tng chi ngn sch nh nc, 20052009 (%) ................................................................... 90 Hnh 8: Chi cng v t cho y t, 2005-2009 ........................................................................ 90 Hnh 9: L trnh BHYT ton dn ........................................................................................ 108 Hnh 10: Khng gian ba chiu xem xt tin trnh bao ph BHYT ton dn ................... 119

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Gii thiu

Gii thiuMc ch ca bo co JAHRTheo tha thun ca Nhm i tc y t (Health Partnership Group - HPG) v B Y t t nm 2007, Bo co chung Tng quan ngnh y t hng nm (Joint Annual Health Review JAHR) c xy dng vi mc ch h tr cho vic lp k hoch hng nm ca B Y t, ng thi lm c s cho vic la chn cc vn trng tm trong hp tc v i thoi gia ngnh y t Vit Nam v cc i tc nc ngoi. thc hin hai mc tiu Bo co JAHR c nhim v i) Cp nht thc trng ngnh y t, trong c nh gi tin t cc Mc tiu Pht trin Thin nin k v mc tiu pht trin lin quan n sc khe ca Vit Nam; ii) Cp nht thc trng cc cu phn ca h thng y t, tnh hnh thc hin cc nhim v ra v cc khuyn ngh ca JAHR nhng nm trc; iii) Phn tch su mt s chuyn la chn cho tng nm, xc nh cc vn u tin v khuyn ngh gii php. Thc tin cho thy, Bo co JAHR ngy cng hng ti tr thnh cng c ca chu trnh chnh sch y t, bng cch tham gia tch cc vo cc khu quan trng ca chu trnh , nh i) xc nh cc vn u tin ca h thng y t da trn s phn tch, nh gi nhng thnh tu, tin b v nhng kh khn, hn ch trong vn hnh ca h thng ny; ii) theo di, nh gi vic thc hin cc chnh sch y t v k hoch hng nm ca ngnh y t; iii) khuyn ngh vic b sung, hon thin chnh sch v cc gii php tng ng, ngn hn v di hn. Bo co JAHR 2011 c xy dng nhm thc hin cc mc ch, nhim v nu trn, c th l h tr cho vic xy dng k hoch y t nm 2012, thc y thc hin k hoch 5 nm ngnh y t giai on 2011-2015.

Ni dung v cu trc ca bo co JAHRJAHR 2007 l bo co u tin, cp tng i ton din cc lnh vc ch yu ca h thng y t Vit Nam. Bo co JAHR 2008 v 2009 phn tch cc chuyn v Ti chnh y t v Nhn lc y t nhng cu phn quan trng ca h thng y t. Bo co JAHR 2010, c xy dng vo thi im kt thc mt chu k k hoch, c mc ch h tr cho vic xy dng K hoch 5 nm ngnh y t 2011-2015. Nt ni bt ca qu trnh xy dng bo co JAHR 2010 l kt hp cht ch v ng gp tch cc cho qu trnh xy dng k hoch 5 nm. Cch tip cn h thng y t theo 6 cu phn do T chc Y t th gii khuyn co ln u tin c B Y t s dung trong xy dng K hoch 5 nm v bo v, chm sc v nng cao sc khe nhn dn 2011-2015. Qua 5 nm xy dng bo co JAHR, n nay bc u hnh thnh s cu trc ca cc bo co JAHR nh sau (Hnh 1): Nm nm 1 ln, trc thm k hoch 5 nm (v d nm 2010), bo co JAHR cn t mc tiu u tin l h tr qu trnh xy dng k hoch 5 nm ca ngnh y t, bng cch i) phn tch su tnh trng sc khe v cc yu t tc ng; ii) phn tch su c 6 cu phn ca h thng y t, iii) Hon thin ch s theo di, nh gi. Nm nm 1 ln, nm u tin ca K hoch 5 nm, ngoi mc tiu ca bo co hng nm, cn cp nht nhng nh hng mi c xc nh ti i hi ng (nh k 5 nm 1 ln), v K hoch 5 nm pht trin kinh t- x hi.

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Bo co tng quan ngnh y t nm 2011

Hng nm, bo cc JAHR cn u tin h tr vic xy dng k hoch nm tip theo ca ngnh, bng cch i) cp nht tnh trng sc khe v cc yu t tc ng n sc khe; ii) cp nht nhng chnh sch mi v nh gi tnh hnh thc hin cc nhim v ra theo c 6 cu phn ca h thng y t; phn tch su mt s chuyn v xut cc gii php tng ng.

Hnh 1: S cu trc v ni dung chnh ca cc bo co JAHRChu k k hoch 5 nm Nm th 1 (2011) H tr xy dng k hoch nm tip theo i) Cp nht cc nh hng mi ca i hi ng v KH 5 nm; ii) tnh trng sc khe; iii) cc chnh sch mi v tnh hnh thc hin nhim v ra theo 6 cu phn; iv) phn tch chuyn v xut cc gii php tng ng. v) hon thin ch s theo di, nh gi Nm th 2 (2012) H tr xy dng k hoch nm tip theo i) cp nht tnh trng sc khe; ii) cp nht cc chnh sch mi v tnh hnh thc hin nhim v ra theo 6 cu phn; iii) phn tch chuyn v xut cc gii php tng ng. Nm th 3 (2013) H tr xy dng k hoch nm tip theo i) cp nht tnh trng sc khe; ii) cp nht cc chnh sch mi v tnh hnh thc hin nhim v ra theo 6 cu phn; iii) phn tch chuyn v xut cc gii php tng ng. Nm th 4 (2014) H tr xy dng k hoch nm tip theo i) cp nht tnh trng sc khe; ii) cp nht cc chnh sch mi v tnh hnh thc hin nhim v ra theo 6 cu phn; iii) phn tch chuyn v xut cc gii php tng ng. Nm th 5 (2010, 2015) H tr xy dng k hoch 5 nm tip theo. i) phn tch su tnh trng sc khe v cc yu t tc ng; ii) phn tch su c 6 cu phn ca h thng y t, iii) hon thin ch s theo di, nh gi.

Ni dung v cu trc ca bo co JAHR Bo co JAHR 2011, c xy dng vo nm u tin ca K hoch 5 nm, vi tiu Nng cao nng lc xy dng chnh sch, i mi c ch ti chnh v bao ph BHYT ton dn, c ni dung v cu trc nh sau: Cc chng thuc phn I sau y c nhim v cp nht tnh trng sc khe v cc yu t nh hng (chng 1); tng quan cc nh hng chin lc ngnh y t (chng 2); cp nht thc trng, bao gm cp nht cc chnh sch mi v tnh hnh thc hin nhim v ra theo 6 cu phn ca h thng y t v khuyn ngh cc gii php cn a vo k hoch nm 2012 v di hn (chng 3 n chng 8). Cc chng chuyn thuc phn II v phn III c nhim v chnh l phn tch su mt s vn c la chn v ti chnh y t v qun tr h thng y t, nhm xc nh cc vn u tin v khuyn ngh cc gii php. Phn IV, gm chng Kt lun v chng Khuyn ngh, c nhim v tng hp nhng nhn nh, nh gi chnh v tnh hnh thc hin cc nhim v ra trong cc cu phn ca h thng y t Vit Nam v cc khuyn ngh v gii php a vo k hoch 2012 v cho di hn.

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Gii thiu

Ph lc 1 cung cp nhng thng tin tm tt v nhng vn u tin v gii php c khuyn ngh, to thun li cho vic theo di kt qu thc hin sau ny. Ph lc 2 cp nht cc ch s theo di, nh gi v nhng mc tiu chnh ca h thng y t, do JAHR la chn. C th, bo co JAHR 2011 c cu trc nh sau. Phn I: Cp nht thc trng h thng y t Chng 1. Tnh trng sc khe v cc yu t nh hng Chng 2. Chng 3. Chng 4. Chng 5. Chng 6. Tng quan cc nh hng chin lc ngnh y t Nhn lc y t Ti chnh y t Dc, trang thit b v c s h tng y t Thng tin y t

Chng 7 (1). Cung ng dch v y t d phng, chm sc sc khe ban u Chng 7 (2). Cung ng dch v khm cha bnh Chng 7 (3). Cung ng dch v sc khe sinh sn, DS-KHHG Chng 8. Qun tr h thng y t

Phn II: Chuyn ti chnh y t Chng 9 (1). i mi c ch ti chnh y t Chng 9 (2). i mi phng thc chi tr dch v khm cha bnh Chng 9 (3). L trnh pht trin bo him y t ton dn Phn III: Chuyn qun tr h thng y t Chng 10 (1). i mi xy dng chnh sch Chng 10 (2). Nng cao nng lc xy dng chnh sch Phn IV: Kt lun v khuyn ngh Chng 11. Kt lun Chng 12. Khuyn ngh Ph lc 1: Tm tt cc vn u tin v gii php Ph lc 2: Cc ch tiu theo di, nh gi.

Phng php1. Phng php tip cn chung ca qu trnh xy dng bo co JAHR 2011 th hin mt s yu cu chung, bao gm: Cn c vo bi cnh kinh t-x hi v thc trng h thng y t Vit Nam. H thng y t Vit Nam ang trong qu trnh i mi v pht trin. Mun i mi v pht trin c hiu qu, th iu quan trng l phi hiu r thc trng ca h thng y t, c lin h vi bi cnh kinh t-x hi Vit Nam, nh gi ng nhng tin b, kt qu, ng 13

Bo co tng quan ngnh y t nm 2011

thi nhn bit r v cc vn cn gii quyt, cc lnh vc cn u t, cc kt qu cn t c, v cc c ch theo di, kim sot qu trnh i mi. Da vo cc quan nim v cc chc nng v tiu ch cng bng, hiu qu ca h thng y t. Qu trnh xy dng bo co JAHR 2011 tham kho v vn dng quan nim c tha nhn chung hin nay v h thng y t c 6 cu phn. Tng cng h thng y t c ngha l hon thin tt c 6 cu phn ca h thng v s tng tc ca chng nhm ci thin tnh cng bng v bn vng trong dch v y t v nng cao sc khe nhn dn [1]. Da vo khung phn tch ph hp i vi tng cu phn ca h thng y t, bao gm phn tch v chnh sch quc gia v cc vn bn php quy, phn tch theo cc tiu ch m mi cu phn ca h thng y t cn t c.

2. Cc phng php chnh c s dng xy dng bo co l i) Tng hp cc ti liu c sn, gm cc vn bn chnh sch, php lut v cc ti liu nghin cu, kho stv ii) Thu thp kin ca cc bn lin quan, nht l ca cn b qun l, chuyn gia ngnh y t v cc b, ngnh lin quan, cc chuyn gia quc t. Tng hp v x l cc ti liu sn c, gm cc vn bn php quy (ca ng, Quc hi, Chnh ph, B Y t v cc b); cc cng trnh nghin cu, kho st; cc bo co ca cc b, ngnh; bo co tng kt chuyn ngnh; ti liu ca cc t chc quc t v ca nc ngoi. Nhm iu phi tm kim v cung cp mt s ti liu v s liu thng k chnh; cc chuyn gia ch ng tm kim v chia s cc ti liu lin quan. Thu thp v x l cc kin ca cc bn lin quan thng qua cc bc sau T chc cc bui tho lun bn trn (brainstorming) vi cc chuyn gia (ch yu l chuyn gia trong nc) nhm xy dng v hon thin Bn nu vn tho lun (Issue paper) theo mu chung (ma trn cc vn ct li v thc trng, cc vn u tin v gii php). Trnh by v nu vn tho lun ti cc hi tho Nhm i tc y t (HPG) da vo ma trn chun b. T chc tho lun nhm theo chuyn vi cch nu vn r rng v sc tch bng bng tm tt, em li hiu qu tt hn, so vi trc y. ng cc d tho chng trn website ca JAHR (www.JAHR.org.vn) ly kin ca cc chuyn gia trong nc v quc t. Gi cc d tho chng ly kin ca cc cc, v v n v lin quan ca B Y t v mt s b, ngnh. Hp Nhm k thut, gm chuyn gia trong nc v quc t, tho lun mt s vn k thut lin quan ca Bo co. Mi chng mi 2-3 cn b qun l v chuyn gia B Y t v mt s ngnh lin quan, cng nh cc chuyn gia quc t nu ph hp, t vn, gp trong qu trnh d tho cc chng v thm nh d tho cui cng (khi cn).

3. Vic phn tch, xc nh cc vn chnh, cc u tin v gii php c tin hnh da trn mt s quan nim chung c tho lun thng nht nh sau. Cc vn bt cp (kh khn, thch thc) l nhng vn cha ph hp, hoc cn yu km, do thiu cc yu t bo m thc hin, nh thiu chnh sch, c ch, ngun lc, qun l, ch o, k thut, v hp tc quc t v.v khng ch l nhng vn ang gp phi, m cn l nhng thch thc mi c th pht sinh do yu cu pht trin h thng y t trong nhng nm ti. Cn c nh gi nhng vn bt cp l: cc mc tiu ra trong 14

Gii thiu

cc chng trnh, k hoch ca ngnh y t; cc tiu ch cng bng, hiu qu, pht trin, cht lng... Cc vn u tin c xc nh trn c s phn tch, tng hp cc (rt nhiu) vn bt cp. l nhng bt cp v thch thc i) bc xc nht, ii) c ngha c bn/then cht gii quyt nhiu vn khc, iii) c tnh kh thi trong thi gian ti. Cc vn u tin c xc nh theo nhm vn , bao gm vn chnh v cc vn c th. Da vo cc vn c th xc nh cc nguyn nhn lm c s xut gii php. Khuyn ngh v cc gii php tng ng vi tng vn u tin, cn c vo cc nguyn nhn xc nh, trong c cc gii php lin quan n chnh sch, ngun lc, qun l, ch o, cng nh cc gii php k thut, v hp tc quc t, cho k hoch ca nm ti, cng nh mt s gii php di hn. 4. Cc ch s theo di, nh gi ca bo co JAHR c la chn v xc nh da trn mt s nguyn tc sau y. Cc ch tiu trong Mc tiu Pht trin Thin nin k m Vit Nam cam kt; Ch tiu trong K hoch 5 nm ca ngnh y t giai on 2011-2015; Ch tiu Quc hi giao cho ngnh y t; Cc ch tiu Chnh ph giao cho ngnh y t trong Quyt nh s 43/2010/Q-TTg; Hng dn ca T chc Y t Th gii v theo di 6 cu phn ca h thng y t; Cc ch tiu phn nh c 3 nhm: u vo, qu trnh hot ng v ch tiu u ra ca h thng y t.

Cc ch s c phn loi theo 7 nhm gm: i) Cc ch s tng qut v dn s v sc khe; ii) Nhn lc y t; iii) Ti chnh y t; iv) Thuc, sinh phm, trang thit b; v) Cung ng dch v; vi) Qun tr h thng; vii) Cc ch s tc ng/u ra. Vic b sung v hon thin b ch s theo di v nh gia tp trung vo tc ng ca chnh sch ti chnh y t, cc ch tiu thuc chng trnh Mc tiu y t quc gia. Mt s ch s c chia theo vng v nhm thu nhp xem xt kha cnh cng bng v khc bit gia cc vng. Ngoi ra, cc ch tiu v phng chng cc bnh khng ly nhim; qun tr h thng y t, v cc ch s tc ng/u ra ca h thng y t nh ch s v chnh lch t l cht v suy dinh dng tr em gia vng cao nht v thp nht.cng c b sung trong Bo co nm 2011.

T chc thc hinCng nh cc nm trc, bo co JAHR 2011 c xy dng vi s phi hp ch o ca B Y t v Nhm i tc y t. C cu t chc iu hnh qu trnh xy dng bo co gm c: Nhm cng tc, gm mt s thnh vin ca B Y t v Nhm i tc y t, c nhim v hng dn v gim st qu trnh trin khai xy dng bo co, bo m ngun lc cho cc hot ng lin quan. T th k, gm i din B Y t (V K hoch - Ti chnh), mt iu phi vin quc t, mt iu phi vin trong nc v mt s cn b h tr, c nhim v gii quyt nhng vn hng ngy v qun l v hnh chnh, t chc hi tho, tng hp cc kin ng gp, bo m cho qu trnh vit bo co c s tham gia ca nhiu bn; bin tp, chnh sa, hon thin bo co.

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Bo co tng quan ngnh y t nm 2011

Chuyn gia t vn, gm cc chuyn gia trong nc v quc t c kin thc, kinh nghim lin quan n cc cu phn ca h thng y t, c nhim v d tho cc chng ca bo co, thu thp kin ca cc bn lin quan v hon thin cc chng ph hp vi cc gp v nhn xt chung.

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Phn I: Cp nht thc trng h thng y t

Phn I: Cp nht thc trng h thng y t

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Bo co tng quan ngnh y t nm 2011

Chng 1: Tnh trng sc khe v cc yu t nh hngVit Nam tr thnh nc thu nhp trung bnh nhng mc thp, vi tc tng trng kinh t hng nm trn 6%. Nhng tc ng ca khng hong kinh t th gii cng nh thay i kh hu lm chm qu trnh pht trin kinh t x hi, qua nh hng n vic thc hin cc ch tiu sc khe t ra. Mc du vy, trong nhng nm qua tnh trng sc khe ca ngi dn Vit Nam c nhng ci thin r rt, th hin mt s ch s sc khe c bn nh tui th trung bnh, t sut t vong tr em, t s t vong m, suy dinh dng.

1. Tnh hnh thc hin cc ch tiu y tCc ch tiu y t c giao ti Quyt nh 147/2000/Q-TTg ngy 22/12/2000 ca Th tng Chnh ph v vic ph duyt Chin lc Dn s Vit Nam giai on 2001-2010; Quyt nh 35/2001/Q-TTG ngy 19/3/2001 ca Th tng Chnh ph v Chin lc chm sc v bo v sc khe nhn dn giai on 2001-2010; Quyt nh 153/2006/Q-TTg ngy 30/6/2006 v Quy hoch tng th pht trin h thng y t Vit Nam n 2010 v tm nhn 2020; Quyt nh 170/2007/Q-TTg ngy 8/11/2007 ca Th tng Chnh ph v vic ph duyt Chng trnh mc tiu y t quc gia Dn s-KHHG giai on 2006-2010; Cc ch tiu y t Quc hi giao hng nm v mt s vn bn khc. Tnh hnh thc hin cc ch tiu y t c trnh by Bng 1. Kt qu nh gi cho thy cc ch tiu y t u t hoc vt so vi mc tiu ra.Bng 1: Kt qu thc hin cc ch tiu y t c bnCh tiu 1. 2. 3. 4. 5. 6. 7. 8. Gim t l sinh () T sut sinh th () T l pht trin dn s (%) Tui th trung bnh (tui) T s t vong m (p100.000) T sut t vong tr em