nh gi kh nng p ng ca dch v y t TP.

HCM n 2020 v cc vn t ra (Phn II)

2. Khi y t ngoi cng lp: S bnh vin t nhn tng nhanh t gn 50% s BV t nhn c nc.Tnh n ht nm 2005 khi bnh vin t nhn c 19 BV c cp php hot ng vi 20 c s bao gm 12 c s a khoa v 8 c s chuyn khoa vi 1466 ging bnh. S ging bnh a vo hot ng l 1384 ging, t l bc s/ging bnh ca khi BV t l hn 0,4Bc s t l ny cho thy cht lng chm sc ca BV t nhn v y l s bc s thun ty ca khi BV. Mt s Bnh vin a khoa c t l hn 1 bc s/ging bnh nh Bnh vin K Hon M, Bnh vin K Vn Hnh. Khi y t t nhn pht trin mnh sau khi c ch trng x hi ha y t, s c s c bit tng nhanh trong giai on 2000-2005. Tc tng bnh qun giai on 20012005 ca ton b cc c s hnh ngh y dc t nhn l 5,1%, s liu qun l cho thy c s tp trung mt s nhm: phng khm a khoa: 34,6%, phng khm chuyn khoa: 4,5% trong tp trung tng cao phng khm ngoi:> 67% , gii phu thm m: 12,5%, X-quang: 10,5%, Cty TNHH dc: 22,7%, Bnh vin a Khoa: 28,8%, Bnh vin chuyn khoa: 27,8%, Phng khm 100% vn nc ngoi : 15%. ....(xem ph lc) Mt mnh: M hnh hnh ngh phong ph chuyn su p ng nhu cu ngy cng a dng ca ngi dn. Ngi dn c la chn chuyn khoa- thy thuc, c iu tr v phc hi sc khe nhanh hn, c chm sc v tn trng nhiu hn. Mt yu: C s cnh tranh khng lnh mnh gia cc c s hnh ngh nh li ko bnh nhn t BV cng sang BV t, gia cc BV t vi nhau. Hnh lang php l cha r rng cha bo v c ngi thy thuc khi c tai bin xy ra, hoc cho bnh nhn khi b iu tr khng ng ch nh. Huyn. M hnh qun l nh nc v y t t nhn cha thng nht cp Qun Gim ti cho cc c s y t cng lp.

II. Phn tch cc yu t tc ng n sc khe cng ng (SKC): Thnh ph cng vi s pht trin kinh t v th ha nhanh chng dn bc l nhiu yu t nh hng n SKC nh: nhim mi trng sng, thiu nc sch, tai nn giao thng, t nn x hi, hnh vi xu trong li sng sinh hot chm khc phc lm gia tng nhiu loi bnh tt m ngnh y t phi i ph nh ung th, tim mch, cc bnh phi, tai mi hng, ri lon tm thnv c bit l cc bnh ly qua ng tnh dc v i dch AIDS ang trn pht trin nhanh. S liu thng k cho thy st xut huyt, nhim HIV, bnh nhn AIDS c xu hng tng mnh, s BN AIDS cht c tc tng bnh qun giai on 2001-2004 rt cao: hn 65%. Bnh Ung th, Tm thn phn lit v Lao cng ng bo ng (xem biu) v cn sm tp trung nghin cu tm ra tc nhn

v cc bin php phng chng ngn chn kp thi. Nu khng khn trng th l mi him ha cho sc khe cng ng, cht lng ngun nhn lc v lm hao tn tin ca ca cc gia nh v ton x hi. Biu 4: Tnh hnh mt s bnh tt trn a bn TP giai on 2001-2004 Tnh hnh mt s bnh tt St xut huyt* Lao Tm thn phn lit Nhim HIV* S BN AIDS* BN AIDS/cht Ung th Tc tng bnh qun 2001 2136 10998 6016 9162 3520 324 6237 2002 2783 11840 6225 13069 4481 388 10521 2003 7537 12465 6387 17782 5933 608 10039 2004 g/ 2001-2004 (%) 8830 12473 7275 22445 8408 1466 10507 60.5 4.3 6.5 34.8 33.7 65.4 19.0

Ngun : Bo co 2005 ca S Y t TPHCM & NGTKTP 2004 (xut bn T4/2005)(*) Hn na, nhu cu khm cha bnh ca ngi dn ngy cng tng v s lng v cht lng cng ang l mt p lc ln cho ngnh y t thnh ph. t ra cc thch thc i vi ngnh y t v cng tc CSSKC: Cc bnh truyn nhim gy dch c kh nng bng pht v quay tr li gy nh hng SKC: t, thng hn, dch hch, st xut huyt, st rt, cm gia cm, si, vim no virt . Cc bnh tt lin quan n nhim mi trng, tai nn giao thng, cc bnh khng nhim trng c trng cho mt x hi cng nghip c chiu hng gia tng nhanh chng i dch HIV/AIDS gia tng nhanh v kh khng ch ang l mt mi nguy c ln i vi ton x hi Cc bnh ngh nghip, bnh hc ng, bnh nhim c ha cht c xu hng gia tng. Vn sc khe tinh thn trong mt x hi c tc th ha nhanh. Vn y t mi trng: vn nc sch v v sinh mi trng. Vn qun l v s l cht thi bnh vin, rc thi ca cc nh my, x nghip cng nghip. Vn nhim khng kh, khi bi, ting n Vn V sinh An ton thc phm: cc ca ng tng do cha kim sot tt ATVSTP dinh dng. Vn y t trng hc: chm sc sc khe hc sinh Vn dinh dng cng ng: phng chng vi cht dinh dng v suy

 cng nhn.

Vn y t lao ng: kim sot mi trng lao ng, chm sc sc khe

Vn o to v pht trin i ng cn b y t, m bo cung cp nhn lc cht lng cao p ng yu cu nhn lc ca cc c s y t v nhu cu KCB ngy cng tng ca nhn dn. III. Kh nng pht trin v kh nng p ng ca DVYT trong tng lai. Khi y t cng lp: - Theo qui hoch pht trin c s vt cht ngnh y t n 2020 c UBND thnh ph ph duyt quyt nh s 165/Q-UB ngy 02/07/2004 l tp trung xy dng cc Trung tm xt nghim, Trung tm Y t k thut cao v cc Vin Trng ti cc ca ng vo thnh ph. Ngoi ra cn d kin nng cp, m rng, xy dng mi mt lot cc BV Vin trng, Trung Tm Y t. Bn cnh nhu cu u t c s vt cht cn l nhu cu o to nhn lc rt ln: tnh ring khi cng lp n nm 2010 th s bc s cn thiu cn b sung gn 28,6% v s nhn vin y t cn b sung l 21,8% trn tng s, n 2020 s nhn lc cn b sung cho bc s cng nh NVYT u l 38% l cha tnh n s ngh hu, ngh vic. Do nhu cu xy dng trng i hc v m hnh vin trng o to thm nhn lc cho ngnh y t TP l nhu cu thit thc. Tuy nhin vn u t cho o to v pht trin ngun nhn lc cha tnh c rnh r nh u t c s vt cht. - Bnh vin Ch Ry xy dng d n Lng Ch Ry vi din tch 82,13ha ti p 5 x Phong Ph, Huyn Bnh Chnh; Trong c BV Ch Ry 2 (7ha d kin s c 500 ging), khu iu dng cho bnh nhn sau iu tr (3,5ha vi 200 ging ) Ngoi ra cha tnh n BV Ch Ry Si Gn 1000 ging trn khu t 5ha ti khu Nam Si Gn v ang ln chng trnh cho mt lot BV khong 500 ging vi ci tn Ch Ry ghp cng cc a danh Cn Th, Gia Lai, Ph Yn, Ty Ninh xy dng cc a phng ). Biu 5: Cc ch tiu d kin cho khi y t cng lp v nhu cu u t Cc ch tiu d kin cho khi Y t cng lp Tng s gin g bnh DK tng thm / v t n h 2 0 1 0 2 0 2 0

g i n g

8 . 1 6 4

T l gin g bnh CL/10 .000 dn Tng s tin nng cp ton b cc CSYT Trong : Tin XDM R cc c s y t cp TP& QH C s tnh Bs/d n s T l bc s CL/10 000d n S BSCL cn c S BsCL

G i 3 5 n , g 2 t r i u n g t r i u n g 9 . 7 0 5 . 9 8 6 8 . 2 4 2 . 7 0 0 1 4 . 1 4 9 . 4 7 8 1 2 . 3 6 4 . 0 5 0

1 0 N g 7 4 1 i 0 N2 g 1

cn thiu T l bc s CL/gi ng bnh NVY T tnh theo chu n B Y T

1 8 i 0 . 2 8

S NVY T cn c S NVY T cn thm (2006 2010)

1 N8 g . 5 2 i 5

N4 g . 0 4 i 1

Ngun : Qui Hoch Pht trin mng li CSVC ngnh Yt TPHCM n 2020 (S Y t TPHCM ) (*) tnh ton da trn cc tiu chun theo qui nh ca B Y t Khi y t ngoi cng lp : Kh nng m rng ca khi BV t nhn: Trung tm chn on Y khoa /c 254 Ha Ho; chun b xy dng khu Gia tc vng chn an v xt nghim vi k thut tin tin hin i. Bnh vin a khoa Hng c d kin m rng thm 2 c s : giai on 20062010 l c s qun G Vp vi qui m 100 ging bnh v mt c s 200 ging qun 12 giai on 2010-2020. Bnh vin a khoa V Anh ang xy dng trn a bn P.7 qun G Vp vi qui m c duyt l 150 ging d kin a vo hot ng u nm 2007.

Bnh vin a khoa Triu An tin n m rng s ging hot ng t 350 ging bnh nm 2005 ln 500 ging vo giai on 2006-2010. Ngoi ra cn mt s BV 100% vn nc ngoi cng ang ln k hoch xin giy php XD v a vo hot ng trong giai on 2006-2010. Biu 6: Hin trng v d bo c s ging bnh ca khi y t ngoi cng lp 2004 D Bo 2010 7409865 1784 2,41 1384 2,28

Dn s trung bnh Ging bnh ngoi CL T l ging NCL/10000dn

6062993

Ngun: QL Dch v Y t T nhn _ S Y t TPHCM 2000-2005 nh gi chung da trn c s qui hoch pht trin mng li ca y t cng lp v cc d kin pht trin ca khi y t ngoi cng lp th kh nng p ng cc dch v y t ca c 2 khu vc n 2020 l hon ton c th tt hn so vi hin nay vi iu kin ngnh y t phi gii c bi ton ngun nhn lc. Hn th na dch v y t cn c th tr thnh mt nhn t tng i quan trng trong c cu cc ngnh dch v ca thnh ph v khu vc khi Vit Nam hi nhp hon ton vo AFTA v WTO. Tuy nhin t c iu th thnh ph cn phi gii quyt trit c vn ti chnh cho pht trin bi v theo d kin i hi ngun u t rt ln cho c s vt cht pht trin (xem biu Cc ch tiu d kin cho khi y t cng lp) bn cnh l chi ph o to nhn lc p ng cho cc c s y t cng lp v ngoi cng lp. Cc vn t ra: Y t d phng: Nng cao nng lc ca cc TT Y t d phng m bo t yu cu phng bnh ch ng, xt nghim chun, pht hin sm cc mm mng gy dch bnh. u t xy dng cc trung tm thuc h y t d phng t chun gii quyt c nhng vn ca mt thnh ph ln t ra cho y t d phng:o to nhn lc cho YTDP, tng cng u t TTB v qun l tt cc ngun lc YTDP, x hi ha YTDP. Cng tc Khm cha bnh: Tip tc u t nng cp c s vt cht v trang b my mc TTB hin i ng b phc v cho cng tc KCB. Tip tc y mnh cng tc x hi ha y t, a dng ha cc loi hnh y t nhm p ng nhu cu KCB a dng ca nhn dn. o to ngun nhn lc: Cn m bo p ng c v s lng ln cht lng, ch trng vn y c trong o to cn b y t. Thng xuyn t chc cc loi hnh o to nng cao nhm mc tiu nng cao trnh chuyn mn ca cn b y t. S tham gia ca cng ng trong cc hot ng CSSKC: tham gia gim st cht lng nc v v sinh mi trng, gim st cng tc qun l v s l rc thi. Ti chnh cho pht trin dch v y t: y mnh XHH cc dch v Y t. Thu ht mi ngun u t trong v ngoi nc pht trin c s dch v y t hng n y t cht lng cao.

 Vn Bo Him Y t: pht trin a dng v nng cao cht lng BHYT gp phn thc hin bnh ng trong CSSK ban u, phng nga bnh tt v bo m an sinh x hi cho cc i tng chnh sch, ngi ngho. Ti liu tham kho: 1/ Qui Hoch Pht trin mng li CSVC ngnh Yt TPHCM n 2020 (S Y tTPHCM) 2/ Bo co Tng kt cng tc y t nm 2000-2005 (S Y tTPHCM) 3/ Nin gim Thng k TPHCM 1995-2004 (Cc Thng k TPHCM) 4/ Nin gim thng k y t 2000-2004 (B Y t) 5/ V mt s ti liu chuyn ngnh. Trch Hi tho: Dn s vi pht trin kinh t x hi TP.HCM thng 2/2006