BO HIM Y T VIT NAM

MC TIU
1. Nu c mc tiu, ngha ca BHYT
2. Trnh by c c cu t chc v s cn
thit ca BHYT
3. ng dng nhng quy nh ca BHYT vo
thc t khm cha bnh v cung ng thuc

I. QU TRNH HNH THNH

18-6-1952 Cng c quc t u tin v An ton x
hi ra i ti Geneve
Huy ng mi thnh vin trong XH ng gp tin
nhm gim gnh nng cho ngn sch nh nc/
thin tai, bnh tt
15.8.1992 BHYT VN chnh thc c thnh lp

II. MC CH NGHA
- Huy ng s ng gp ca ngi lao ng v
ngi s dng lao ng thanh ton chi ph cho
ngi c BHYT
- Chm sc sc khe mang tnh cht x hi, khng v
mc tiu li nhun

III. GII THCH T NG

1. BHYT
-

Ly tin ca ngi khe gip ngi m au, bnh tt

BHYT nh nc, BHYT t nhn

2. Qu BHYT
-

Thu ph BHYT + ngun thu hp php

3. Hnh thc thanh ton

4. Thn nhn
5. Thnh vin trong h gia nh
7. Ngi s dng lao ng
8. CS khm cha bnh BHYT ban u

IV. T CHC BHYT

BHXH

BYT

BHYT VN

BHYT Ngnh

BHYT Tnh/ TP

UBND Tnh/TP TW

BHYT Q/H

IV. CC HNH THC BHYT VN

C 2 hnh thc:
BHYT bt buc
BHYT nh nc
BHXH

BHYT t nguyn

BHYT VN
BHYT t nhn
BHYT kinh doanh

i tng

BHYT / BHXH

BHYT kinh doanh

Ngi l

16 65 tui

Phng thc, CQ qun Bt buc, nh nc

l

Cng ty BHKD t nhn,

nh nc, c phn

Tnh cht

Nhn o, cng ng

Cn i thu chi, ngha

v nh nc

Ngun qu

Ngi l + ngi s
dng l

Ngi tham gia

Phng thc thanh

ton

Chyn cho csyt KCB

Tr cho ngi c
BH, BV k H
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V. BHYT BT BUC
1. i tng, mc ng, phng thc ng
Cn b, cng chc, vin chc, ngi lao ng:
4,5% tin lng tin cng
Ngi ang hng lng hu, tr cp mt sc
lao ng hng thng: 4,5% tin lng hu, tr cp
(BHXH)
Ngi c cng CM, lu hc sinh nc ngoi, h
g ngho: 4,5% mc lng ti thiu (NSNN)
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2. Mc thanh ton:
- Tr em, ngi hot ng CM trc 19/8/1945, b
m VN anh hng, thng binh bnh binh >81%:
100% chi ph khm cha bnh, dv k thut cao
- Ngi c cng CM, s quan,h s quan, khm bnh
tuyn x, tng chi ph <15% lng ti thiu: 100%
chi ph, dv k thut cao =< 40 thng lng ti thiu

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- Ngi hng lng hu, tr cp, h gia nh

ngho: 95%, dv k thut cao =< 40 thng lng ti
thiu
- i tng cn li: 80% dv k thut cao =< 40 thng
lng ti thiu

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* Vt tuyn, khng ng ni ng k KCB ban u:

ngi bnh thanh ton cho c s KCB
- 70%: BV hng III, cha xp hng
- 50%: BV hng II
- 30%: BV hng I v hng c bit
dv k thut cao =< 40 thng lng ti thiu

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* C s KCB khng c hp ng vi BHYT

- Ngoi tr: =< 55.000, 120.000, 340.000
- Ni tr: =< 450.000, 1.200.000, 3.600.000
- Nc ngoi: =< 4.500.000
*Bnh nhn ung th: 50%
- BHYT lin tc >= 36 thng
- Tr < 6 tui
- B QP, B CA, Ban c yu chnh ph
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3. Quyn ca ngi c th BHYT

- KCB ni tr, ngoi tr/ cng lp, ngoi cng lp (c
hp ng vi BHXH)
- CS KCB ban u, chuyn vin ph hp tuyn, cp
cu ti c s KCB BHYT

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4. Qun l v s dng qu BHYT

- 90% qu KCB
- 10% qu d phng KCB

tin ti tr, vin tr

tin li hp

php

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5. Cc hnh thc thanh ton chi ph KCB BHYT

5.1. Gia BHXH vi CS KCB
a. Theo ph dch v
b. Theo nh sut
c. Theo nhm bnh

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5.2. Gia BHXH vi ngi tham gia BHYT

Thanh ton bng tin mt
- Vt tuyn
- C s KCB khng hp ng BHXH
- KCB nc ngoi

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VI. BHYT T NGUYN

1. i tng, mc ng, phng thc ng
- H gia nh:
+ Ngi 1: 4,5% mc lng ti thiu
+ Ngi 2, 3, 4 ng 90%, 80%, 70% ngi 1
+ Ngi th 5 tr i ng 60% ngi th 1

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- H g cn ngho, g nng, lm ,ng, dim nghip, :

4,5% mc lng ti thiu (50% NN)
- Hc sinh, sinh vin: 3% mc lng ti thiu ( NN
50%, 30%)
- i tng khc: 4,5% mc lng ti thiu

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2. Quyn li, thanh ton

- Th BHYT c gi tr sau 30 ngy; DVKT cao sau
180 ngy; thai sn sau 270 ngy; thuc ung th,
chng thi ghp sau 36 thng (50%)
- Thanh ton 80% chi ph KCB ni, ngoi tr (80%
DVKT cao =< 40 thng lng ti thiu)
- KCB khng ng tuyn = BHYT bt buc

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VII. THUC CUNG NG CHO BHYT

1. Yu cu :
Cht lng, hiu qu
Ph hp pht
Gi r
2. Nguyn tc :
Thng qua Hi ng thuc v iu tr
Danh mc thuc thit yu
u thu
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VII.TRNG HP KHNG C BHYT

1. Khm cha bnh c NSNN chi tr.
2. iu dng, an dng
3. Khm sc khe
4. Xt nghim, chn on thai
5. K thut h tr sinh sn, KHHG, no ht thai, ph thai
6. S dng dch v thm m
7. iu tr lc, cn th v tt khc x ca mt

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8. Chn tay gi, mt gi, rng gi, knh mt

9. KCB phc hi chc nng
10. T t, t gy thng tch.
11. Nghin ma ty, nghin ru hoc cht gy nghin khc
12. KCB cc tn thng do hnh vi VPPL ca ngi gy ra.
13. Gim nh y khoa, gim nh php y, gim nh php y tm
thn
14. Th nghim lm sng, nghin cu khoa hc.

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