Nhm 12: Thc trng v phng thc ci tin cc ti thc dch v y t Vit Nam

Nguyn B Hiu V nh Thi Trn Cao K Trn Anh Dng Phan Th Hi Yn

Khi qut v dch v cng mt quc gia:

Theo ngha hp, dch v cng c hiu l nhng hng ha v dch v m chnh ph c trch nhim cung cp hoc qun l vic cung cp nhm m bo li ch ca cng dn... Theo , dch v cng l loi dch v do nh nc trc tip thc hin hoc y quyn cho n v ngoi nh nc thc hin di s gim st ca t chc cng quyn. C th hiu dch v cng l dch v do nh nc chu trch nhim phc v nhng yu cu c bn, thit yu chung ca ngi dn khng v mc tiu li nhun. Nhiu nh nghin cu cho rng, dch v cng bao gm c dch v cng cng ln dch v hnh chnh cng. Nhm dch v cng cng lin quan n dch v x hi nh trng hc, bnh vin, hot ng nghin cu...; dch v cng ch bao gm c cung cp nc sch, v sinh mi trng, giao thng cng cng... Nhm dch v hnh chnh cng gm cp php, chng nhn, xc nhn, thu cc khon ng gp vo ngn sch, qu nh nc; gii quyt khiu ni, t co v x l vi phm hnh chnh, lut php (Nguyn nh Phan - Nng cao cht lng dch v hnh chnh cng thnh ph H Ni p ng yu cu hi nhp - ti nghin cu khoa hc cp b, H Ni 2009). T nhng khi nim nu trn, c th phn dch v cng thnh nhim v hnh chnh m nh nc phi thc hin v th hai l cung cp nhng sn phm thit yu cho i sng v nhng th nm ngoi dch v c bn, do nh nc m nhn hoc giao cho cc t chc khc cung ng cho cng chng. Ngi s dng dch v cng khng ch l ngi tiu dng thng thng m cn l ngi np thu, h c quyn v ngha v cng dn trong khun kh lut php quy nh.Vi t cch l ngi np thu v l cng dn, ngi dn s hu t chc ang cung cp dch v v h c nhng mong mun dn s vt xa nhu cu. Do khch hng ca chnh ph c th l nhng cng dn ca t nc mnh, hoc ca mt quc gia c quan h hp tc khc, nn cht lng dch v cng cn nh hng ti hnh nh quc gia trong cng ng quc t (Hong Vn Hi - Xu hng hin i trong qun tr dch v thuc khu vc cng - H Ni thng 6 nm 2010). Khc vi hng ha v dch v t thng c cung cp bi cc doanh nghip, cc t chc kinh doanh, dch v cng do chnh ph hoc cc t chc do chnh ph ch nh cung cp cho mi i tng thuc bt c tng lp v a v x hi no. Vic cung cp dch v cng mi quc gia u ph thuc vo mc tiu c bn nhm m bo cung ng mc tt nht. Nu i theo hng th trng trong phn phi ngun lc, th nhng nguyn tc c bn s nm gia ranh gii chnh tr v

kinh t. Trong , c trch nhim ca x hi v ngha v ca nh nc i vi nhm ngi ngho d b tn thng. Trong th gii hin i, du hiu nhn bit mt chnh ph tt l mc m bo phc li chung v phc li cng cng cho ngi dn ca mnh. Nhm m bo cung ng dch v cng tt hn, nhm nghin cu ca Jairo Acuna-Alfaro nhn mnh n vai tr ca t chc gim st thc hin chnh sch v vic m bo tiu chun cht lng ca cc dch v do c quan chnh ph cung ng. Nhng n v qun l cung ng dch v cng chu trch nhim bo co gii trnh, song phi c quyn mnh m bo thc hin chnh sch theo ng yu cu; phi c nng lc phn bin, b sung, sa i chnh sch v cung ng dch v cng khi cn v iu quan trng l gy dng vn ha hng ti s u vit trong cung ng dch v cng (Jairo Acuna Alfaro - Nng cao hiu qu qun tr quc gia v y mnh ci cch hnh chnh Vit Nam - Ci cch nn hnh chnh Vit Nam - NXB Chnh tr Quc gia 2009). Vic xc nh loi hnh t chc khu vc cng n nay cha c s thng nht, mi quc gia u c nhng cch lm ring; song tu trung li, u c ba thnh phn c bn l: 1) Dch v hnh chnh cng (cp giy php, giy chng nhn, xc nhn....); 2) Dch v cng ch (chm sc sc khe, gio dc o to, vn ha x hi, thng tin truyn thng, th thao, gii tr, nghin cu khoa hc k thut v v sinh mi trng...); 3) Dch v an ninh, trt t x hi (Hong Vn Hi -Xu hng hin i trong qun tr dch v thuc khu vc cng - H Ni thng 6 nm 2010).

Thc trng v h thng bnh vin ti vit nam:

H thng bnh vin Vit Nam S pht trin h thng bnh vin gn lin vi qu trnh pht trin ca h thng y t, bnh vin gi vai tr quan trng trong vic chm sc sc kho nhn dn. H thng bnh vin Vit Nam gm ch yu l cc bnh vin cng (chim 93,3%). Cc bnh vin t bao gm c bnh vin bn cng v bnh vin c vn u t nc ngoi mi ch chim 3,7% bnh vin v 2,2% ging bnh trong c nc. Ngoi ra cn c 22 bnh vin c cp php ang tin hnh xy dng.S lng cc c s y t ngoi cng lp nhiu nhng quy m cn nh. T l bnh vin t v ging bnh t ca Vit Nam l rt thp so vi cc nc trong khu vc nh Thi Lan (30% v 22,5%), Indonesia (42% v 32%), Malaysia (62,4% v 164,4%), Philippin (67% v 50%) [11]. Song song vi bnh vin thuc B Y t, cn c bnh vin do cc b, ngnh khc qun l nh Qun i, Cng an, Bu in, Giao thng, Gang thp, May mc...Cc bnh vin ny thng l bnh vin a khoa v iu dng phc hi chc nng, ch yu phc v cho cn b cng nhn vin ca b, ngnh . Quy m ca bnh vin thng mc trung bnh v nh. Hin nay, Vit Nam c 1.024 bnh vin cng vi 126 772 ging bnh, c u t nhiu trang thit b (TTB) hin i nhng so vi nhu cu cung cp dch v y t

th hu ht c s vt cht, nh ca, in nc, thit b thng dng ca cc bnh vin vn cha t tiu chun ti thiu. khu vc t nhn, n nay c nc c 68 bnh vin vi hn 4.000 ging bnh, hn 30.000 phng khm, dch v y t t nhn . H thng bnh vin chuyn khoa Vit Nam kh pht trin v cng c phn cp thnh tuyn trung ng v tuyn tnh, thnh ph trc thuc trung ng. Cc chuyn khoa thng l sn, nhi, lao, da liu, tm thn, cc bnh ly truyn qua ng tnh dc. c bit, h thng YHCT rt pht trin v bao ph hu ht cc tnh/thnh ph. Hin nay cc bnh vin chuyn khoa chim 25% tng s bnh vin ca Vit Nam . Nhn chung cc bnh vin Vit Nam c quy m nh. S bnh vin di 100 ging chim gn 70% (570 bnh vin). S bnh vin c quy m 101 - 300 ging chim 20% (165 bnh vin); s ging t 300 - 500 ging chim 7,2%; s t 501 - 700 ging chim 2,4% (20 bnh vin). C 8 bnh vin trn 700 ging, khong 1%, trong c 3 bnh vin c quy m trn 1.000 ging l Bch Mai, Trung ng Hu v Ch Ry . So vi quy m ging bnh ca cc bnh vin ca mt s nc trong khu vc cng rt khc nhau: s ging bnh qun ca bnh vin Malaysia l 288 ging, ca Trung Quc l 138,7 . Thc t cho thy vi mng li bnh vin v trm y t ca vit nam la cha cung cp nhu cu ca ngi dn hin nay.S lng dng bnh ca cc bnh vin tnh v trung ng l cn thiu nng n.tnh trng mt dng bnh c rt nhiu bnh nhn nm l rt ph bin.Trong khi bnh vin cp huyn nhiu ni li thiu bnh nhn. Nguyn nhn l do ngi dn c xu hng c c bnh l mun cha cc bnh vin tuyn trn thay v bnh vin a phng. Th hai l do cc bnh vin a phng c cha c diu kin khm cha bnh y Phng hng ci tin v phat trin h thng bnh vin ti vit nam: 1) i vi bnh vin cp a phng , x phng : Cn b xung thm nhn lc, c s trang thit b c bn khm cha bnh , tng cng thm cc trm y t ti thiu mi x c 1 trm y t 2) Vi cc bnh vin cp tnh tr ln truyn mn cao cn u t xy dng thm cc bnh vin vi quy m ln ph hp vi nhu cu hin nay. 3) Cn nghin ca v tnh trng cp thit tng vng v tng tnh m cn tng cng thm cc bnh vin trnh trng hp ni tha ni thiu. 4) Thc trng v c s h tng v trang thit b ca bnh vin: Trong nhng nm gn y, mc d cha tng xng vi nhu cu thc t nhng h thng bnh vin c nng cp v u t tng i ng u tt c cc tuyn, v c s h tng v TTB k thut. Nhiu bnh vin c ci to v xy dng mi bng c ngun trong nc v ngun t nc ngoi vo khong 1.472 t ng/nm, cho c tuyn trung ng v a phng .H thng sy, hp tit trng, git l c cng c. H thng x l nc thi, cht thi bnh vin c ch u t.

Mc d t c nhng thnh tu v chuyn mn k thut nhng so vi cc nc trong khu vc v cc nc pht trin th cc bnh vin Vit Nam cn mc thp. Mi y, Chnh ph c quyt nh ph duyt d n nng cp ton din h thng bnh vin tuyn huyn v mt s bnh vin a khoa khu vc lin huyn (Quyt nh 225/2005/TTg). Theo quyt nh ny, d n s thc hin trong 3 nm 2005 - 2008 vi tng s vn hn 8.000 t ng nng cp hn 300 bnh vin cc loi, k c u t c s h tng k thut, TTB v o to cn b chuyn mn, m bo sau nng cp s thc hin tt chc nng nhim v tuyn huyn, gim ti cho cc bnh vin tuyn trn . Tuy nhin, s dng c cc TTB y t mt cch c hiu qu, cn c k hoch u t ph hp vi nhu cu v nng lc khai thc ca bnh vin. Khi so snh tnh hnh u t my CT v MRI ti Vit Nam cho thy s ngi dn bnh qun mt my thp hn Indonexia, nhng cao hn Malaysia hoc Singapore, hai nc c mc GDP bnh qun u ngi cao hn v dn s gi hn (Bng 1). Vi u t rt ln vo TTB nh vy, vn t ra l hiu qu s dng TTB nh th no? So snh vi tnh hnh s dng TTB nc ta vi cc nc khc cho thy s ln chp ct lp ca nc ta rt thp, X- quang v siu m li rt ca. iu ny mt phn no cho thy kh nng chi tr ca ngi bnh vi dch v k thut cao, chi ph ln cn thp, trong khi nhu cu s dng dch v chn on hnh nh thng thng l rt cao. Xt v cng sut s dng TTB cho thy cng sut s dng my Vit Nam rt thp.Ch so snh cng sut s dng my ct lp, cng sut s dng trung bnh ti bnh vin cng ch khong mt na so vi Canada v 70% so vi M. Ngay c trong nc cng c s khc nhau rt ln trong cng sut s dng TTB y t gia cc bnh vin. S ln thc hin bnh qun mt ngy i vi chp ct lp vi tnh, X - quang v xt nghim vi sinh u tng t 2000 n 2005. Tuy nhin cng sut thc hin bnh qun mt ngy ca bnh vin huyn thp hn hn so vi bnh vin tnh v trung ng . Hin nay, cng tc bo tr, bo dng, sa cha TTB y t hu ht ph thc v da vo cc nh cung cp v thiu kinh ph, thiu i ng cn b k thut chuyn trch cng tc bo dng v sa cha (trch ngun t hi y t cng cng vit nam). Bi vit ca Phm tr Dng.

Phng hng ci tin thc trang:

Pht trin ngun nhn lc chuyn ngnh trang thit b y t 1)Kt hp vi cc trng i hc k thut trong nc v cc trung tm o to chuyn ngnh ca nc ngoi o to cn b i hc v sau i hc chuyn ngnh trang thit b y t. - a nhng ni dung c bn v qun l, k thut - cng ngh, k nng s dng trang thit b y t vo chng trnh o to cn b i hc v trung hc Y, Dc.

- Nng cao cht lng, m rng quy m o to i ng cng nhn k thut thit b y t. - Ban hnh chnh sch ph hp cc c s y t c iu kin tip nhn cn b k thut c o to nh: k s y sinh hc, c nhn v cng nhn k thut thit b y t. 2) u t trang thit bi y t Trang thit b y t l lnh vc chuyn dng v rt t tin i hi nhiu yu cu kht khe v k thut cao, chnh xc, an ton v n nh. Nhu cu kinh ph trang b mi cng nh duy tr hot ng lin tc ca trang thit b c l rt ln. Huy ng vn u t trang thit b y t. - Kt hp cc ngun vn bao gm ngun ngn sch Nh nc, cc d n ODA, vn vay u i v thc hin x hi ho trong cng tc u t trang thit b y t. - Thc hin lng ghp cc chng trnh, d n, cc ngun vin tr ca cc t chc quc t, quc gia v cc t chc phi chnh ph. - Xy dng c ch thu hi vn duy tr hot ng v ti u t trang thit b y t. - Ban hnh quy nh v kinh ph dnh cho cng tc kim chun, bo dng v sa cha trang thit b y t hng nm. 3) nh hng u t trang thit b y t. u t trang thit b y t c trng tm, trng im nhm t c tnh hiu qu, khoa hc v kinh t. 4) Pht trin cng nghip trang thit b y t. Xy dng k hoch u t chiu su, i mi cng ngh sn xut trang thit b y t m trong nc c u th. Trc ht tp trung sn xut cc thit b y t thng dng phc v y t c s, chng trnh dn s - k hoch ho gia nh, chm sc sc khe ban u, dng c s dng mt ln v cc trang thit b phc v y t hc ng v gia nh. Xy dng quy ch nhm to mi trng hp dn cho cc doanh nghip, cc c s nghin cu khoa hc v cng ngh thuc cc ngnh, cc a phng tham gia sn xut trang thit b y t. Khuyn khch dng trang thit b y t sn xut trng nc, gim dn nhp khu, n nm 2010 ch nhp khu nhng thit b y t cha sn xut c trong nc. Tng bc xy dng v trnh Nh nc xem xt ban hnh cc chnh sch khuyn khch, u i i vi cc c s sn xut trang thit b y t trong nc.

C chnh sch u tin thch ng trong vic c cn b i o to v nghin cu sn xut trang thit b y t. 5)Cng c h thng kinh doanh, xut nhp khu trang thit b y t: Thng nht qun l Nh nc v kinh doanh , xut nhp khu trang thit b y t t trung ng n a phng. Thit lp h thng thanh tra, kim tra v gim st cht lng trang thit b y t ang lu hnh trn th trng. C chnh sch h tr v vn v k thut cho cc c s thuc thnh phn kinh t nh nc nhm pht huy vai tr ch o trong lnh vc kinh doanh trang thit b y t. - To iu kin thun li cc thnh phn kinh t c th tham gia hot ng kinh doanh trang thit b y t theo quy nh ca Nh nc v hng dn ca B y t. 6) T chc mng li hot ng ca chuyn ngnh trang thit b y t. 7) Tng cng cng tc qun l Nh nc: - Hon chnh v i mi h thng b my qun l Nh nc v trang thit b y t t Trung ng n a phng. Cc c s y t c cn b nghip v theo di cng tc trang thit b y t. Cc bnh vin, cc vin Trung ng, bnh vin a khoa tnh c phng vt t k thut thit b y t. Cc trung tm y t huyn c cn b chuyn mn theo di cng tc vt t thit b y t. Tng bc nng cao nng lc qun l trang thit b y t ca cc c s y t trong ton ngnh. Thc hin kim chun nh k trang thit b y t ang s dng ti cc c s s y t cng nh sn phm sn xut trong nc v nhp khu. Tng bc xy dng v cng c Vin trang thit b v Cng trnh y t. Phi hp vi tng cc Tiu chun- o lng - Cht lng o to kim nh vin, xy dng v ban hnh cc quy trnh kim chun trang thit b y t. Xy dng thm mt c s kim nh trang thit b y t ti thnh ph H Ch Minh. Cng c v xy dng c ch hot ng ca cc trung tm dch v k thut trang thit b y t.Trc mt tp trung xy dng trung tm dch v k thut trang thit b y t ti Nng m bo dch v k thut cho khu vc min Trung v Ty nguyn.a dng ho cc loi hnh dch v k thut thit b y t.

y mnh cng tc thanh tra, kim tra cht lng, gim st hiu qu khai thc s dng trang thit b y t ti cc c doanh theo cc quy nh ca Nh nc. 8)Tng cng cng tc nghin cu khoa hc, chuyn giao cng ngh v hp tc quc t v trang thit b y t: B Y t thnh lp c s nghin cu vi s tham gia ca cc c quan trc thuc B Y t, cc c s khoa hc cng ngh, cc nh khoa hc nghin cu kh nng ng dng nhng trang thit' b y t, cc phng php iu tr v chn on mi xut hin trn th gii p dng c chn lc vo Vit Nam. C chnh sch khuyn khch cc nh khoa hc, cc c s khoa hc v cng ngh trong v ngoi ngnh tham gia nghin cu ch to, khai thc s dng v thc hin dch v k thut v trang thit b y t. M rng hp tc vi cc tp on sn xut trang thit b y t c uy tn trn th gii trong vic lin doanh sn xut v chuyn giao cng ngh. ng dng cng ngh thng tin trong hot ng trang thit b y t: Xy dng k hoch tng th v trin khai tng bc ng dng cng ngh thng tin trong qun l trang thit b y t. nh hng th h k thut - cng ngh ca thit b y t cn trang b cho tng tuyn, tng khu vc m bo vic ni mng, truyn s liu hnh nh trong tng c s, tng khu vc v trong ton ngnh, p ng nhu cu t vn chn on, iu tr v o to t xa. . Thc trng v ngun nhn lc cho y t hin nay: (cadn.com.vn) Ti Vit Nam, ngun nhn lc ang thiu v s lng v yu v cht lng; trong khi c cu phn b cc ngnh li khng ng u gia cc vng min.Cc trng i hc, cao ng o to nhn lc cho ngnh y t tuy tng nhng cha p ng c nhu cu thc t ca x hi. Hin nay, mt s trng mi ch o to theo kh nng, nng lc ca mnh v th yu ca hc sinh m khng theo nhu cu thc tin ca x hi. Thi gian ti, cc trng phi tin hnh kho st, nh gi thc tin cng tc o to cho st thc tin; ng thi phi tin hnh tng bc v xem li cch thc o to ph hp vi nhu cu ca x hi... l kin ch o ca Th trng ti Hi tho.

"D n nghin cu, nh gi thc trng cng tc gio dc nhn lc y t ti Vit Nam" do cc gio s, tin s Trng i hc Y t cng cng trin khai, gm chui 3 nghin cu l nhn lc bc s a khoa, iu dng v c nhn y t cng cng: nh gi thc trng v cc chnh sch h tr o to; Nghin cu ti cc trng o to nhn lc cho ngnh y t v Nghin cu v sinh vin, cu sinh vin. Tin s V Hong Lan, Trng i hc Y t cng cng cho bit, nghin cu "Nhn lc bc s a khoa, iu dng v c nhn y t cng cng c thc hin nghin cu ti 11 trng i hc v 6 trng Cao ng: nh gi thc trng v cc chnh sch h tr o to" l 1 trong chui 3 nghin cu kt hp nh gi thc trng o to nhn lc y t ti Vit Nam. Qua cung cp bng chng v xc nh cc lnh vc u tin cn c i mi p ng tt hn cho nhu cu chm sc sc khe nhn dn, giai on 2011-2020 nhm phn nh thc trng ngun nhn lc y t v r sot cc chnh sch lin quan n o to nhn lc y t Vit Nam. Nghin cu cng ch ra, trung bnh c nc c 6,5 bc s/10.000 dn s; phn b khng u, ch yu tp trung thnh th, vng kinh t pht trin vi t l 60% bc s tp trung thnh th trong khi dn s thnh th ch c 28,4% dn s c nc. T l Trm y t x c bc s cao nht vng Bc Trung B, ng bng sng Cu Long (trn 96%), thp nht Trung du v min ni pha Bc (ch 32,4%), mt s tnh c t l thp nht l Lai Chu 3,3%. Trung bnh c 10,4 iu dng/10.000 dn s; cht lng yu, ch yu l trnh s cp, trung cp; phn b khng u v s lng cn b y t d phng tuyn tnh ch bng 2/3 nhu cu v tuyn huyn ch bng 1/2 nhu cu... Qua cho thy, nhn lc y t Vit Nam ang thiu v s lng v yu v cht lng (khong 25% c trnh i hc tr ln); phn b khng ng u, nht l cc tuyn khm cha bnh ban u, cc vng kh khn, nng thn v cc lnh vc y t d phng, chuyn khoa lao, tm thn... Nghin cu cng nu r hin ti c 15 trng i hc v 65 trng cao ng v truo c tuyn v o to khong 1.488 bc s v 24 iu dng. Bn cnh , nm 2009 cc trng i hc tuyn hc vin theo chnh sch tuyn sinh theo a ch ti 13 trng, p ng 71% nhu cu gi ngi i hc ca cc tnh./. Phng hng cho pht trin ngun nhn lc cho nganh y t: + o to lin thng, bi dng bc s chuyn khoa v o to theo a ch l nhng loi hnh o to c nh gi l m bo cht lng u ra v ph hp vi nhu cu thc t. Vic tng s lng u vo h o to theo a ch v lin thng s gp phn p ng nhu cu nhn lc vng trng. +Tnh trng mt s hc vin h c tuyn khng theo kp chng trnh o to, hoc s cn b c cht lng tt th li khng tr v a phng lm vic

lm nh hng n vic s dng ngun nhn lc y t cc a phng cn c cc chnh sch i ng cho cc cn b thu ht lm vic ti a phng .+nng cao hn cht lng o to cn sng lc sm cht lng hc sinh h c tuyn trc khi gi ln trng o to, thi gian o to cn di hn. +tng cng cc ngun vn cho o to cc trng i hc cao ng, trung cp. Cp hc bng cho nhng hc sinh i du hc nc ngoi nhm nng cao trnh . C cc cn b sang hc tp quan sat nc ngoi v p dng vo trong nc. + Ngoi ra cc bnh vin u ngnh c i ng thy thuc ng, tay ngh cao, thit b hin i cn c nhim v tch cc phi hp vi a phng o to bc s chuyn khoa theo lt ct dc. Thc trng v cht lng chm sc y t ca nc ta: Dch v y t l mt dch v kh c bit.V bn cht, dch v y t bao gm cc hot ng c thc hin bi nhn vin y t nh khm, cha bnh phc v bnh nhn v gia nh.Thc t, ngi bnh t khi nh gi chnh xc cht lng dch v y t mc d h c th cm nhn qua tip xc vi nhn vin y t, trang thit b, c s vt cht. Mt ngi bnh c phu thut kh lng bit c cht lng ca ca m nh th no, ngoi tr cm gic au sau m v vt m c nhn thy. Cht lng dch v y t bao gm hai thnh phn: cht lng k thut (technical quality) v cht lng chc nng (functional quality). Cht lng k thut l s chnh xc trong k thut chn on v iu tr bnh. Cht lng chc nng bao gm cc c tnh nh: c s vt cht bnh vin, giao tip vi nhn vin y t, cch thc t chc quy trnh khm cha bnh m ngi bnh phi thc hin, cch thc bnh vin chm sc ngi bnh Ch c nhn vin trong ngnh y t l nhng ngi c trang b kin thc c th nh gi cht lng k thut ca dch v y t.Ngi bnh him khi c kh nng nhn nh v nh gi cht lng k thut.Trong a s cc trng hp, ngi bnh nh gi dch v y t da vo cht lng chc nng hn l cht lng k thut. Cc chng trnh o to nhn lc v chuyn mn v qun l trong ngnh y t t trc n nay ch yu ch trng o to kin thc v k nng m bo cht lng k thut m t quan tm n cc kin thc v k nng m bo cung cp cht lng chc nng.Bn cnh , tnh cnh tranh ca cc dch v y t trong thi gian qua khng cao. Cc yu t trn lm cho cht lng dch v y t Vit Nam mt cn i nghim trng gia hai phn cu thnh chnh: k thut v chc nng. Trong khi nhu cu ca ngi bnh v x hi ngy cng pht trin, ngnh y t vn cha theo kp pht trin ny ca x hi, c bit l vic nng cao cht lng chc nng ca dch v y t.

Thc t cho thy, vic cc bnh vin ngy cng qu ti khin cht lng k thut v cht lng chc nng u gim.Bnh vin cng lp ch yu u t vo cht lng k thut bng cch u t con ngi v thit b pht trin k thut mi v gia tng quy m m bo phc v nhu cu ngy cng tng. Do khng c o to cng nh cha c nhn thc v thnh phn cht lng chc nng ca dch v y t, a s cc bnh vin Vit Nam, c bit l bnh vin cng lp khng p ng c yu cu ngy cng cao ca ngi dn. Trong khi ngi bnh ngy cng c nhiu s la chn v gn nh ch c kh nng nh gi cht lng dch v y t thng qua cm nhn v cht lng chc nng. Vic c th nhn thy r khi ngi bnh n bnh vin vic thi ca cc bc s i vi bnh nhn v ngi nh nhiu khi c thi khng tt. cc bnh vin ln nhiu khi c qu nhiu th tc hnh chnh rm ra, khin ngi nh bnh nhn kh chu . Trong khi o vic s quan tm ca cc nhn vin y t c thi khc nhau v phn bit gia cc bnh nhn. hin tng nhn tin ca ngi nh ca bnh nhn c a i hn l thc tin m cc bnh vin cng mc phi hin nay. Phng hng ci tin cht lng dich v y t: + ci thin tnh trng ny cn phi c s u t rt ln v con ngi v c s vt cht. Nn bt u bin son v a cc chng trnh o to kin thc v k nng lin quan n cht lng chc nng vo cc trng y t by gi to s chuyn bin v cn c sau ny. + Cn gim ti mt s th tc khng cn thit, ngoi ra cc bnh vin cn c hng dn ch dn r rng cho ngi dn n khm v iu ch bnh. Minh bch cc khon r rang khi cung cp cc dch v y t. +C cc chnh sch i ng v to iu kin ngi dn d dng tip cn cc dnh v y t.

Thc trng v u t cho ngnh y t t 2011- 2015:

1.1. Vn u t pht trin tp trung giai on 2006-2010 l 7.132 t ng: (n v tnh: triu ng) Nm Tng s Trong nc Nc ngoi Chun b u t I B Y t Trong nc 760.200 410.000 932.200 528.000 2006 2007 2008 2009 2010

1.191.200 1.513.200 1.390.000 1.462.000 1.576.000 685.000 890.000 763.000 896.000 980.000 506.200 623.200 623.200 3.800 811.200 510.000 560.000 6.000 856.000 521.000 590.000 6.000 1.054.000 614.000

Nc ngoi II B, ngnh khc Trong nc Nc ngoi

350.200 431.000 275.000 156.000

404.200 581.000 362.000 219.000

301.200 575.000 253.000 322.000

335.000 600.000 375.000 225.000

440.000 516.000 366.000 150.000

1.2. Vn Chng trnh MTQG thuc ngnh Y t: (n v tnh: triu ng) TT CHNG 2006 2007 2008 TRNH 1.317.000 1.755.000 1.895.000 Phng chng cc bnh x hi, bnh dch nguy him v HIV/AIDS Vn s nghip Vn TPT Vin tr V sinh an ton thc phm Vn s nghip Vn TPT Vin tr Dn s - K hoch ha gia nh Vn s nghip Vn TPT Vin tr 572.000 442.000 60.000 70.000

2009 2.231.000

2010 2.220.000

690.000

1.010.000

1.170.000

1.450.000

1.220.000

1 2 3 B 1 2 3 C 1 2 3

550.000 140.000

535.000 170.000 305.000 85.000 80.000 5.000 660.000 490.000 70.000 100.000

600.000 180.000 390.000 110.000 100.000

700.000 230.000 520.000 137.000 130.000 7.000

960.000 260.000

55.000 55.000

230.000 215.000 15.000

10.000 615.000 535.000 644.000 624.000 770.000 740.000

80.000

20.000

30.000

.qua bng s liu: trong bng 1.1 vn tp trung cho cc b ngnh: th b y t chim trn 60% s tin u t so vi cc ngng khc. Mc u t qua cc nm cng khc nhau, trong phi ni n nm 2010, mc u t cho b y t la 1054000 triu so vi tng u t nm 2010 l 157600 triu chim gn 67% .s tin

u t tng mnh so vi nm 2009 ch l 85600 triu ng. nguyn nhn l do s khi phc kinh t sau nm 2009. Trong cc ngun vn u t vn trong nc vn l ch yu.N thng chim t trng trn 60% so vi vn u t t nc ngoi. Bng 1.2: Cho ta thy: i vi trng trnh phng chng cc bnh x hi v HIV/AIDS,t nm 2006 n 2010 u c vn u t pht trin. ngc li i vi chng trnh n ton thc phm ch c 2 nm 2009 va 2010 l c vn u t pht trin va chng trnh dn s v k hoch ha gia nh ch c 2 nm 2006 v 2007 cc nm sau th khng. Nguyn nhn ca vic ny l do : + X hi ngy cng phat trin bnh x hi l vn bc bi nc ta hin nay vn ny cn c u t v pht trin hon thin. + V v sinh an ton thc phm : do i sng cng cao nn nh cu n ung sch s cng cao c bit l khi cc phng tin truyn thng lin tc a ln cc vn mt v sinh thc phm vi nm gn y. + s bng n cc phng tin truyn thng nhiu nm gn y m vic k hoach ha dn s i su vo ngi dn nn vn u t cho pht trin my nm gn y l khng c. Ngoi hai loi vn u t ni trn cn c vn h tr cho Mc Tiu y t v vn tri phiu chnh ph cho ngnh y t.

1.3. Vn h tr mc tiu Y t:
Tng vn h cho y t giai on 2006-2010 l 3520 t ng (470 t ng nm 2006, 900 t ng nm 2007, 900 t ng nm 2008, 750 t ng nm 2009 v 500 t ng nm 2010). Trn c s tng mc vn c phn b, cc tnh ch ng phn b vn u t cho cc c s y t a phng nh bnh vin tuyn tnh, cho cc bnh vin huyn, cc bnh vin a khoa khu vc (bao gm c cc phng khm a khoa khu vc) thuc n ci to nng cp cc bnh vin huyn, bnh vin a khoa khu vc c ph duyt ti Quyt nh s 225/2005/Q-TTg v sau ny c u t cho cc trung tm y t d phng tuyn huyn. 1.4. Vn tri phiu Chnh ph u t cho ngnh Y t: 1.4.1. Cc bnh vin tuyn huyn v cc phng khm a khoa khu vc theo n ph duyt ti Quyt nh s 47/2008/Q-TTg: - Ngun vn u t khong 17.000 t ng, gm 14.000 t ng t tri phiu Chnh ph, 3.000 t ng t ngn sch a phng v cc ngun vn hp php khc; T l h tr vn TPCP, mc vn TPCP, ngn sch a phng v cc ngun vn khc ca tng tnh theo Quyt nh s 582/Q-TTg ca Th tng Chnh ph. C th mc phn b tng nm: Tng vn TPCP c giao n nay l 9.150 t ng, gm: nm 2008 c giao 3.750 t ng, nm 2009 c giao 3.000 t ng v 2010 l 2.400 t ng. t 65,4% so vi k hoch; cn li 4.850 t ng, nm 2011 d kin phn b 1500 t ng.

Theo tng hp bo co ca cc a phng, nm 2008 phn b cho 464 bnh vin; nm 2009 phn b cho 516 bnh vin; nm 2010 phn b cho 540 bnh vin; tng cng n nay 589 bnh vin/trung tm y t huyn v mt s phng khm a khoa khu vc c phn b vn u t t ngun tri phiu Chnh ph, chim 91,3% (589/645), cn 56 bnh vin c trong danh mc c u t nhng cha c phn b vn, nguyn nhn l do vn c cp cha p ng nhu cu nn phi xem xt, u tin u t tp trung, c trng im, mt khc mt s bnh vin hin nay mi ang hon chnh cc th tc u t nn cha c cp vn. 1.4.2. Cc bnh vin tuyn tnh theo n c ph duyt ti Quyt nh s 930/Q-TTg: Tng s vn u t thc hin n giai on 2009-2013 khong 45.280 t ng, trong : (1) Ngun tri phiu Chnh ph h tr cc a phng khong 32.628 t ng; (2) Ngn sch hng nm ca cc a phng v cc ngun vn hp php khc khong 10.002 t ng; (3) T ngun h tr pht trin chnh thc (ODA) khong 2.340 t ng... Nm 2009 c giao 2.000 t ng phn b cho 123 d n, trong 1.920 t ng cho 117 d n ti a phng: 42 BVK tnh, 37 bnh vin Lao, 26 bnh vin Tm thn, 17 Bnh vin Nhi, Sn Nhi v 80 t ng cho 6 n v trung ng trc thuc B Y t. Nm 2010, tng vn TPCP giao l 3.200 t ng. Trong 380 t ng cho 11 n v trung ng trc thuc B Y t v 2.820 t cho 148 d n ti cc a phng gm: 42 bnh vin a khoa tnh, 45 bnh vin Lao v Bnh phi, 35 bnh vin Tm thn, 21 bnh Nhi, 5 trung tm Ung bu. Nh vy, tnh n ht k hoch nm 2010, tng vn TPCP u t cho ngnh y t l 14.350 t ng (trong tuyn huyn l 9.150 t, tuyn tnh l 5.200 t). Trong thi gian qua, do nhu cu thc tin, ngnh y t t chc, thnh lp nhiu loi hnh t chc mi nn nhu cu u t c s vt cht, mua sm trang thit b rt ln, c bit l khi thc hin cc d n u t chi ph n b, gii phng mt bng kh ln nhng kh nng cn i ngn sch nh nc khng p ng c nhu cu. - Theo Lut Ngn sch nh nc, cc a phng phi ch ng b tr ngn sch ca a phng u t cho cc c s y t trn a bn nhng thc t th ngun vn ngn sch v cc ngun vn hp php khc ca cc a phng cn rt hn ch - Tnh trng u t dn tri chm c khc phc dn n thi gian thc hin cc d n u t ko di, chm a vo s dng dn ti km hiu qu. - Vic chm trin khai thc hin i mi c ch ti chnh theo Kt lun s 42KL/TW ca B Chnh tr v i mi c ch hot ng, c ch ti chnh (trong c tin lng v gi dch v y t) i vi cc n v s nghip y t cng lp dn n cc c s khng c ngun thu ti u t, nn gn nhu hon ton trng ch ngun vn ngn sch nh nc (trung ng v a phng). Mt khc, trong phn b ngn sch u t, mt s a phng cha quan tm ng mc u t cho y t d phng.

- Mt s a phng ph duyt cc d n u t vt qu quy hoch pht trin h thng y t c Th tng Chnh ph ph duyt ti Quyt nh 153/Q-TTg; vt qu nh sut u t xy dng theo hng dn ca B Xy dng, vt qu hng dn chuyn mn k thut v thit k mu cc c s y t, danh mc trang thit b theo tng tuyn ca B Y t dn ti nhu cu u t tng cao, gy lng ph ngun lc ca Nh nc.

Phng hng gii php ci tin cho vic u t sao cho hiu qu trong nganh y t:
1. Tng cng u t cho Y t: R sot, iu chnh, b sung Quy hoch tng th pht trin h thng y t giai on 2006-2010 v tm nhn 2020 c Th tng Chnh ph ph duyt, ban hnh quy hoch pht trin mng li cc c s y t chuyn ngnh lm cn c cc a phng ch ng xy dng cc d n u t m bo hiu qu, trnh lng ph. R sot, sa i b sung cc hng dn chuyn mn, k thut, c bit l nh sut u t xy dng cc cng trnh y t, tiu chun trang thit b y t, tiu chun thit k cc c s y t ph hp vi tng tuyn, tng khu vc, ph hp vi kh nng khai thc s dng ca cn b y t. Trin khai thc hin c hiu qu vic u t, nng cp cc bnh vin huyn theo Quyt nh s 47/2008/Q-TTg; mt s bnh vin a khoa tnh thuc vng min ni, kh khn, cc bnh vin lao, tm thn, ung bu, nhi theo Quyt nh s 930/Q-TTg; cc trung tm y t huyn theo Quyt nh 1402/2008/Q-TTg; cc trung tm phng chng HIV/AIDS theo Quyt nh 1107/Q-TTg ca Th tng Chnh ph. Tip tc u tin cc ngun vn u t, nng cp cc trm y t x theo Quyt nh 950/Q-TTg, Quyt nh 800/Q-TTg ca Th tng Chnh ph, c bit u tin cc x cha c trm y t hoc c nhng l nh tm, cc x mi chia tch, phn u ht nm 2010, s x c trm y t t 100% v khong 40% s x t chun quc gia theo chun mi. Tng cng huy ng cc ngun lc u t cho ngnh y t, m bo mc u t cho y t tng cao hn tc pht trin kinh t x hi theo ng ch o ti Ngh quyt s 18/2008/NQ-QH12, trong bo m 30% kinh ph cho y t d phng. Cc a phng ch ng, b tr ngn sch a phng u t cho cc c s y t, c bit l b tr vn i ng cho cc d n c u t t ngun vn TPCP, m bo thc hin cc n ng tin . Phn b vn tp trung u tin cho cc vng kh khn, cc a phng c nh hng thin tai bo lt, cc cng trnh u tin, cc cng trnh c khi lng thc hin ln, cc cng trnh c c kh nng sm hon thnh sm a cc cng trnh y t vo s dng, phc v nhu cu chm sc sc khe nhn dn. Tip tc m rng hp tc quc t song phng, a phng, cc t chc chnh ph, phi chnh ph, cc t chc Ngn hng, ti chnh nhm tng cng thu ht

ngun lc u t, tip cn cng ngh mi, tin tin ca Th gii, gp phn y nhanh qu trnh hi nhp trong lnh vc y dc. T chc trin khai c hiu qu cc d n ODA, d n NGO. y nhanh tin thc hin cc D n h tr Y t ng bng Sng Cu Long, D n h tr Y t cc tnh min ni pha bc; D n h tr Y t Ty Nguyn; D n h tr y t cc tnh nam trung b... Sm hon thnh vic chun b trin khai cc d n H tr y t cc tnh Bc trung b (vay WB); D n h tr o to, pht trin ngun nhn lc y t (ADB); D n Pht trin bnh vin tnh, vng t ngun vn vay JICA giai on 2. Tip tc huy ng v tranh th ngun vin tr ca cc t chc Chnh ph, phi chnh ph khc cho pht trin h thng y t a phng. Xy dng n th im thc hin vic cha bnh theo nhu cu bng k thut tin tin mt s bnh vin tuyn trung ng, bnh vin chuyn khoa tuyn cui ti thnh ph H Ni v thnh ph H Ch Minh trnh Th tng Chnh ph mc tiu chnh nhm huy ng cc ngun lc tng cng u t trang thit b tin tin phc v ngi bnh, vi mc thu ph hp l, thu ng, thu , c s gim st ca c quan hu quan, m bo hi ha li ch ca cc nh u t, ca thy thuc, ng thi ngi ngho cng c hng th vi s h tr ca Nh nc (Thng bo s 362/TB-VPCP ngy 25/12/2009 ca Vn phng Chnh ph). Thc hin tt n lun phin, cn b y t tuyn trn v h tr tuyn di, tng cng o to cn b y t, c bit l cn b y t c trnh cao bo m khai thc, s dng cc c s y t, trang thit b c hiu qu. Tng cng cng tc qun l nh nc i vi cc d n u t cho y t, c bit l cng tc kim tra gim st, bo m thc hin cc d n u t ng quy nh, trnh lng ph. 2. X hi ha: Huy ng cc cc ngun vn u t, tn dng c s vt cht hin c tng s ging bnh; xy dng thm cc bnh vin mi; Pht trin y t ngoi cng lp: to iu kin khuyn khch pht trin cc bnh vin t nhn gp phn p ng cc nhu cu a dng ca nhn dn, chia s gnh nng i vi cc c s y t Nh nc.Mc tiu gim ti chi u t cho ngnh y t. 3. i mi c ch hot ng, c ch ti chnh: Khn trng xy dng Ngh nh i mi c ch hot ng, c ch ti chnh trnh Chnh ph ban hnh theo hng tng cng t ch ton din cho cc n v. i mi phng thc phn b ngn sch. Trin khai khung gi dch v y t mi trn c s tnh ng tnh , phn no nh nc chi th khng thu. y mnh vic vay vn tn dng u i Ngn hng Pht trin u t pht trin>.mc ch phn b ngun lc sao cho hp l v hiu qu.