Luat BHYT moi Kham dung tuyen van phai tra tien

Thứ hai, 28 Tháng chín 2009, 12:16 GMT+7


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Luat BHYT moi: Kham dung tuyen van phai tra tien? “Dang khong phai chi tra dong nao, gio benh nhan phai chi tra thi chac chan nguoi benh se keu roi”. "Chac chan nguoi benh se keu ca" - day la nhan dinh cua ong Ly Ngoc Kinh, Cuc truong Cuc Quan ly kham chua benh (Bo Y te) truoc khi luat BHYT moi duoc trien khai tu 1/10 toi.

Keu vi kham dung tuyen van phai tra tien

Theo ong Kinh, truoc day, benh nhan tham gia BHYT khong phai tra dong nao neu kham dung tuyen thi duong nhien la moi chuyen suon se. Nhung theo quy dinh moi, tu 1/10/2009, mot so doi tuong benh nhan BHYT kham dung tuyen van phai dong tu 5%-20% chi phi kham chua benh. Quy BHYT chi thanh toan tu 80-95% ma thoi.

“Dang khong phai chi tra dong nao, gio benh nhan phai chi tra thi chac chan nguoi benh se keu roi”, ong Kinh noi.

Ba Tong Thi Song Huong, Vu truong Vu BHYT (Bo Y te) cho hay: Nhung doi tuong duoc quy bao hiem thanh toan 100% la tre em duoi 6 tuoi, nguoi co cong, luc luong cong an nhan dan, doi tuong kham chua benh tai tuyen xa va co chi phi cho 1 lan kham chua benh thap hon 15% muc luong toi thieu (tuc la duoi 97.500 dong).

Nhung doi tuong nhu huu tri, tro cap mat suc, dan toc thieu so, dien bao tro xa hoi, nguoi ngheo se duoc thanh toan 95% chi phi kham chua benh. 5% con lai benh nhan phai tu tra.

Nhung doi tuong con lai deu phai tra 20% chi phi kham chua benh, quy bao hiem chi thanh toan 80%.

Luat BHYT moi: Kham dung tuyen van phai tra tien?, Tin tuc - Su kien,

Tu 1/10/2009, benh nhan BHYT kham dung tuyen van phai tra tien (tu 5% den 20%).

“Muc cung chi tra nhu tren da can nhac, Quoc hoi cung da thao luan o 2 ki hop roi moi bieu quyet. Muc dong nhu tren khong co y nghia nhieu ve mat tai chinh. Muc dich cua cung chi tra la gan trach nhiem cua nguoi benh, cung tham gia kiem soat cac dich vu y te, co nen doi hoi su dung cac dich vu y te khong can thiet hay khong”, ba Huong cho biet.

Phi bao hiem tang manh

Truoc day, nguoi dan tham gia BHYT phai dong phi BHYT bang 3% muc luong toi thieu (tinh o tai thoi diem tham gia). Theo thong tu huong dan cua lien bo Y te - Tai chinh thi tu 1/10/2009, muc phi nguoi dan phai dong khi tham gia BHYT la 4,5% muc tien cong/tien luong/luong huu/tro cap/mat suc lao dong/muc luong toi thieu (cao gap 1,5 lan so voi hien hanh).

Nhu vay, phi tham gia BHYT se tang so voi quy dinh hien hanh tu 120.000 den 320.000/nguoi tuy khu vuc nong thon hoac thanh thi.

- Phi tham gia BHYT doi voi hoc sinh sinh vien bang 3% muc luong toi thieu.

- Nhung doi tuong: Nguoi ngheo, nguoi co cong, nguoi cao tuoi duoc Nha nuoc dam bao phi BHYT.

- Ngan sach nha nuoc ho tro toi thieu 50% muc dong doi voi nguoi thuoc ho can ngheo, toi thieu 30% doi voi hoc sinh sinh vien va nguoi thuoc ho nong lam ngu nghiep co muc song trung binh, giam muc phi BHYT theo ho gia dinh.

Giai thich ve viec: Nguoi benh tham gia BHYT vua phai cung chi tra, lai vua chiu muc phi cao hon so voi truoc day, ba Huong noi: “Muc dong cua ta van thap so voi cac nuoc va thap so voi chinh chi phi hien tai. Chi phi y te la khong bao gio luong truoc duoc va luon luon gia tang”.

Tong hop tren cac so lieu cua bao hiem xa hoi (BHXH) Viet Nam cho thay: Nam 2007, muc phi BHYT binh quan la 170.000 dong/nguoi, muc chi binh quan la 220.000 dong/nguoi. Nam 2008, muc phi BHYT binh quan la 220.000 dong/nguoi, muc chi binh quan la 250.000 dong/nguoi.

“Nhu vay, quy bao hiem luon trong tinh trang boi chi”, ba Huong noi. Du kien nam 2009, tinh trang nay tiep tuc dien ra va kha nang quy se tham hut khoang 2.000 ty dong!

Dieu dang noi la tinh trang tham hut nay chu yeu xuat phat tu nhung nguyen nhan: Nang gia thuoc, lam dung thuoc va ky thuat cao trong dieu tri (nham rut ruot quy BHYT). Va nhung nguyen nhan nay chu yeu den tu bac sy, vi nguoi benh khong co chuyen mon de dua ra doi hoi. The nhung, voi viec tang muc phi BHYT va cung chi tra de giup quy do “tham hut”, nguoi benh dang phai “ganh” trach nhiem giai quyet hau qua khong phai do minh gay ra.

Nhung truong hop dac biet van duoc quy bao hiem thanh toan:

- Kham chua benh ngoai gio hanh chinh, ngay nghi, ngay le (nguoi benh BHYT huong quyen loi nhu ngay thuong).

- Thanh toan bao hiem cho nguoi bi tai nan giao thong nhung khong pham luat giao thong (tai nan lao dong khong duoc thanh toan).

- Quy bao hiem thanh toan 50% chi phi mua thuoc dieu tri ung thu, thuoc chong thai ghep khong co trong danh muc cua Bo Y te nhung duoc phep luu hanh tai Viet Nam.

- Nguoi kham chua benh tai co so y te khong dang ky hop dong kham chua benh BHYT, kham chua benh o nuoc ngoai cung duoc quy bao hiem thanh toan theo chi phi thuc te nhung muc toi da khong vuot qua muc chi phi binh quan theo tuyen chuyen mon ky thuat.

(Theo VNN)

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