Cần giảm chi phí thuốc men trong điều trị bệnh

Chi phí cho thuốc khá lớn trong tổng chi phí khám, chữa bệnh Ảnh: giadinh.net(ĐCSVN) – Chất lượng chăm sóc sức khoẻ nhân dân phụ thuộc nhiều vào chính sách tài chính y tế, bởi tài chính y tế gắn liền với bảo hiểm y tế, dịch vụ nhân công, thiết bị giúp chẩn đoán, chữa bệnh, thuốc chữa bệnh, chất lượng phục vụ người bệnh… Tuy nhiên, hiện nay, tài chính cấp cho hoạt động y tế còn eo hẹp, và phần nhiều dành cho chi phí thuốc men, nên hiệu quả khám, chữa bệnh chưa cao.

Thực tế cho thấy, hiện nay, nguồn tài chính cung cấp cho các bệnh viện công lập chủ yếu từ ngân sách nhà nước, nhưng con số này chỉ chiếm khoảng 6,4% GDP và bằng 1/10 các nước phát triển. Hầu hết các bệnh viện phải tự trang trải bằng các dịch vụ do bệnh viện cung cấp (được chi trả từ quỹ bảo hiểm y tế và một phần trực tiếp từ người bệnh). Nguồn thu này chiếm tỷ trọng gần 97% ở bệnh viện tự chủ toàn phần, 72% ở bệnh viện tuyến trung ương, gần 82% tại bệnh viện tuyến tỉnh và gần 55% ở bệnh viện tuyến huyện.

Điều đáng nói là, trong khi ngân sách nhà nước cấp cho y tế thấp, nhưng người bệnh luôn phải chịu giá dịch vụ, giá thuốc cao ngang với những nước phát triển, nhất là biệt dược. Việt Nam đang phải nhập khẩu tới 90% nguyên liệu từ nước ngoài, nếu không có sự hỗ trợ của nhà nước chắc người bệnh còn phải chịu giá thuốc cao hơn nữa. Theo tính toán của các chuyên gia ngành y tế, để có kết quả điều trị tốt nhất, thì kinh phí phải được phân bổ theo công thức 4-4-2, tức là chi cho nhân công 40%, thiết bị và chi khác 40%, và cho thuốc 20%. Tuy nhiên, số liệu về tài chính y tế quốc gia năm 2007, cho thấy tổng chi cho thuốc phòng, chữa bệnh là 28,4 ngàn tỉ đồng, chiếm khoảng 40% tổng chi y tế, còn tính bình quân đầu người chi cho mua thuốc đạt gần 17 USD/năm. Đây là một con số bất hợp lý trong khám và điều trị bệnh.

Nhưng theo số liệu riêng rẽ của từng cơ sở khám chữa bệnh thì tỷ lệ này lại còn bất hợp lý hơn nữa. Tại một bệnh viện phía Nam, thống kê từ năm 2007 đến năm 2009 thì chi cho thuốc năm 2007 chiếm 60,47%; năm 2008: 74,47%; năm 2009: 71%; 10 tháng đầu năm 2010 chiếm 64,5%. Còn theo một báo cáo của một nhóm dược sĩ khi tiến hành điều tra ở Nam Định và Quảng Nam cho thấy kinh phí bình quân của cả đợt điều trị cho 1.200 bệnh án được khảo sát là 242.221,3 đồng trong đó chi tiền thuốc trung bình là 152.546,2 đồng, chiếm 63% chi phí. Cơ quan Bảo hiểm y tế cũng xác nhận chi phí cho thuốc chiếm tới 60% tổng chi của bảo hiểm y tế. Trên thực tế, chắc chắn tỷ lệ này sẽ cao hơn bởi còn một lượng thuốc khổng lồ mà bệnh nhân phải tự mua điều trị thêm.

Như vậy, trong những năm trở lại đây, chi cho thuốc khi điều trị bệnh luôn tăng và luôn vượt ngưỡng 60% tổng chi. Như vậy, ngành y tế đang đối mặt với khó khăn mà trước hết là thiếu nguồn tài chính và cơ chế phân bổ chi.

Tại Hội thảo “Đổi mới cơ chế tài chính y tế – thực trạng và giải pháp” vừa được Bộ Y tế tổ chức, để giải quyết tình trạng này, có ý kiến cho rằng cần giảm tỷ lệ chi phí thuốc xuống còn 27% trong khi giữ nguyên các chi phí khác để lấy phần tiết kiệm được từ thuốc dùng để tăng thu nhập cho y bác sỹ, bảo trì khấu hao máy móc thiết bị. Theo các chuyên gia thì giải pháp này không những không ảnh hưởng đến chất lượng chữa bệnh mà còn làm tăng hiệu quả của nó nhờ giải quyết được việc tăng thu nhập cho nhân viên y tế ít nhất là từ 2-3 lần, tăng chất lượng dịch vụ và sự hài lòng của bệnh nhân. Đồng thời, qua đây chúng ta sẽ có điều kiện thực hiện tốt chính sách khám chữa bệnh cho các đối tượng chính sách, người nghèo và trẻ em, chăm sóc sức khoẻ người cao tuổi.

Bên cạnh đó, cần quan tâm nhiều hơn nữa đến chính sách bảo hiểm y tế, vì đây là xu hướng tạo ra sự công bằng nhất. Bảo hiểm y tế sẽ tạo ra sàn chăm sóc sức khỏe cơ bản cho mọi người. Những người nghèo được nhà nước hỗ trợ hoặc cấp miễn phí thẻ bảo hiểm y tế, khi khám chữa bệnh được bảo hiểm y tế chi trả. Đối với loại sử dụng dịch vụ cao, chúng ta có quy định bảo hiểm y tế sẽ chi trả hỗ trợ bao nhiêu phần trăm. Người nghèo cũng không phải chi trả nếu nó vượt mức cao một cách quá mức. Ngoài việc chú trọng tới các đối tượng nghèo, cận nghèo thì cũng cần có chế độ khuyến khích các đối tượng có thu nhập cao mua BHYT theo những gói dịch vụ có chất lượng cao hơn tương xứng với mức thu nhập của họ. Như vậy, BHYT toàn dân là giải pháp quan trọng trong vấn đề này.

Ngoài ra, cũng cần nghiên cứu và có cơ chế quản lý, kiểm soát giá thuốc, không để cho giá thuốc leo thang một cách bất hợp lý như hiện nay.

Thương Huyền


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