Lối ra để cân bằng thu chi BHYT

phauthuat_resize.jpgTiến sĩ Tống Thị Song Hương, Vụ trưởng Bảo hiểm xã hội (BHXH) Bộ Y tế, vừa cho biết: Năm 2008, cả nước có hơn 40 triệu người tham gia Bảo hiểm y tế (BHYT) và dự kiến trong năm 2009 sẽ tăng lên 50 triệu người. Tuy nhiên, vấn đề khó khăn hiện nay là quỹ BHYT liên tục bội chi.

Dự tính năm 2009, quỹ BHYT thu trên 10.000 tỷ đồng trong khi chi hơn 13.000 tỷ đồng (Báo SGGP ngày 7-4-2009). Theo báo cáo của BHXH Việt Nam và Bộ Y tế, dự kiến năm 2009, quỹ BHYT bội chi tới 2.000 tỷ đồng (Báo Tuổi Trẻ ngày 16-4-2009).

Qua hai thông tin trên, chúng ta thấy số tiền bội chi của quỹ BHYT rất lớn, từ 2.000 tỷ đồng trở lên, trong khi yêu cầu của quỹ BHYT là phải cân bằng được giữa thu và chi.

Nếu áp dụng giải pháp đồng chi trả 20% cho cả hai đối tượng (BHYT tự nguyện và bắt buộc) trên dự chi của BHYT năm 2009 là 13.000 tỷ đồng, số tiền sẽ thu được là 13.000 tỷ x (20/100) = 2.600 tỷ đồng. Số tiền 20% này cộng với số tiền thu phí tham gia BHYT (10.000 tỷ đồng) thì số bội chi thực sự vào khoảng 400 tỷ đồng.

Giả sử lấy 400 tỷ đồng chia đều cho 50 triệu người tham gia BHYT thì số tiền phải thu thêm là: 400.000 đồng chia cho 50 triệu = 8.000 đồng/người.

Theo tôi, cơ chế “bao cấp”  thanh toán 100% chi phí khám chữa bệnh cho BHYT cần được thay thế bằng nguyên tắc “Nhà nước (BHYT, BHXH) và nhân dân cùng làm”. BHYT có cân bằng được thu chi thì nhà nước mới có thể đầu tư phát triển cơ sở vật chất cho ngành y tế như xây dựng thêm bệnh viện, mua sắm trang thiết bị y tế kỹ thuật cao…

Giả sử 2.000 tỷ đồng bội chi được sử dụng để xây dựng thêm giường bệnh thì tối thiểu sẽ có thêm từ 2.000 đến 4.000 giường bệnh mới với đầy đủ máy móc trang thiết bị chẩn đoán và điều trị được xây dựng mới trong năm 2009 (1 tỷ đồng trên 1 giường bệnh là tiêu chuẩn xây dựng của bệnh viện tư).

Hơn 16.000 trẻ em bị bệnh tim bẩm sinh đang chờ được mổ, tình trạng quá tải bệnh nhân tại các bệnh viện hiện nay đang chờ nhà nước đầu tư thêm cơ sở vật chất cho ngành y tế. Điều này chỉ có thể thực hiện được khi BHYT cân bằng được thu chi, ngân sách nhà nước mới có thể được đầu tư cho ngành y tế để nâng cao công cuộc chăm sóc sức khỏe toàn dân

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