Mức đóng BHYT tự nguyện theo quy định sửa đổi: 900.000 đồng/người/năm?

bao_hiem_ye_te_2911.jpgNgày 28-11, tại Hà Nội, liên bộ Y tế – Tài chính – BHXH VN tiếp tục họp bàn về thay đổi một số quy định bảo hiểm y tế tự nguyện (BHYTTN) tại Thông tư 06 nhằm tạo thuận lợi cho người có nhu cầu tham gia.

Ba phương án sửa đổi

Tại đây, Bộ Y tế đã đưa ra 3 phương án sửa đổi, bổ sung thông tư về BHYTTN. Phương án 1: Bỏ quy định tỉ lệ 100% thành viên hộ gia đình và 10% số hộ trong địa bàn xã, phường tham gia BHYTTN. Theo phương án này, nhu cầu tham gia của các đối tượng dễ dàng được đáp ứng. Tuy nhiên, mức đóng sẽ bị đẩy lên rất cao, khoảng 900.000 đồng/người/năm. Với mức đóng này, nhiều người có thu nhập thấp sẽ khó có khả năng tham gia.

Bộ Y tế cũng đề xuất các giải pháp bảo đảm sự ổn định quỹ khi thực hiện phương án 1 là Nhà nước bù đắp toàn bộ kinh phí thiếu hụt để bảo đảm quyền lợi người tham gia. Ước tính chi phí phải bù khoảng 2.400 tỉ đồng nếu có khoảng 3 triệu người tham gia. Bên cạnh đó, có thể tính tới việc điều chỉnh mức đóng BHYT ở các nhóm khác để gia tăng quỹ BHYT. Tuy nhiên, bà Tống Thị Song Hương, Vụ trưởng Vụ BHYT – Bộ Y tế, lo ngại nếu thực hiện theo phương án 1, mức bội chi sẽ rất lớn; hơn nữa chỉ có người bệnh mới tham gia, tình trạng “lựa chọn ngược” sẽ tái diễn.

Phương án 2, được Bộ Y tế đưa ra, là bỏ quy định 10% số hộ trong địa bàn xã, phường tham gia BHYTTN và giữ lại điều kiện 100% số thành viên trong hộ gia đình. Với phương án này, theo Bộ Y tế, sẽ hình thành ý thức trách nhiệm và hiểu biết về việc tham gia BHYT ngay từ trong chính các thành viên hộ gia đình. Nếu theo phương án này, mức đóng của người tham gia BHYTTN sẽ tương đương với mức đóng BHYT bắt buộc, bằng 320.000 đồng/người/năm. Việc nâng mức đóng nhằm bảo đảm công bằng giữa các đối tượng tham gia BHYT, đồng thời quyền lợi cũng được hưởng tương đương và góp phần hạn chế mức độ mất cân đối quỹ. Song người dân khu vực nông thôn khó có thể tham gia do mức đóng cao.

Do đó, sẽ có hai khung mức đóng: từ 250.000 – 450.000 đồng/người/năm đối với hộ gia đình khu vực thành thị và từ 200.000 – 350.000 đồng/người/năm đối với hộ gia đình khu vực nông thôn.

Phương án 3: Vẫn giữ quy định 100% số thành viên trong hộ gia đình tham gia, tuy nhiên mức đóng BHYT sẽ giảm đối với trường hợp có trên 10% số hộ trong xã tham gia tại thời điểm phát hành thẻ BHYT.

Linh hoạt mức đóng, mức hưởng

Thứ trưởng Bộ Y tế Cao Minh Quang cho rằng để an toàn quỹ, nếu nâng mức đóng lên 900.000 đồng/người/năm là không khả thi vì giá quá cao. Ông Quang đề nghị nên nâng mức đóng tương đương với BHYT bắt buộc, bởi sắp tới viện phí sẽ phải điều chỉnh, các dịch vụ y tế ngày càng mở rộng, vì vậy chi phí cho bệnh nhân BHYT cũng tăng theo. Đại diện Bộ Tài chính gợi ý, nếu thực hiện theo phương án 1 thì có thể đưa ra các mức đóng khác nhau để người dân lựa chọn. Chẳng hạn, như cá nhân mua thì mức đóng sẽ cao hơn, còn 100% thành viên hộ gia đình mua thì mức đóng sẽ giảm dần và 100% dân cư trong cộng đồng tham gia sẽ thấp hơn nữa. Thậm chí, các mức hưởng cũng có thể khác nhau. Nếu như chỉ mua thẻ bảo hiểm nội trú thì phí thấp hơn, nếu mua ngoại trú sẽ phải đóng cao hơn.

Theo đại diện Bộ Tài chính, bội chi quỹ còn do tình trạng lạm dụng dịch vụ y tế. “bội chi không chỉ tại người dân mà còn do bác sĩ”- đại diện Bộ Tài chính nhận xét.

Quản lý quỹ bằng thu chi hợp lý

Theo đại diện BHXH VN, không chỉ đã tiêu hết sạch 2.800 tỉ đồng kết dư trong 12 năm, mà đến thời điểm này quỹ BHYTTN còn được Chính phủ đồng ý cho sử dụng thêm 2.000 tỉ đồng tạm ứng từ quỹ BHYT bắt buộc để phục vụ cho công tác khám chữa bệnh. Ông Hoàng Kiến Thiết, Trưởng Ban BHYTTN, cho rằng người tham gia BHYTTN đều có khả năng chi trả vì hiện nay Chính phủ đã lo cho các đối tượng chính sách: người nghèo, cận nghèo, trẻ dưới 6 tuổi… Nếu không đề ra các nguyên tắc để kiểm soát thì cơ quan bảo hiểm chỉ là nơi chi trả cho người ốm, thiếu đâu Nhà nước lo đó, chứ không còn là BHYT nữa.

Ông Nguyễn Huy Quang, Vụ Pháp chế – Bộ Y tế, đề nghị cần có hình thức thu chi hợp lý để hạn chế lựa chọn ngược. “Nếu chỉ khi ốm mới tham gia thì không còn yếu tố BHYT vì hình thức BHYT nào cũng cần có điều kiện, bảo đảm công bằng nhưng không thể đủ lực để bao cấp tràn lan”- ông Quang nói.

Theo Người lao động

 

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