Thực hiện an sinh xã hội ở việt nam vì mục tiêu công bằng

Thyc hien an sinh xa hoi
is Viet Nam vi muc tieu cong bSng
Nguyen Tfaanfa Ogt'
' Tnrtmg Dai hgc San khiu - Difn inh Tp. Hfi Chf Minh.
Email:
Nhin ngiy 26 thing 8 nim 2016. Chdp nhgn dang ngiy 6 thing 10 nim 2016.
T6ra tat: An sinh xa hfi (ASXH) la mft trong nhihig hinh thdc phan phoi co bdn. Trong nhiing
ndm qua, vifc thuc hifn ASXH da d?it dugc nhihig thanh tuu nhit djnh, vi da gop phin cai thifn
ddi sfing ngudi ngheo, gidm bit binh ding vd bat cong, gop phan thuc day sir phat trien xa hgi.
Song vifc thirc hien ASXH con bgc lp nhifiu hgn che nhu: mfic df bao phCi cua hf thing bao hiem
xa hgi (BHXH), bao hifim y tl (BHYT) con thap, chinh sdch BHYT con nhieu bat cgp, quy BHXH
chua quan ly hifu qua, chua can doi ttong phdn bo tai chinh thyc hifn ASXH. NhSm thyc hifn tot
hon ASXH va qua do thyc hifn cong bang xa hgi tot hon, cin phai: ndng cao muc df bao phu cda
hf thing ASXH; nang cao nang lire quan ly nha nude, hoan thifn hf thong phdp ludt doi v6i h?
thong ASXH; can bdng ttong phan bo ngufin I\rc tai chinh; co chinh sach c\i thfi doi vdi nhom phi
chinh thirc; tdng cudng tuyfin truyin, ndng cao nhgn thi;c cua ngudi dan ve cdc chinh sach ASXH.
Tfi khod: Cfing bdng xa hfi, an sinh xd hfi, Viet Nam.
Abstract: Social security is one of the basic forms of disttibution. In recent years, the
implementation of social security has received certain achievements, for its conttibutions to
improving the lives of the poor, reducing inequality and injustice, and to the social development.
Yet, the implementation also revealed many things to be improved such as the low coverage of the
social and health insurance systems, inadequate heahh insurance policies, ineffective management
of the social insurance iiind, and the imbalanced financial allocation. In order to better implement
social security to better perform social equity, we need to improve the coverage of the social
security system, the capacity of state management, and the legal homework on the social security
system. It is necessary to balance the allocation of financial resources, promulgate specific policies
for the informal sector and sttengthen the sensitisation to and raising the awareness by the people
of social security policies.
Keywords: Social equality, social security, Vietnam.

Nguyfin Thanh D?it

1. Mddau

ddng Tfauong binfa va xa fadi, Kho bgc Nhd
nude. Vifc phdi hgp gifia ngdnh Lao dgng
Hf thdng ASXH la mft ttong cdc phuemg Thuong binh vd xa fadi va ca quan BHXH
thfic phan phdi cua cai eua xa hfii cho cdc ngdy cdng cfadt cfafi. Difiu do gifip tdng
ca nhdn. Mgt ttong nhung ngudn thu nhdp cudng han cdng tdc kilm tta, giam sdt vifc
ma moi ngudi nfadn dugc tfi xd hfi Id thu thi hanh Bg ludt Lao dgng vd thuc hifn cdc
nhdp qua hf thdng ASXH. Vi vdy, khi xem chfi df BHXH cho ngudi lao dgng d khu
xet su pfadn phdi cd cdng bdng hay khfing, vyc kinh te ngodi qudc doanh; tang eudng
chfing ta can phdi xem xfit sy hudng thy cfia qudn ly nha nude vfi vifc ky kit hgp ddng
mdi ngudi khfing ehi qua sy phdn phdi trye lao ddng, dang ky thang luong, bdng luang,
tilp tfi qud trinh sdn xuit (ehdng hgn tu thda udc lao ddng tdp thfi; xfi ly vd ngan
luong md ngudi lao dfng dugc hudng), ma chgn nhifiu doanh ngfaifp kfau vye ngodi
cdn qua su pfaan phfii d hf tfafing phfic Igi qudc doanh cd hanfa vi vi pfaam vl pfadp lu|it
xa hpi vd ASXH. Vdy d Viet Nam hifin nay, BHXH ddm bao cdng bdng xd hgi (CBXH).
Vfi BHYT: "Dfin cudi 2015, cd 64,6
fafi thfing ASXH cd tfadnfa tuu va hgn chfi gj,
lara the ndo de thye hifin tdtfacmASXH, qua trifu ngudi tham gia BHYT, dgt ty le bao
pfafi
71,4% ddn sfi. Trong 6 thang diu ndm
dd bao dam tdt hom cfing bdng? Dd la vdn dfi
2016, dd ed ttfin 70,8 trifiu ddi tugng tham
md bdi vifit dfi c ^ tdi.
gia, tang khodng 0,83% vd vdn dang tieh
cyc trien khai cdc gidi phdp de dat mue tifiu
78% dan sfi cd BHYT cufii nam nay". Ty lfi
2. Thanh tuu trong thijTc hifn ASXH

nay cho thdy vific trien khai cdc ehinh sdch
He thdng ASXH d nude ta ttong nhiing BHYT dd dgt nhifiu kfit qua thugn lgi, ndng
nam qua da dgt duge tfadnh tyu ttfin tdt ed dan do bao phfi toan dan. Dgi hgi Dang XII
nhdn dinh: "Chdt lugng khdm, chiia bfinh
cac try cdt eua hf thdng ASXH.
Vfi BHXH: theo thfing kfi cfia Bg Lao dugc nang len, iing dyng nhifiu tfaanfa tyu
ddng Thuang binh va Xa hdi, dfii tugng kfaoa hpe ky tfauat cao. Dd tich eye trien
tham gia BHXH tinh dfin thdng 10 nam khai nhieu gidi phap giam qud tdi bfnh vien
2015 dgt ttfin 12,07 trifu ngudi, chilm tten vd dgt kfit qud budc ddu. Tap tnmg xay
23% lyc lugng lao dgng (trong dd, tham gia dyng hf thong cdc bfnh vifin tuyfin huyfin,
BHXH bit bude tren 11,85 trieu ngudi, tuyfin tinh vd tuyen cudi. Dpi ngu can bf y
tdng ttfin 2,25 trifiu nguoi so vdi cudi nam tfi phat trifin ca vl sfi lugi^ vd chdt lugng.
2010; tham gia BHXH ty nguyfin ttfin 223 Ddy mgnh cai each hanfa cfainh, nang cao y
nghin ngudi, tdng ttfin 148 nghin nguoi so dfic va dfii mdi ca cfafi tdi chinfa dfii vdi ede
vdi cuoi nam 2010) [9]. Sd lifu thdng kfi dan vi sy nghifp y te cfing lap, budc dau
cfao thiy ty If ngudi dan tham gia BHXH thyc hifn 16 trinh tinh dfing, tinh du gia tri
ngdy cang tdng; quyen lgi ngudi lao ddng dicfa vu y tfi cung vdi hd ttg cho ddi tugng
ngay cang dugc ddm bdo; edng tdc chi ttd chinh sdch, ngudi ngheo. Cac co sd y tfi tu
da CO sy phdi hgp ttdeh nhifm nfaip nhdng nhan, y hpc cfi truyfin va cdng nghifp dugc
giiia CO quan BHXH vd edc nganh Lao dugc kfauyfin khich phat trien. Tdng cudng

37


Khoa hgc xd hfi Viet Nam, s6 1 (110) - 2017
qudn ly chat lugng va gid thudc chfia bfinfa"
[3, tt.239-240].
Vfi fafi thdng bao hilm thdt nghifp
(BHTN): dfin nam 2015 ed tten 9,9 ttifu
ngudi tfaam gia BHTN, tang 3,6 trifu ngudi

so vdi cuoi ndm 2010. Tinfa tfi tfadng
01/2011 dfin cufii nam 2015 cd trfin 2,07
trifiu lugt ngudi dugc hudng trg cap tfadt
nghifip. Tfing 5 ndm 2011-2015 ca nude dd
tao vifc ldm cho khodng 7.827 nghin ngudi;
tuyfin mdi dgy nghe gdn 9.171 ngfain ngudi,
tdng trfin 20% so vdi giai doan 2006-2010;
ty lfi fagc cd vifc ldm sau khi tfit nghifip dgt
khoang 70% [9]. Sfi lugng ngudi tham gia
BHTN nhu ttfin cho thiy tinh uu vifit cfia
tru cpt ndy ttong hf thfing ASXH, gdp phdn
ddm bao CBXH. Thuc hifn edc quy dinh vfi
BHTN cho ngudi lao ddng nhdm giai quyfit
kip thdi nhfing khd khan eho ngudi lao
dfng bi mdt vific lam, i ^ i vifc... Id ca sd
quan ttgng dfi ngudi lao dgng hod nhap vdo
tfai trudng lao ddng va cd sinfa kl. Ngodi ra
vific trifin kfaai pfaoi fagp vdi edc trung t§m
va trudng day ngfafi tu vin vific lam, gidi
tfaieu vific lam, ho ttg fagc ngfal cfao ngudi
tfait ngfaifp cQng tgo ra sy cdng bdng dfii
vdi nhom can ttg gifip ndy.
Ve trg giiip xd fafi, uu ddi ngudi cd
cdng: tinh dfin ndm 2015, ca quan BHXH
dd ttg cip thudng xuyen eho khoang 2,643
trifiu dfii tugng, tdng gin 1,8 lin so vdi cufii
ndm 2010. Ngdn sacfa trung uong chi ttg
cdp xd hfii hang thdng cho dfii tugng bao trg
xd hfi tgi cgng ddng tdng nhanh, ndm 2015
khodng tren 11,6 nghin ty ddng, tdng gin

gap 3 Ian so vdi ndm 2010. Tinh dfin nay cd
nude ed 408 co sd ttg gifip xd hdi, nudi
dudng, chdm sdc trfin 41,4 nghin dfii tugng
bdo trg xd hdi (trong do, sd dfii tugng ngudi
ldn, tte em bj khuyfit tat, tdm thin ehilm tdi

56,5%) [9]. Co quan BHXH chi tta diy dii,
kip thdi ttg cip uu ddi thudng xuyen eho
tren 1,4 trifiu ngudi cd cfing; thyc hifn day
dfi cdc chinh sach vfi cfadm soc sfic kfade, im
ddi gido dye vd cde chinh sdch uu ddi khdc
ddi vdi nguoi cd cdng. Cdc phong ttdo "dfin
on ddp nghia", "uong nude nfad ngudn",
"xa, pfauong ldm tdt cdng tdc tfauong binh,
lift sy, ngudi cd cdng" dugc phdt trifin sdu
rfng d tat ca cdc dia phuomg; huy dfng
nhifiu ngufin lue ttong xd hgi, cfng dfing de
ehdm sdc ddi sfing vgt chat, tinh thdn cho
nguoi cd edng vdi cdch mgng. Giai doan
2011-2015, ca nude dd huy ddng tten 1.250
ty dfing xdy dyng Quy den om dap nghTa;
xdy mdi khodng 46 ngfain nfad tinfa ngfaTa;
sfia chiia ttfin 43 nghin nhd vdi tten 10,6
nghin ty dong; cd gan 11 nghin ba me Vifit
Nam anh hung cdn sdng dugc edc co quan,
dan vj nhgn cham sde, phung dudng... Den
cufii nam 2015 cd 98,5% hf gia dinh ehinh
sach ed mfic s6ng bdng ho^e cao han mfic
sfing trung binh hd dan nai eu tni, tdng
thfim 8,5% sd hg so vdi nam 2010; 98% xd,

phudng lam t i t cfing tde thuang bmh, lift sT
vd ngudi cd cdng, tang them 6% sfi
xa/phudng so vdi nam 2010 [9]. Cdc kfit
qua tfayc hifn chinh sdcfa ttg giiip xa hfi, uu
ddi ngudi ed edng thfi hifn tinh nhan vdn
sau sde trong sy trg gifip eua xa hfi. Ddy
dugc xem la nhdm yfiu the, de bj tfin
tfauong vd tfaifit tfadi can sy bdo ttg va cfaia
sfi nfait.
Ve gidm ngheo: vdi hifu qud tfi ngufin
lyc ddu tu cua cdc chinh sdch, chucmg trinfa,
dy an ve gidm ngfaeo, ty If hfi ngfafio ea
nude dd gidm tfi 14,2% cu6i ndm 2010
xufing cdn 5,97% cudi ndm 2014 (ttong do
edc huyfn ngheo giam cdn 32,59%); cufii
nam 2015 ty If fafi ngfaeo gidm cdn dudi


Nguyen Thanh Bjtt
4,5%, gidm binh quan 2%/iidm (cdc huyfn
ngfaeo gidm binh qudn 5%/nam, con khodng
28%) [9]. Kfai ty lfi faf ngheo giam thi su
gidn each vfi thu nhdp gifia cdc ting ldp ddn
eu dugc tfau hep. CJ ndng thfin cdc xa ngfaeo
duge edi thifn ro rft. Ngudi ngheo dugc ho
trg cdi thifin mfit bude vfi difiu kifin sdng;
dugc tifip can tdt horn cdc chinh sdch vd
ngudn luc ve vdn fafi trg cfia Nfad nude va
cfng dfing; nfad dd ddi sdng cfia hg dugc
ndng lfin.

Nhin ehung, ede chinh sdch ASXH dd
hudng dfin nhifiu dfii tugng hom. Dfii vdi
ehinh sdch BHXH, ddi tugng tham gia ngdy
cdng duge md rfing dfin cdc thanfa pfain
kinfa tfi faudng den bao pfafi toan dan. Cdc
cfafi do huu tri^ thai sdn, dm dau, tfi tuit
dugc quy dinh cu thl. Tdi cfainh cfia quy
BHXH vfi thu, ciii va ddu tu dugc quan ly
tap trung, chat che, cfing khai, minfa hgcfa,
hgcfa todn dfic i^ vdi ngdn sdcfa nfad nude.
Cdc quy dinfa cua Lugt BHXH da dugc sfia
ddi ngay cang pfafi hgp vdi Bg ludt Lao
ddng vd nguyfin vgng cfia nguoi lao dgng.
Chinh sach BHYT dd timg budc md rgng
cac ddi tugng va ddm bdo quyfin lgi cfia
ngudi tham gia BHYT, thl faifn tinfa cdng
bdng hem. Vific td chue khdm chfia bfinh
eho ngudi ed the BHYT duge quy dinh cy
thl vdi chit lugng djch vu tot horn. BHYT
dd that sy ttd thanh try cdt quan ttgng trong
faf thdng ASXH, tgo thudn lgi cho ngudi
ngheo va ngudi tfau nh|ip thdp ttong vifc
tifip can cae dicfa vu y tfi. Cac cfainh sach
BHTN dugc trifin kfaai cd faifu qua tren todn
qudc. Ca quan BHTN cd sy phfii hgp ch^t
chfi vdi cdc trung tdm va trudng dgy nghe
de trifin khai cdng tdc tu van vifc ldm, gidi
thifu vifc lam, fao ttg fagc ngfae cho ngudi
thit ngfaiep. Cfal dQ cfao ngudi lao dgng tfaat

ngfaifp dugc gidi quyet ddy dfi, dfing tfadi
gian. Cac cfainfa sdcfa bao ttg thudng xuyfin
va dot xudt dd cd nhung tdc dgng hfit sfic to
ldn dfin nhdm ngudi ylu thl. Cac cfainfa
sdcfa nay tfai faifn qua cdc ehl df ttg gifip
khdc nhau (vfi tdi ehinh, ehdm sdc sfic khoe,
phuc hfii chfic ndng, hgc vanfaod,fagcngfal,
tgo vific ldm...). Nfaa nude dd ed nfaifiu
ehinh sdch tao dieu kifin thudn lgi dl cde tfi
chfic xa hpi va ed nhdn (tfi chfic phi chinh
phfi, cae doanh nghifp) tifin hanh hogt dgng
tfi thifn gifip do cde dii tugng kfad khdn.
Cde chinfa sdch uu dai ddi vdi ngudi cd
edng vdi dit nude thfi hifn duge tinh thin
"ufing nude nhd ngufin", "dfin on dap
nghia"; gdp phin dn dinh, ndng cao ddi
sfing vdt cfadt vd tinfa thdn eho gia dinh
ngudi ed cfing; ddm bdo mfic sfing cua gia
dinh ngudi cd cdng cd mfic sdng bdng hode
cao ban mfic sfing cfia cgng ddng nai cu
tni. Cae chinfa sach giam i ^ f i o duge thuc
hifn theo faudng diu tu cd ttgng tdm, ttgng
difim nfadm giam ngheo nhanh vd bfin vihig,
nhdt la doi vdi nhihig dia bdn khd khdn,
viing ddng bdo ddn tdc vd mifin nui. Cdc
cfainfa sach ASXH tilp tue duge hodn thifn
ttfin edc ITnfa vye lao dgng, vifc ldm,
BHXH, BHYT, bdo ttg xd fadi; dd gdp phin
cdi thifin ddi sdng ngudi ngheo; gidm bat
binh ding vd bit cfing; gdp phdn 6n dinfa,

tfafic day sy phdt ttien xd hfii.

3. Han che trong thyc faien ASXH
Thu nhdt, mice dg bao phu cua h^ thdng
BHXH, BHYT cdn thdp
Dfii vdi BHXH, ty If tham gia (kl cd
hinfa thfic bit bugc d khu vuc ehinh thuc va
ty nguyfn d kfau vye phi cfainfa tfauc) mdt du


Khoa hgc xahfi Vift Nam, so 1 (110)-2017
cd tang len nhung cdn thdp. Theo bao cdo
giam sat thyc hifn Ludt Bao liifim xd hfii
nam 2015 cua Tdng Lifin dodn Lao dgng
Vift Nam, d 6 tinh Hd Nam, Nam Dinh,
Phil Yen, Khanh Hda, Ddng Thdp vd An
Giang, ty If bao phfi BHXH binh qudn cfia
6 tinh dugc gidm sat la 13% luc lugng lao
dfng tham gia BHXH (chi khodng 6,9%
ddn sfi ttfin dia bdn tinh); cfi 100 doanh
nghifip hoat dfing tfai chi cd 40 doanh
nghifip dang ky ddng BHXH [10]. Ty If bao
phfi thap ndy do nhifiu nguyfin nhdn khae
nhau, ttong do nguyfin nhdn ldn nfaat la cdc
doanh nghifp ehua thue hifn tdt nghia vu
ddng BHXH eho ngudi lao dgng. Ben cgnfa
dd, cdc ehinh sdeh eho ddi tugng phi ehinh
thfic tham gia BHXH cdn hgn chfi. Mgt bf
phdn ldn lao dfng phi chinh thfic (nhu lao
dgng thdt nghifp, lao dfng ttong cae hfi gia

dinh, lao dfng ttong nfing nghifip, lao dfng
ty do, lao dgng ldm tfaue, ngudi cao tudi...)
khfing tham gia cdc quy BHXH; khi ggp rfii
ro hp chu yfiu dua vao gia dinh faogc ty lo.
Nfaa nude khdng co khd nang chi tta cho tat
cd cac nhdm ddi tugng ndy nhung nfadm ndy
lgi ein nhit sy trg gifip ciia xd hfi thfing qua
hf thfing ASXH. Ddi vdi BHYT, theo bdo
cao cfia BHXH Vift Nam 2015, ty lfi bao
phu BHYT cde dia phuang khdng dfing
dfiu, nhifiu tinh, thanh pho cd ty lfi tham gia
BHYT thdp hom mfic binh qudn chung cita
cd nude. Dfin hit thang 5 nam 2015, co 31
dia phuong cd ty if bao phfi BHYT dgt
dudi 70% dan sd todn tinh, ttong do cfi din
15 tinh, thdnfa phfi mdi bao phfi dugc dudi
60 % dan sd. Vdi mye tifiu din cufii nam
2016 ndng mfic do che phfi lfin 78% thi vin
chua thfi bao phfi dugc todn ddn tham gia
BHYT. BHYT la cho dya an sinh thilt ylu
ddi vdi ngudi ddn, vifc cfaua bao phu hit

40

BHYT toan ddn Id han ehl ddng kfi ttong
thyefaifinCBXH.
Thu hai, chinh sdch BHYT cdn nhieu
bdt cap
Hifn nay, tinh ttgng qud tdi d cdc bfnh
vifn tuyin qugn/huyfn va cde bfnh vifin

chuyfin khoa da dugc cdi thifn tot ban
nhung chua dap iing nhu cau eiia nhdn ddn
trong khdm cfaiia bfnfa. Sfi ngudi khdm
chfta bfnh tang nfaanh so vdi mfic phdt triln
cfia cac bfnh vifn. Trong khi mgng ludi y tl
phudng, xa tgi vin chua khdng djnh dugc
vai trd co sd mft each diy dfi. Tinfa trang
qua tdi pfa6 bien d cdc bfinh vifn ldn. Ngudi
cd the BHYT khi chiia bfnh van phdi ddng
mdt sd khodn ehi pfai kfafing hgp ly (nhu cdc
dich vu ky thugt mdi, edc chi phi do bfnh
vifn thyc hifn ty chfi tdi chinh...). Van con
su phdn bift ddi xfi gifia dfii tugng thu
hudng BHYT voi cde doi tugng khac tai he
didng edc bfnh vifin dugc ddng ky tfaam gia
khdm chfia bfnh. Chat lugng kham cfafia
bfnfa cho nfadm tfaam gia BHYT tfaudng kem
hom so vdi nhdm sfi dung dich vu y tfi.
Nhihig ngudi tham gia BHYT khi khdm
chfia bfnh d cde bfnh vifn tu nhan tid khfing
dugc chdp nhdn cung cdp dich vy theo thfi.
Mdt khdc, do cd quy dinh thanh todn cde
chi pfai tgi tuyen tten dugc tru vdo cae bfnh
vifn nhgn ddng ky khdm chiia bfnh ban
dau, nfin ede bfinh vifn cd ddng ky ban ddu
thudng mudn giu bfnh nhan lai (khfing cho
hodc gdy khd khdn cho bfnh nhdn chuyen
lfin tuyfin khae). Bfinh nhdn cd nhu ciu dieu
tri tgi tuyin kfadc noi dang ky ban ddu do
kfao xin duge giiy chuyen vifn bode ngai

phai chd dgi lau nfin cd xu hudng di khdm
chfta bfnh vugt tuyen, ttdi tuyfin. Vifc ho
ttg kinh phi cho dfii tugng hgc sinh, sinfa
vien tfaudng rit ehdm va nhifiu khfi. Vdi


Nguyfin Thanh Dgt
nhiing bat cap trfin, cfing vdi su tdc dfng
cua ea chfi kinh te thi trudng vdo ITnh vyc y
tfi, neu cdc chinfa sdcfa BHYT kfadng duge
cdi tfaifin tfai sS khd thuc hifn tdt facm cdng
bing xd fagi (CBXH) trong BHYT.
TTiu ba, giip BHXH cfnca qudn ly hieu qud
Hifn nay quy BHXH dang cd nguy ca vd
trong edn dii tfau ehi ma nguyfin nfadn cfainfa
la cfai nhieu faon tfau. Sfi thu chfi yfiu cdn cfi
vao sfi luang dugc ky ttong hgp dfing lao
dgng (cfafi kfafing can cfi vdo sfi luomg tfauc
hnh). Mgt bf phan ldn doanh nghifp cfi tinh
ng dgng BHXH hodc trdn ddng BHXH ciing
Id bieu hifn yeu kem cua qudn ly quy
BHXH. Theo sd lifu tfadng kfi 2014, "cfai cd
150.000 doanfa ngfaiep (DN) tfaam gia
BHXH, ttong kfai ea nude cd 300.000 DN
dang faogt dgng... Sd ngudi tfaudc difn pfaai
nop BHXH bit bugc khodng 16 trifiu nhung
chi cd gin 11 trifiu nguoi ddng BHXH, ldm
cho sd thit thu len den 56.000 ti ddng".
Mac dfi trong ndm 2015, tinh trang ng, ttdn
ddng BHXH giam dang ke nhung vin edn

ty lfi ldn khfing ddng BHXH. Tfaeo bdo cao
cfia Tdng Lifin dodn Lao dgng Vift Nam,
nam 2015 cd 6 tinh giam sat tinh ttang ng
dgng, ttdn ddng BHXH, BHYT cfia cde DN
dien ra phd bien d tat ca cdc tinh, thanh
pfad. Tdng sfi ng cua 6 tinh gidm sat la ttfin
433 ti ddng. Ti lfi trung bmh sd DN ddng ky
tham gia BHXH ttfin tfing sfi DN ddng ky
hogt dfing chi chifim 40% vd ti If DN ng
BHXH trfin sfi DN tham gia ddng BHXH Id
44,9%. Nhu vdy, cu 100 DN hoat ddng thi
cd gin 80 DN vi pham phdp ludt ve BHXH
(60 DN khdng ddng va 18 DN ng BHXH).
Ngoai ra, ttong nfaifiu trudng fagp edc cfainh
sach tai cfainh cung bi Igi dung "dn chdn"
ngudn ngan sdeh nha nude ddnh cho an sinh
xa fagi. Vi dy, mgt so ngudi khfing ndm

ttong difn duge hudng ttg cap nhung khai
bdo tfaat ngfaifp dfi fauomg trg cdp; mft sd
ngudi di ldm de kifim tfau nhdp d noi khac
nhung khfing bao cao thufi; mgt sfi ngudi sfi
dung lao dgng khdng ddng cdc khodn bao
hifim cho ngudi lao dfing.
Thu tu, chua cdn ddi trong phdn bd tdi
chinh thue hi?n ASXH
Dfii vdi nhiing hf ngheo, vimg ngheo,
vung khd khdn, ddn tgc thifiu sfi, hg kfad tun
kifim vific ldm faodc ty sdn xudt ldnh doanh.
Tdi chinh dugc pfadn bd cfao dfii tugng nay

cfafi yfiu la ttg cip tfaudng xuyen nen kfadng
cdi thifin duge nhifiu mfic sfing cua mft bfi
phan dan cu ndy. Doi vdi nhdm ddi tugng
lao dfing phi cfainfa tfafic vd nfadm cgn ngfafio
hifn nay, edc chinh sacfa tai cfainh van cfaua
khdc pfauc dugettnfatrang ddi sdng bdp bfinfa
eua fag, \a hg de tdi ngheo. Theo Bdo cdo
Piiat trien con ngudi Vift Nam ndm 2015
cua td cfauc UNDP, Vift Nam da phdt trifin
faf thfing ASXH ea bdn dua tten "quyen" va
theo "vdng ddi", hf tfadng nay cfaia thdnh hai
nhdnh ro rang vdi BHXH tuomg ddi hdo
phdng cho nhihig ngudi ldm vifc ttong khu
vyc chinfa thfic vd ttg giiip xa hfi rdtfagnchfi
eho nhung ngudi ngheo nfait. Trong kfai cfai
tifiu edng cfia Vift Nam cho ASXH ndi
chung bdng 2,8% tfing sdn phim qude nfi
(GDP), thi rieng pfadn trg gifip xd fafi cfai
chilm 0,4% GDP (2013). Tmh ttgng ndy vd
difn bao phfi hgn chfi cfia ttg gifip xd hfi dd
ddn tdi sy "bo sdt nhdm d giiia" (gfim nfadm
can ngfaeo va nfadm trung luu ldp dudi
thudng lam vifc d khu vyc pfai cfainfa tfauc,
nhdm nhiing ngudi chua dfi tifiu chuan dfi
dugc nhdn trg gifip xd hgi hode ehua ed khd
ndng tifip can bao hiem xa fadi). Do khdng
thudc difn bao phfi ciia eac he thdng ASXH
nfin nhiing dfii tugng nay d trong tinh trgng

Khoa hpc xa hfi Vift Nam, sfi 1 (110) - 2017
gidm ngheo bin vdng vd bdo vi cdc nhdm
ddi tugng di bi tdn thuang)
Cdn ddy mgnh thyc hifn chmh sdch uu
dai ddc bifit ddi vdi ngudi ed cfing, thuong
binfa, gia fflnfa lift sT, Bd me Vift Nam anh
hung, cfainfa sdcfa ttg cap xd hfi eho cdc dfii
tugng ylu thl; diy manh phdt triln nhifiu
hinh thfic boat dgng dfin on ddp nghia; dfii
mdi phuang phap tiep cdn xdy dyng
ehuang trinh gidm ngfaeo vd ho ttg hg
4. Mgt si giai phap
ngheo mgt each ddng bg hom; hodn thifn va
da dgng hda cde cfauang trinfa hd ttg dde thii
Thu nhdt, ndng cao mue do bao phti cua hi cfao cde nhdm doi tugng yeu the, d6ng thai
kfauyfin khich sy tham gia ciia cdc to chuc
thdng ASXH
Bk ndng cao mfic dp bao pfafi ciia fafi xd hfi vdo cdc chuong trinh bdo ttg.
Thu ba, ndng cao ndng l\cc qudn ly nhd
tfaong ASXH cin tgo tfaudn lgi cfao ngudi
dan tham gia BHXH; chfi ttgng dfin md nude, hodn thien he thdng phdp ludt ddi vdi
rfng cdc ddi tugng tfaam gia BHXH ty he thdng ASXH
Cac tinh, thanh phd ein phdi cfafi dfng
nguyfin; fa§ ttg mdt pfain pfai ddng BHXH
ty nguyfn cho cde ddi tugng cd thu nhdp xdy dyng va ban fadnh ke faoacfa ttiln kfaai
thdp; khuyen khich phdt trifin bdo hifim xa tfayc hifn eac chinh sach ASXH tgi dia
fadi ty nguyfn dya tren ca sd xafadifaoanfau phuomg vdi nhiing chi tifiu, gidi pfadp cy the
bao faifim nhdn thg. Cin hodn thifn cac co tfaeo timg nhdm ddi tugng. Cin minh bach
cfae fao ttg pfai tham gia BHYT mdt each va dom gidn hda cde thu tyc hdnh chuih.
hgp ly ddi vdi ede nfadm dfii tugng ddn cu Cdn fing dyng edng ngfaf thdng tin, hodn

kfadc nfaau; kfadng dugc pfaan bifit doi xfi chinh edc phdn mem dang trifin kfaai ttong
giiia ngudi cd the vdi ngudi khong ed the qud trinfa quan ly hf thong ASXH. C§n
trong khdm chfia bfnh dich vy; trien khai thudng xuyfin thanfa tta, kifim tta vd ed bifn
dfing bf edc gidi pfadp ndng cao chdt lugng pfadp ciing rdn vd trift dfi ttong vifc xfi ly
kham cfafia bfinh BHYT, ndng cao chat edc vi phgm vfi BHXH, BHYT, BHTN, bdo
lugng khdm bfinh chfia bfnh tgi cde ca sd y ttg xa hfii, xda ddi gidm ngheo. Cin diy
te, dde bift la tuyfin y tfi ea sd, d cdc vung mgnh chfing tham nhiing, tf ngn mit dSn
kho khan, vung ddng bao dan tfc, huyfn chu ttong qudn ly nha nude vl ASXH. Cha
ngfafio; day mgnh phdt trien co cfafi kfadm huy dfing su tham gia cfia cac th cfafic xa
chfia bfnh cua khu vyc y tfi tu nhdn cfao ddi hgi ddn sy khde ttong viec theo doi, danh
tugng BHYT (dieu nay se gdp phdn gidm gia thyc hifn chinfa sach ASXH. Day mgnh
thifiu tinh trgng qua tdi d cae bfnh vifn cfauang trinfa BHTN, faudng ngfaifp, ddo tao
va day ngfae. Tgo ea fagi va h6 ttg nhieu
tuyen trung uong).
hom cho eac nhdm yeu thfi, ngudi dan d
Thu hai, cdn md rgng cdc chinh sdch icu
vtmg sdu, vung xa.
dai, xod ddi gidm ngheo (diiu ndy gdp phdn
dl bi tdn thuang khi phdi ddi phd voi edc cfi
sfic vd cd khd ndng rit faan che dfi dau tu eho
tuong lai. Mfic df ttg c ^ xd fadi ciing qud
tiiip nen khd tgo ra sy khdc bift ttong cufc
song cua nhiing nguoi cd dfi tifiu chudn thy
hudng vd din dfin mft sfi hf qud, ttong do cd
tinh trgng cdi phfi bien d ttfi em thudc cae hf
gja dinh ngheo va cd mue thu nhdp thip.

42

Nguyfin Thanh Dat
Thd tu, cdn bdng trong phdn bd ngudn
luc tdi chinh
Vifc phdn bfi tdi chinh phdi can cfi vdo
edc dicfa vy ASXH cung iri^ cdc dilu kifin
sdng kfadc vl vung mifin vd mfic thu nhap
cfia ddn sd. Nfiu cung fing cdc dicfa vu eho
vfing giau vi sfic mua cde dich vy ASXH ldn
ma bd qufin ede viing ngheo, ngudi ngheo thi
se dan dfin bat binh ddng. Thyc hifn cfing
bang ttong phan bfi ngan sdch thfi hifn qua
su minh bach ttong chi ngan sdeh eho cdc try
cgt ciia hf tfafing ASXH. Vi v^y, can tiep tue
ehinh sdch tin dung uu dai dfii vdi nhihig hf
ngfaeo cd kfaa ndng lao dgng nfaimg thifiu
vdn vfi dau tu sdn xuit kinh doanh. Ap
dung linh hogt edc phuomg thfic cfao vay tin
dung, c i n tfau BHXH cdn cfi vao mfic tien
luomg, tien edng thye t l cfia ngudi lao ddng
(dieu nay mgt mat se tdng nguon thu cho
quy, ddm bdo dugc quyen lgi cfia nguoi lao
ddng; mat khae tao ra sy binh dang gifia ede
ca quan, dom vi nhd nude vd cde co quan
dan vi khfing phdi cfia nhd nude).
Thic ndm, cd chinh sdch cu thi ddi vdi
nhdm phi chinh thuc
Can ed ehinh sdch giai quyfit hgp ly mfii
quan hf gifia nhu cau va khd ndng tham gia
faf tfafing ASXH cua nfadm pfai chinh tfafic.
Nhu cdu tfaam gia bdo biem xa hdi tu

nguyen ciia lao ddng nhdm nay rat ldn, hg
ciing mudn ddng cao de hudng mfic eao
nhung khd ndng ddng gdp lgi rit hgn chfi.
Day lai la ddi tugng dang dugc hudng rit it
eac ehuang trinh pfafic lgi xa hgi. Vi vay,
cdn edi edeh manh me thfi tyc tham gia vd
thanh toan BHXH (difiu dd sfi tao difiu kifn
thuan lgi hem cho ngudi lao dfng nhdm nay
dfi dang tilp can vd tham gia). Chang han,
chi sfi dung mgt giiy td duy nhdt Id cfaiing
minh nfadn ddn (theo mau mdi) hodc hg
chilu (cip ddi hgn) dfii vdi nhiing ngudi

tham gia BHXH ty nguyfn Ian ddu; bd qua
cdng doan tham tra ngudn tfau nfadp vdi
nfaiing ngudi tfaam gia; ddy mgnh edc
chucmg trinh vifc lam, tiep can cac ngudn
lyc phdt trifin kinh tl, xa hdi...
Thu sdu, tdng eudng tuyen truyen, ndng
cao nhdn thuc cua ngudi ddn vi cdc chinh
sdeh ASXH
Tang cudng cfing tdc phoi hgp vdi Bf
Thdng tin vd Truyfin thong, cac co quan
bdo chi; cd kfi hogch tuyfin truyfin, phfi bifin
sdu rdng cae ehinh sach, vdn bdn quy pfaam
phdp ludt ASXH din ngudi dan. Tuyfin
truyen chfi ttgng dfin cdc nfadm ngudi
ngheo, nhdm ddn sd trfi, nfadm lao dgng di
eu, nhdm dan sd co trinh do nhdn tfafic thip
d nhimg vung nfing thdn vd vfing kem pfadt

trifin. Can giiip ngudi ddn nhdn thfic duge
ring, tiiam gia BHXH, BHYT, BHTN la lgi
ich tuong lai cua chinh minh; vifc khflng ky
kit hgp ddng lao dfing vdi chfi sfi dyng lao
dpng sfi gay thift hgi eho chinfa minh, ddng
thdi tiep tay cfao chfi sfi dung lao dgng vi
pfagm phdp lugt. Cdn gifip ngudi ddn nhgn
thfic dugc ring, nfiu pfadt faifin nfaung bit
cap trong cac cfainh sdeh ASXH, nguoi lao
ddng cd the thfing qua cdc kfinh khdc nfaau
dfi dfi dgt nguyfn vgng cua minh (nhu gap
tryc tifip dai difn co quan cfafic ndng, qua
bdo ddi...). Suphdn hfii tryc tiep eua ngudi
lao dgng Id yeu td quan ttgng dfi cdc co
quan qudn ly tien hanh tim cde gidi phdp
khic phuc kip tfadi pfau fagp. Cin gifip
nguoi ddn thay ddi y thfic f lai, ttdng chd
vao nha nude.

5. Ket luan
Trong he thdng cac hinh thfic pfadn pfadi
hifn nay, phan phdi thfing qua ASXH dd

43


Khoa hpc xdhgi Vift Nam, so 1 (110)-2017

dat dugc nhung k i t qud tfailt tfayc gop phan

Chfnh tri quic gja (2013), Nhimg thdch thuc

thyc hifn CBXH. Tuy nfaifin, trong giai

vd gidi phdp ddi vdi ehinh sdeh an sinh xd hpi

dogn tiep tfaeo edn tfayc hifin nhifiu gidi phdp

ben vOng eho tdt cd mpi ngudi tgi Viit Nam vd
Diic, Nxb Chfnh trj qudc gia. H i Nfi.

dfi hodn thifin hf thfing ASXH. Cfi nhu vgy
thi ehung ta mdi dam bdo CBXH tot ban,

[5]

Lfi Quoc Ly (Chii bifin) (2012), Chlnh sdch
xod ddi gidm nghio thuc trgng vd gidi phdp,

qua do mdi gift dugc fin dinh vd phdt trien

Nxb Chinh tri quic gia. H i Nfli.

ben vflng xa hgi.
[6]

Vu v a n Phdc (ChCi bifin) (2012), An sinh xa
hdi d Viit Nam hudng tdi 2020, Nxb Chfnh tri
quic gia, H i Ngi.

Tai lifiu tfaam khao
[7]

Thu tudng Chinh phii (2013), gwyeV dinh sd
12i5/QD'TTg ngay 23/07/2013 vi chiin luge

[1]

Mai Nggc Cudng (Chu bien) (2009), Xdy dtmg

phdt triin ngdnh Bdo hiim xd hgi Viit Nam

vd hodn thiin hi thdng chbth sdch an sinh xd hgi
a Viit Nam, Nxb Chfnh iri qu6c gia. H i Nfli.
[2]

din ndm 2020. Hk}<^i.
[8]

Bill D^i Dung (2012), Cong bdng trong phdn

lugn ca bdn vi cong bdng xa hgi trong diiu

phdi - ca sd de phdt triin bin vang, Nxb

kiin nude ta hiin nay, Nxb Khoa hgc xi hfi.

Chfnh tq qudc gia. H i Ngi.
[3]

Ding Cfing sin Vi^t Nam (2016), Vdn kiin
Dgi hpi dpi biiu todn quoe ldn thir XII, Nxb
Chfnh tri quic gia, H i Nfli.

[4]

44

Ph^m Thi Nggc T r ^ (2009). Nhiing vdn di ly

Hfli ding Ly luin Trung uong - Nhi xuat bin

H i Ngi.
[9]

/>ttin.aspx?IDNews=24363

[10] />