Đánh giá hoạt động của các phòng chẩn trị y học cổ truyền tỉnh khánh hòa

UY BAN NHAN DAN TINH KHANH HOA
SOf Y TE
BAO
CAO
KET
QUA
D^
TAI
NCKH
CAP
TiNH
DANH GIA HOAT DQNG CUA CAC PHONG
CHAN
TRI
Y
HOC CO TRUYEN
TiNH KHANH HOA
Cd quan quan ly:
Sd
KHOA
HQC
& CONG NGHE KHANH HOA
Cc^
quan chu
tri:
SCf
Y TE KHANH HOA
Cd quan
thrfc
hien: HQI DONG Y KHANH HOA
Chu nhiem de tai: TSDK. NGUYEN

THl/CfNG
Nha
Trang,
thang 07 nm 2009
UY BAN NHAN DAN TINH KHANH HOA
sd
Y TE
BAO CAO KET QUA DE TAI
NCKH CAP TINH
DANH GIA
HOAT
DONG CUA
CAC
PHONG
CHAN TRI
Y
HOC CO TRUYEN
TINH KHANH HOA
OC
Cd quan chu tri
S^i?;fST^ANH
HOA
Mai Thi Thanh
Cg
quan
thrfc
hien
,Y
KHANH HOA
'HO CHU TICH

1
Xuan Minh
sdK
Cd quan quan ly
& CONG NGHE KHANH HOA
iC
"/
MUC LUC
• •
MUCLUC
i
NHUNG
CHLT VIET
TAT
iv
MUC LUC CAC BANG vi
MUC LUC CAC BIEU DO viii
DAT VAN
DE 1
CHVONGI
3
TONG QUAN
TINH HINH HOAT DONG
YHCTTU^
NHAN 3
1.1. Tinh hinh hoat dgng YHCT tu nhan tren the gidi 3
1.2. Tinh hinh hoat dgng YHCT tu nhan tai
Viet
Nam 4
1.3.

Tinh hinh hoat dgng YHCT tu nhan tai Khanh Hda 8
1.4. "Phdng chdn tri YHCT" theo Phap lenh hanh
nghi
y,
dugc tu nhan
16
1.4.1.
PCT-YHCT la mgt hinh thirc to chirc hanh
nghi
YDHCTtunhan 16
1.4.2.
Dieu kien va pham vi hanh nghe ddi vdi mgt
PCTYHCT 17
1.5.
Dao dire hanh nghi YHCT Viet
Nam 20
CHVONGII
DOI
TlTgnVG
VA PHU'ONG PHAP NGHIEN CUtJ 21
2.1.
Dia ban nghien
ciiu 21
2.2.
Doi tugng nghien
ciin
21
2.3.
Thilt ke nghien
ciiu

21
2.4. Cd mdu va phuong phap chgn mau 22
2.5.
Cac ky thuat ap dung trong nghien cim
28
2.6.
C6ng cu sir dung 28
2.7.
Xir ly
va
phan tich s6 lieu 28
u
CHVONGIII
KET QUA NGHIEN CUtJ 29
3.0. Khai quat ve cac mau khao sat 29
3.1.
Ket qua khao sat mang ludi to chiic
ciia
cac PCT
YHCT tinh Khanh Hda 30
3.1.1.
Kit qua thu thap tir mau "Cac
PCT" 30
3.1.2.
Ket qua thu thap tir mau "Nhung ngudi hanh
nghl"36
3.1.3.
Kit
qua thu thap tir mau " Cac chuyen gia" 38
3.1.4.

Ket qua thu thap tir mau "Nhung ngudi dan
sdng tren dia ban nghien
ciiu"
40
3.2. Danh gia thuc trang hoat dgng
cua cac PCT - YHCT Tinh Khanh Hda 42
3.2.1.
Kit qua thu thap tir mau "Cac
PCT" 42
3.2.2. Ket qua thu thap tir mau "Nhimg ngudi hanh
nghe"51
/ OH
3.2.3.
Ket
qua
thu thap tir mau " Cac chuyen gia"
53
3.2.4. Ket qua thu thap tir mau "Nhiing ngudi dan
sdng tren dia ban nghien
ciiu"
57
CHVONGIV
BAN
LUAN 69
4.1.
Mang ludi t6 chirc cac PCT-YHCT tinh Khanh Hda 69
4.1.1.
Su thanh lap he thing cac PCT - YHCT tinh KH

69

4.1.2.
Dac dilm he thong PCT - YHCT tinh KH 70
4.1.3.
Nhan xet chung ve s6 lugng cac PCT va dgi ngu
cac thdy thuoc YHCT tinh Khanh Hda 72
4.2.
Danh gia thuc trang hoat dgng cua cac PCT
!
74
4.2.1.
Su chgn lua noi dieu tri ctia ngudi dan khi dau 6m. 74
4.2.2.
Ly do ngudi benh chgn den PCT 76
4.2.3.
Nhimg phuong phap dieu tri tai PCT 77
4.2.4. Nhirng loai benh dugc dieu tri tai PCT 78
Ul
4.2.5.
Nhirng bien chiing trong qua trinh dieu tri 80
4.2.6.
Thai do cua thay thu6c va nhan vien PCT
d6i vdi benh nhan 80
4.2.7.
Gia djch vu YHCT tai PCT 80
4.2.8.
Vai trd cua PCT trong cdng
ding 81
4.2.9.
Viec chap hanh cac qui dinh vl pham vi hanh
nghl.82

4.2.10.
M6i quan he giira PCT vdi Tram y tl ciing
dia ban xa/phudng 83
4.3.
Nhirng van de can
uu
tien giai quyet 83
CHVONG
V
KET
LUAN 87
5.1.
vl mang ludi to chirc cac PCT- YHCT tinh Khanh Hda 87
5.2. Ve thuc trang hoat ddng cua cac PCT- YHCT tu nhan
tinhKhanhHda 88
HAN CHE CUA DE
TAI
90
KIEN NGHI
Nhung giai phap kha thi nham nang cao hieu qua hoat ddng
cua cac PCT - YHCT tinh Khanh Hda
91
A. Nhdm giai phap nham giai quyet nhirng van de can uu tien
thuc hien 92
B.
Nhdm giai phap mang tinh chien
luge
lau dai 94
DE
XUAT

HU6NG
NGHIEN CUtJ TIEP THEO 96
TAI
LIEU THAM KHAO 97
PHU
LUC 100
IV
NHUNG
CHCT
VIET
TAT
F
F
Chir viet tat
CR, DK, NT,
NH, VN, CL
ND-
103
PCT
PKS
PL-07
PL-1993
SL
TL
TT-01
TT-07
Cum tir
dtfcJc
thay the
Thi xa Cam Ranh, Huyen Dien Khanh, Thanh pho' Nha

Trang, Huyen Ninh Hoa, Huyen Van Ninh, huyen Cam
Lam.
Nghi dinh so
103/2003/ND-CP
ngay 12 thang 9 nam 2003
ciia
Chinh
phii
quy dinh chi tie't mgt
so'dieu
cua Phap lenh
hanh nghe y,
dggc tg
nhan.
Phdng chan tri
Phieu khao sat
Phap lenh s6 07/2003/PL - UBTVQH ngay 25 thang 02
nam 2003
ciia
Uy ban Thudng vu Qudc hgi quy dinh vl
hanh nghe y, dugc tu nhan.
Phap lenh hanh nghe y,
difdc tg
nhan nam
1993
S6
lugng
Tile
Thong
tu^

s6'01/2004/TT-BYT
ngay 06 thang 01 nam 2004
ciia
Bg Y
te'hgdng
dan ve hanh nghe y,
dgdc tif
nhan
Thong
tu*
so' 07/2007/TT-B YT ngay 25 thang 5 nam 2007
ciia
Bg Y te'
hu'dng
dan ve hanh nghe y, y hoc co truyen
va trang thiet bi y
te'
tg
nhan
ChCr
viet tat
WHO
YDHCT
YHBT&TT
YHCT
YHHD
Cum
tir dxidc
thay the
World Health Organization : T6 chiic Y te

Thi
gidi.
Y dugc hgc c6 truyen
Y hgc b6 trg va thay the
Y hgc c6 truyen
Y hgc hien dai
vi
MUC LUC CAC BANG
Bang
Bang I
Bang 2
Bang 3
Bang
4
Bang 5
Bang 6
Bang 7
Bang
8
Bang
9
Bang 10
Bang
11
Bang 12
Bang 13
Bang 14
Bang 15
Bang 16
Bang

17
Bang 18
Bang
19
Bang 20
Bang
21
Tieu
de
Phan bo cac PCT trong
tinh
Ket qua kham va dieu tri
ciia
he tho'ng hgi Dong y
Phan bo
so'
Iifdng
mlu cac PCT
Phan
bd
so'
lUdng mlu
nhiing nggdi hanh nghe
Phan bo
so'lu'dng
mlu
ciia
ngudi dan (16 1)
Phan bd
so'

lufdng
mau
ciia
ngudi dan (16 2)
t F
fv
Phan bd s6 lugng cac mau khao sat
Th6ng tin ca nhan ve nhirng ngudi dimg dau cac PCT
F
S6
lugng ngudi giiip viec cd trong
1
PCT
Trinh do chuyen m6n cua nhiing ngudi giiip viec
Qui md t6 chiic cac PCT
F
S6 lugng PCT dugc thanh lap theo thdi gian
Viec hgc tap nang cao trinh do chuyen mdn tai PCT.
/
F
Mdi quan he giira PCT vdi Tram y te
Thdng tin ca nhan ve nhiing ngudi hanh nghe
F F
\
F
Trac nghiem kien thiic phap luat cua thay thude YHCT
\
r
\
F

Nhan xet ve s6 lugng cac PCT va thay thu6c YHCT
F F
Y kien chuyen gia so sanh cac PCT tu nhan vdi cac co sd
dieu tri bang YHCT ctia Nha Nude.
Su chgn lua
each
dieu tri bang Ddng y cua ngudi dan
Cac loai benh dugc dieu trj tai PCT
Nhirng loai benh ma PCT chira cd hieu qua
II
9
12
24
25
26
27
29
31
31
32
33
34
35
35
36
37
38
39
40
42

44
Vll
Bang
Bang 22
Bang 23
Bang 24
Bang 25
Bang 26
Bang 27
Bang 28
Bang 29
Bang 30
Bang
31
Bang 32
Bang 33
Bang 34
Bang 35
Bang 36
Bang 37
Bang 38
Bang 39
Tieu de Tr
Nhung bien chimg trong qua trinh dilu tri tai PCT
Ket qua khao sat viec chdp hanh cac qui dinh vl hanh
nghi
F
,
So lugng benh nhan den kham tai 01 PCT qua cac nam
F

S
S6 tien lam tir thien tai
01
PCT qua cac nam.
Cac nhdm benh
din
vdi PCT
ciia
ngudi hanh
nghi
Nhiing phuong phap dieu tri sd trudng
Y kien ngudi hanh
nghi
vl cac vdn de cdn uu tien giai
quyet
Y kien chuyen gia ve ly do ngudi benh chgn
din
kham
Nhan xet ciia chuyen gia ve chat lugng kham chira benh va
thai do phuc vu benh nhan tai PCT
Y
kien
cac chuyen gia ve vai trd xa hdi
ciia
PCT
F F \ F
•>.
\ F
Y kien
ciia

chuyen gia ve cac van de can uu tien giai quyet
Ly do ngudi dan chgn den PCT tu nhan
Nhiing loai benh khien ngudi dan tim den cac PCT
Nhirng phuang phap dieu tri tai PCT
Thai do
ciia
thay
thude
va nhan vien PCT
Y kien cua ngudi benh ve vai trd cham
sde
sire khoe cdng
ddng cua PCT
Y kien ciia ngudi benh ve gia dich vu kham chira benh
tai
PCT
Tai bien gap phai khi dieu tri tai PCT
F F
S W \
-S.
F
Bang 40 Y kien
ciia
ngudi benh ve cac van de can uu tien giai quyet
46
47
49
50
51
52

53
54
55
56
56
58
59
61
62
66
66
67
67
j
Tong cong: 40 bang
Vlll
MUC LUC CAC BIEU DO
•> >
Bieu do
t \
Biiu do I
Bieu do 2
Bieu do 3
7
>
Biiu do 4
Biiu do 5
9
\
Biiu do 6

•7 \
Bieu do 7
Tieu de Trang
Trinh do chuyin mon
ciia
nhimg nguoi hdnh nghi
Su chgn lua cdeh diiu tri bdng Ddngy
ciia
nguoi ddn
Cdc nhom binh dugc diiu tri tgi PCT (theo khao sat tai
PCT)
Cdc nhdm benh chira co hiiu qud tgi PCT
So lugng binh nhdn din khdm tgi 01 PCT qua cdc
ndm
F
\
So tiin
Idm tic
thien tgi 01 PCT qua cdc ndm
F F
Cdc nhom binh khiin ngudi ddn
tim
den PCT
(theo
phong van benh nhan)
•9
f
-y
Tdng cpng: 7 biiu do
37

41
43
45
50
51
60
DAT
VANDE
Phdng chan tri y hgc cd truyin (PCTYHCT) la mdt trong cac hinh
t \ t \
thirc td chiic hanh nghe y dugc hgc c6 truyen tu nhan dugc qui dinh trong
Phap lenh so 07/2003/PL -
UBTVQHI1
ngay 25 thang 02 nam 2003 cua
•>
F
> ,
Uy ban Thudng vu Qu6c hgi (PL- 07) quy dinh ve hanh nghe y, dugc tu
nhan.
Qua viec ban hanh PL- 07, Nha nude da khuyen khich viec phat trien
y, dugc tu nhan ndi chung, YHCT tu nhan ndi rieng, tao dieu kien cho
nhirng ngudi hanh nghe YHCT tu nhan tham gia kham chira benh, cham
sde
siic
khde cho cdng d6ng bang cac phuong phap cua YHCT. Tinh
/
F \
Khanh Hoa den thang 01/2007 da cd 169 ngudi dugc cap phep hanh nghe
I
F

loai hinh PCT . Trung binh hang nam, he thdng cac PCT cua hgi
vien
Ddng y da kham chira benh cho 577.000 lugt benh nhan [2]. Qua kiem tra
F
\
F
danh gia cua Sd y te, hoat ddng cua cac PCT trong tinh hau het la dimg cac
qui dinh
ciia
phap luat, tuy nhien van cd 1 s6 cd sd cdn vi pham ve dieu
kien va pham vi hanh nghe
[11,12].
F
> >
Trong
nude
da cd mgt s6 c6ng trinh nghien
ciiu,
dieu tra ve vai trd
cua Ddng y d ca sd, ve tac dgng cua c6ng tac xa hoi hda YHCT hoac
danh gia nhu cau sir dung phuang phap dieu tri bang YHCT tat cong
dong [3, 7, 14,
16,
17,
21].
Cac c6ng trinh neu tren
true
tilp hay gian tiep
cd khao sat mang YHCT tu nhan. Tuy nhien, da
sd'

cac cong trinh do deu
di sau nghien
cii^
mang YHCT trong he tho'ng y te Nha
nifdc,
chga
phan
biet rach rdi
giu'a
2 mang YHCT trong y te cong lap vdi mang YHCT
ngoai c6ng lap; chua tha'y cdng trinh nao nghien
cii^
chuyen vetd chii'c
So lieu do Phong nghiep vu Y - So Y te cung cap.
va hoat dgng
ciia
cac PCTYHCT, ma cd the noi do la hinh
thi?c
hanh
nghe YHCT
tg
nhan tieu bieu
d
Khanh Hda hien nay. Do vay cac c6ng
trinh ay
chga
danh gia he't hieu qua hoat dgng
ciia
gidi YHCT ben ngoai
cac td

chuTc
y te Nha
nxidc
bao gom cac hgi vien Hgi Dong y va
nhicng
ngu'di hanh nghe YHCT
tif
nhan khac.
Trong bo'i canh tinh Khanh Hda dang ciing ca ngdc phan da'u thgc
hien Quyet dinh so 222/2003/QD-TTg ngay
03/11/2003 ciia Thii
tgdng
Chinh phu phe duyet Chinh sach Qudc gia ve Y
Dggc
hgc cd truyen de'n
nam 2010, trong do cac chi tieu kham
chtfa
benh bang Dong y d cac
tuyen gom cd tuyen Trung
gdng
10%, tuyen tinh 20%, tuyen huyen 25%
va tuye'n xa 40%, thi song song mang YHCT cdng lap, dieu de tha'y la he
tho'ng PCTYHCT
tg
nhan
d
dia ban xa
phgdng
trong tinh cd vai trd rat
quan trgng.

Vl
nhifng
Iy do dd, chiing tdi tien hanh nghien
ciiu
de tai:
''Ddnh
gid hogt dpng cua cdc phong chdn tri y hpc cd truyin tinh Khdnh Hoa"
vdi 3 ndi dung la:
Mpt,
Khao sat mang ludi td chiic cua cac PCTYHCT tinh Khanh Hda.
Hai, Danh gia thuc trang hoat ddng cua cac PCTYHCT tinh Khanh Hda.
Ba, Tren co sd nhirng khao sat va danh gia dd, de xuat cac giai phap kha thi
de nang cao hieu qua hoat ddng ctia cac PCT- YHCT trong tinh.
CHVONGI
TONG QUAN
TINH HINH
HOAT
DONG YHCT TlT NHAN.
1.1.
Tinh
hmh hoat
dgng YHCT tw nhan
tren the gi&i
Theo To chiic Y tl
Thi
gidi (WHO) thi d cac nude dang phat triln,
ngudi dan cd xu hudng
sir
dung YHCT trong viec cham sde
stic

khde cho
minh. O cac nude cdng nghiep hda, cd khoang 50% dan so dang sir dung y
hgc bd trg va thay
thi
(YHBT & TT, Complementary & Alternative
F
Medicine) dudi hinh thiic ket hgp vdi y hgc hien dai [25]. Ngudi ta diing
hinh anh mdt ngdi sao 5 canh de md ta mdt nen y hgc tuong lai cua nhan
loai gdm 5
ITnh
vuc miii nhgn, dd la: YHCT phuong Ddng, y hgc mdi
trudng, y hgc di truyen, y hgc tai sinh dua vao cac te bao gdc va y hgc nano
F F
[5].
Qua dd chiing ta thay rd tren the gidi ngudi ta danh gia cao vai trd cua
YHCT trong viec cham sde
siic
khde. Tir cac ndi dung ve cham sde
siic
khde ban dau cua WHO den mdt sd cac nghien
ciin ciia
cac td chiic va ca
nhan khac [23, 24, 26, 27] dlu neu cao vai trd cua YHCT, YHBT & TT va
cac hinh thiic td chiic kham chira benh khdng do Nha
nude
dau tu trong
cham sde
siic
khde tai cdng ddng. Tac gia Gerry Bodeker cho biet cac
^

F
khuynh hudng chi dao trong cham sde
siic
khde cdng ddng tren tdan the
gidi se la su
kit
hgp YHHD va YHCT, YHBT & TT, va cung cho bilt rdng
nin
YHCT chau A dang dugc qudc tl cong nhan va str dung, hien nay dang
dugc toan cau hda mdt each manh me [25]. Gerry Bodeker da khao sat ve
lanh vuc YHCT tu nhan tai 23
nude
tren
thi
gidi, cho bilt thay
thude
YHCT tu nhan da dugc cdng nhan su hgp phap, viec sir dung YHCT cua
dan chiing tai
ITnh
vuc y tl tu nhan dang cd khuynh hudng phat trien.
1.2. Tinh hinh hoat
dgng YHCT tw nhan
tai Viet Nam
Ve mat lich sti, cac PCTYHCT cd tiln than tir Tap doan Ddng y
dugc thanh lap ngay sau khi cd Quylt dinh thanh lap Hdi nghien cim
Nam dugc ngay 27 thang 8 nam
1946,
try sd tai s6 nha 75 pho Hang B6
- Ha ngi
[19].

Sau khi Hgi D6ng y dugc thanh lap theo Quylt dinh s6
399/NV/QD ngay 03 thang 6 nam
1957,
he thong Tap doan D6ng y dugc
•> y
. F
phat trien manh nhd cd Nha
nude
bao trg. Ddng thdi vdi dd, he thdng
- ^ t t
cac kinh tieu thuoc Ddng y ciing dugc chuyen d6i thanh Hgp tac xa
D6ng dugc, thu6c nam, thuoc dan tgc. Sau khi Chi thi
118/CT/TW
ngay
X
Ft
30/9/1981 ciia
BCH Trung uong Dang ve viec ciing c6 t6 chiic va tang
t \
cudng cdng tac
ciia
Hgi y hgc cd truyen dan tgc Viet Nam trong giai
X
F F
doan mdi ra ddi, nhieu tinh thanh phd da thanh lap Trung tam thira ke
ling dung Ddng y dam nhan viec kham chira benh bang D6ng y. Trong
qua trinh chuyen d6i ca che quan ly cua Nha
nude,
ngay 06 thang 9 nam
1989 Bd Y tl ban hanh Quylt dinh so 508/BYT/QD vl Dilu le Phdng

chdn tri YHDT. Cdng vdi tir khi cd ca che khoan 10 va thuc hien cd
^
F
phan hoa cac doanh nghiep Nha
nude
thi he thdng cac PCT trong ca
nude
Cling dugc thay ddi hinh thirc quan ly va bat dau cd xu hudng suy
giam. Nhiing PCT cd bl day kinh nghiem ket hgp vdi cdng tac thira ke
tot van duy tri ton tai nhung hdu
hit
cac PCT dlu gap nhilu khd khan do
m.,
F F
cac nguyen nhan: 1/ Nha
nude
chi hd trg ca che chinh sach cdn he thdng
PCT tu san,
tir
tieu, tu quan. 2/ Ddi ngu Luong y cd nhilu kinh nghiem
giam dan do tudi cao
[19].
"Phap lenh hanh
nghi
y, dugc tu nhan" ldn
ddu tien dugc ban hanh ngay
13
thang
10
nam

1993
va sau dd dugc thay
the bdng "Phap lenh hanh nghe y dugc tu nhan" so 07/2003/PL ngay 25
*
Cira
hang
thang 02 nam 2003 (PL-07) da khuyin khich dang kl viec phat triln y
dugc tu nhan ndi chung va YHCT tu nhan ndi rieng. Nhiing ngudi hanh
nghe YHCT tu nhan dugc tao dieu kien tham gia td chiic Hgi D6ng y,
phat huy chuyen m6n kham chira benh, cham sde sire khde cho cdng ddng
bang cac phuong phap cua YHCT.
Din
thang 4/2004, ca
nude
cd 4.000 Td
chdn tri YHCT tai cac Tram y tl xa (40%); cd 7.000 PCT- YHCT tu nhan
tren tdng so
10.732
phudng/xa trong ca nude [13].
Din
thang
10
nam 2008,
trong 63 tinh thanh phd ca nude thi cd 7 tinh cd Trung tam thira kl
iing
\
F
^
t
^

dung Ddng y, cdn lai hau het deu cd Phdng chan tri Ddng y, td chiic thira
F
y
t
F
ke,
kham chira benh bang Ddng y cho nhan dan va benh nhan bao hiem y te
ben canh benh vien YHCT tinh. Ca
nude
cd 638 quan, huyen, thi hau het
deu cd PCT cap huyen, da dang, nhieu hinh thiic. Cd nai xac dinh PCT la
CO
quan chuyen mdn cua Hdi Ddng y. Phan ldn cac PCT thuc hien che do
tu quan. Cd PCT ket hgp vdi cac nha chiia. Cdn d cap xa phuong, PCT tdn
tai dudi 2 hinh thiic: PCT
ciia
cac cap Hdi Ddng y hoat ddng trong Tram y
te va PCT
ciia
hdi vien Ddng y.
Theo tren, hoat ddng YHCT tu nhan tai Viet Nam hien nay
chii
yeu
la d cac PCTYHCT
phii
hau nhu kin ca nude. Trung uong Hdi Ddng y Viet
Nam danh gia chung trong nhiing nam qua cac PCT da gdp phan tich
cue
trong cham soc, bao ve
siic

khoe nhan dan; da tap hgp dugc nhieu Luong y
t \ F F
gidi,
td chiic kham chira benh ddng thdi lam cdng tac thira ke, tam dac,
truyen nghe cho the he sau, ddng thdi cdn tham gia lam tir thien va cac
cdng tac xa hgi tai dia phuong
[19].
Ngay 04 thang 7 nam 2008, Ban Bi thu Trung uong Dang (khda X)
da ra Chi thj sd 24-CT/TW vl phat triln
nin
Ddng y Viet Nam va Hdi
Ddng y Viet Nam trong tinh hinh mdi, neu rd mdt trong cac nhiem vu va
t
ft
giai phap la day manh xa hdi hda, khuyen khich cac td chiic, ca nhan trong
va ngoai nude thanh lap cac co sd kham chira berth, chac chan se md dudng
cho mdt giai doan phat trien mdi
ciia
cac PCTYHCT trong ca
nude.
Nhieu cdng trinh nghien
ciiu
ve hoat ddng cua YHCT phuc vu
siic
khde cdng d6ng da cho thay su ddng gdp ngay cang rd net
ciia
mang
YHCT tu nhan.
Trong 2 nam 1999-2000, tai
tinh Phii

Yen, tac gia Le Van
Thi^c
va
cdng sg da dieu tra vai trd
ciia
Ddng y d cd sd. Ket qua cho tha'y: (a)
benh nhan de'n kham va
chiJa
tri tai cac cd sd Ddng y chiem
ti
le kha cao
(39,6%).
(b) Tai cac cd sd D6ng y, thu6'c dggc
sii
dung
chii
ye'u la thud'c
thang.(c) Phan dong nggdi dan da cd y thu'c de'n viec
sii
dung thuoc Nam
de chiia benh cho ban than va gia
dinh,
nhgng sg hieu biet
ciia
hg ve tac
dung chiia benh
ciia
cac cay thud'c cdn han che'. (d) Nggdi dan khi bi
benh tg mua thud'c de dieu tri ma khdng kham chiem ti le rat cao
(42,5%) [7].

Tac gia Huynh Lien Doan d Khoa YHCT
Trgdng
Dai hgc Y
DUdc
thanh pho' Ho
Chi
Minh va cong sg da
btfdc
dau danh gia nhu cau sti
dung
phifdng
phap YHCT trong cham soc
siIc
khoe ban dau tai cdng
dong d 2 phuong thugc thanh ph6 H6 Chi Minh. Ke't qua nghien
ciiu
cho
tha'y gan 50% dan
s6'
nghien
cii^i
cd thdi quen
sii
sung YHCT, chu ye'u la
cac phgdng phap khdng diing thud'c, li do thich diing YHCT la vi cd hieu
qua, ddn gian,
it
to'n kem, va 83% cd nguon hieu bie't ve YHCT tir gia
truyen [3].
Cdn d phia Bac, tac gia Tran Thiiy trong mgt c6ng trinh nghien

cii'u
ve
"Tinh
hinh YHCT
ciia
mdt tinh
dbng
bang sdng Hong" [17] dd
ke't luan: 1/ Tai cdng dbng, viec cham soc
siic
khde cho nhan dan do 2
mang
lifdi
y
tela:
he tho'ng y te'nha
ngdc
va he tho'ng y
te'tu*
nhan, ngubn
nhan
Igc
y te YHHD chiem da so' tai cong dbng (92,58%) nhgng viec
cung cap dich vu YHCT
chii
ye'u do y te'tg nhan dam trach. Tai cac Tram
y te dich vu YHCT
dggc suf
dung rat
it,

hinh thu'c cdn ngheo nan,
chii
ye'u
do cac can bg YHHD ke't hdp them vao dieu tri tai cong dbng, cac can bg
y te d day khong
dii
kha nang de cung cap dich vu YHCT phuc vu nhu
cau cham soc
siJc
khde
ciia
nggdi dan tai cdng dbng. Tai cac hg gia dinh,
YHCT du'dc
siJ
dgng vdi ti le tu'dng dd'i cao, trong do
chii
ye'u la
sii
dung
thud'c nam. Viec
siir
dung YHCT tai hg gia dinh
chii
ye'u do nggdi dan tg
dam nhan va mgt phan do cac
Igdng
y d trong va ngoai dia phgdng cung
cap.
2/ Cd 2 ngubn cung cap thud'c YHCT chinh, mua la
chii

ye'u va tg
kie'm. Cac che pham YHCT cdn it, nhin chung khdng dap u'ng dggc
nhti
cau
ciia ngiTdi
dan tai cdng dbng ca ve hinh
thilc
va hieu
Igc
dieu tri. 3/
Cac ye'u to' tac dgng
din
viec
sii
dung YHCT tai cong dbng la: nhu cau
thgc tiln ve cham soc sii'c khde
ciia
ngu'di dan, kie'n thu'c va kinh nghiem
vl YHCT
ciia
ngu'di dan, tinh san cd
ciia
ngubn thuo'c YHCT va ngubn
dich vu YHCT, uy tin cua thay thuoc trong dieu tri va tg van, sg can nhac
ciia
ngirdi dan ve
tinh
hieu qua va
tinh
an tdan, tinh kinh te cua YHCT

trong dieu tri va nhu cau trbng cay thuoc nam.
Nam
2003,
tai Binh Dinh, Vd Ngoc Phai va Trirdng Quang Dat khi
nghien cti'u ve tac ddng
ciia
cdng tac xa hgi hoa YHCT de'n hieu bie't
trbng-siJ
dung thud'c Nam va day an huyet
ciia
nhan dan mgt so' xa huyen
Phu Cat, da khang dinh rang xa hgi hoa la
chii
trgdng diing dan
ciia
nganh y te'; kien thu'c, thai do
ciia ngUdi
dan trong
siJ
dung cac phgdng
phap dieu tri bang YHCT va trbng thud'c Nam da dggc nang cao
[21,
22].
Tan man tren internet cd mgt so' bai bao lien quan It nhieu de'n
mang hanh nghe YHCT tg nhan. Qua cac bai viet nay, c6ng tac xa hgi
hda YHCT da
dufdc
md ta dan rd net, ke't qua
ciia
xa hgi hoa YHCT da

da dang hoa cac hinh thu'c cung cap dich vu cham soc
siIc
khoe nggdi dan,
bao gbm ca trong
Ilnh
vgc
ciia
Nha ngdc,
ciia
tap the va
ciia tU
nhan
[16].
Lien quan de'n cac hinh
thilc
dich vu y te ngoai cdng lap, trong dd cd
YHCT, da cd bai vie't ve cac benh vien cd td
chilc
phd'i hdp c6ng-tg thi
khu vgc ph6'i hdp c6ng-tg du'dc benh nhan danh gia td't hdn la khu vgc
cdng ve chat
lu'dng
phuc vg, thai do, chat lu'dng can bg, trang thie't bi.
[14].
1.3.
Tinh
hinh hoat dgng
YHCT twnhan
tai tinh Khanh Hoa
Theo tai

lieu
do Phdng Nghiep vu Y Sd Y te cung cap thi tinh de'n
ngay 22 thang 01 nam 2007, Sd Y te da cap phep hanh nghe tg nhan ve
kham
chiJa
benh bang YHCT loai hinh PCT cho 169
ngUdi
trong ca tinh.
Sd cung da cap phep hanh nghe kinh doanh thud'c YHCT cho 14 nggdi,
trong dd cd 12 ngu'di kinh doanh thud'c phien va 2 ngu'di san xuat- kinh
doanh thuo'c thanh pham. Bang 1 du'di day trinh bay sg phan bd' cac PCT
tai cac huyen trong
tinh,
dbng thdi tam lien he theo so' lieu tdng dieu tra
dan
so'fan
mdi nhat ngay
01/10/1999
(vi
so'lieu
ve dan
sdchu'a
du'dc cap
nhat) de hinh dung mgt
each
tgdng dd'i ti le
so
dan cd 01 PCT.
Bang I. Phan bd cac PCT trong tinh
Dia ban

Sd lugng PCT
Sd
dan
(1.000
ngudi)
Sd
(1.000
dan)/1
PCT
CR*
26
194
7,46
DK
21
131
6,23
NT
94
324
3,44
NH
15
213
14,2
VN
13
117
9
Tdng cdng

169
979
5,79
-
Bang 1 cho thay binh quan trong tinh
ciJ
khdang
5.790
nggdi dan
thi cd
01
PCT, nhgng phan bd' khong deu, d thanh phd' Nha Trang cd mat
do PCT tap trung cao nhat vdi khdang 3.440 nggdi dan cd 01 PCT, trong
khi d cac huyen, thi thi mat do PCT tha'p hdn 2-3 fan, huyen Ninh Hda cd
de'n khdang 14.200
ngiTdi
mdi cd
01
PCT.
Den thang 12/2007, con sd PCTYHCT tg nhan tang
len
la 186,
trong dd cd
10
PCT do bac
si
YHCT phu trach, 16 PCT do y sT YHCT
phu trach va 160 PCT do
lirdng
y phu trach [15].

Mang hanh nghe YDHCT tg nhan nhg tren cdng vdi mang YHCT
trong he tho'ng Nha
niTdc
tao thanh mang
liTdi
kham chu'a benh bang
YDHCT tai Khanh Hda, dem so vdi mang y
diTdc
hgc hien dai (YDHHD)
vln cdn thieu rat nhieu ve cd sd vat chat va nhan
Igc,
ngubn
Igc
tai chinh
dau tur phat trien [13]. Cu the: Tai Sd Y te cung nhg tuyen huyen khdng
cd can bg chuyen trach theo ddi hoat dgng kham chiia benh bang
YDHCT. Nhan
Iiic
YDHCT ca tinh ve YHCT cd 01 bac
si
chuyen khoa 2
YHCT, 05 thac
si,
bac
si
chuyen khoa 1 YHCT, 19 bac
si
YHCT, 43 y sT
YHCT, 07 dieu
diTdng

YHCT va 172 lirdng y thi trong dd mang hanh
nghe YDHCT
tiT
nhan ddng gdp 10 bac sT YHCT, 16 y si YHCT va
160
* Ten cac huyen, xem bang
NHCTNG
CHlT
VIET TAT
10
liTdng
y

Toan tinh khdng cd benh vien YHCT; 2/5 benh vien tuye'n tinh
cd khoa YHCT; 4/6 Trung tam y te huyen, thj xa cd td YHCT; 00/16
Phdng kham da khoa khu vgc cd td YHCT; 19/137 Tram y te
xa/phgdng/thi tran cd td YHCT. Trong nam 2006, ti le
lUdt
benh nhan
kham chiia benh (KGB) bang YHCT so vdi tdng sd
Iggt
benh nhan den
KCB chung tai benh vien Dieu dgdng- Phgc hbi
chiJc
nang la
12.500/40.543 bang
30,83%;
tai benh vien da khoa tinh
la
17.584/435.005 bang 4,04%. Neu xem hoat ddng KCB tai Khoa YHCT

Benh vien tinh va Benh vien Dieu dgdng - Phgc hbi
chiJc
nang la dai
dien cho hoat ddng KCB bang YHCT tai tuye'n tinh
ciia
Khanh Hda thi ti
le
lirgt
benh nhan KCB bang YHCT ke ca kham benh va dieu tri ngi
trii,
ngoai
trii
so vdi tdng so'
Iggt
benh nhan de'n KCB chung tai 2 benh vien
tren la 30.084/475.548,
tire
la bang 6,33%. So lieu thong ke
10
thang dau
nam 2007 tai 2 benh vien tren la
22.109/399.801
bang 5,53%. Nhg vay
cac ti le nay cdn rat thap so vdi chi tieu tai Quyet dinh 222/2003/QQD-
TTg yeu cau ti
le
KCB bang YHCT tai tuye'n tinh la 20%, tuye'n huyen
la
25%
va tuye'n xa la 40% tdng

Iggt
nggdi dggc kham va dieu tri [15].
Song hanh ciing nganh y te, ve phia Hdi Ddng y, tinh de'n
31
thang
12 nam 2007, so'
liTdng
hgi vien
la
656 nggdi, trong dd cd 165 * nggdi cd
dang ky hanh nghe du'dc Sd y te' cap phep (theo Bao cao
tdng
ke't
nanl
2007
ciia
Hgi Ddng y). Dd'i chieu vdi tho'ng ke cap phep hanh nghe
YHCT ttr nhan den thang 12/2007 d tren cho tha'y mgt phan sg
phiTc
tap
* Cac BSYHCT va
1 si
YSYHCT la can bo duong chirc, hanh
nghi
YDHCT tu nhan
dang ngoai gia.
•* 165
PCT tu nhan cua hoi vien + 5 PCT eua tl chiic hoi
cSp
tinh va huyen, tong cong

he thing Hoi Dong y co 170 PCT tinh
din
31/12/2007.
11
trong
Igc Iggng
hoat ddng YHCT tg nhan trong tinh. Rd rang cd tbn tai \
sd nhiing nggdi da dang ky hanh nghe nhgng chga la hgi vien Hdi Ddng
y, dbng thdi cdn 1 so' ddng hgi vien Dong y chga dang ky hanh nghe.
Cung khong
loai
trii kha nang cd nhieu nggdi (la hoac khdng la hgi vien
Hdi Dong y) dang hanh nghe ma khong dang ky hdp phap. Thuc vay, tir
thang 7 de'n thang 9 nam 2008, Tinh Hgi Ddng y Khanh Hda da khao sat
tho'ng ke trong tdan tinh, thay cd 256 trudng hgp hanh
nghi
khdng gidy
Ft
\
,»
phep nhu the. Cg the la: cd 133 ngudi hanh nghe kham chira benh ; 26
ngudi budn ban dugc lieu , 97 ngudi chiia benh bang bai thude gia truyen
(tai lieu ngi bg Hdi Ddng y- thang 10/2008).
Cd the ndi, he thong cac PCTYHCT tai Khanh Hda hien nay gan
nhg "dbng nghia" vdi mang hanh nghe YHCT
tiT
nhan Khanh Hda, vi
loai
hinh nay chiem hau
nhiT

dai da so' trong s6' cac cd sd da dggc cap
phep.
Va nhg vay, ti
le 170/186
bang
91,4%
cua 170
* PCT
ciia
he thing
t F
^^
F
hdi Ddng y tren tdng sd
186
PCT dugc cap phep hoat ddng tren toan tinh
(den thang 12/2007) cho phep sti dung nhirng thdng tin hoat ddng ciia he
F
' % t
thdng Hdi Ddng y lam can
cii
tham khao
chii
yeu cho hoat ddng chung cua
mang hanh nghe YHCT tu nhan tai Khanh Hda, ben canh cdng tac trgng
tam la kham chira benh cdn cd nhiing hoat ddng xa hdi khac.
Rat khd de cd sd lieu chinh xac ve hoat ddng kham chira benh
ciia
cac PCTYHCT tu nhan ndi chung vi cdng tac thdng ke bao cao chua chat
^ (NH27

+
NT32
+
DK18
+
CL2
+
CR54=133)
' (CR6
+
NT13+NH7
= 26)
' (VN18
+
NH01 +NT34
+
DK04
+
CL10
+
CR24 =
97)
12
che.
Nhung
cd
thi
tham khao
so
lieu

cua he
thing
Hdi
Ddng
y
trong
2 nam
2006
va
2007 theo Bang
2 sau day:
Bang
2: Ket qua
kham
va
dieu
tri
ciia
he
tho'ng
hdi
Ddng
y 2 nam
2006
va 2007
*
Nam
2006
2007
(So

vdi
2006)
So
benh nhan deii kham
Tdng
so'
(lurgt)
444.107
572.575
Tang
28,93%
Trong
do
Diing
thud'c
(Iirgt)
405.842
So'
thang
thud'c
sijf
dgng
(thang)
728.000
929.724
Tang
27,77%
Miln
giam
(liTdt

benh
nhan)
34.766
59.882
Tang
72,24%
Qui ra
tien
miln giam
(dbng
)
905.803.000
251.585.300
Giam
72,26%
Tinh
hinh benh
tat
chii
ye'u la
nhdm benh
dau
nhiJc,
chd'ng
dau
liTng
man do
thoai
hda cot
s6'ng,

cam
mao, phong tha'p,
cao
huyet
ap, suy
nhggc than kinh,
di
chiing liet
nufa
nggdi
do tai
bie'n mach
mau nao,
liet
day than kinh so' VII,
dau
than kinh
tga, rdi
loan kinh nguyet,
suy
nhggc
cd
the, cac
benh
ve
dirdng
hd hap,
benh du'dng tiet nieu- sinh
dgc
v.v

Cdng
tac
kham chiia benh trong
he
tho'ng
hdi
du'dc trien khai
td't,
chga
cd
phan
anh nao ve sai sdt
chuyen
mdn, cac cd sd
phat
huy td't
viec mien
giam
phi cho
benh nhan.
Nguon: Bao cao tong ket nam 2007 cua Hoi Dong y
13
Ve mat td chirc, cac PCT chiu sg quan ly nha
nude
vl chuyen mdn
F
Ciia
nganh y te va tuan theo cac quy dinh khac cua phap luat cd lien quan,
vi dg cd nghTa vu nop thue do hoat ddng dich vg kham chira benh. Ngudi
F

^
chil
CO
sd neu la hdi vien Ddng y thi sinh hoat hdi theo Dieu le, Hdi thuc
hien chiic nang tap hgp, tuyen truyen, bdi dudng chuyen mdn va doan ket
hdi vien. Nam 2008, Hdi hanh
nghi
y tl tu nhan tinh Khanh Hda ra ddi, da
va se thu
hiit
mgt s6
chii
PCT gia nhap vao hgi mdi nay. Sd Y te'
thiTdng
xuyen td
chiJc
tap huan va thanh kiem tra cac hoat ddng YHCT trong
khudn khd quan ly hanh nghe y dgdc tg nhan ndi chung. Theo Bao cao
ngay 22 thang 5 nam 2006 cua Doan kiem tra Sd Y te
[11],
thi nhin chung
mang nhiing co sd hanh nghe YDHCT tu
nhan
trong tinh deu chap hanh
diing nhiing qui dinh ve dieu kien va pham vi hanh nghe; tuy
nhien
van cdn
nhiing sai pham nhu:
- Co sd hanh nghe khdng hgp phap cdn dien ra d nhieu noi.
- Vi pham cac che do chuyen mdn cdn kha phd bien nhu qui che

nhan
thude,
qui
chi
thuoc ddc, qui dinh vd khuan trong cham cim, luu hanh
thude
thanh phdm khdng cd sd dang ky, thude qua han sir dgng.
- Biln hieu khdng dung qui djnh, khdng dang ky danh sach ngudi
giiip viec.
- Viec mac ao blouse va deo bang ten khi lam viec chua chap hanh
nghiem, viec md so sach theo ddi hoat ddng chuyen mdn d mdt sd co sd
chua diing yeu cau
Mdt nam sau, theo bao cao ngay 27 thang 4 nam 2007
ciia
Doan
Thanh tra Sd Y tl [12], trong
ting
so 17 co sd YHCT dugc kiem tra thi hau
hit
dlu cd ddy du co sd phap ly dl hoat ddng, ngudi hanh nghe cd du cac
tieu chudn qui dinh; dilu kien hanh
nghi
ngay cang dugc cac co sd chu
14
trgng hon, ca sd khang trang, sach, dep; chdp hanh kha tot cac qui ehl
chuyen mdn va hanh nghe diing trong pham vi cho phep, trang bi cac
phuang tien tiet trimg
khii
khudn dat yeu cdu, niem
yit

gia diing qui dinh,
md day
dii
cac loai sd sach theo ddi hoat ddng chuyen mdn, nhieu co sd
dau tu trang bi hien dai phuc vg tdt cho cdng tac kham, chdn ddan benh va
dieu tri. Tuy nhien, van cdn nhieu thieu sdt, hdu
hit
cac sai pham da neu d
dgt kiem tra nam 2006 van tdn tai nhu la: cd 03 co sd hanh
nghi
cham
ciiu
* '
F
ma chil ca sd khdng cd bang cap chuyen mdn, khdng cd giay chiing nhan
dil dieu kien hanh nghe, mdt sd co sd xoa bdp cd nhan vien hanh nghe ma
khdng cd chung chi dao tao do co quan cd tham quyen cap.
Tai Hgi Ddng y tinh cdn
Iiru tri?
mdt
sd'tai
lieu de cap ve mang y te'
tir
nhan,
nhir
danh sach va dia chi cac hgi vien cd md PCT, cac bao cao
hoat ddng kham
chiJa
benh, cac bao cao tam dac nhifng bai thud'c hay
cay thud'c quy da ap dgng tai PCT, cac bao cao

ciia
mgt
so'
PCT dien hinh
v.v Nam 1997, bao cao thgc tap t6't nghiep ctia hgc vien Nguyin
Thgdng, ldp Dai hgc Quan tri kinh doanh, ma
sd'2219/DTTX/KH
Trgdng
Dai hgc md ban cdng thanh phd' Hd
Chi
Minh vdi de tai: "
Dit
bao so'
lifcfng
benh nhan va doanh thu tai Phdng chan tri
Tinh
Hoi y hoc
cd
truyen Khdnh Hoa "
[9]
fan dau tien da khao sat ve md hinh td
chiJc
va
hoat dgng
ciia
mgt PCTYHCT gan lien vdi td
chiJc
Hgi. Bao cao cho
tha'y day
la

mgt cd sd kham chiia benh, bao che', che' bie'n thud'c YHCT
quy m6 nhd gbm cd 3 bd phan: Bd phan chan tri, bg phan
diTdc
va bg
phan quan ly vat tur tai chinh.
Lufdng
benh nhan de'n day binh quan 453
nggdi/
1
thang; trong do dieu tri bang cac phgdng phap khdng diing thud'c
15
la
chii
yeu (80,5%). Cac loai benh
thirdng
gap
la
dau
nhii:c
(44,49%), suy
nhirgc
(19,38%).
I
Mgt van de cd
lien
he hiiu cd vdi hoat ddng
ciia
YHCT Khanh Hoa
ndi chung d ca 2 mang cdng lap va ngoai cdng lap la khau dao tao nhan
Igc.

Co quan chtic nang dao tao can bg y te ndi chung, YHCT ndi rieng
cho tinh la Trudng Cao dang Y te, cho den nam 1998 da dao tao 2 ldp
luong y, tdng cdng 52 hgc vien
^
Tir dd den nay, 2008, chua dao tao them.
Hdi Ddng y cd chiic nang bdi dudng chuyen mdn YHCT, tinh den thang
7/2007 da md tdng cdng
51
ldp, bdi dudng cho 1.796 hgc vien [8], nhung
F
y
cac Giay chirng nhan bdi dudng chuyen mdn cua Hdi la khdng
dii
tinh phap
ly de hgc vien cd the dang ky la ngudi dung dau mdt co sd hanh nghe
t
y
YHCT theo luat dinh hien hanh. Ndi com la cdn tdn dgng mdt Ldp Luong
F
^^
F
7
y thira ke (khoa II) do Trudng Trung hgc Y te (nay la Trudng
Cao.
dang Y
te) phdi hgp vdi Hdi Ddng y td chiic, cd 49 hgc vien theo hgc tir nam
1997
F F
• ' • •
den nam

1999
da hoan tat chuang trinh dao tao nhung chua
thi
tdt nghiep
dugc do vudng nhirng qui dinh ve "Xac dinh trinh do chuyen mdn" tai
Chuang II - Thdng tu so
13/1999/TT-BYT
cua Bd Y tl ban hanh ngay 06
thang 7 nam 1999 hudng dan thuc hien Phap lenh hanh nghe y dugc tu
nhan thugc
ITnh
vuc y, dugc cd truyen [1].
'
Tai lieu
Imi
trd tai Hoi Dong y tinh.