15 mot so nhan to anh huong den chat luong qtri

9{^hien aiu - Trao &

MOT SO NHAN TO ANH Hl/CiNG OEN
CHAT LUdNG QUAN TRj CONG CAP TINH:
NGHIEN CUfU TRUCiNG HOP CHAT Ll/dNG
DICH VU Y TE Cl LONG AN
TS. Le van Chie'n

^

r - ^ ndm 2009, ChUPng trinh Phat trien
Lidn hidp qud'c (UNDP) phd'i hpp vdi
i i Mdt tran To qud'c Viet Nam vd Trung
tdm Nghidn edu phdt trien vd hd trp cpng
dong tiln hdnh nghien cdu chd't lUpng quin
tri cdng d p tinh trdn cd sd d i l u tra •^ kiln,
danh gid eda ngUdi ddn v l c h i t lupng djch
vu edng vd thd tyc hdnh ehinh do ede d p
chfnh quyln eung d p (PAPI). Cdng trinh
nghien cdu dupe thye hidn trdn m l u dilu
tra tai 30 tinh, thanh p h i dgi didn eho ede
vdng, miln trong cd nUde. Nghidn edu ndy
thu hut sy quan 1dm rdng rdi eua ngudi ddn.
bdi nd eho phep hp dua ra y kiln ddnh gid
ve nhdng thdnh tyu edng nhu hgn e h l trong
hoat dpng cda cdc d p chinh quyln tinh,
huydn vd xa. Ddng thdi, day cdn Id n^uln
so lidu, thdng tin gid trj eho cdc nhd khoa
hpc, nhd nghien cdu va qud trinh hoach
djnh ehinh sdch d Viet Nam.
Ndm 2011, vdi sy giup dd cda UNDP,

'•' Hpc vien Chinh trj - Hanh chinh qudc gia Hd
Chi Mmh

nhdm nghidn cdu thudc Hpc vidn Chinh
trj - Hanh ehinh qud'e gia Ho Chf Minh da
tiln hdnh nghien cdu mpt s l y i u t l "diu
vdo" dnh hudng d i n chit lupng "diu ra" ciJa
qudn trj edng d p tinh. Nghidn edu ndy tip
trung tim hilu nhdng khd khdn, thudn M
md ede cd'p chinh quyln td tinh d i n xa phai
dd'i mdt hdng ngdy, cd dnh hudng tryc tiep
hole gidn t i i p d i n c h i t lupng djch vy vd thu
tyc hdnh ehinh cdng. Ndi cdch khdc. nlu
nhu PAPI ddnh gid k i t qud hoat ddng cija
ehinh quyln cdc d p td gdc dp cua ngUdi
ddn, ngUdi thy hudng djch vy (ddnh gid tiJ
phfa d u ) thi nghidn edu nay ddnh gid hogt
ddng cda cdc ddn vi eung dng djch vy cdng
{ddnh gid td phia cung). Nghien cdu dUdc
thyc hidn tgi 4 tinh: Hdi Duong vd Nam Djnh
(miln B I C ) , Long An vd Tien Giang (miln
Nam). Ddy la cac tinh cd d i l u kidn ty nhifln
typng dd'i giing nhau nhUng danh gid cua
ngudi ddn v l tdng mdt c h i t lUpng qudn trj
cdng Igi khd khde nhau.
Bdi v i l t nay gidi thidu mdt p h i n kit quS
nghidn cdu, eu the la nhdng nhdn t l Inf*
•

•

"4/2012


9{ghien cdu - Trao doi

hudng d i n chat lupng djch vy y t l eda Long
An. o l lam ro nhdng y i u to nhU: nguin
nhdn lpc, tdi ehinh, phUdng thde lanh dgo
Inh hudng d i n chat lupng djch vy y t l eda
tinh Long An, ehdng tdi so sdnh nhdng nhdn
to ndy cda tinh vdi mdc chung cda cd nUdc
va tinh Tien Giang.
1. Dieu kien tU nhidn, kinh t l - xa h$i
tinh Long An
Ve vi tri dia ly: Long An n i m trong vdng
Ddng Thdp Mudi, thude D i n g b l n g Sdng
Cdu Long; tllp gidp vdi Tp. H i Chi Minh
va tinh Tdy Ninh ve phia Odng, gidp vdi
Campuchia v l phia Bdc, gidp vdi tinh Odng
Thdp v l phia Tay va gidp tinh T i l n Giang
ve phia Nam; Id tinh thupc vdng Kinh t l
trpng diim phia Nam, dupe xdc dinh la vdng
kinh te ddng lyc ed vai trd ddc bidt quan
trpng trong chiln lupc phdt trien kinh t l cda
Viet Nam; cd dUdng bien gidi qud'c gia vdi
Campuchia ddi 137,7 km, vdi hai eda khau
Binh Hidp (Mdc Hda) va Tho Mo (Ddc Hue),
Dien tieh tu nhien eda Long An Id
4,491,4 km^ chiem ty Id 1,3% so vdi dien

tich ca nudc vd bdng 8,74% dien tich cda
vdng Dong bang Sdng Cdu Long.
Ve din so: Nam 2010, Long An cd

khodng 1,4 tridu ngudi, chilm 10% ddn s l
vdng Oing blng Sdng Cdu Long, 2% ddn s l
cd nudc. Trong dd, ddn s l sd'ng d ndng thdn
chilm 82,5%, thdnh thj Id 17,5%. Oilu ndy
cho thd'y trinh dd phdt triln cda Long An v i n
d mdc thip so vdi trung binh cda cd nude.
Mdt dd ddn s l Id 321 ngudi/km^ thip hdn
mdt dd ddn s l trung binh eda vdng Ding
blng Sdng Cdu Long (426 ngUdi/km^), eao
gd'p 1,2 l l n mdt dd ddn s l trung binh trong
ed nude (263 ngUdi/km^).
Tinh hinh kinh te - xi hdi: Ndm 2010,
gid trj ting sdn pham tren dja bdn tinh (theo
gid hidn hdnh) dgt khoang 33.469 ty dong;
theo gid ndm 1994 dgt khodng 12.777 ty
ding, tdng 12,6% so vdi ndm 2009. Thu
nhdp binh qudn dau ngudi tang td 23,1 trieu
ding/ngudi {nam 2010) len 27,7 tridu ding/
ngUdi (ndm 2011),tUdng dUdng 1.113 USD/
ngUdi/ndm (xem Hinh 1).
2. lUldt so' yeu to' dnh hUdng tdi higu
qud cong tac qudn trj va hanh chinh cdng:
Nghien cdu chat lUpng djch vg y te cdng
Trong nghien edu cda PAPI, chat lupng
djch vy y t l dupe nghien cdu d tryc ndi dung
thd 6: "cung dng djch vy edng". Trong dd,

PAPI nghien cdu 4 dich vu cdng chd yeu,
gom ITnh vuc y l l , giao
dye lieu hpc cdng lap,
Hinh 1: Thu nh$p binh quan dau ngUdi (tri$u d6ng/nam)
cd sd ha ting cd bdn
vd an ninh trdt ty. Vdi
ndi dung nay. Long
An dupe ddnh gia
khd thap, ddng thd 22
trong s l 30 tinh dupe
PAPI khdo sdt.
Trong nghidn edu
nay, ehdng tdi chi tap
trung khdo edu nhdng
nhdn t l anh hudng
den chat lUpng dich vy
y te cdng (mdt trong
4 ndi dung ma PAPI
nghidn cdu). Theo
Ngudn: Bio cio kinh te - xa hdi Long An nim 2011
•, tri _ QX Anmo


'J^ghiin cdu - Trao d

k i t qud nghidn edu, chd't lupng dich vy y t l
cdng eda tinh Long An thip hPn mde trung
binh eda ed nudc nhung cao hdn so vdi Tiln
Giang (xem Hinh 2).
Nhan td' "diu vio" cua ITnh vi/c y te d

Long An bao gdm:
Thd nhi't, vi cd sd vit chi't vi ngudn tii
chfnh: Tinh din ndm 2010, todn tinh cd 211
cd sd y t l , trong dd cd 3 bdnh vidn tuyin
linh, 3 bdnh vidn khu vpc, 14 trung tdm y t l , 1
bdnh vidn tu nhdn, vdi ting s l 3.332 giUdng
bdnh, trong dd ed 2,440 giudng thudc cde
bdnh vidn, s l edn Igl thudc cdc phdng khdm
khu vpe, bdnh vidn dilu dudng vd cdc trgm
y t l xa/phudng, S l giudng bdnh tinh trdn
mdt van ddn {bao gdm giudng bdnh cdng
Idp td phdng khdm da khoa khu vUc trd Idn,
giudng y t l IU nhdn, phdng kham da khoa
qudn ddn y, benh vien, benh xd) dgt mdc 23
giudng benh/vgn dan, tha'p hPn mde trung
binh eda ea nUde (25,5 giudng bdnh/van
ddn) nhung eao hdn so vdi mdc 19,1 giudng
benh/van dan cua tinh Tien Giang.

mdc, thilt bj hu hdng thi benh vidn phdi ti/
bd l i l n d l sda chda.
Ngodi phin thu vidn phi (theo quy djnh
eda Bd Y l l ) vd thu bdo hilm y t l , ndm
2011, cdc bdnh vidn d Long An dupe ngdn
sdch Unh d i u tU 48 tridu ding/gudng bdnh/
ndm, thd'p hdn so vdi mde 52 tridu ding/
giudng bdnh/ndm d T i l n Giang. Tuy nhidn,
ndm 2010, mdc d i u tU cda Long An iai cao
hpn so vdi T i l n Giang (Long An d i u tU48
tridu ddng cdn T i l n Giang chi d i u tU 27 trilu

ddng/giddng bdnh/ndm).
Ndm 2010, luy dupc danh gid cao hdn
so vdi Tiln Giang nhung Long An vdn co
k i t qud khd thip trong so 30 tinh dupe PAPI
khdo sdt. Nguydn nhan (theo k i t qua phdng
v i n lanh dgo benh vien tinh) Id do vien phi
qua thap, khdng thay d l i td nam 1995, gay
khd khdn eho cdng tdc khdm, chda benh, vi
cdng khdm edng Id, khdng ed dilu kidn tai
d i u tu. Dd la tinh trgng ehung eua ede benh
vien d Long An.

Thd hai. ve ngudn nhin ldc: Toan tinh
ed 4.438 edn bd y t l (ca trong cac benh vien
cdng lap vd benh vien tu nhan), trong do
cd 2.796 can bd y le va 291 can bd nganh
dupe, thude ede ed sd edng Idp (binh quan
19,3 edn bd y te vd 2 can bd ngdnh dupc/
vgn dan). So vdi Tien Giang,
ly le can bp y le/vgn ddn ciJa
Hinh 2: Danh gia cua ngudi dan ve chat luLong An eao hdn nhUng ly le
edn bd dupe/van ddn Igi thip
Health Care
hdn nhilu (2 so vdi 4,5). Nlu
tinh ly Id bdc sy/vgn ddn thi
con s l ndy cdn thd'p hdn {4,6
bde sT/van ddn so vdi 4,8 bac
sT/vgn ddn). TUdng tU, tv' le
bdc sT/giudng benh d Long An

dat mdc 0,2, trong khi con s6
nay cda Tien Giang Id 0,25.
Tinh trgng thilu bdc sT
da ddn de'n hien tupng "qua
tdi" tai cdc benh vidn. Day
la mdt trong nhdng nguydn
Nguon: PAPI 2010

Cung giong nhU he thdng bdnh vidn
cdng trong cd nudc, trang thilt bj d cdc
benh vien cda tinh Long An thudng do chinh
quyen trung Udng, dai didn Id Bd Y t l , eung
d p theo cac chUPng trinh myc lieu. Khi may

•

•^•^

:.o 4/2012


9{gfiien cdu • Trao doi
Bdng: ThSng ki nginh Y ti Long An
2005

2006

2007

2008

2009

2010

S6' can bo dUdc

326

148

171

203

302

S6' duoc sj/van dSn

2,3

1,1

1,2

1,4

2,1

2,0

S6 can bp y, bac sT

2.310

2.291

2.472

2.403

2.573

2.796

667

291

Trong do bac sT

567

552

617

578

611

S6' bac sTA'an dSn

4,1

3,9

4,4

4,0

4,3

4,6

16,6

16,3

17,4

16,8

17,9

19,3

2.074

2.324

2.705

2.807

2.807

3.332

14,9

16,5

19,1

19,7

19,5

23,0

So can bp y ta/vgn dan
S6 giudng benh
Sd giudng benh/van d&n

Nguon: Tic gia tinh toin td sd liiu cda Ting cijc Thong ke
tgi llnh, khie phue linh trang thieu bdc sy.
ihdn khien ngudi dan phdn ndn v l chd't
Long An da cd chinh sdch trp cap cho bde
upng dich vy y te d day. Tai mpl benh vidn

sy v l tam viec d dja phUdng Id 170 trieu
3a khoa cda tfnh Long An, mdt bac sT da
;hia se: Trung binh mdi ngiy chung tdi phii dong. Tuy vdy, trong nhdng ndm qua, nd lyc
kham cho hdn 2.500 benh nhin, mdi bic sT cda cdc d p chinh quyen tinh Long An chua
khim cho 150-200 benh nhan/ngiy. Do dd, mang Igi k i t qud nhu mong dpi. Tinh trgng
thdi gian bic sTdinh cho benh nhan li qui thieu bac sy d bdnh vien cac tuyen v i n diln
it, khong dd de td vi'n, giii thich, tim hieu ra gay git.
oan ke tinh trang benh cua benh nhin. Vi
Thd tu, ve vi tri dia ly: Tiep gidp vdi Tp.
vay, benh nhin khong the nio hii long vdi
Ho Chi Minh, trung tdm kinh t l Idn eda ed
bic sT~ Thim chf, nhieu binh nhin noi ring, nudc, Long An cd nhieu thudn lpi trong phdt
fip da di kham nhieu lan nhdng chua bao gid triln kinh te, gidm ngheo vd gidi quyet viec
bic sTdat ong nghe hay dung den ngUdi hq. lam. Tuy nhien, vj tri ndy Igi gay khd khan
Ve phfa bic sT, viec khim vdi "mat do" binh nhat djnh eho Long An trong viee xdy dung
ddi ngd y bdc sy dap dng nhu eau khdm,
nhin day giy ip ldc rat Idn, nguy cd sai sdt
ve chuyin mon rat cac Theo thong ki cda
chda bdnh eda ngudi dan tgi dia phUdng.
chung toi, mdi bic sTchi dinh khoang 3 phut Theo Gidm die Benh vien Da khoa tinh, mdt
Gho mdt binh nhin, nhUng khim thtfc sU cho trong nhdng nguyen nhdn khiin dpi ngu bde
benh nhan chi chiem khoing 24 giiy.
sy d tinh thilu nghiem trpng Id do tinh nim
g i n vdi Tp. Hd Chi Minh hdn nhilu sinh vidn
Thu nhgp td bdnh vien tha'p, khdng dd
Irang trai cho eude sing ndn nhieu bde sT nganhykhiratrUdngdachpnTp.HoChiMinh
d l Idm vide vdi mong mudn cd thu nhdp cao.
phdi md phdng khdm rieng tai gia dinh. Mdt
Nhu vdy, khdo sat va so sdnh gida Long
3an bd trung tdm y t l huydn Thgnh Hda cho

An va T i l n Giang cho thay, chat lupng dich
3iet, khoang 80% bac sT d ddy cd phdng
vy y t l cda Long An td't hdn la do Long An cd
nach rieng tgi gia dinh.
ThU ba, vi cam kit chfnh tri cda lanh ty le giudng benh, can bd y tl/vgn ddn cao
(xem tiip trang 70)
Jgo cac cip: D l thu hdt bac sy v l cdng lac
Khoa hnc nhinh tri - Qo A.nr\\o


'J(inh nghiim • Thdc tien

t i t edng tde xdy dpng t l chdc ddng vd phdt
triln ddng vidn trong cdc KCN, nhd't Id trong
giai dogn khdi d i u nhU hi$n nay.
Vi$c xdy dpng, phdt triln t l chde ddng
trong cdc doanh nghidp KCN, nhd't Id doanh
nghidp 100% v i n nude ngodi Id v i n d l quan
trpng, nhdm phdt huy tdt vai trd eda Ddng

trong vide tdp hpp, lanh dgo qudn ehdng,
tgo sp ding thudn thdc d l y phdt triln san
xud't - kmh doanh; dam bdo mdi trUdng ddu
tu. Ddy Id vide ldm mdl vd khd, ddi hdi phdi
dupe thpc hidn Idu ddi vd nhit qudn d l t l
chdc ddng trong cde KCN ngdy cang dupc

phdt triln.a

MOT SO NHAN TO ANH Hl/CiNG.

(tiip trang 61}
hdn ehd khdng phdi do ehl s l edn bd dupc
va s l bde sy/vgn ddn, Bdn cgnh dd, ddu tu
tdi ehinh cung Id nguydn nhan ldm cho chit
lupng djch vy tdt hPn, bdi theo bdo cdo eua
tinh, ndm 2010, Long An dupe ddu tU nhilu
hdn (48 trieu ding/giudng bdnh so vdi 27
tridu dong/giudng bdnh eua T i l n Giang).
Ngodi ra, v; tri dia ly (gan Tp. Ho Chi Minh)
cung anh hudng d i n ehd't lUPng djeh vu y
te eda tinh, bdi nhieu ngudi dan 6 Long An
cd the d i n khdm vd dieu trj trUe t i i p tgi ede
benh vien d Tp. Hd Chi Minh. Dieu nay lam
giam dp lUe dd'i vdi hd thong bdnh vien cda
Long An, mdc dd cde benh vien d Tp H i
Chi Mmh da thu hut mdt lupng khdng nhd
can bd y te eda Long An v l Idm vide.
3. Mpt so' kien nghj chfnh sach
Qua khdo sat, nghien edu d Long An,
tren cd sd so sanh vdi tinh hinh ehung eda
cd nUdc va tinh Tien Giang, chdng tdi xin
dua ra mdt sd kien nghj chinh sich nhu sau:
Thd nhi't, Nhd nude vd tinh Long An
cdn ddu tu ndng cao chat lUpng va khd
ndng khdm, chda bdnh cho benh vidn tuyIn
huyen vd trung tdm y t l xa. Hidn nay, tinh
trgng qua tai d cdc benh vien tuyin tinh va
trung Udng diln ra gay gat, trong khi benh
vidn tuyen huyen vd trung tdm y te xd do
khdng dUdc dau tu thich ddng ndn khdng

ddm bao cho vide kham, chda bdnh td't nhU
tuyin tren, ddn d i n tinh trgng ngudl dan do
d i n len khdm, chda benh d cde bdnh vidn

tinh vd trung Udng. Neu Nhd nude ddu tutit """
hdn eho ede bdnh vien tuyin huydn, trung
tdm y t l xd thi ngUdi dan cd t h i dUde hudng
dtch vu y t l t i t ngay tai dja phUPng, giam dp
Ipc cho cde bdnh vidn tuyin tren
Thd hai, eho phep cdc bdc sy, dUdc sy
md phdng khdm ngodi gid tham gia kham
chda benh theo bdo hilm y te. Dieu ndy vda
gidp cdn bd y t l tdng thu nhdp, ddm bdo
cudc sd'ng, vda gidm dp lUe eho cdc benh
vidn cdng.
Thd ba. can cd chinh sdch tien lUdng
ddi ngd phd hpp nhdm ddm bdo ddi sd'nf
cho bdc sy, ddc biet la tuyin huyen VJ
tuyen xa. Trong ngdn hgn, ehinh saeh thi
hdt bac sy v l dja phUPng cdng tde Id eai
thilt, nhUng n l u chf cd chinh saeh trd ea
mdt ldn khi mdi v l edng tde la ehua dd. D
vdy, chinh sdch nay edn di ddi vdi cdng td
tuydn truyen, van ddng vd cd ehinh sdch di
ngd phd hpp vdi dpi ngu can bd y t l dar
Idm vide tgi tinh, de dpi ngu nay yen ta
cdng tdc vd khdng cd cam giac bj "bd rdi" k
ehl quan tdm thu hdt ngudi mdi ve cdng ta
Trong ddi hgn, ehinh sach tien lUdng ph
ddm bdo cudc sdng cho dpi ngu cdn bp

bac sy de khdng ai phdi lam them ngodi g
vi ly do thu nhdp, Chinh saeh ndy vda de
bdo duy tri chat lupng dpi ngu y, bdc sy hi
tgi, vda thu hdt them sinh vidn mdi Ipa ch
ngdnh y de theo dull nhdm xay dpng i
ngu y, bac sy cda Long An trong tUdng lai
- 3 0 4/21 •