*BO HIM Y T VIT NAM

*MC TIUNu c mc tiu, ngha ca BHYTTrnh by c c cu t chc v s cn thit ca BHYTng dng nhng quy nh ca BHYT vo thc t khm cha bnh v cung ng thuc

I. QU TRNH HNH THNH18-6-1952 Cng c quc t u tin v An ton x hi ra i ti GeneveHuy ng mi thnh vin trong XH ng gp tin nhm gim gnh nng cho ngn sch nh nc/ thin tai, bnh tt15.8.1992 BHYT VN chnh thc c thnh lp*

*II. MC CH NGHAHuy ng s ng gp ca ngi lao ng v ngi s dng lao ng thanh ton chi ph cho ngi c BHYTChm sc sc khe mang tnh cht x hi, khng v mc tiu li nhun

*III. GII THCH T NG1. BHYTLy tin ca ngi khe gip ngi m au, bnh ttBHYT nh nc, BHYT t nhn2. Qu BHYTThu ph BHYT + ngun thu hp php3. Hnh thc thanh ton

*4. Thn nhn5. Thnh vin trong h gia nh7. Ngi s dng lao ng8. CS khm cha bnh BHYT ban u

*IV. T CHC BHYT BHXH BYT

BHYT VN

BHYT Ngnh BHYT Tnh/ TP UBND Tnh/TP TW

BHYT Q/H

*IV. CC HNH THC BHYT VNC 2 hnh thc: BHYT bt buc BHYT nh nc BHXH BHYT t nguynBHYT VN BHYT t nhn BHYT kinh doanh

*

BHYT / BHXHBHYT kinh doanhi tngNgi l16 65 tuiPhng thc, CQ qun lBt buc, nh ncCng ty BHKD t nhn, nh nc, c phnTnh chtNhn o, cng ngCn i thu chi, ngha v nh ncNgun quNgi l + ngi s dng lNgi tham giaPhng thc thanh tonChyn cho csyt KCBTr cho ngi c BH, BV k H

*V. BHYT BT BUC1. i tng, mc ng, phng thc ngCn b, cng chc, vin chc, ngi lao ng: 4,5% tin lng tin cng Ngi ang hng lng hu, tr cp mt sc lao ng hng thng: 4,5% tin lng hu, tr cp (BHXH)Ngi c cng CM, lu hc sinh nc ngoi, h g ngho: 4,5% mc lng ti thiu (NSNN)

*2. Mc thanh ton:Tr em, ngi hot ng CM trc 19/8/1945, b m VN anh hng, thng binh bnh binh >81%: 100% chi ph khm cha bnh, dv k thut caoNgi c cng CM, s quan,h s quan, khm bnh tuyn x, tng chi ph

Ngi hng lng hu, tr cp, h gia nh ngho: 95%, dv k thut cao =< 40 thng lng ti thiui tng cn li: 80% dv k thut cao =< 40 thng lng ti thiu

*

* Vt tuyn, khng ng ni ng k KCB ban u: ngi bnh thanh ton cho c s KCB70%: BV hng III, cha xp hng50%: BV hng II30%: BV hng I v hng c bitdv k thut cao =< 40 thng lng ti thiu

*

* C s KCB khng c hp ng vi BHYTNgoi tr: =< 55.000, 120.000, 340.000Ni tr: =< 450.000, 1.200.000, 3.600.000Nc ngoi: =< 4.500.000*Bnh nhn ung th: 50%BHYT lin tc >= 36 thngTr < 6 tuiB QP, B CA, Ban c yu chnh ph*

*3. Quyn ca ngi c th BHYTKCB ni tr, ngoi tr/ cng lp, ngoi cng lp (c hp ng vi BHXH)CS KCB ban u, chuyn vin ph hp tuyn, cp cu ti c s KCB BHYT

*4. Qun l v s dng qu BHYT90% qu KCB tin ti tr, vin tr10% qu d phng KCB tin li hp php

*5. Cc hnh thc thanh ton chi ph KCB BHYT5.1. Gia BHXH vi CS KCBTheo ph dch vb. Theo nh sutc. Theo nhm bnh

*5.2. Gia BHXH vi ngi tham gia BHYTThanh ton bng tin mtVt tuynC s KCB khng hp ng BHXHKCB nc ngoi

*VI. BHYT T NGUYN1. i tng, mc ng, phng thc ngH gia nh: + Ngi 1: 4,5% mc lng ti thiu+ Ngi 2, 3, 4 ng 90%, 80%, 70% ngi 1+ Ngi th 5 tr i ng 60% ngi th 1

- H g cn ngho, g nng, lm ,ng, dim nghip, : 4,5% mc lng ti thiu (50% NN)Hc sinh, sinh vin: 3% mc lng ti thiu ( NN 50%, 30%)i tng khc: 4,5% mc lng ti thiu

*

2. Quyn li, thanh tonTh BHYT c gi tr sau 30 ngy; DVKT cao sau 180 ngy; thai sn sau 270 ngy; thuc ung th, chng thi ghp sau 36 thng (50%)Thanh ton 80% chi ph KCB ni, ngoi tr (80% DVKT cao =< 40 thng lng ti thiu)KCB khng ng tuyn = BHYT bt buc

*

VII. THUC CUNG NG CHO BHYT1. Yu cu : Cht lng, hiu quPh hp pht Gi r2. Nguyn tc :Thng qua Hi ng thuc v iu trDanh mc thuc thit yuu thu

*

*VII.TRNG HP KHNG C BHYT1. Khm cha bnh c NSNN chi tr.2. iu dng, an dng 3. Khm sc khe4. Xt nghim, chn on thai 5. K thut h tr sinh sn, KHHG, no ht thai, ph thai6. S dng dch v thm m7. iu tr lc, cn th v tt khc x ca mt

8. Chn tay gi, mt gi, rng gi, knh mt9. KCB phc hi chc nng10. T t, t gy thng tch.11. Nghin ma ty, nghin ru hoc cht gy nghin khc12. KCB cc tn thng do hnh vi VPPL ca ngi gy ra. 13. Gim nh y khoa, gim nh php y, gim nh php y tm thn14. Th nghim lm sng, nghin cu khoa hc.*

*