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Friday, May 24, 2024

What are we going to do about healthcare?

By: Prim. Janez Remškar, dr. med.

Do I know what the government will do to halt the downward spiral at least partially in healthcare? I do not even dare think about a turnaround with this government!

Do I know what the Minister or the Ministry of Health is doing in terms of legislation in the healthcare sector? Perhaps. Currently, they are preparing laws, pardon, preparing laws urgently, to limit doctors’ strikes. Does the government realise why doctors are striking in the first place? Salaries, as the only demand presented by the Fides union, are among the demands. In addition, the government or Necenzurirano portal should at least be honest enough to provide the public with data on basic salaries and not manipulate with sums resulting from all kinds of bonuses, among which the largest sum is undoubtedly overtime work. What will the government do now that doctors have relinquished numerous hours of on-call duty and thus income, and will work in line with the EU’s recommendation of working 40+8 hours per week?

Is the government aware that doctors, especially in primary healthcare, are tired of the workload in clinics, on-call duties, and emergency room shifts? What will the government do with the outdated laws in healthcare, especially the Health Services and Health Insurance Act (ZZVZZ) and the Healthcare Act (ZZDej), which are 32 years old and long overdue for reform? We will not get anywhere with just minor adjustments. We need a radical reform!

Do I know what the strategic council or its president is doing regarding the resolution of professional and ethical problems that doctors face daily? I do not know. I assume they are discussing and preparing proposals for the government. What kind? Primarily professional ones. These should be acceptable to everyone, both patients and providers. There is not much tangible information heard in public. They probably believe that in healthcare, it is necessary to continue working “around the corner”, to keep unpleasant aspects minimised for patients, providers, and employers.

Do we know what they are doing in terms healthcare financing ZZZS regulation? No!

The measures ahead of us, necessary if we look at well-organised healthcare systems in the EU, include:

1) Revised organisation of healthcare. The legislator holds the reins here and must undertake some unfriendly measures. Merely implementing pleasing measures or adjustments, as has been attempted so far, will not bring about changes, let alone healthcare reform. I cannot imagine what the president of the strategic council meant when he stated that we do not need reforms. Perhaps he realised that reform is not possible due to partial interests involved in healthcare. If so, it would be right for him to resign. Why does he not do that? If there is another reason, why not explain it as an advocate for honesty towards patients and the organisation of healthcare? As a director of a department that did not deal with economics and investments, after spending five years at the Ministry of Health during which four ministers were replaced, I left on my own. The reason? I was powerless due to numerous influences, interests in healthcare, changing governments, to move essential matters in the aforementioned legislation and thereby establish conditions for well-organised and controlled healthcare, good healthcare for patients. Despite this, I managed with colleagues to prepare the first Mental Health Act, the first Patients’ Rights Act, the first Alternative Medicine Act, and also the Healthcare Development Resolution from 2008 to 2013. The first law was heavily criticised by the profession, psychiatry, which to this day is primarily organised in institutional care. Due to the payment system based on referrals, we failed to introduce a genuine second opinion in the second law. The Alternative Medicine Act was shelved by the new government in 2008, saying that implementation was impossible. The same fate befell the aforementioned resolution. This way, nothing could be regulated!

And what needs to be done urgently? Hospitals need to be organised into public non-profit companies. A licensed physician for a specific specialty must appear on the market or in a regulated public system with a defined network of providers or as a pure private practitioner. This is how it is in the EU. Unfortunately, we do not have a defined network of healthcare activities neither at the primary nor at the secondary level. Politics and the profession are responsible for this.

With legislation, the powers, and responsibilities of all levels of leadership in healthcare must be clearly defined (including staffing, utilisation of personnel, space, equipment, the arrangement, and transparency of the quality and safety of services for patients). It will also not work without clear definitions of the responsibilities of supervisory bodies (boards of current healthcare institutions).

2) Revised methods of financing. For years, we have not been able to cover all the needs of the population solely with public funds, leading to waiting lists. This burden has been blamed on doctors in public institutions, who are accused of not working enough, and on concessionaires, who are accused of being solely profit-oriented. Has anyone (the Ministry of Health, the People’s Voice with Mr. Jenull and Mr. Prof. Keber at the helm, ZZZS) presented numerical data to support these accusations? The fact is that concessionaires have more registered patients than doctors in health centres. The fact is that neither ZZZS nor the Ministry of Health have taken action against hospitals so far for not meeting the planned allocation programme. The fact is that ZZZS does not have regulated pricing relationships between healthcare services. Accusations against concessionaires, who must provide everything from premises to equipment with their own funds and loans, that they do not have to contribute to the education of doctors and that they exploit this, are unfounded. Who provides a significant portion of the funds for premises, equipment, and apparatuses for doctors in health centres or hospitals? The municipality and the Ministry of Health! The staffing composition for individual services in health centres and hospitals (which is financed by ZZZS) is also unclear, with staffing often exaggerated in many places due to union demands with the consent of ZZZS. Therefore, politics does not mention changes in legislation, the need for reform, because it does not want to tackle it.

Despite all the promises made by the parties Gibanje Svoboda, the SD, and the Levica for the healthcare sector, now after two years, they do not know where or how.

The group that knows a lot (or really?) about the problems but does not know how to approach things without tarnishing public, pardon, state healthcare, to maintain the power of suppliers and corruption, to continue controlling the insurance system without accountability, continues to deceive people that they have access to everything. To prevent this from happening, at least according to the government and our independent media, responsible doctors who do not work and concessionaires are to blame. It would be funny if it were not so sad.

Excuse me, government, stop making fun of Slovenians. If you do not know how, stop working. If you are afraid or unable to act (due to your four-year survival in power and the salaries of your representatives in parliament, not the survival of patients) because of the interests of suppliers, corruption, influential individuals collaborating with politics as needed, local political interests, in short, the interests of everyone except patients’ interests, stop working!

Since this will not happen, Slovenians will continue to be exposed to poor access to healthcare services except at the emergency level and the manipulations of our political public media.

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