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sreda, 19 januarja, 2022

What are we going to do with healthcare?

By: Dr Janez Remškar

I recently drew attention to the fact that since 2000, according to statements by politicians, we are implementing so-called health care reforms. But the state of health care is getting worse for patients and staff! Left central governments have ruled us for ¾ of the last 30 years! The fallacy of left-wing politics needs special attention! All this time, left-wing politicians are “trying” to regulate health care and promise everything possible in the pre-election programmes! They are constantly “committing” to maintaining public health! They are “fighting” corruption! They are standing on the “trenches” for a collective agreement, a balance sheet, together with the unions! At the same time, the same unions have no comments on the outrageously high salary of Dr Golob who also works in the public sector! Apparently for our unions, in the struggle for labour, he is the right candidate. Attention again; The “left political power” has been in power for ¾ of the last 30 years! And what have they arranged in healthcare? Nothing! Let’s look at the most important problems for patients!

Accessibility for ordinary people to health services is getting worse, even though we are insured for everyone!! It is written so in the documents! The rights basket is practically unlimited! At the same time, they put us in queues that are being extended! Why? Due to the lack of organisation, the fragmentation of services in many hospitals, and often insufficiently experienced staff with inadequate analysis and review of complications! Many expensive appliances are unused, as are the spaces. All this makes health care more expensive! There is only as much money as ZZZS collects, and that depends too much on the number of employees! I do not know if we are aware of the fact that underutilised equipment and premises are expensive! Have we not yet realised that a small number of interventions, of any kind, pose potential uncertainty and danger to patients? Do we still believe that everything that is done in healthcare is good and great? That is how they told us during the former state!! Of course, it was not like that!! And even now it is not so! With what I have written, I want to encourage people to think differently, namely that it is not only important that we have “our own friendly hospital”! For patients, the outcome of treatment is much more important! Do we have data on the results of work in “our” hospital and comparisons between hospitals? No! Why are we not interested in that? Do we really care where and how we are treated? One of the first tasks of politics is to immediately introduce a unified information system in health care for the whole of Slovenia! This will mean a review of the work done and the start of competition between hospitals, which now have guaranteed money, no matter how they work! The system needs to be shut down immediately so that one hospital has even more information systems! It will cost something, we will witness many protests, but the cost of change will be recouped immediately!

For years and years, we have found that we have too few family doctors! Why? Maybe here this work is uninteresting for a doctor who has invested so much in one of the most difficult studies? Let’s finally admit that this is true! Let’s face it, it is underrated! Let’s admit that the orientation we have at the beginning of our studies, that research work is very important, is wrong! This is due to the thinking of “important people” from years ago and their role on the side of left-wing politics, I will not highlight the names! The doctor must be a researcher with his patient! Before working in the research field, he must first master the work at the patient’s bedside. Based on the anamnesis and examination, he must make the widest possible differential diagnosis (that is, what he must think about when the patient is in trouble) and find, confirm the right diagnosis! In case of uncertainty, he must be honest and refer such a patient forward in time! He must know his abilities and acknowledge what he cannot handle! I estimate, in my experience, that we give too little of this to medical students! Clearly, the work of a family doctor is extremely responsible! He is not properly rewarded for this! Every specialist is worth more in the eyes of the people, even though a family doctor is a specialist! This is followed by the fact that doctors, especially in cities, have adapted to this and turned to “switchmen” who quickly write referrals, which, frankly, patients also demand somewhat quickly! Patients are often not interested in the professionalism of a personal physician; they are interested in kindness and willingness to write a referral and sick leave! All this means longer waiting times and more expensive medicine! Therefore, it is necessary to immediately change the role of the family doctor and give him the weight he has abroad! He needs to be given more authority and demand more responsibility, because he is the one who must watch over all our problems, connect all this, which is extremely important! This would be holistic medicine, which we talk about a lot, but we do nothing!

Corruption is certainly one of the major problems. Everything is based on the regulation of relations between the management of health institutions, doctors, care representatives and suppliers! My experience in this area is disastrous. In the general hospital, it happened that the representatives of the pharmaceutical company (wholesaler) came to the director, after the hospital was behind with the payment of the delivered medicines, with the suggestion that they could give a loan!??? Before that, they were doing commercials for new, more expensive drugs and only visiting doctors and nurses, they did not go to the director to talk about how this would be funded! Something similar was happening elsewhere, where management demanded a precise specification for a very expensive appliance! The answer of the expert, you will not believe, was: you do not know about this! After several months of effort, however, the management came up with an accurate description of what kind of device we need. We then got the device at a very reasonable price! But do not think that management has won the sympathy of employees who, at a lower price, did not have everything possible at their disposal, not even education in the most exotic places because of the purchase. Interestingly, the ministry, at the time Mrs. Celarc Kolar or the members of the OJ LJ council, among them also a member Dr Breclja, were not interested in this at all!? I am convinced that corruption can be prevented quickly! It is necessary to determine what the hospital can do, with what standardised equipment and connect all this with the previously mentioned data on the quality and safety of work for patients! Stable financing is needed, after a signed contract (without any price changes in the middle of the year). Management must have clearly written instructions so that it can only operate within the allocated finances. The council of the institute, as the managing and supervisory body of the institute, must be responsible for professional and financial operations. We cannot afford printing money, as before, due to healthcare losses now that we are in the euro area! It is equally unacceptable that the disorderly ordering and the swallowing of bidders is covered from reserve finances, as the Minister Mrs. Celarc Kolar did!

The division between public and private health care. With orderly public health care, no major waiting times, no corruption, with clear data on quality, safety, the controversies about what we need, public or private health care, would be unnecessary, superfluous! It is clear that the foundation of regulated systems is public health. In European countries, the ratio between public and private is, on average, 80:20 in favour of the public, with concessionaires also being considered private, even though they are financed from public funds! Those who want more comfort and not safer services, perhaps treatment with a particular doctor, pay more, take special insurance for it, and take advantage of all this on a special insurance policy! This is how it is arranged in organised systems. Insurance for completely separate treatment is also possible, but it is more expensive! Treating the same disease, starting on the policy for real supplementary insurance (not ours voluntarily) or by direct payment with a private individual and then continuing with compulsory insurance in a public institution, preferably with the same doctor, can cost the doctor his license in many places. In our queue conditions, it can even happen that a patient with a serious illness is not referred or examined in a timely manner, and this is only discovered after examination, for a fee, at a private company! This is unacceptable and we should have an overview of it! The question is why are doctors allowed to work for other employers in the public and private sectors? Many hospitals could not and cannot do the programme awarded by the ZZZS with their staff! Doctors can only work for a private individual or concessionaire with the permission of the employer, so there are no obstacles due to the non-compete clause! Why? For the same reason as we allow private work with direct payment to the dentist because there is not enough money to cover all the needs of compulsory insurance. So why do we not fix this? Due to clutter, poor organisation and consequently because of too little money!

Things can be sorted out quickly, but, at least in the field of health care, state policy must recede into the background and forget about ideology! Politics should at least come together in this area! Healthcare can be neither left nor right, it can only be good, accessible! Even local politics must immediately stop interfering in the work of hospitals! We can convince them of this if we have data on the work done, quality, safety and prices in all hospitals!! At the same time, it will be difficult for them to get involved in what an individual hospital should do, even “theirs”!

Janez Remškar is a doctor and publicist.

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