Operácia kĺbu? Najlepšie na ortopédii v Ružomberku.(Konečne aspoň čiastkové hodnotenie nemocničných oddelení.) | Medicínske právo
              

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Operácia kĺbu? Najlepšie na ortopédii v Ružomberku.(Konečne aspoň čiastkové hodnotenie nemocničných oddelení.)


 | 14.7.2010 | komentárov: 288

Dušan Zachar z INEKO na servroch e-health.sk a eTREND zevernil zaujímavé hodnotenie nemocničných zariadení. Preberáme ho a ponúkame ho aj našim čitateľom.

Obrazok



Pred pár dňami zverejnila zdravotná poisťovňa Dôvera výsledky svojho hodnotenia nemocníc za minulý rok. Nemocnice sa vraj za ostatný rok ani nezlepšili ani nezhoršili.

Čo však stojí za povšimnutie, je uvedenie šiestich top nemocničných oddelení vo vybraných medicínskych odboroch (ortopédia, chirurgia, interné, neurológia a gynekológia a pôrodníctvo), s ktorými boli pacienti najviac spokojní. Pre ľudí je to totiž oveľa užitočnejšia informácia ako napríklad celkový rebríček nemocníc. Pretože ak sa chystám na operáciu bedrového kĺbu, tak si chcem vybrať čo možno najkvalitnejšie ortopedické oddelenie a nezaujíma ma, akú kvalitnú zdravotnú starostlivosť dotyčná nemocnica poskytuje v oblasti pôrodníctva.

Je ale škoda, že Dôvera nezverejnila celý rebríček nemocničných oddelení, teda aj tých menej kvalitných, a že hodnotenie oddelení bolo posudzované len na základe jedného kritéria – výsledkov prieskumu spokojnosti pacientov, a nie aj podľa ostatných "tvrdších" 13 parametrov, ktorými boli hodnotené celé nemocnice. Treba však veriť, že je to prvý krok týmto smerom.

Zvyšovanie transparentnosti zverejňovaním plnohodnotných a kvalitných informácií o poskytovanej zdravotnej starostlivosti je jedným zkľúčových predpokladov pre zvyšovanie celkovej kvality zdravotníctva, ktoré sa vyznačuje enormnou informačnou asymetriou. Bez dostatku kvalitných informácií nemôže v zdravotníctve fungovať efektívna súťaž. Neinformovaný pacient sa totiž nedokáže kvalifikovane rozhodovať.

V oblasti merania úrovne kvality poskytovateľov zdravotnej starostlivosti existuje na Slovensku už viac rokov legislatívne upravená povinnosť poisťovní každoročne spracovať hodnotenie poskytovateľov (všeobecnej a špecializovanej ambulantnej a ústavnej) zdravotnej starostlivosti podľa určených indikátorov kvality. Ministerstvo zdravotníctva tohto roku rozšírilo počet indikátorov z 25 na 44, pričom sa zvýšil počet indikátorov, ktoré umožňujú merať efektívnosť poskytnutej zdravotnej starostlivosti, čo je chvályhodné. Problémom však je, že mäkko nastavenéministerské kritériá pre vyhodnotenie indikátorov kvalitynedovoľujú výraznejšiu diferenciáciu poskytovateľov vo výsledkoch, a tak informácia od VšZP, že takmer 98% poskytovateľov dosiahlo tzv. štandardnú úroveň (ešte mohli získať vysokú alebo nízku úroveň), je pre pacienta takmer nepoužiteľná. Ministerstvom určený postup vyhodnotenia a samotný výber indikátorov pravdepodobne do značnej miery tiež limituje možnosti zdravotných poisťovní vytvoriť na základe indikátorov nejaký zmysluplný celkový rebríček poskytovateľov zoradených podľa kvality a parciálne rebríčky podľa jednotlivých indikátorov, ktoré by skutočne niečo hovorili a boli by zároveň aj "user friendly", a teda by pre pacienta mali pridanú informačnú hodnotu.

Zdravotná poisťovňa Union sa však i napriek tomu posnažila vytvoriť na svojej internetovej stránke užívateľsky orientovanú aplikáciu, ktorá o.i. umožňuje na jednom mieste si kliknutím vybrať napr. všetky oddelenia ortopédie vo všeobecných nemocniciach v SR/kraji/okrese, pri ktorých vyskočia "smajlíci" označujúci získaný "rating" pri jednotlivých hodnotených indikátoroch kvality. Problémom však je, že pri všetkých nemocniciach a indikátoroch svietia rovnako sa usmievajúci smajlíci znázorňujúci štandardnú úroveň. Pacientovi to signalizuje, že je jedno, kam pôjde na operáciu bedrového či kolenného kĺbu, lebo všetky nemocničné oddelenia ortopédie na Slovensku majú rovnakú úroveň. A to v skutočnosti asi nebude pravda.

Dôvera, na rozdiel od VšZP a Union-u, nezverejňuje na svojej web-stránke vyhodnotenie "štátnych" indikátorov kvality. Asi sa spolieha na vlastné hodnotenie, ktoré umožňuje väčšiu diferenciáciu poskytovateľov podľa kvality a zahŕňa v sebe aj dôležité hodnotiace kritérium náročnosti diagnóz (tzv. case mix). Do jej hodnotenia poskytovateľov by sme však do budúcna navrhovali doplniť viac parametrov efektívnosti, pri ktorých sa porovnávajú dosiahnuté výsledky (napr. liečby) s vynaloženými finančnými prostriedkami, lebo v opačnom prípade máme na stole len neúplný obraz stavu poskytovanej zdravotnej starostlivosti na Slovensku.

Dušan Zachar, INEKO

(článok bol zverejnený 29.6.2010 na serveri eTrend tu)
foto: 2.bp.blogspot.com




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