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Dovoľme nemocniciam vyberať poplatky


 | 22.4.2011 | komentárov: 292

V ostatných dňoch sa v spoločnosti opätovne rozvírila diskusia o poplatkoch v zdravotníctve. Stratová Všeobecná zdravotná poisťovňa (VšZP) sa snaží šetriť, a tak znižuje úhrady nemocniciam, z ktorých sú mnohé zadlžené. Niektoré, najmä menšie nemocnice, už vyčerpali do značnej miery svoj potenciál na zefektívňovanie činností, a tak hľadajú ďalšie cesty, ako sa dostať k dodatočným zdrojom.

Obrazok Jednou z ich požiadaviek je, aby hospitalizovaní pacienti platili za pobyt a stravu v nemocnici aspoň to, čo by inak museli tiež zaplatiť, keby zostali doma. To treba podporiť. Okrem okamžitého priameho finančného efektu pre nemocnice by totiž takéto poplatky obmedzili aj zbytočné hospitalizácie, keďže pacienti by sa väčšmi domáhali riadneho vyšetrenia a liečenia v čo najkratšom čase. Samozrejme, nemocnice nemôžu pristúpiť k takémuto spoplatneniu svojvoľne, ale mali by presvedčiť zákonodarcu, aby zmenil príslušné normy. V opačnom prípade budeme svedkami ďalšieho živelného šírenia poplatkov v zdravotníctve, ktoré zrejme v mnohých prípadoch nie sú v súlade so zákonom. Takými sú pravdepodobne aj v ostatnom čase medializované snahy malackej nemocnice o zavedenie spoluúčasti pacienta za niektoré jej zákroky (napr. za laparoskopickú operáciu žlčníka a kyretáž) či vyberanie peňazí za trhanie zubov bratislavským neštátnym zdravotníckym zariadením, keďže pri oboch prípadoch tieto výkony už plne uhrádza zdravotná poisťovňa z verejného zdravotného poistenia. Väčšina poskytovateľov, ktorí žiadajú od ľudí poplatky, to však robí menej okato a definuje ich ako platby za nadštandardné služby spojené s poskytovanou zdravotnou starostlivosťou. Veľakrát však udivuje, čo všetko považujú poskytovatelia za tzv. nadštandardné služby.

Zaujímavým javom je, že v priebehu pár rokov masívne vzrástli priame platby pacientov v SR nad priemer krajín EÚ, ako aj OECD (pozri nižšie grafy). A nedá sa to pripísať len na vrub „Zajacových 20- a 50-korunáčiek“. Tie boli totiž v roku 2006 zrušené, ale vysoká úroveň priamych platieb obyvateľstva zostala aj potom zachovaná. Dôvodom je nekontrolovateľný nárast rôznych polooficiálnych poplatkov. Problémom je, že tieto platby sú často neregulované, vznikajú živelne, osoh z nich majú väčšinou len jednotlivci, a nie celý zdravotnícky systém, pričom môžu neúnosným spôsobom dopadať na sociálne slabšie vrstvy obyvateľstva. Preto odporúčame, aby sa ministerstvo zdravotníctva a vláda SR nebáli zaviesť regulovanú spoluúčasť pacientov, ktorá by o.i. zlegalizovala dnes už aj tak vyrubované poplatky, niektoré by zakázala, niektoré nové by naopak umožnila a stanovila by ochranný limit pre sociálne odkázaných. Bolo by to dokonca aj sociálnejšie riešenie, ako je ponechanie dnešného stavu, kedy máme v oblasti nárokov na poskytovanie zdravotnej starostlivosti socializmus na papieri, ale v realite tu vládne divoký kapitalizmus s rozvinutou korupciou.

Ministerstvo zdravotníctva odmieta zavádzanie platieb pacientov a považuje ich za nesystémové riešenie. Namiesto toho navrhuje v súlade s vládnym programom individuálne zdravotné pripoistenie. Táto cesta je však oveľa tŕnistejšia a výsledok neistý. Neprešiel ňou do konca ani reformátor Rudolf Zajac. Vyžaduje si to politicky neľahké rozhodnutie o rozdelení diagnóz na také, ktoré budú hradené z verejného zdravotného poistenia a na také, ktoré si budú musieť ľudia hradiť sami. Už aj dnes máme v legislatíve upravené individuálne zdravotné poistenie, ale keďže neexistuje definovaný štandard a nadštandard, prakticky tento trh na Slovensku neexistuje. Nie je totižto čo poisťovať. Tento proces je okrem politickej citlivosti tiež náročný na odborné kapacity a čas. A práve čas hrá proti. Je málo pravdepodobné, že v druhej polovici volebného cyklu politici dovolia prijatie tohto nepopulárneho opatrenia. A to ešte v tomto období čaká ministerstvo podľa plánov aj konsolidácia VšZP, transformácia nemocníc a technicky náročné zavedenie DRG-systému do platieb pre lôžkové zariadenia.

Ak preto nemáme stratiť ďalšie volebné obdobie na zavedenie poriadku v zdravotníckych poplatkoch, mala by vláda pristúpiť aspoň na zavedenie paušálnych platieb za pobyt a stravu v nemocniciach. Ďalším krokom by mala byť regulácia existujúcich poplatkov tak, aby ich lekári nevyberali za výkony a služby, ktoré už majú zaplatené z verejných zdrojov, a aby neúnosne nezaťažovali chorých ľudí. Ak vláda nenájde odvahu na tieto zmeny, bude podiel priamych platieb na celkových výdavkoch v zdravotníctve a tiež chaos spojený s vyberaním poplatkov s veľkou pravdepodobnosťou ďalej stúpať.

Autor: Dušan Zachar , INEKO

Zdroj: etrend.sk , pôvodne tu
Foto: peniaze.pravda.sk


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