Hosť mesiaca OKTÓBER MUDr. Jozef Bodnár | Medicínske právo
              

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Hosť mesiaca OKTÓBER MUDr. Jozef Bodnár


 | 14.10.2011 | komentárov: 293

V októbri prijal pozvanie byť hosťom mesiaca MUDr. Jozef Bodnár, zakladateľ prvého súkromného bioptického a cytologického laboratória HIS-DG, s.r.o. na Slovensku, kde dnes pôsobí ako riaditeľ spoločnosti a vedúci lekár- patológ. Ako prvý na Slovensku rozpracoval metodiku diagnostiky a liečby predrakovinového stavu krčka maternice a HPV, stal sa tiež hlavným autorom monografie Chlamýdia – patogén 21. storočia (2001). V novembri minulého roku, bol pri príležitosti realizácie spoločného projektu Komory pre medicínske právo- MEDIUS so spoločnosťou HIS-DG, s.r.o., uverejnený s pánom doktorom rozhovor „Viete o čo ide pri Liquid Based Cytology?“ Aktuálne sa v rámci činnosti Komory angažuje pri organizovaní konferencie pod názvom "Riziká poskytovania zdravotnej starostlivosti v súčasných legislatívnych podmienkach", ktorá sa uskutoční dňa 20.októbra 2011 o 15:00 v konferenčných priestoroch Hotela Yasmin v Košiciach.

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MEDIUS: Pán doktor, ďakujem  za prijatie pozvania byť hosťom mesiaca október  na portáli pravo-medicina.sk. Prvá otázka sa týka Vášho profesijného pôsobenia. Kde momentálne pracujete, na akej pozícii a čomu sa venujete?

        Aj ja ďakujem za pozvanie byť hosťom mesiaca. Momentálne pracujem ako lekár- patológ v bioptickom a cytologickom laboratóriu, ktoré je neštátnym zdravotníckym zariadením, na pozícii vedúceho lekára a zároveň riaditeľa spoločnosti. Naša práca spočíva v diagnostikovaní choroby resp. v stanovení konečnej diagnózy v bioptickom a cytologickom materiály, ktorý je odoberaný v ambulanciách klinických lekárov (napr. gastroenterologickej- vzorka žalúdka, gynekologickej- časť tkaniva krčka maternice a pod.). Čiže výsledok našej práce predstavuje akýsi „cestovný lístok“ k tomu, aby bola pacientovi nastavená vhodná liečba. 

MEDIUS: Akým aktivitám sa venujete v rámci Komory pre medicínske právo- MEDIUS?
V rámci Komory pre medicínske právo- MEDIUS mi pripadla zodpovednosť za marketing, čiže propagáciu myšlienok širokej verejnosti. Teda nielen v odborných lekárskych resp. právnických kruhoch, ale tiež u občanov  ako potenciálnych pacientov. Našou úlohou je vysvetliť chápanie vzťahu lekár – pacient ako rovnocenného partnerského vzťahu budovaného na základe rešpektovania vzájomných práv, ale aj povinností.

MEDIUS: Financovanie  zdravotníctva  je v súčasnosti na Slovensku, ale aj v iných štátoch (USA) predmetom živej diskusie. Skloňujú sa pojmy ako šetrenie, efektivita, prístup k zdravotnej starostlivosti či kvaliná zdravotná starostlivosť. Ako vnímate  /posudzujete momentálny stav hospodárenia s peniazmi v slovenskom zdravotníctve?

        Toto je otázka, na ktorú môžem odpovedať veľmi jednoducho a nepovedať nič a zároveň môžem o nej rozprávať aj niekoľko hodín a nedosiahnem nič. Treba zdôrazniť, že financovanie zdravotníctva na Slovensku sa dostalo do fázy, ktorá sa dá nazvať hocijako, len nie uspokojivá. Aj napriek tomu, že sa o financovaní zdravotníctva hovorí ako o celku, je potrebné si uvedomiť, že je značne disproporcionálne. Najväčším nešťastím, podľa môjho názoru, bolo zredukovanie trhu zdravotných poisťovní, vďaka ktorému máme dnes dve a pol poisťovne. Na jednej strane je štátna poisťovňa a na druhej súkromná. Tento stav v žiadnom prípade nemôžeme nazvať konkurenčným prostredím. Dnes sa deje vo fáze financovania to, že jedna poisťovňa viac menej kopíruje druhú a svojím tlakom a reštrikčnými opatreniami dostáva lekársky stav pod značný tlak. Je tiež potrebné zdôrazniť, že im v tom výdatne pomáhajú aj legislatívne diery, na základe ktorých sa na Slovensku deje to, čo sa deje. Ďalšou veľkou anomáliou nášho zdravotníctva je oddlžovanie štátnych zdravotníckych zariadení. Je predsa nemysliteľné, aby zariadenia, v ktorých hospodári štát, ktorý je garantom dodržiavania práva a právnych noriem, hospodáril vo svojich organizáciách tak, že ich dostane do stavu, ktorý sa nedá nazvať inak ako stav „tesne pred finančným krachom“. Na druhej strane si treba tiež všimnúť disproporcionalitu aj zo strany súkromných lekárov resp. nemocníc, ktoré si takéto hospodárenie dovoliť nemôžu, pretože by jednoducho neprežili ďalší rok. A tu logicky vyvstáva otázka, či je tento stav ústavný. Ďalšou oblasťou je samotné financovanie zdravotníctva, ktoré napr. konkrétne v našom prípade je maximálne neobjektívne. Naše zdravotnícke zariadenie od svojho vzniku vykonáva vyšetrenia, ktoré svojim spôsobom majú charakter neodkladnej zdravotnej starostlivosti, pretože ak dostanete na vyšetrenie napr. vzorku z prsníka, kde je podozrenie na malígne nádorové ochorenie, tak diagnóza postavená musí byť, aby pacientka bola včas nastavená na liečbu. Rovnako je to napr. aj pri preventívnych cytologických vyšetreniach, kde sú anomálie ešte väčšie, pretože všetky poisťovne svorne hlásajú, že preventívna zdravotná starostlivosť je plne hradená poisťovňou. Avšak v zdravotníckych zariadeniach nášho druhu sa jednoducho preventívna starostlivosť neodlišuje od všeobecnej zdravotnej starostlivosti. Naše zdravotnícke zariadenia fungujú tak, že poisťovňa si objednáva objem zdravotnej starostlivosti. Avšak všetky zariadenia tento objem ďaleko prekračujú, pretože jednoducho nevedia ovplyvniť ani počet a ani charakter vyšetrení. To znamená, že niektoré prípady je možné vyšetriť štandardným diagnostickým postupom, ale niektoré si vyžadujú špecializované dovyšetrenia. Z toho vyplýva, že žiadne laboratórium nášho druhu nevie dopredu vypočítať predpokladaný objem vyšetrení a logicky každý mesiac vykonáva vyšetrenia nad rámec objednaného limitu. Aby zariadenie vôbec dostalo zmluvne dohodnutý finančný objem, musí každý mesiac vystaviť tzv. dobropis, v ktorom sa zrieka zaplatenia nadlimitných výkonov, ktoré poisťovňa uznala. Pýtam sa teda, ako sa nazýva tento stav z právneho hľadiska?

MEDIUS: Aké body vidíte ako kľúčové vo vzťahu lekár pacient?

        V prvom rade je to dôvera a vzájomná úcta, v druhom rade konkrétny prístup, v treťom rade profesionalita a odborná spôsobilosť a nakoniec v štvrtom rade rešpektovanie pokynov lekára zo strany pacientov.
 
MEDIUS: Akú úlohu by mal v tomto vzťahu zohrávať štát?

        Štát by mal byť garantom dodržiavania práva v procese poskytovania zdravotnej starostlivosti. To znamená, práv pacienta na poskytnutie maximálnej zdravotnej starostlivosti a rešpektovanie jeho osobnosti ako človeka zo strany poskytovateľa a na druhej strane rešpektovanie a ochranu práv lekára ako poskytovateľa zdravotnej starostlivosti. Pod garantom právnej spôsobilosti mám na mysli aj ústavou zakotvené práva súkromného podnikania, ktoré by mali byť rovnocenné právam štátnych zariadení. Treba si uvedomiť aj to, že súkromný sektor sa nemalou mierou podieľa na daňových príjmoch štátu, z ktorých ten financuje verejný sektor. Štát by mal tiež dbať a trvať na odbornej spôsobilosti revíznych lekárov, ktorý v konečnom dôsledku revidujú prácu lekárov a posudzujú, či išlo o výkon adekvátny resp. neadekvátny. V mnohých prípadoch sa však stáva, že prácu jedného odborníka posudzuje odborník z inej oblasti, ktorý o fungovaní napr. bioptického laboratória nemá ani predstavu. Taktiež by som chcel povedať, že revízny lekár schvaľuje aj závažné a finančne náročné terapeutické postupy a teda jeho odborná erudícia v danej oblasti by mala byť minimálne na úrovni poskytovateľa zdravotnej starostlivosti.

MEDIUS: Aký je Váš názor na transfomáciu nemocníc na akciové spoločnosti?

        Pokiaľ štát bude garantom oddlžovania a nie garantom hospodárenia, tak je úplne jedno, aký charakter bude mať štátom vlastnené zdravotnícke zariadenie. Všeobecne si však myslím, že transformácia nemocníc je nevyhnutný proces, pretože je najvyšší čas, aby zákony začali platiť pre všetkých.

MEDIUS: Akým aspektom témy financovania sa hodláte venovať v príspevkoch?

        V mojich príspevkoch sa hodlám venovať témam týkajúcich sa proporcionality a rovnoprávneho financovania štátneho a neštátneho zdravotníckeho sektora, ďalej témam kvalifikovaného prístupu v oblasti financovania zdravotníckych zariadení a tiež témam doplatkov v zdravotníctve.




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