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BODKA ZA DISKUSIOU UNIVERSTATIS DISPUTATIONES 2014: Ktorý liek je pre mňa najlepší?


 | 22.10.2014 | komentárov: 303

Na Farmaceutickej fakulte UK v Bratislave sa 15. októbra 2014 uskutočnila druhá diskusia z cyklu univerzitných dišpút UNIVERSITATIS DISPUTATIONE 2014. Pozvaní hostia diskutovali na tému Ktorý liek je pre mňa najlepší? Kvalitná zdravotná starostlivosť vs. obmedzenosť zdrojov. UD 2014 je projekt univerzitných dišpút, ktorú už tretí rok organizuje Komora pre medicínske právo – MEDIUS. Tento ročník sa prvýkrát koná aj v Bratislave v spolupráci s odbornými partnermi, ktorými sú Univerzita Komenského v Bratislave a Farmaceutická fakulta UK, ako aj ELSA Bratislava a SLoMSA (Slovenská asociácia študentov medicíny). Nad projektom prevzal záštitu primátor mesta Bratislava – doc. RNDr. Milan Ftáčnik, CSc. Projekt sa podarilo zorganizovať aj vďaka finančnej podpore GlaxoSmithKline (GSK), poisťovne Dôvera, spoločnosti Phoenix a spoločnosti Medtronic.

Obrazok

Celá diskusia  bola venovaná problematike nároku pacienta vyplývajúceho z verejného zdravotného poistenia, kategorizácie liekov, efektivity v zdravotníctve a kvality zdravotnej starostlivosti. Je pacient spotrebiteľom s právom neobmedzeného výberu lieku a zdravotníckej pomôcky? Aké princípy ovplyvňujú realizáciu práva na kvalitnú zdravotnú starostlivosť? 

K týmto otázkam sa vyjadrili MUDr. Rudolf Zajac – bývalý minister zdravotníctva, MUDr. Marián Faktor – konzultant v spoločnosti Dôvera, zdravotná poisťovňa, a.s., Zuzana Dančíková z Transparency International a PharmDr. Tatiana Foltánová, PhD. zo Slovenskej aliancie pre zriedkavé choroby.

Druhú dišputu otvoril svojím príspevkom MUDr. Rudolf Zajac. V prezentácii sa zameral na kľúčový problém súvisiaci s témou diskusie, a to ako zadefinovať nárok pacienta vyplývajúci z účasti na verejnom zdravotnom poistení. Účastníkom predstavil rôzne možnosti jeho riešenia v Holandsku, Českej republike, Slovenskej republike, popísal ich výhody a nevýhody. Pozornosť venoval otázke efektivity v zdravotníctve, jej stručnej a pochopiteľnej definícii a hodnoteniu stavu efektivity zdravotníctva v Slovenskej republike.

Ako druhý vystúpil MUDr. Marián Faktor z poisťovne Dôvera. Hneď v úvode sa na účastníkov dišputy obrátil s otázkou, aké problémy trápia v slovenskom zdravotníctve ich. Publikum menovalo dlhé čakanie na výkony, neprehľadnosť v poplatkoch, slabú informovanosť pacienta. Taktiež definoval jednotlivé aspekty pojmu nárok pacienta (vecný, časový, geografický a finančný). Podobne ako jeho predrečník sa nevyhol téme financovania v zdravotníctve a efektivite využívania zdrojov. V závere sa dotkol problému určenia objektívnych kritérií pre meranie kvality v zdravotníctve, pričom uviedol, že z pohľadu pacienta je kvalita vnímaná predovšetkým v rozmere spokojnosti so službou t. j. ako pocit komfortu, ktorý je spojený s prístupom zdravotníckeho personálu k pacientovi.
Treťou rečníčkou bola Zuzana Dančíková z Transparency International Slovensko, kde sa venuje monitorovaniu transparentnosti v sektore zdravotníctva. Na začiatku svojho príspevku spravila drobný prieskum medzi prítomnými. Ten ukázal, že korupcia bola aj medzi prítomnými vnímaná ako problém, na druhej strane, ale angažovanosť v boji proti nej sa ukázala ako nízka. Ďalej vo svojom príspevku definovala korupciu ako problém, a to aj v zdravotníctve, ktorý jednoducho povedané, znižuje objem verejných zdrojov. Transparentnosť, naopak, zvyšuje šance odhaliť nesprávne rozhodnutie, umožňuje odmeňovať etický prístup a sprostredkovať verejnosti informácie o prijímaní konkrétneho rozhodnutia.

Vystúpenia hostí uzavrela PharmDr. Tatiana Foltánová, PhD., ktorá sa zamerala na situáciu pacientov so zriedkavými chorobami. Tieto choroby nie je možné ovplyvniť životosprávou a trpia nimi väčšinou deti, pričom 95 percent z nich je neliečiteľných. Akútnym problémom týchto pacientov je okrem náročnej a nie vždy existujúcej diagnostiky nedostupnosť liečby a starostlivosti. Poukázala na problém problémy s liečbou liekmi na zriedkavé choroby, ktorá sa uhrádza len na základe výnimiek, nakoľko lieky dostupné na európskom trhu, nie sú zaradené do zoznamu kategorizovaných liekov.
Po otvorení diskusie reagovali hostia vzájomne na prezentované názory ostatných rečníkov. MUDr. Zajac sa vyjadril k načrtnutému problému korupcie v zdravotníctve a zvyšovaniu transparentnosti. Korupciu označil za zraniteľný bod tranzitných systémov, medzi ktoré patrí aj Slovenská republika; za jav, ktorý sa vyskytuje tam, kde nefunguje systém služieb ako by mal, a preto časť úhrad prebieha neformálne. Zároveň ale konštatoval, že na jej výskyt majú vplyv aj kultúrno – sociálne  podmienky („národná črta“), čo ukazuje napr. komparácia s Českou republikou. V otázke nastavenia systému verejného zdravotného poistenia zdôraznil (aj vo vzťahu k pacientom so zriedkavými chorobami), že systém by mal na jednej strane poskytovať „záchrannú sieť“ pacientom, ktorých liečba je vysoko nákladná na základe princípu solidarity, na druhej strane sa nezaobíde bez jasne definovaných pravidiel a spoluúčasti pacienta na úhradách.

V tejto veci sa zdalo, že sa hostia zhodli na potrebe konkretizovania nároku pacienta vyplývajúceho z verejného zdravotného poistenia. Na otázku z publika, prečo štát nárok doteraz jasne nedefinoval, zaznela opakovane odpoveď, že ide o politicky riskantný (nepopulárny krok), ktorý odhaľuje skutočnosť, že poskytovanie zdravotnej starostlivosti nie je zadarmo. Podľa MUDr. Faktora by vhodným kľúčom pre stanovenie toho, čo zahrnúť do balíka uhrádzanej starostlivosti mala byť tzv. relatívna nákladovosť, a teda pri existencii alternatív s rovnakým účinkom, by mal byť uhrádzaný lacnejší variant. 
Hostia ďalej odpovedali na otázky publika týkajúce sa problematiky tzv. nadlimitov, ale vyjadrili sa napríklad aj k nakladaniu zdravotných poisťovní s dokumentáciou od zadávateľov klinického skúšania.
Diskusia bola vysoko odborná a niesla sa v príjemnom a tolerantnom duchu. Záznam si budete môcť pozrieť už čoskoro na portáli www.medius.sk.

Fotografie z diskusie sú dostupné TU.




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