Vyšlo: https://belobog.sk/dockame-sa-ludskych-podmienok-v-zdravotnictve/
Ak dnes niekto musí absolvovať v slovenskom zdravotníckom zariadení odborné vyšetrenie alebo nebodaj hospitalizáciu, môže si gratulovať, ak neodíde s frustrujúcim pocitom beznádejnej katastrofy. A to napriek modernému vybaveniu a často aj nepochybnej snahy personálu robiť svoju prácu najlepšie, ako sa dá. Za všetko jeden príklad z osobnej skúsenosti, keď som niekoho viezol na urgentný príjem do (nemenovanej) nemocnice. Bolo krátko po 17-tej hodine popoludní a keď sa službukonajúci mladý lekár presvedčil, v akom stave je pacient, povedal: „Počkajte chvíľku pred ambulanciou, hneď sa vám budem venovať, len dojem obed.“
Lekári a zdravotné sestry sú pod enormným tlakom. Niekto to zvláda lepšie, niekto horšie a prenáša svoj stres aj na pacientov, ale nikto z nich za systémové zlyhávanie nemôže. Ak je náhodou čitateľ zdravý a nemá vlastnú skúsenosť, stačí do vyhľadávača zadať slová „Slovensko zdravotníctvo kolaps“. Veru, píše sa o tom intenzívne už niekoľko rokov a nie je vidieť žiadne svetlo na konci tunela. Zlepší sa to niekedy? S niektorým novým ministrom?
Milí čitatelia, musím napísať rovno a bez okolkov, že je to bez šance. Dôvody sú systémové. Zdravotníctvo je v kapitalistickom prostredí arénou podnikania – a to je podľa platného Obchodného zákonníka najmä činnosť zameraná na dosahovanie zisku. Z dizajnu financovania zdravotnej starostlivosti na Slovensku je zrejmé, že príjmy podnikateľov v zdravotníctve majú svoj strop, odvíja sa hlavne od príspevkov platiteľov zdravotného poistenia. Ich zisk je rozdiel medzi týmito príjmami a nákladmi, ktoré na svoje výkony musia vynaložiť. Pre podnikateľa v zdravotníctve je neracionálne mať priveľkú nevyužitú kapacitu (prázdne pohotovostné lôžka, personál, ktorý je v pohotovosti a „nič nerobí, len čaká“, prístroje, ktoré nie sú sústavne v prevádzke…), je neracionálne príliš veľa prostriedkov venovať na pohodlie pacienta a podobne. Presne ako zdôrazňuje klasická mantra spoza oceána: „It is ECONOMY, stupid!“
V súbehu s tým, že pacient na zdravotníckom „trhu“ prakticky nemá na výber, lebo tu existuje len veľa tvárí, ktoré všetky reprezentujú len jeden systém, je pre racionálneho podnikateľa optimálne udržiavať svoje systémy v stave tesne pred kolapsom. Na maximum využívať všetky kapacity a všetky „ľudské zdroje“, lebo vtedy sa maximalizujú aj zisky. Žiadna „reforma zdravotníctva“ alebo „stratifikácia nemocníc“ s tým neurobí vôbec nič principiálneho, okrem možného vplyvu na zisky podnikateľov. Tí sa však vždy prispôsobia a dotlačia systém do stavu tesne pred kolapsom.
Napokon, aj v USA, ktoré na zdravotníctvo vydávajú najviac na svete, 20 % svojho HDP (Slovensko 7 %), a podľa štatistík je tam zdravotníctvo tretím najmohutnejším odvetvím, teda aj v najbohatšom zdravotníctve sveta sa už dávno písalo (Stanford Medicine), že zdravotné poisťovne vytvorili systém, kde poskytovatelia starostlivosti podstatne viac hľadia na svoje zisky ako na pacienta.
Čitatelia by mohli položiť otázku, kde na svete je najlepší systém zdravotníctva a či to nie je v kapitalistickej krajine. Nuž podľa rôznych kritérií dostávame rôzne výsledky, no najlepšie sú na tom krajiny EÚ ako Francúzsko, Španielsko, Taliansko. Posledným dvom menovaným pomáhajú aj priaznivé prírodné podmienky, no Francúzsko nielen vydáva na zdravotníctvo viac peňazí (asi 5000 EUR na obyvateľa, Slovensko asi 1300 Eur – súvislosť medzi objemom financií a kvalitou zdravotníctva je v štatistike zreteľná), ale do organizácie zdravotníctva podstatne viac zasahuje štát.
Treba pripomenúť, že zdravotníctvo je vo výlučnej kompetencii členských štátov EÚ a medzi štátmi sú výrazné rozdiely v organizácii a financovaní zdravotníctva. Na Slovensku priame organizačné kompetencie ministerstva zdravotníctva končia schválením zdravotníckeho zariadenia ako poskytovateľa zdravotnej starostlivosti a ostatné kompetencie sú hlavne metodické. Na rozdiel od toho vo Francúzsku štát schvaľuje každú zmluvu medzi zdravotníckym zariadením a zdravotnou poisťovňou, určuje a kontroluje štandardy a podmienky poskytovania zdravotnej starostlivosti, určuje ceny výkonov, prístrojov aj liekov, ba čo viac, určuje smerné čísla pre prijímanie uchádzačov na zdravotnícke vysoké a odborné školy. Aj preto je vo Francúzsku dvakrát viac lekárov na 1000 obyvateľov ako na Slovensku. Podľa našich ekonomických stratégov (spomeňme si, že Sulík mal ambíciu riadiť zdravotníctvo) je štát „zlý vlastník“, lebo produkuje málo zisku, ale na príklade Francúzska je vidieť, že produkovanie zisku v zdravotníctve ani nemá byť cieľom štátu. Štát nemá záujem udržiavať zdravotníctvo (kvôli zisku) v tesne predkolapsovom stave.
Na ilustráciu stavu slovenského zdravotníctva v európskom kontexte uvediem dva obrázky:
Pri jeho posudzovaní je vhodné zobrať do úvahy počet obyvateľov v dotyčných krajinách. Z tohto pohľadu by na tom Slovensko a Maďarsko boli takmer rovnako a Česko (zarovno s Poľskom) by bolo takmer rádovo lepšie ako Slovensko.
Francúzsko po zohľadnení počtu obyvateľov je prakticky „na nule“ – pripomeňme si, že počty lekárov tam priamo reguluje štát.
Práve podobné ukazovatele by mali byť v stratégii štátu dôležitejším ukazovateľom ako „zisky v zdravotníctve“.
Čo s tým?
Vo svetle nedávneho článku Devany o protestoch a o čakávaniach ľudí od predčasných volieb a od zmeny vlády si treba uvedomiť, že súčasný stav zdravotníctva nie je výsledkom len posledných niekoľkých rokov, keď je pri moci súčasná vládna koalícia. Väčšina vyššie uvedených údajov odráža obdobie ešte počas vládnutia Smeru a jeho koalícií. A nezabúdajme, že kozmetická reforma zdravotníctva formou „stratifikácie nemocníc“ pochádza ešte od ministerky Kalavskej.
Robert Fico síce venoval veľa energie ústavnému obmedzeniu zisku zdravotných poisťovní, no uvedomme si, že:
1. Skúsený právnik Robert Fico mohol vedieť, že snahy o zákonné obmedzenie zisku je v prostredí liberálneho kapitalizmu ťažko priechodné a táto iniciatíva bude dlhodobo neúspešná. Teraz nie je dôležité, že jeho argumenty boli pravdivé a že nie je ľudsky správne pripustiť v zdravotníctve bežné podnikanie zamerané na zisk – dôležitý je konečný výsledok.
2. Vo Francúzsku nie je zisk zdravotných poisťovní, ani poskytovateľov zdravotnej starostlivosti, obmedzený zákonom. Ale štát využíva priame prostriedky na riadenie zdravotníctva. EÚ nebráni Francúzsku uplatňovať vlastnú politiku v zdravotníctve a nebránila by ani Ficovi.
3. Výchova absolventa lekárskej fakulty trvá 6 rokov a absolvent sa stane kvalifikovaným lekárom až po niekoľkých rokoch praxe a ďalšieho odborného vzdelávania. Nie je v možnostiach jedného vládneho obdobia významne ovplyvniť počet lekárov v zdravotníctve. Nedá sa to urobiť žiadnou „reformou“. S výnimkou migrácie…
4. (a nie posledné) V zdravotníctve vo svetovom meradle nie sú až takým problémom zisky zdravotných poisťovní, ktoré sa pohybujú v jednotkách percent z prijatého poistného. Nie sú ani na Slovensku, kde vari len ZP Dôvera má „štandardný“ zisk niekoľkých percent, najväčšia Všeobecná zdravotná poisťovňa je často v strate. Ale problémom je, že za cenu relatívne istej svojej „porcie z koláča“ umožňujú zdravotné poisťovne (a vlády) dosahovať astronomické zisky dodávateľom poskytovateľov zdravotnej starostlivosti, najmä farmaceutickým firmám.
Podľa prehľadu na portále Fierce Pharma tie najúspešnejšie svetové farmaceutické spoločnosti dosahujú profitabilitu 20 – 30 % z tržieb (z cien za lieky!). Dokonca Moderna a BioNTech (hlavní dodávatelia prípravkov na „vakcináciu“ proti SARS-CoV-19) dosiahli za rok 2021 ziskovosť 66 % (Moderna), resp. 54 % (BioNTech).
Záverom treba zdôrazniť, že ak nám záleží na tom, aby sme sa dožili dlhšie a mali kvalitnejší život, ku ktorému bude prispievať aj kvalitnejšie zdravotníctvo, tak musíme svoju štátnu moc zveriť zástupcom, ktorí majú inak orientované priority než všetky doterajšie vlády za éry samostatného Slovenska. Je potrebné, aby sme riadenie štátu zverili politikom, ktorí odvážnejšie a dôraznejšie budú budovať štátny sektor v záujme všetkých občanov a nepripustia, aby v ňom dominovali kapitalistické vzťahy so zameraním na tvorbu zisku.
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