Question 2 – WHAT WOULD I DO IF I WERE MINISTRY OF HEALTH?
Editorial – Marius Enescu
I chose this item because I feel more comfortable (it is my job) and because I talked to many people inside and outside the system.
It is clear the system is not good: it malfunctions frequently, it has poor coverage in number and quality, it leaves all people dissatisfied and some of them die because of the system. Let us face it, it is true that no health system in the world is perfect, but then we could do a lot better.
The doctors are leaving the country in spite of some salary increase, because they feel the system is wrong and with poor output.
How to stop the brain hemorrhage, that is a good question, but it is obvious that putting more money in it will not solve the problem, they will go away anyway, and the system will still be going wrong. The problem is the poor actual coverage of medical service that insurance provides. That is a political issue – our financial contribution (this is no tax!) to the health insurance is taken by the government and treated like a tax, that means they found a way to insert it in the consolidated budget and dispose of it as they wish. And it has been done ever since we departed communism, regardless the political views of the
governing party. I mean when you have all that money to your hand, you cannot give it up, can you? That is private money, but the manager of the National Health Insurance is appointed by the government. They decide how much we have to pay and how to use it. Our private money!. Secondly, there are points where rules do not apply. Did you know that out of the money collected for health insurance in the County of Constanta some 20% is taken annually and given to the County of Vaslui, which is always uncovered (they have too few jobs and too many people busy drinking their children’s government allowance – that was a poor joke but with a spark of truth). The National Insurance never pays a hospital the real amount / cost for medical services they perform. It is like going to the bakery and say: I want to buy a nice well baked bread. How much is it? “Oh , one bread is 2 Euros’.
“Okay, take one Euro and we’re square and fair!”
“No can do – my expenses are 2 Euros!”
“I didn’t ask what expenses you have, I offered you one Euro because that’s all the money I can afford for it! Take it or leave it”
So the hospital takes the minimal pay and shuts up, because loosing the contract with the national insurance means closing business and having jobless doctors and nurses . But this explains why all state
Hospitals in Romania are in deep debt and barely functional. They do not get the kind of money their services cost in reality, but who cares? I have seen great professors in highly ranked clinics bragging about their modesty as they refused a 10 000 Euro job abroad only to stay in their clinic. Yes, I understand such character, because he makes another 20 000 under the counter, so we actually turned our top facilities in private clinics kept with public funds. On the other side, every new government starts its healthcare politics by demonizing doctors and presenting them as sources of financial destabilization – if one or two prominent specialists are jailed in front of cameras it is so much the better. No wonder patients start losing faith.
Everybody shuts up happy it still works somehow. In a recent interview, the present Minister of Health admitted dissociated pricing of medical service in state system but had no idea how to change things. It is clear that we need some changes. We cannot go on lying to people they can have anything on insurance, because they start paying and buying stuff from the very moment they enter the hospital. We are destroying the private medical service providers by compelling them to work exclusively on the insurance money if they get contract with government health programs (also under – estimated as pricing), and finally and most importantly we destroy our own patients who
become trapped in a system where everything is free, but you survive only if you pay.
Some of the best and more valuable ideas I am returning to our readers are as follows:
- Radical change of physician status – doctors should not be considered like public clerks anymore; they should be hired as independent professionals, like lawyers, for instance; they may sign contract with the best paying hospital that can provide conditions for his practice
- Radical change of hospital status – hospital should be turned into an association or shares enterprise, and should be encouraged to work by performance and have self-sustainability as primary task; Local or Regional administration should impose basic coordinates of local healthcare policy, the rest is dedicated to patient care. Salaries will be secret and negotiated personally as in Europe (say goodbye to money in the pocket), and the hospital will do business like hotels – “empty bed is loss, occupied bed is profit”. But they need freedom to contract medical service with national insurance and private insurance corporations as well. Service for cash will also be considered. Let us see who is a good manager now.
- Clearance and officially accepted norms for private insurance, including international;
- Respecting the principle “money follows the patient”
- Government should have to supervise only the emergency system (ambulance and similar systems, ER systems, establish number of vehicles and units in territorial grid, public sanitation measures and control, the national coverage recovery hospitals and research Institutes, supervision of specialty, competence and ability academic degrees, etc.)
- We have to accept the idea that the present day contribution cannot cover all medical expenses; 2 measures must be taken:
- – creating an insurance system with 2 steps like Germany; basic and “private” ; patients that want “private “ status will pay higher contribution, but they will expect better conditions in hospital and be seen by highly ranked specialists. There is no discrimination because failure is not accepted in any of the levels.
- – creation of a basic package of medical services – one that can be the bottom referential applied to uninsured people; that will include a few tests, x-rays and emergency maneuvers and surgery;This will give the people a lot of choice:
- Primary type insurance – basic package +A+B (A and B can be covered by cash for specified service(s))
- Ordinary insurance – basic package + A (A can be covered in cash for a certain service)s)
- Basic – for uninsured and homeless (paid by government) but also for financially challenged people
- Cash – direct service; for anybody else who pays nominal price of services
Like this, anybody can find a way in, according to possibilities and there is no pressure on the patient or the personnel., as hospitals will have all necessary medication and tools. For sure this will not work perfectly from the beginning, but we can do simulations and experiments on some particular hospitals and generalize the system when ready and possible. This has to be done having in view the expansion of the private system as well. Maybe it will not be the best system, but for sure it would be better than what we have now. What do you think?