– The whole case is terribly sad. These are powerful attacks against the welfare provision we have built up in Norway, says Karita Bekkemellem. She is the managing director of NHO Geneo. A new national association for around 1,000 actors within the health and welfare industry. Bekkemmellem is concerned about the discontinuation of the current arrangement with free choice of treatment. In all likelihood, it will already happen in January. Facts about free choice of treatment The free choice of treatment scheme was established in November 2015. It means that patients can choose where they want to receive treatment. Patients can choose between public treatment facilities, private treatment facilities that have an agreement with the public sector, and private treatment facilities that have been approved by Helfo, a public agency that works under the Directorate of Health. The financing is done by the treatment centers sending their claims to Helfo, which pays out the money. Helfo then invoices the regional healthcare institutions, which ultimately pay. From the start in 2015, just over 56,000 patients have used the scheme. Last year, the state paid out NOK 385.3 million in reimbursements related to free choice of treatment through the health institutions. In total, just over NOK 1.2 billion has been paid out in refunds since the start. The vast majority of treatments are linked to drug treatment and psychiatry, but also treatment and rehabilitation of diseases such as rheumatism, Parkinson’s, multiple sclerosis (MS) and complex epilepsy are now included in the scheme. – The government starts at the wrong end – As we see it, this is about showing political action without looking at the consequences of the changes. It is reminiscent of simple political craftsmanship, says Bekkemellem. – The government starts at the wrong end. They cut a scheme that is an important offer for 30,000 users, and argue, among other things, that there are so many non-serious players. Instead, they could introduce measures to weed out the rogue actors. Today’s arrangement means that you can choose where you will receive treatment if you fall ill. Either in public hospitals, or in private institutions approved by Helfo. The government takes the bill. According to the proposal to the government, the Helfo approval of companies will now be removed. This means that many companies no longer have agreements with the public sector. It will then be up to the healthcare institutions to fix the capacity challenge. The government does not have an overview of how many treatment centers will then be available. Several actors within the health service fear that a liquidation will have major consequences. Especially for patients within addiction and psychiatry. Missing information NHO Geneo are also skeptical. And now, just a few months before the scheme can be wound up, they lack concrete plans from the government. – We ask why we have not received information about how this is to be carried out. We are not aware of any concrete plans for how the patients, the employees and the affected companies will be looked after during a transition period, says Karita Bekkemellem. The government has said that six months have been set aside for a transition phase from the old to the new scheme. In this way, patients who have started a treatment should be given the opportunity to complete it. – But we have also not received any information about how they are going to build up a new, public offer. So we have no idea what we’re getting into, says Bekkemellem. NHO Geneo therefore believes that the winding down of the current scheme must be postponed until the new scheme is in place. In addition, they believe that the transition phase must extend over more than six months. – No dialogue The association has requested a meeting with Minister of Health and Care Ingvild Kjerkol (Ap). Instead, they have had a meeting with State Secretary Karl Kristian Bekeng. The time for the meeting has not yet been set. However, NHO Geneo does not have concrete proposals for how to make a transition as best as possible. – We are interested in a good dialogue. It is natural to follow this up with our members, so that we are confident that we will get good compensation in place. We hope a meeting with Bekeng and the civil service will give us some answers, says Bekkemellem. Among other things, she fears that a too rapid transition could have major consequences for private healthcare companies. – This will affect the entire operating basis for many. It covers an offer and expertise that has been built up over many years. Karl Kristian Bekeng in the Ministry of Health and Care does not agree with the criticism from NHO Geneo. A SETTLEMENT: – From the outset, this government has promised a settlement with privatization and market thinking in the hospitals, says State Secretary Karl Kristian Bekeng in the Ministry of Health and Care. Photo: Esten Borgos / BORGOS FOTO AS Promises to secure the offer – This is not symbolic politics, says Bekeng. He refers to the evaluation of the scheme, which says that it has not worked as desired. The scheme has apparently not resulted in shorter waiting times or more efficient services. – In addition, we see that it is an open door for unscrupulous actors, says Bekeng. The evaluation also shows that the number of patients who have used the scheme has increased from year to year. But the expenses of the public hospitals in connection with the scheme have also increased considerably, claims Bekeng. – Those expenses amounted to over NOK 500 million in 2021. This means that the hospitals lose management and control over an increasing part of the treatment offered in the specialist health service. Karl Kristian Bekeng promises that patients undergoing treatment will be taken care of. But it is up to the regional health organizations to ensure this. He also claims that the dialogue between the government and the health service has been good. – The ministry had meetings with both NHO, Virke, Spekter and several of their member companies ahead of the consultation note being presented, says Bekeng. – We have a good dialogue with the regional health authorities, who in turn follow up with their health authorities. We have communicated clearly that the regional healthcare organizations must ensure that the patients continue to receive the services they need. See the full response from the Ministry of Health and Care Here are the responses from State Secretary Karl Kristian Bekeng in the Ministry of Health and Care: – NHO has sent you a letter asking for proposals on how the transition should be made. They believe it is high time that a plan for the transition is put forward as soon as possible. Why is it taking so long to answer this? Do you have a plan? If so, what does it entail? – Patients who are being treated by providers of free choice of treatment must be taken care of. The ministry has tasked the regional health organizations with ensuring that patients who receive treatment from private providers through the approval scheme in free choice of treatment can continue the offer they need when the scheme is discontinued. – In addition, we propose a transitional arrangement which ensures that patients who are in a course of treatment with an approved provider can complete the treatment they have started if they wish. We propose that the transitional arrangement should apply for 6 months (until 1 July 2023). It is up to the healthcare institutions to ensure a professionally sound offer within the framework provided. – NHO also believes that a good transition requires dialogue with the health actors themselves, but claims that there has been little or no dialogue between the government and NHO’s members in any case. What dialogue have you had with the health actors regarding this? – The ministry had meetings with both NHO, Virke, Spekter and several of their member companies ahead of the consultation note on winding down the approval scheme being presented. This was to obtain views and input from the employers’ organizations of the approved suppliers. Subsequently, NHO has sent a consultation opinion on the proposal for liquidation. – We have a good dialogue with the regional health authorities, who in turn follow up with their respective health authorities. We have communicated clearly that the regional healthcare organizations must ensure that the patients who currently receive healthcare services through the approval scheme can continue the offer they need even after the scheme has ended. The regional health organizations follow this up and must assess what measures are necessary to fulfill this responsibility. – NHO believes that the process here is going too fast, and that more than six months must be set aside for a transition period. Is it something you have considered? Why/Why not? – This transitional arrangement is proposed to last for six months. It is up to the regional health organizations to ensure a professionally sound offer within the framework provided. – From the outset, this government has promised a settlement with privatization and market thinking in the hospitals. It should come as no surprise then that the Minister of Health, in his first hospital speech in January this year, advocated removing an arrangement that strengthens private actors at the expense of the public hospitals. – The ministry has had a dialogue with the regional health authorities, who believe that the scheme can be discontinued from 1 January 2023. The Directorate of Health points out in its consultation statement that the majority of patients who will be part of the transition scheme will be able to be fully treated during a transition period of 6 months. It is important to point out that it will not be possible to admit new patients after 1 January 2023. The transition scheme therefore only regulates patients who have started their treatment before 1 January 2023. If these patients have not completed treatment during this during the transition period of 6 months, they will have to be transferred to a public hospital or a private enterprise with an agreement with a regional health authority. It will probably be a matter of few patients. – NHO also believes that the lack of dialogue and little information or plans about how this transition will be carried out is a sign that this is purely symbolic politics. How do you react to this? – This is not symbolic politics. In the previous government’s own evaluation of the scheme, it was found that it did not provide shorter waiting times or more efficient services. In addition, we see that it is an open door for unscrupulous actors to be allowed to run clinics at the expense of the public. The public hospitals’ expenditure on this scheme has increased year by year, and amounted to over NOK 500 million in 2021. This means that they lose management and control over an increasing part of the treatment offered in the specialist health service. Now tighter times have been announced and it will be all the more important to ensure that we get the most out of every penny in the health budgets.
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NHO Geneo butchers the liquidation of Free treatment choice. Call it symbolic politics – news Nordland
