– Now the limit has been reached. Defensibility is at stake. We cannot accept that birth and maternity leave have become an offsetting item. It is absolutely terrible that someone should experience such treatment, says Rødt politician Seher Aydar. She has just read the story of Ingrid Leiråmo from Dønna in Nordland. The woman who herself had to drive several hours to get to a maternity ward when the heart of the child in her stomach stopped beating. Because there are challenges in maternity care. Among other things, maternity wards and wards that are closed in the summer and make pregnant women travel a long way. For example in Vestland, Møre and Romsdal, Troms and Finnmark, and Nordland. In Helgeland, they plan to be closed for the summer for four months until next year. Seher Aydar believes that pregnant women and those giving birth are prioritized away from the health service. And that economy is one of the reasons. Get around NOK 13,000 for a birth – We have a funding system that makes it unprofitable to prioritize birth and maternity, she says. Norwegian hospitals are currently financed through a two-part system. They get half of their income through fixed income, a so-called framework financing. They receive the rest of the income based on the activity at the hospitals, so-called input-based financing (ISF). A normal birth gives hospitals around NOK 13,000. For a complicated birth with caesarean section, they receive around NOK 45,000. This is how much the hospitals are paid for a birth Somatic services, i.e. medicine that treats physical challenges, are financed with approximately 50% basic funding and 50% Performance-based funding (ISF) in 2022. The hospitals code each treatment that is carried out, and are reimbursed the amount per treatment . This is done through the DRG system. DRG, diagnosis-related groups, is a system that classifies patients into groups that are medically and resource-wise similar. The system has been used to correct for differences in patient composition when comparing cost levels between somatic hospitals in Norway. (source Store medical encyclopedia) The figures below are from the Dips grouper. And is divided into births and caesarean sections with and without complicating secondary diagnoses (bk). 50% DRG – reimbursement in kroner amount.Normal birth without birth: 13702,-Normal birth with birth: 20982,-Caesarean birth without birth: 32584,-Caesarean birth with birth: 45283,- – The idea that a hospital can be run as a store is very unfortunate. ISF has been a disaster. It is a system that makes it unprofitable to prioritize delivery, maternity and other care tasks, because the hospitals make little profit from it, Seher Aydar believes. In the larger cities, the influx of patients is steady. Thus, the hospitals always have enough income to keep the various departments open. In the districts, the activity will vary. With effort-based funding, the hospitals will therefore not have enough money to operate certain services to the same extent throughout the year, Aydar believes. Therefore, for example, hospitals must have maternity wards that are closed in the summer. – It creates a risk for women who are about to give birth. The distances are already too long and cannot be longer, says Aydar. There is research that shows that the risk of complications during childbirth increases when the distance to the delivery room or ward increases. Olaug Bollestad, leader of KrF, also reacts to what is happening with maternity services in Norway. Will remove ISF – Those giving birth deserve better than this. These cases upset me, both as a woman, mother, politician and intensive care nurse. Pregnant women are in a very vulnerable situation. We cannot accept that they should be insecure about the offer they receive, she says. – We do not run the maternity ward to make money, but to help women in the critical situation a birth can be. Both Bollestad and Aydar believe that something should be done about the way hospitals are financed. MORE PEOPLE: Olaug Bollestad in KrF believes, among other things, that we need more people in maternity care. – By training more midwives, reviewing and following up on the professional environment’s recommendations and creating attractive workplaces throughout the country, we shall ensure a safe and sound maternity service for the entire population of Norway, she says. Photo: Mathias Oppedal / news They believe that effort-based funding must go away, and be replaced by fixed sums in the form of framework funding. – It will ensure stable services and will guarantee that we have the necessary preparedness at all times, says Aydar. State Secretary Karl Kristian Bekeng (Ap) in the Ministry of Health and Care does not agree. – Contributes to balance Firstly, Bekeng believes that it is wrong to claim that birth and maternity are given priority. – Norway is one of the best countries in the world to give birth in. Pregnancy and birth care in this country maintains a very high quality in an international context. Fortunately, most are satisfied with the birth and maternity care, he says. Bekeng believes that the lack of personnel is the biggest challenge for maternity services in Norway at the moment. Something he believes cannot be solved by changing the funding model. According to Bekeng, effort-based financing (ISF) contributes to the efficient operation of the hospitals. Furthermore, he believes it is important not to focus on just one way of financing hospitals. CHALLENGE: – There is a great need for midwives, and at times the working situation can be challenging in maternity wards with 24/7 operation. Several places are experiencing that it is difficult to recruit sufficient staff at maternity wards and health centres, says State Secretary Karl Kristian Bekeng in the Ministry of Health and Care. Photo: Esten Borgos / BORGOS FOTO AS – All financing methods for health services have strengths and weaknesses. Combining framework funding and ISF contributes to a balance, he says. In the proposal for the state budget for 2023, the government proposes to change the fraction for financing the hospitals. They will reduce the proportion of performance-based funding from 50 to 40 per cent, with a corresponding increase in the framework funding. – This will give the healthcare organizations increased room for action. It can make it financially easier for hospitals to prioritize tasks that do not generate income through ISF, he says. DO THEY REACH THE HOSPITAL? A woman is lying on the bathroom floor and labor is in progress. Charles is unsure whether they will manage to get her to the hospital, or whether they will have to receive the child themselves.
ttn-69
Women have to travel far to give birth. Rødt and KrF believe that pregnant women are given priority – news Nordland
