The Norwegian healthcare system faces a number of challenges. Several hospitals have full emergency departments and long waiting lists. Many employees in the healthcare system feel overworked and stressed. We are at the beginning of a GP crisis. The number of beds in the healthcare system has also been greatly reduced in 30 years: From 22,000 to 10,800 somatic beds per day From 8,000 to 3,200 psychiatric beds per day Researchers from three different hospitals believe that the reduction in beds has gone too far. They also believe that the above-mentioned problems in the healthcare system have one main cause: the enterprise reform. – Health and care is not a product that can be sold on a market. It must reflect the needs of the population and not what gives economic benefit. So says professor emeritus Sven Erik Gisvold at St. Olav’s hospital/NTNU. Together with Oluf Dimitri Røe and Torgeir Bruun Wyller, he has written the article “Are we heading towards a bedless, heartless and two-part healthcare system?” in the journal Samfunn ekoniomi. Norway is one of the countries with the fewest somatic hospital beds per inhabitant in the whole of Europe, according to Gisvold. serious The background was galloping expenses and a desire for better control over the economy. Before this, the hospitals had administrative budgets. They set up a budget with costs for operations and received grants accordingly. Hospitals now largely receive their income through work performed. The more treatments they perform, the more money they make. This is inspired by the New Public Management philosophy, according to the researcher. – Hospitals must be run according to the same financial principles as any fully industrial company. The demand for profit is dominant, says Gisvold. Sven Erik Gisvold is professor emeritus at St. Olav’s hospital/NTNU. He is critical of the enterprise reform. Photo: Marthe Svendsen / news The researchers claim that the reform has several serious consequences: A sharp reduction in beds in the hospitals Full emergency departments Patients are discharged too early More stressed and tired employees Increase in emergency readmissions New hospitals are built too small – If this trend is to be allowed to continue, or should we try to prevent public infrastructure being taken over by commercial forces and systems, asks Gisvold. The Ministry of Health and Care does not wish to be interviewed. They write in an e-mail that the reform has given better control over resource use in the hospitals. Read the full answer further down in the case. Has passed the tolerance limit The reform also led to the hospitals having to use their own profits to expand or build new ones. All the regional health undertakings are running at a loss according to figures obtained by Dagens Medisin. This leads to new hospitals being built too small, says Gisvold. As a result, there will be fewer beds and fewer employees who have to perform more tasks – which in turn means that employees have to work faster. – Then you get to a point where you go too fast in the corners, says Gisvold. He refers to German research showing that the risk of serious complications and death increases if the average occupancy rate at the hospital is over 90 per cent. In large hospitals such as St. Olav and Ahus, it is around 100 per cent, according to Gisvold. We have thus passed the limit for how few beds we can have in the healthcare system, the researchers believe. – It goes well up to a certain level, but then the safety of the patients is dramatically affected, says Gisvold. He adds that there is broad agreement that there is no need for 22,000 somatic beds and that the downsizing began before the reform was introduced. Nevertheless, he believes that it has gone too far. Gisvold believes that the healthcare system has passed the limit of how few beds we can have in the healthcare system, without compromising patient safety. Photo: Marthe Svendsen / news Social economist: Costly – We have multiplied the number of employees in the health bureaucracy and they have salaries in the millions. That’s what Bjarne Hansen says about the financial consequences of the healthcare company reform. He is professor emeritus in administrative economics. The social economist believes that the reform has led to an economic reprioritization – from health services to bureaucracy and administration. He says it is not possible to give a clear answer as to whether costs in the health care system have decreased after the reform, which was, after all, the goal. According to the social economist, the reform has led to a downsizing of health services, particularly in the areas of addiction and psychiatry. – Here, there have been fewer admissions and shorter length of stay. But it has also led to treatment offers from non-profit and voluntary organizations in these areas having disappeared, says Hansen. Has created throwing balls Gisvold and the two other authors behind the article also believe that the co-operation reform explains some of the problems in the healthcare system. It was introduced in 2012. At that time, much of the responsibility for patients was transferred from health organizations to municipalities. Patients were to be transferred more quickly to the municipalities, and municipalities are now obliged to receive a fully treated patient from the hospital within two days. If they fail to do so, they must pay daily fines. The result is that the patients become throwaway balls, according to the researchers: – It becomes an economic monopoly game between hospitals and municipalities where for the hospital it is all about getting rid of the patient and getting him transferred to another budget, says Gisvold. The researchers’ proposed measures: The reduction in beds must be stopped immediately The hospitals return to a needs-based accounting model The hospitals must have separate budgets for operation and investment, as other public enterprises have New hospital buildings must lead to separate allocations from central authorities Each hospital will become an independent unit and units consisting of several hospitals are liquidated. Hospitals in the region cooperate Hospital boards must be elected democratically Several reasons for fewer beds Karl Kristian Bekeng (Ap), State Secretary in the Ministry of Health and Care, sends a written reply. When asked if the Labor Party believes the enterprise reform has been successful, he replies as follows: – The health enterprise reform has meant that the hospitals have better control over the use of resources and more stable finances than before 2001. In addition, the hospitals treat far more people, and new hospitals have been built all over the country, according to the Secretary of State. Karl Kristian Bekeng (Ap) is state secretary in the Ministry of Health and Care. He mentions several positive effects of the enterprise reform. Photo: Esten Borgos / BORGOS FOTO AS Bekeng writes that there has been a revolution in patient care in terms of technology and treatment methods, and that there are many things that lead to shorter hospital stays. – What previously required hospitalization can now be solved with day treatment, he writes. Bekeng points to figures from the OECD which show that the reduction in hospital beds has been greater in Sweden and Denmark, which do not have the same business model. – The researchers believe there should be separate budgets for operations and investments. Do you agree? – We only have a money bag. It wouldn’t get bigger by splitting it in half. The advantage of the current system is that it triggers investments if you can operate more efficiently, says Bekeng. He writes that the reform has been evaluated seven times through committees appointed by the previous government and through research. The government has now set up a hospital committee which will investigate changes in the management of the hospitals and the health enterprise model. The deadline for the selection is 31 March 2023.
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Researchers at NTNU believe the healthcare reform is to blame for blown up hospitals – news Trøndelag
