The matter in summary: – The Midwives’ Association believes that the maternity services in Norway are being reduced because it is too cheap to give birth. – This is due to the health enterprise model, which prioritizes financial profitability over health professional and social economic responsibility. – The hospitals receive 40 percent of the income based on what they do, and a normal childbirth yields less income than complicated interventions. – The National Audit Office has expressed concern about staffing in maternity care, and believes that the hospitals lack strategies to cover the staffing needs. – Helse Nord’s finance director acknowledges that the decentralized delivery structure affects the economy, but rejects that they are not investing in the delivery area because of finances.- Health Minister Ingvild Kjerkol sees the need to change the maternity services in Norway, and is including the input of the trade unions into a new hospital plan. The summary is made by an AI service from OpenAi. The content is quality assured by news’s journalists before publication. – When we do good midwifery work, we are punished for it financially, and that sounds very strange. But it is a fact that little money will come out of it. Head of the Midwives’ Association, Hanne Charlotte Schjelderup, says she and her fellow colleagues end up in a squeeze in Norwegian maternity wards. The reason is the enterprise model, which is about how hospitals are run financially. It has received criticism for prioritizing corporate economic “profitability” ahead of health-related and social economic responsibility. Schjelderup believes it makes it uneconomical to have completely normal births. And if it is not economical, it is not a priority. Best financial payoff The trade unions Jordmorforbundet and The Norwegian Midwives Association believe that staffing in Norwegian maternity wards is so low that it compromises patient safety and quality. And they believe that the maternity services are in a vicious spiral. According to the Midwives’ Association, the hospitals and health regions are not investing in expanding maternity services because they earn little money from births. At least the successful ones. It is the case that Norwegian hospitals are financed in a special way. 60 percent of the income is a basic income, which can be used where needed. They get 40 percent based on what they do. Every intervention and every treatment has its code and its sum. A normal birth, for example, gives just over NOK 13,000, while removal of the prostate gives NOK 19,100. If the birth is complicated and a caesarean section is required, the hospital receives NOK 43,000. – We see that in order to save money within our part of the service, low staffing or a closed offer gives the best financial results for those who sit and look at the bottom line and their budgets. It is very unfortunate, says Schjelderup. This is the enterprise model. A majority in the Storting consisting of the Labor Party, the Conservative Party and the Progressive Party decided in 2001 to introduce an enterprise model for the hospital sector. It meant that the state took over the ownership of the hospitals from the county municipalities, through state enterprises called health enterprises. Five regional health enterprises were established: Helse Nord, Helse Midt -Norway, Helse West, Helse Sør, and Helse East These regional health organizations own the individual hospitals. The enterprise model requires that both the local and regional health organizations follow the Accounting Act. This means, among other things, that operation and investment are in the same budget. If the hospitals need new buildings or new equipment, they must provide equity in order to be able to apply for a loan from the Ministry of Health and Care. The hospitals must build up this equity capital by operating patient treatment with a financial surplus. Therefore, one can see that hospitals try to make patient treatment more efficient or cut patient services in the years before they are to make large investments in new hospital buildings. It has also been seen that the hospitals built after the enterprise model was introduced have been built too small from day one, due to tight financial constraints. Childbirth in change In 2020, the National Audit Office came out with a devastating report on, among other things, the child care offer, in which the alarm was raised. The report was followed up with a new report this year. Here they conclude that the situation has worsened. The National Audit Office is concerned about sickness absence, the use of part-time and poor recruitment of both specialist nurses and midwives. The hospitals are once again harshly criticized for lacking strategies and plans to cover the staffing needs in maternity care. It is impossible to predict when labor will start or how it will develop. The feeding wards – and the living rooms – must therefore have sufficient staffing at all times. – Those giving birth today are older than before. They have several illnesses and this presents us with challenges in relation to the fact that they need more follow-up. One in three births is initiated. It also requires resources and monitoring in a completely different way than with a natural birth, says Schjelderup. The income model makes it difficult Helse Nord’s financial director Eirik Arne Hansen also sees the challenges with the way hospitals are financed. But he does not agree that they do not invest in the maternity area because of finances. Nevertheless, he acknowledges that the decentralized food structure affects the wallet. Because there are many maternity wards in the north with a low number of births. And the weighting of demographic changes means a significant reduction in the framework for Helse Nord. – It is not possible to change the costs for preparedness, regardless of activity. The national income model gives the region increased challenges in achieving budget balance, says Hansen. Health Minister Ingvild Kjerkol has seen the need to change the business model. It is expected that the new hospital plan will address this. Photo: Per Sveinung Larsen / news Unlucky market thinking It is 20 years since the controversial health enterprise model was introduced. A committee has looked at how this works, and in particular how they can reduce “unfortunate effects of market thinking.” Among other things, they propose framework funding as a main principle. In this way, less attention will be given to the activities that generate income in particular, the committee believes. This report is part of a new National Health and Cooperation Plan. It was supposed to be finished by Christmas, but has been postponed until after the New Year. – Financing of hospitals and maternity care is something we are now reviewing and looking at in the work on the plan. We will take the input from the Midwives Association and the Norwegian Midwives Association into that work, says Health Minister Ingvild Kjerkol. She sees the need to change the maternity services in Norway today. And especially in Tromsø, to ensure that the neonatal intensive care unit is on par with that in Trondheim, Bergen and Oslo. – So that we take care of the smallest and most vulnerable patients. It is what determines the good start in life for the children who arrive, and for the families that are created. At the same time, Kjerkol has asked Helse Nord to look at what measures can be taken in the north, to ensure a sustainable specialist health service. Including the maternity offer. – We will create a service for the future, where we secure enough professionals, she says.
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The Midwives’ Association criticizes the health enterprise model – news Troms and Finnmark
