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It was created to guarantee the equitable access of citizens to health structures and the practice of medicine, which will be determined by what is needed to care for the patient, not by their financial situation. From the beginning, there were many obstacles. Paraskevas Avgerinos, former Minister of Health and main speaker of the historic law 1397 with which the National Health System was established in 1983, reveals in his book “The change ended early” (Estia, 2013) the battles he fought to approve the law and the reactions he faced even from his “comrades” in PASOK.
“The implementation of a structured SEN inevitably conflicts with established interests, which try to avoid radical and anthropocentric interventions,” he wrote.
Thirty-seven years later, the country has a network of modern hospitals, specialized units, and services with high-level scientific, nursing, technical, and administrative personnel. However, despite the legislative and structural interventions that have been made from time to time, it still presents serious problems: in the organization, in the operation and, finally, in its effectiveness. During the ten-year crisis, financial difficulties (lack of funds, shortage of health personnel, medicines and consumables) were added to the institutional “murmurs” of the SEN (party logic, organizational failure, lack of control mechanisms, lack of evaluation) of executives).
And then the crown practiced. The NSS resisted the pressure, its people are now the “heroes behind the masks”. “Your reward is our valuable obligation,” Health Minister Vassilis Kikilias said Sunday. “By decision of the prime minister, they have received extraordinary financial support, while other ways of rewarding them are being studied.” Extraordinary financial support is something: the least that the State owes to those who have surpassed themselves and their resistance to offer in this “war.” But the challenge is different: attacking the core of SEN pathogenesis, which has not been cured through the reforms that have been attempted so far, at its core. So that the NSS is ready to face not only the possible second wave of COVID-19 or the next pandemic, but to meet the needs of the Greek people, as it should, in the coming decades.
We asked four people who know this well to tell us what would change. Anastasia Kotanidou, professor of Pneumology – Intensive Care at the EKPA School of Medicine, emphasizes the need for “staff renewal, to enrich it with younger generations, who will contribute to knowledge and experience.” Vassilios Bekos, director of the Intensive Care Unit of the Naval Hospital of Athens and the Bioclinic of Athens, talks about the “redistribution of resources and capacities”. “Humanity, justice, the economy, preparedness, everything to be cared for by a health system that will function as a safety net for all, especially the most vulnerable,” says George Chrousos, professor emeritus of pediatrics and endocrinology at EKPA . “The problem is not easy,” admits former Health Minister Alekos Papadopoulos, “but now it must be solved. Based on current needs and not on the memories, phobias and obsessions of our generation, which still haunts us.”
Alekos Papadopoulos *: To change the obsolete organization
Thirty-six years have passed since the establishment of the NSS and twenty of my relatively short transitions from the Ministry of Health. Following developments in the health field from a cold distance, I conclude:
Many improvements have been made to the system, especially in infrastructure construction and the supply of modern medical equipment. There are other important improvements and serious efforts on the part of all governments. However, the NSS did not advance and did not adapt.
The main problem of the health sector in our country is the obsolete organization. This resulted from the lack of a clear philosophy and spirit that guided the perpetual modernization of the system. A spirit that would dispel the fascinating post-political obsessions and nested stereotypes born in other political and social atmospheres.
Reconstruction of the NSS should begin and end as soon as possible. The demographic evolution in the coming years will put more pressure on health systems than on pension systems. Then a significant increase in government spending on health will be needed. Let us not console ourselves for a crown. Any increase in government spending on health, under the current system, will not lead to a substantial improvement in the services provided. While a complete rebuild of the system, by contrast, can lead to dramatic performance improvements, with almost the same levels of funding.
10 necessary incisions
Fully indicative it must:
• Adopt a principle according to which legal entities governed by public law are, to a certain extent, suitable for exercising supervisory or redistributive functions, but not for production processes.
• Strengthen the supervisory and executive function of the Ministry of Health with the objective of guaranteeing public health, establishing strict mechanisms of supervision and certification of the services offered by public and private organizations. This requires a small, modern ministry to produce only health policies with about 200 specialized employees and only about 20 classic administrators, as is the case everywhere today.
• Improve the competitiveness of public hospitals so that they become legal entities of private law, not for profit, through the installation of modern systems of accounting, administrative information and corporate governance. To return, instead of the current BoDs, boards of directors with members through executives of hospital institutions and elections of real and non-immersed managers.
• Create strong regional health administrations.
• Establish a new decent wage system with performance criteria.
• Eliminate government fees for hospitalizations and make full DRG-based payments.
• Personal physicians to act as guardians and patients to access health services through an electronic medical visit system.
• Increase the number of intensive care units, consequently reducing the excess beds of various clinics.
• Abolish the multiple management system and return the ranks of deputy directors and curators.
• Create public-private health partnerships between EOPYY, the private health sector and the insurance market, adapting the corresponding French model. The problem is not easy, but now it must be solved. Based on the needs of today and not on the memories, phobias and obsessions of our generation, which still haunts us. However, great discipline is required in the design and implementation of reform programs and subprograms. With a method and capacity to transform the contradictions and contradictions that exist in the current system. There is no useless communication for those who will try, because when you try to get impressions, you lose the case.
* Mr. Alekos Papadopoulos has served as Minister of Health, Interior and Finance.
Anastasia Kotanidou *: Dealing with the “aging” of health personnel
The purpose of a health system is to address the health and care needs of the population across the spectrum of care. The biggest problem facing NSS hospitals is the large shortage of non-medical personnel, especially nurses.
Many departments operate with nursing personnel below safety limits, while others, including some particularly important ones, such as intensive care units, do not operate at all due to lack of personnel. For physicians, the “full and exclusive employment” institution needs to be applied only to director-coordinators with improved salaries and the ability to provide paid private work within the hospital.
For other physicians, provide full but not exclusive employment so that they can be employed at two or more hospitals on the basis of individual employment contracts.
The issue of the “aging” of the health care population is also a priority, because the massive exodus of the governing body of NSS physicians, combined with the migration of young physicians, has resulted in a layer of physicians in the NSS. they are at the end. professional fatigue In other words, there is no mechanism for staff turnover that will enrich you with younger generations, who will not only “get the job done,” but contribute to new knowledge and skills.
Here are some more interventions and changes that are absolutely necessary:
• More efficient case management within the hospital and reduction of unnecessary incident imports that can be treated at the primary level.
• Development of alternative hospital structures, such as post-hospital services and home care.
• Evaluation, control and quality mechanisms at all levels of the SEN.
• Strengthening and improvement of nursing staff with new study programs and better salaries.
• Immediate development of special units such as intensive care units (ICU) and intensive care units (ICU).
• Possibility of evening clinics for ICU doctors.
• Possibility for ICU doctors to practice their basic specialty for specific periods of time, to avoid exhaustion.
• Development of specific lifelong learning programs for all executives of the NSS units.
• Adoption of an external quality assurance system, which will ensure that the infrastructure meets international operating requirements and standards.
• Establish a special committee to determine service and operation specifications, information needs, and reporting requirements for hospitals and to promote a culture of compliance with the accreditation process.
• Establishment of a control system through the registration and monitoring of quality indicators, such as hospital mortality, complication rates and reimportation rates within 30 days, under the Ministry of Health system.
• Hospital network with program agreements between hospitals and management, possibly management.
• Conversion of hospitals into legal entities under private law and their inclusion as subsidiaries in health districts (as legal entities under public law) according to RES. The new legal form of state hospitals will allow them to overcome the accessories of the single public salary and establish incentives for economic and clinical efficiency, which will differentiate the fees of doctors, nurses and administrators, with the aim of increasing it. productivity.
• Digitization – control – monitoring of the project produced.
• Control: pricing of services provided in real time.
• Creation of special post-hospital care centers with public-private associations for ICU and floor decongestion, reduction of hospital costs and better conditions for the rehabilitation of patients.
* Ms Anastasia Kotanidou is Professor of Pulmonology – Intensive Care at the 1st University Intensive Care Clinic of the EKPA School of Medicine and President of the Hellenic Society for Intensive Care.
George P. Chrousos *: clinical excellence with performance indicators
During the ten-year crisis, financial difficulties (lack of funds, shortage of health personnel, medicines and consumables) were added to the institutional “murmurs” of the SEN (party logic, organizational failure, lack of control mechanisms, lack of evaluation) of executives). INTIME NEWS
The wise saying that there is no evil, pure good, adjusts to the current situation in the country, as in any crisis. The SARS-CoV-2 pandemic has costs for our country, but also potential secondary benefits. The National Health System has found itself a valuable helper in the state’s effort to manage the crisis and will benefit from it for the good of all.
The establishment and operation of the Greek NSS was a great step forward, in many ways. For approximately two decades I lived in it and had the opportunity to appreciate it from the inside, both before and after the financial crisis. I was lucky to serve in one of its best pieces, the Children’s Hospital “Agia Sofía”. The problems existed and were exacerbated by the economic crisis, as in the entire NSS, and they are well known, mainly the lack of funds, the lack of personnel and the inequality in personnel and resources, bad things that can be solved. On the other hand, however, many good things have happened, such as computerization, networking, cost control, the addition of modern special units, renovations, and equipment. I would like to give a brief description of some ideas to improve the functioning of the NSS, based on my experiences outside and within the system.
The mission of the NSS is to provide excellent health services to the people of the country and this can be achieved with good financial, administrative and legal management, the use of new cutting-edge technologies, the establishment of specialized care protocols for all special populations. and the consolidation of the clinic. excellence. The state provides the necessary financial support and exercises a fair and exhaustive macro rather than micro-management. Many of the suggested improvements below have low or zero costs:
Improvement of the computerization of expenses: income, implementation of a legal audit, use of experienced space executives as consultants, selected based on excellence. Complete and detailed registration and periodic evaluation of staff and a more effective legal framework for civil, administrative and / or criminal liability, including conflict of interest as an element that the patient has the right to know.
More complete application of telemedicine, especially for residents of mountainous areas and islands, with an emphasis on advice and preventive medicine and long-term monitoring of patients. Regular training of medical and nursing students, as well as doctors and other healthcare providers, in asynchronous environments and 3D models. Modernization of hospital medical records by digitizing medical records by assisting with special computerized methods of health information, and by creating national disease registries based on privacy policy.
Establishment of specialized protocols for the care of special populations, such as adolescents, the elderly (polypharmacy treatment, geriatric specialization establishment), women of all ages, people with mobility or other disabilities, speakers of foreign languages (for example, foreigners, refugee, refugee) and interpreter) and increase dental units for good and affordable service for the most vulnerable. Orientation of medical procedures based on the value and metaphysical beliefs of each patient.
Improving clinical excellence by creating reference centers with a single database, establishing a hospital research institution based on the standards of the clinical center of the US National Institutes of Health. USA, To conduct experimental clinical trials. Certification of all laboratory units by the corresponding Authority, rationalization of paraclinical examinations and understanding of the econometric dimension of medical procedures with adequate training and control. Appointment of directors of educational programs based on a specific epistemology, assignment and book to record medical operations and skills, and training in more than one center, depending on educational needs. Evaluation of clinical excellence with performance indicators to be published on the Internet. Intense and close cooperation of the NSS with the country’s universities, one of the most important for its high level of operation.
Finally, preparation for emergency preparedness (epidemics, natural disasters, etc.), with the preparation of special national action plans and regular preparedness control exercises.
* Ο κ. Γεώργιος Π. Χρούσος είναι ομότιμος καθηγητής Παιδιατρικής και Ενδοκρινολογίας στο ΕΚΠΑ, διευθυντής του Ερευνητικού Πανεπιστημιακού Ινστιτούτου Υγείας Μητέρας, Παιδιού, και Ιατρικής Ακριβείας. Επικεφαλής έδρας UNESCO Εφηβικής Υγείας και Ιατρικής.
Βασίλειος Μπέκος *: Καθηκοντολόγιο και αξιολόγηση
Η κατάχρηση μιας λέξης προκαλεί τη σημειολογική φθορά της, όπως έγινε με την «αλλαγή». Κάθε «αλλαγή» του ΕΣΥ προϋποθέτει επιθυμία και πίστη σε αυτό. Διότι η αληθινή επιθυμία βελτίωσης της παρούσας κατάστασης είναι “σπίθα» που θα πυροδοτήσει μια σειρά αλλαγών, ενώ η πίστη στον σκοπό θα αναζητήσει τη δύναμη και τους πόρους ώστε να τις επιτύχει.
Προετοιμασία – σχεδιασμός – υλοποίηση, λοιπόν, απαιτούνται για το Εθνικό Σύστημα Υγείας της επόμενης. Οι βασικοί άξονες είναι οι εξής:
• Καταγραφή προσώπων και εξοπλισμού, πλήρης, λεπτομερής, με στοιχεία για την καταλληλότητά τους και
• Διαρκής ενημέρωση της κεντρικής αρχής με έναν πανεθνικό ηλεκτρονικό φάκελο ασθενών, με άμεση εφαρμογή στις μονάδες εντατικής θεραπείας, στις ειδικές μονάδες και στις υπηρεσίες ΤΕΠ – ΕΚΑΒ.
• Η υγεία να είναι κοινό αγαθό όλων, σε όλη την επικράτεια. Λήψη μέτρων εξάλειψης ανισοτήτων ιδιωτικού και δημόσιου συστήματος υγείας, επαρτω ι τ τ τ τ τ τ τ τ τ τ τ τ
• Βελτίωση συνθηκών νοσηλείας και αύξηση δυνατοτήτων δημόσιας υγείας (π.χ. εξειδικευμένες επεμβάσεις και εξοπλισμός) ταυτόχρονα με την ενεργητική επιτήρηση και τον έλεγχο των παρεχόμενων υπηρεσιών της ιδιωτικής υγείας (π.χ. ακρίβεια ιατρικών ενδείξεων, παρεχόμενες υπηρεσίες εντατικής ιατρικής).
• Δημιουργία εθνικού συστήματος ενοποίησης των υγειονομικών υπηρεσιών με ένα εξειδικευμένο σύστημα διακομιδών ασθενών, τέτοιας ποιότητας και ασφάλειας όπως η νοσηλεία σε μονάδα εντατικής. )
• Ανακατανομή πόρων (ανθρωπίνων – υλικών) και δυνατοτήτων του με αποκλειστικό υνώμονα τις βέλτιστες υπ
• Καθηκοντολόγιο για όλους.
• Περιορισμός διοικητικού και βοηθητικού προσωπικού με αξιοποίηση της τεχνολογίας. Οι γιατροί και νοσηλευτές οφείλουν –και απαιτείται– να είναι ο πυρήνας της λειτουργίας του ΕΣΥ.
• Αναβάθμιση της νοσηλευτικής υπηρεσίας ποιοτικά –έπειτα και αριθμητικά–, διότι αυτή αποτελεί την «ψυσ Δυστυχώς, σήμερα η πλειονότητα των νοσηλευτών με χαρά θα αντάλλασσε μια «άχοιτη ε α η η η η η η η η η η η
• Οι συνθήκες (υλικοτεχνικές και εργασιακές) είναι ιδιαίτερα σκληρές γι ‘αυτούς και η επιθυμία μετεκπαίδευσης πολλών νοσηλευτών κρύβει τον πόθο μιας “τίμιας» διαφυγής από την καθημερινή νοσηλευτική πράξη και όχι τη βελτίωση των παρεχόμενων υπηρεσιών.
• Δημιουργία δομών αποσυμπίεσης υπαρχουσών κλινικών (όπως οι κλινικές ημερήσιας νοσηλείας), μονάδων αυξημένης φροντίδας, κέντρων αποκατάστασης, νοσηλείας στο σπίτι.
• Ταυτόχρονα, επαρκής στελέχωση των Κέντρων Αριστείας Ιατρικής, όπως οι Μονάδες Εντατικής Θεραπείας, τα εξειδικευμένα διαγνωστικά / επεμβατικά κέντρα, σε λειτουργική διασύνδεση με το εθνικό σύστημα διακομιδών.
• Τέλος, συνεχής ποιοτική αξιολόγηση όλων των παραπάνω: κάθε έκπτωση από τους ττχ ταχςς τηχυς
• Δημιουργία «μικρού και ευέλικτου» υγειονομικού συστήματος εθνικής εμβέλειας. Καθότι η υγεία «κοστίζει» αλλά είναι «ανεκτίμητη αξία», δεν υπάρχουν περιθώρια τώ ιώιπ πόηηςκπ
• Επιβάλλεται η δημιουργία μιας «υγειονομικής εφεδρείας κρίσεων» πουτθήκττ υεε εε εεε εεεε Αυτή η ‘εφεδρεία “αποτελούμενη από κλινικούς ιατρούς και νοσηλευτές, θα ενισχύει το έργο των Μονάδων Εντατικής Θεραπείας, παρέχοντας υψηλού επιπέδου υπηρεσίες στο μεγαλύτερο ποσοστό πολιτών με κάθε διαθέσιμο μέσο.
Προϋπόθεση, η εκπαίδευσή τους μέσω ενός εθνικού συστήματος συνεχιζόμενης ιατρονοσηλευτικής εκπαίδευσης, αξιόπιστα πιστοποιημένου και υποχρεωτικής συμμετοχής, το οποίο θα αποτελεί αναγκαία και απαραίτητη συνθήκη ένταξης και παραμονής στον υγειονομικό χάρτη της χώρας κάθε λειτουργού της υγείας.
* Ο κ. Βασίλειος Μπέκος είναι πλοίαρχος ιατρός Πολεμικού Ναυτικού, εντατικολόγος / αναισθησιολόγος, διευθυντής Μονάδας Εντατικής Θεραπείας στο Ναυτικό Νοσοκομείο Αθηνών και στην Βιοκλινική Αθηνών.
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