Valsts kontroles rev\u012bzija atkl\u0101j kr\u012bzi slimn\u012bcu finans\u0113jum\u0101 un darb\u012bb\u0101<\/p>\n
Valsts kontroles nesen veikta padzi\u013cin\u0101ta rev\u012bzija Latvijas vesel\u012bbas apr\u016bpes sist\u0113m\u0101 ir atkl\u0101jusi satrauco\u0161u un daudzsl\u0101\u0146ainu probl\u0113mu kopumu, kas skar slimn\u012bcu finans\u0113\u0161anu un darb\u012bbas efektivit\u0101ti. Konstat\u0113ts, ka ik gadu vair\u0101k nek\u0101 700 miljoni eiro, kas veido gandr\u012bz 40% no vesel\u012bbas apr\u016bpes bud\u017eeta, tiek novirz\u012bti, lai uztur\u0113tu v\u0113sturiski izveidotu un arvien vair\u0101k sadrumstalotu slimn\u012bcu t\u012bklu, nevis lai nodro\u0161in\u0101tu pacientiem vienl\u012bdz\u012bgu un kvalitat\u012bvu medic\u012bnisko pal\u012bdz\u012bbu. \u0160\u012b situ\u0101cija rada dzi\u013cu vil\u0161anos un neizpratni par l\u012bdzek\u013cu efekt\u012bvu izlietojumu, \u012bpa\u0161i \u0146emot v\u0113r\u0101, ka slimn\u012bcu skaits ir audzis l\u012bdz 41, un da\u017e\u0101dos l\u012bme\u0146os eso\u0161o pakalpojumu kvalit\u0101te un saturs b\u016btiski at\u0161\u0137iras. Rev\u012bzijas sl\u0113dziens ir skarbs \u2013 eso\u0161\u0101 sist\u0113ma darbojas k\u0101 d\u0101rga \u201cbutaforija\u201d, kas nesp\u0113j efekt\u012bvi kalpot sabiedr\u012bbas interes\u0113m.<\/p>\n
Novecoju\u0161i tarifi un netaisn\u012bga finans\u0113juma sist\u0113ma<\/p>\n
Viena no galvenaj\u0101m probl\u0113m\u0101m ir novecoju\u0161ie slimn\u012bcu tarifi un pa\u0161reiz\u0113jais finans\u0113\u0161anas modelis, kas ir gan sare\u017e\u0123\u012bts, gan iek\u0161\u0113ji netaisn\u012bgs. Lai gan kop\u0161 2011. gada tiek ieviesta starptautiski atz\u012bt\u0101 ar diagnoz\u0113m saist\u012bto grupu (DRG) pakalpojumu apmaksas sist\u0113ma, kur samaksa tiek noteikta atkar\u012bb\u0101 no pacienta \u0101rst\u0113\u0161anas gad\u012bjuma sare\u017e\u0123\u012bt\u012bbas, t\u0101 joproj\u0101m darbojas tikai da\u013c\u0113ji. Slimn\u012bcas sa\u0146em apmaksu 16 da\u017e\u0101dos veidos, un daudzi tarifi ir novecoju\u0161i vai matem\u0101tiski piel\u0101goti pieejamajam finans\u0113jumam. \u0160\u012b sist\u0113ma visnetaisn\u012bg\u0101k skar divas augst\u0101k\u0101 l\u012bme\u0146a slimn\u012bcas \u2013 R\u012bgas Austrumu kl\u012bnisko universit\u0101tes slimn\u012bcu un Paula Stradi\u0146a kl\u012bnisko universit\u0101tes slimn\u012bcu \u2013, kur\u0101s hospitaliz\u0113 40% pacientu un sniedz sare\u017e\u0123\u012btus pakalpojumus. Piem\u0113ram, 2025. gad\u0101 R\u012bgas Austrumu kl\u012bniskajai universit\u0101tes slimn\u012bcai finans\u0113jums samazin\u0101ts par 12,7 miljoniem eiro, bet Paula Stradi\u0146a kl\u012bniskajai universit\u0101tes slimn\u012bcai \u2013 par 6,8 miljoniem eiro. Savuk\u0101rt slimn\u012bc\u0101m ar nelielu pacientu pl\u016bsmu fiks\u0113tais uz\u0146em\u0161anas noda\u013cu finans\u0113jums nodro\u0161ina stabilus ien\u0101kumus, radot iek\u0161\u0113ju netaisn\u012bbu sist\u0113m\u0101 un kav\u0113jot vesel\u012bbas apr\u016bpes un pakalpojumu att\u012bst\u012bbu tur, kur ir visvair\u0101k pacientu. Rezult\u0101t\u0101 notiek \u0161\u0137\u0113rssubsid\u0113\u0161ana, kur slimn\u012bcu pamatpakalpojumus faktiski sedz ar ambulatoro pakalpojumu finans\u0113jumu.<\/p>\n
Neskaidr\u012bba un form\u0101la normu izpilde<\/p>\n
Papildus tam slimn\u012bcas str\u0101d\u0101 nep\u0101rtraukt\u0101 neskaidr\u012bb\u0101, jo l\u012bgumi par teko\u0161\u0101 gada finans\u0113jumu tiek groz\u012bti pat katru m\u0113nesi. Nav izsekojams, vai neizlietotie l\u012bdzek\u013ci tiek novirz\u012bti priorit\u0101r\u0101m pacientu vajadz\u012bb\u0101m vai vienk\u0101r\u0161i pakalpojumiem, ko slimn\u012bca sp\u0113j sniegt. Sist\u0113mas sare\u017e\u0123\u012bt\u012bba rada \u0113rtu pamatu p\u0101rmai\u0146u neveik\u0161anai, jo \u201cnevienu jaut\u0101jumu nevar sak\u0101rtot, kam\u0113r nav atrisin\u0101ti visi p\u0101r\u0113jie\u201d. Ne caursp\u012bd\u012bgums paver iesp\u0113ju dal\u012bt ierobe\u017eoto finans\u0113jumu bez skaidriem krit\u0113rijiem.<\/p>\n
Sadrumstalotais slimn\u012bcu t\u012bkls un speci\u0101listu tr\u016bkums<\/p>\n
Kop\u0161 2016. gada, sadarb\u012bb\u0101 ar Pasaules Banku izstr\u0101d\u0101tie priek\u0161likumi slimn\u012bcu t\u012bkla pak\u0101peniskai optimiz\u0101cijai l\u012bdz 2025. gadam nav \u012bstenoti. Pat vair\u0101k, 2018. gada reforma nemazin\u0101ja slimn\u012bcu skaitu, bet gan palielin\u0101ja to l\u012bdz 41. Form\u0101lais slimn\u012bcu dal\u012bjums pa l\u012bme\u0146iem (no I l\u012bdz V) praks\u0113 nestr\u0101d\u0101, jo past\u0101v neskait\u0101mi iz\u0146\u0113mumi un piel\u0101go\u0161an\u0101s katras slimn\u012bcas faktiskaj\u0101m iesp\u0113j\u0101m. Tas noz\u012bm\u0113, ka pacients ak\u016bt\u0101 situ\u0101cij\u0101 var non\u0101kt slimn\u012bc\u0101, kur\u0101 attiec\u012bgais pakalpojums netiek sniegts, lai gan citur l\u012bdzv\u0113rt\u012bg\u0101 slimn\u012bc\u0101 tas ir pieejams. Valsts kontrole nor\u0101da, ka ar\u012b saisto\u0161as pras\u012bbas noteiktu pakalpojumu snieg\u0161anai slimn\u012bc\u0101m nav noteiktas, k\u0101 rezult\u0101t\u0101 pakalpojumu kvalit\u0101te at\u0161\u0137iras. T\u0101pat nav ieviesta kvalit\u0101tes r\u0101d\u012bt\u0101ju v\u0113rt\u0113\u0161ana, ko bija pl\u0101nots sasaist\u012bt ar finans\u0113jumu. Rev\u012bzij\u0101 konstat\u0113ts, ka visu l\u012bme\u0146u slimn\u012bcas kop\u0101 nesp\u0113j nodro\u0161in\u0101t vair\u0101k nek\u0101 pusi no uz\u0146em\u0161anas noda\u013c\u0101s nepiecie\u0161amajiem speci\u0101listiem, lai gan tas v\u0113rt\u0113ts viena m\u0113ne\u0161a griezum\u0101, tendence ir satrauco\u0161a. Lielu da\u013cu de\u017e\u016bru nodro\u0161ina rezidenti un sta\u017eieri, kam\u0113r sertific\u0113tu speci\u0101listu tr\u016bkums saglab\u0101jas. Revidenti atkl\u0101ju\u0161i ar\u012b \u201cneiesp\u0113jamas situ\u0101cijas\u201d, piem\u0113ram, nesertific\u0113ts \u0137irurgs dokumentos nor\u0101d\u012bts de\u017eur\u0113jam 452 stundas m\u0113nes\u012b \u010detr\u0101s slimn\u012bc\u0101s, bet neonatologs vienlaikus uzr\u0101d\u012bts de\u017eur\u0113jam div\u0101s Latvijas viet\u0101s. \u0160\u0101di dati liecina par form\u0101lu normu izpildi, kas neuzlabo pacientu dro\u0161\u012bbu.<\/p>\n
Neefekt\u012bvais uz\u0146em\u0161anas noda\u013cu t\u012bkls un dubult\u0101s izmaksas<\/p>\n
Tr\u016bkst ar\u012b pamatojuma pla\u0161ajam uz\u0146em\u0161anas noda\u013cu t\u012bklam, kura kop\u0113jais finans\u0113jums gad\u0101 sasniedz ap 100 miljoniem eiro, bet kura izveid\u0113 nav \u0146emta v\u0113r\u0101 faktisk\u0101 pacientu pl\u016bsma. No fiks\u0113t\u0101 maks\u0101juma atkar\u012bga divu zem\u0101ko l\u012bme\u0146u slimn\u012bcu eksistence, veidojot 45-48% no to valsts finans\u0113juma, tom\u0113r to uz\u0146em\u0161anas noda\u013c\u0101s non\u0101k tikai 6% no visiem uz\u0146emtajiem pacientiem. Kam\u0113r neatliekam\u0101s pal\u012bdz\u012bbas brig\u0101des IV l\u012bme\u0146a slimn\u012bc\u0101s ieved 16 l\u012bdz 36 pacientus dien\u0101, atsevi\u0161\u0137\u0101s zem\u0101ko l\u012bme\u0146u slimn\u012bc\u0101s tie ir pat viens pacients 20 dien\u0101s. Viena zem\u0101k\u0101 l\u012bme\u0146a slimn\u012bcas uz\u0146em\u0161anas noda\u013ca valstij ik gadu izmaks\u0101 vid\u0113ji 850 000 eiro. Interesanti, ka steidzam\u0101s medic\u012bnisk\u0101s pal\u012bdz\u012bbas punkti, kas l\u012bdz 2019. gadam past\u0101v\u0113ja zem\u0101k\u0101 l\u012bme\u0146a slimn\u012bc\u0101s, turpina darboties, nodro\u0161ina pla\u0161\u0101ku pakalpojumu kl\u0101stu, bet izmaks\u0101 maz\u0101k \u2013 vid\u0113ji 350 000 eiro gad\u0101. Tas skaidri par\u0101da, ka, nomainot nosaukumu un statusu, izmaksas palielin\u0101tas par 2,5 miljoniem eiro gad\u0101, nemainot pakalpojuma saturu.<\/p>\n
Ieteikumi un n\u0101kotnes perspekt\u012bvas<\/p>\n
Valsts kontrole ir sniegusi Vesel\u012bbas ministrijai piecus ieteikumus, kurus ievie\u0161ot ne v\u0113l\u0101k k\u0101 2029. gad\u0101, ir cer\u012bba sak\u0101rtot slimn\u012bcu t\u012bklu, lai pacienti sa\u0146emtu kvalitat\u012bvus pakalpojumus. Ieteikumi paredz p\u0101rskat\u012bt uz\u0146em\u0161anas noda\u013cu t\u012bklu, nodro\u0161inot pilnu speci\u0101listu komandu pieejam\u012bbu, k\u0101 ar\u012b pl\u0101not slimn\u012bcu pakalpojumus, sasaistot pieejamo finans\u0113jumu ar pakalpojumu kvalit\u0101ti. T\u0101pat slimn\u012bcas sa\u0146ems taisn\u012bgu samaksu, \u0146emot v\u0113r\u0101 pacientu \u0101rst\u0113\u0161anas gad\u012bjumu sare\u017e\u0123\u012bt\u012bbu. Lai gan Vesel\u012bbas ministrs Hosams Abu Meri atz\u012bst probl\u0113mas un sola p\u0101rmai\u0146as, vi\u0146\u0161 nor\u0101da, ka p\u0101rmai\u0146\u0101m pretojas pa\u0161vald\u012bbas un slimn\u012bcu vad\u012bba. Lai situ\u0101ciju uzlabotu, nepiecie\u0161ami skaidri politiskie l\u0113mumi un b\u016btiskas p\u0101rmai\u0146as gan slimn\u012bcu t\u012bkla strukt\u016br\u0101, gan finans\u0113\u0161anas sist\u0113m\u0101.<\/p>\n","protected":false},"excerpt":{"rendered":"Valsts kontroles rev\u012bzija atkl\u0101j kr\u012bzi slimn\u012bcu finans\u0113jum\u0101 un darb\u012bb\u0101 Valsts kontroles nesen veikta padzi\u013cin\u0101ta rev\u012bzija Latvijas vesel\u012bbas apr\u016bpes…\n","protected":false},"author":2,"featured_media":1183,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[23,28,29,789,32,33,22,30,31,35,39,38,36,37,34,40,20,26,27,785,788,24,25,786,787,21],"class_list":{"0":"post-1182","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-aktualitates","8":"tag-aktualitates","9":"tag-breaking-news","10":"tag-breakingnews","11":"tag-drg-sistema","12":"tag-featured-news","13":"tag-featurednews","14":"tag-headlines","15":"tag-latest-news","16":"tag-latestnews","17":"tag-latvia","18":"tag-latvian","19":"tag-latviesu","20":"tag-latviesu-valoda","21":"tag-latviesuvaloda","22":"tag-latvija","23":"tag-lv","24":"tag-news","25":"tag-popularakas-zinas","26":"tag-popularakaszinas","27":"tag-slimnicu-finansesana","28":"tag-slimnicu-tikls","29":"tag-top-stories","30":"tag-topstories","31":"tag-valsts-kontrole","32":"tag-veselibas-aprupe","33":"tag-zinas"},"share_on_mastodon":{"url":"","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/posts\/1182","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/comments?post=1182"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/posts\/1182\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/media\/1183"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/media?parent=1182"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/categories?post=1182"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/lv\/wp-json\/wp\/v2\/tags?post=1182"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}