sexta-feira, junho 06, 2003
Ainda sobre o SNS
Encontrei este relato de um médico noruegês sobre o serviço de saúde público do seu país. O relato é algo antigo (é de 1989 - agradeço se alguém tiver dados mais actualizados) mas as deficiências apontadas não são muito diferentes da realidade portuguesa. Há apenas duas diferenças. Primeiro a Noruega possui mais recursos que Portugal. A segunda é que, segundo a descrição feita, o estado norueguês é (ou pelo menos era) ferozmente contra a iniciativa privada no sector da saúde.
Eis alguns excertos:
"All Norwegian hospitals were socialized with the passing of the Hospital Act of 1969 (by a non-socialist government). Unnecessary waiting for hospital admission was unknown before 1969. The hospitals were paid on a fee-for-service-system. Later this system was replaced by a system of annual payments regulated by the number of patients geographically assigned to the hospitals. This system allocated most patients to specific and local and central hospitals in each state. Only acute treatment could be given to out-of-county or out-of-state patient. Over a millennium after Norway was united into one kingdom, the country was divided into 20 "health-states". Inefficiency, waste, waiting lists and pain ensued.
In 1982 the time had come to give primary health care the same treatment. The aim was to contain cost. The former fee-for-treatment-system was replaced. All Federal District Doctors - mainly in rural areas - were transferred to the counties. All private practitioners were "offered" an annual fee of approximately 40% of their budget to become regulated by the counties. They also retained a fee-for-service-system, but the fees were reduced to compensate for the 40% annual fee. I addition the patients have to pay a use fee of approximately $ 10 for each visit to a general practitioner. Also almost all new doctors are forced to become salaried employees of the counties; very few annual fees have been awarded since 1982. This reform has caused waiting lists and deterioration of services. In Bergen the waiting time for an appointment with your general practitioner is several weeks.
Today the payment for the health care and pension system amounts to a 6-10 % tax on incomes and a 12-17 % tax on employers. The system today faces grave economic difficulties and cuts are made."
"The Norwegian Health Care System is failing. Quality is decreasing, waiting lists are long and many doctors are discontent. Because of the low user fees the demand is artificially high and increasing. The economy of both Health- and Pension-systems are deteriorating and cuts in the budgets are made. Plans for making the system more efficient are implemented continuously - DRGs are presently introduced at some governmental hospitals and a patient list system assigning patients to one doctor for a compulsory one year period is proposed"
No final (esta comunicação foi feita numa conferência em San Diego - EUA) o dr Jan Sommerfelt pettersen deixa um alerta para os EUA (que na altura começava a desenvolver o Medicare)
"The trends towards socialized health care in the USA are depressing. Why are so many Americans so eager to repeat the errors we have made in the last 50 years and just recently started to remedy?"
nota: Arnold Kling do EconLog têm alertado continuamente para a necessidade de cortes no Medicare como forma de evitar o agravamento do défice nos EUA.
posted by Miguel Noronha 4:02 da tarde
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