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Medical first aid services could be cut

A RULING coalition deputy has quietly proposed to restrict provision of medical services during the late evening hours as a way to give relief to on-duty doctors. While the Health Ministry is supporting this proposed limitation and points to infrequent overnight use of these services, the Health Policy Institute think-tank and some medical experts believe doing so will limit people’s access to needed health care.

A RULING coalition deputy has quietly proposed to restrict provision of medical services during the late evening hours as a way to give relief to on-duty doctors. While the Health Ministry is supporting this proposed limitation and points to infrequent overnight use of these services, the Health Policy Institute think-tank and some medical experts believe doing so will limit people’s access to needed health care.

Parliament advanced the proposal to a second reading in mid-June and will deal with it again in September.

The draft revision to the law on health-care providers, introduced by Jozef Valocký, a deputy from the major ruling coalition party Smer, would set limits in the operation of Slovakia’s medical first aid service, known as LSPP.

Currently, doctors provide this service in selected health centres after they close their regular offices overnight until 7:00. Doctors treat patients within the LSPP service after the normal hours of general practitioners, paediatricians and dentists and the service enables a person without an urgent or life-threatening health problem to visit a doctor when regular offices are closed.

For urgent, acute health crises Slovakia has a system of emergency ambulances which are able to reach a person in need of urgent care, for example a victim of a heart attack, within 15 minutes.

Valocký claims that a reduction in the LSPP service will lower the workload of doctors and nurses and that this change in the law will prevent abuse of LSPP by patients who try to seek treatment for less-than-urgent health conditions during night-time hours.

The Health Ministry is supporting Valocký’s proposed revision to the law.

“This is an MP’s draft revision responding to our analysis, and we identify with it,” said Adam Hochel, the director general of the health section at the Health Ministry, quoted by the Sme daily.
According to the Health Ministry’s analysis, utilisation of LSPP services after midnight decreases to 3 to 8 percent depending on the kind of LSPP.

“After 24:00 other segments of the heath-care system can treat these patients,” Hochel said, as cited by the SITA newswire. The patients can consult regarding their problems with a health centre by phone, call an ambulance or go directly to the central admission reception in hospitals.

According to the ministry’s calculations, limiting LSPP services after midnight would increase calls for ambulances by 0.9 percent.

The Health Policy Institute (HPI) think-tank does not agree with restricting usage of LSPP services.
“This proposal avoids advance public discussion and it is at odds with the government’s stated programme for its term,” HPI writes in its position paper, further stating that “it would reduce availability of health care in some of Slovakia’s regions”. HPI also writes that it also secures riskless business to centrally-selected companies, for which doctors will compulsorily serve on the basis of a timetable drawn up by the self-governing regions’ offices.

“In its programme the current government clearly states that the Slovak government will maintain the availability of health care,” Tomáš Szalay from HPI told The Slovak Spectator. “Cancellation of continuous provision of the medical first aid service means that in regions with less available health care, people simply will not have a place to go for such treatment during overnight hours.”

Szalay also criticised the idea that people suffering from less-than-urgent problems should call an emergency ambulance.

“The emergency system is designed so that it provides urgent medical treatment, i.e. that an ambulance arrives within 15 minutes to treat a heart attack or similarly urgent case,” he said.
“Now we add into this system, which is already sometimes abused by people who call an ambulance when it is not necessary, the possibility to call an ambulance in less-than-urgent cases because the LSPP service does not operate.”

According to Szalay, Valocký’s proposal would make this kind of abuse standard behaviour. He pointed out that while a patient visiting an LSPP pays €2 for a visit, the service of an emergency ambulance is free of charge and also more convenient for the patient since no travel is necessary because the ambulance will come to the patient. Szalay says he believes that for these reasons the proposed revision will increase abuse of the emergency ambulance system.

Valocký also proposes in his draft to establish a fixed network of LSPP services and permits to run such services would be issued by the Health Ministry. The proposal states that when granting permissions via tenders, the ministry should take into consideration the availability of the service as well as the number of citizens in an area.

According to the ministry’s analysis the current LSPP network is too dense. The ministry wants to optimise the current LSPP network in order to have services available to patients within a radius of 45 km.

The Association of Providers of LSPP believes that changing LSPP services in the manner proposed by Valocký would increase the costs. According to it, ambulances will need to pick up patients as well as take them back home and it is also concerned that the revision will complicate the situation of medical personnel who will need to travel longer distances to serve in an LSPP. Due to low levels of night-time public transport, doctors and nurses will be forced to stay in an LSPP facility until the morning.

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