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Sveikata: negi kyšiai mieli?

Prieš savaitę plačiai nuskambėjo, kaip aš neva tiesiog imu ir siūlau įteisinti priemokas sveikatos sistemoje. Į tai gana skausmingai sureagavo ir Sveikatos ministras, pasiūlęs man nesikišti į jo daržą.

Kadangi žiniasklaida ne visada būna veidrodis be iškraipymų, tai jaučiu pareigą detalizuoti tam tikrus viešumoje pasirodžius teiginius ar netgi juos patikslinti, grąžinant tą prasmę ir kontekstą, kuris ir buvo mano realiai nuskambėjusiuose, o ne cituojamuose teiginiuose.

Mano rūpestis - kad būtų realiai pradėta kovoti su korupcija (apie tai jau rašiau).

Sveikatos sritis - viena iš šešių korupcijos paveiktų arba korupcijai jautrių sričių. Tad prieš pradėdami diskusiją dėl priemonių korupcijai pažaboti tinkamumo atsakykime sau į kelis klausimus:

  • Kaip mes vertiname faktą, kad apklausoje penktadalis Lietuvos gyventojų pasakė, kad pernai davė kyšį sveikatos sistemoje?
  • Kaip mes vertiname faktą, kad analogišką darbą dirbantys gydytojai privačiame ir valdiškame sektoriuje neretai gauna atlyginimą, kuris skiriasi kelis kartus? Ir kodėl net geriausi specialistai nebūtinai pabėga į privačią sveikatos priežiūros įstaigą?
  • Koks yra pirmas ir pagrindinis klausimas palatos draugams tik patekus į ligoninę?
  • Ką labiau šiandien skriaudžia dabartinė sistema - žmones, kurie turi daug socialinių ryšių ir yra gerai gydomi „po blatu”, ar tuos, kurie tokių ryšių neturi ir į dideles ligonines su didelėm bėdom atvyksta, pavyzdžiui, iš nedidelių miestelių.

Dar kartą noriu pabrėžti, kad sveikatos srityje (kaip ir kitose penkiose srityse) korupcijos nepastebėti neįmanoma.

Ši  sritis turi savo specifiką ir todėl priemones kovai su korupcija turi pasiūlyti atitinkamas ministras. Aš, kaip koordinuojantis rengiamą kovos su korupcija planą netoleruosiu tik vieno - butaforinių priemonių ir iliuzinės kovos.

O kalbant apie priemokas - prisegu savo atsakymus portalui ekspertai.eu, kurie iškėlė skaudžius klausimus.

1. Ar Konstitucijos 53 straipsnis įtvirtina savo piliečių nemokamą gydymą?
Konstitucijos 53 straipsnis nustato, kad Valstybė laiduoja žmogui pagalbą susirgus, ir įpareigoja tokios pagalbos teikimo tvarką nustatyti įstatymu. Tai reiškia, kad valstybė turi nustatyti kas yra medicininė pagalba, o kas ne, kada, kokiomis sąlygomis nemokamos pagalbos laidavimas turi būti realizuojamas. Pavyzdžiui, ar visiems apmokama brangi plastinės chirurgijos pagalba nusprendus, tarkime, šiaip pasigrąžinti, o ne likviduoti traumos padarinius. Arba, ar visiems reikia apmokėti visas brangias psichoterapijos paslaugas. Arba, ar valstybė turi apmokėti lyties keitimo operacijų sąnaudas. Mano manymu, Konstitucija kalba apie tai, kad kritiniu atveju nei vienas neturi būti paliktas be būtinos medicinos pagalbos, kai visuomenėje yra realios galimybės ją suteikti. Tačiau Konstitucija neįpareigoja visuomenės sąskaita gydyti tų, kurie sąmoningai savo veiksmais sukelia neigiamas pasekmes savo sveikatai, pavyzdžiui, rūkydami arba vartodami alkoholį, nei finansuoti, pvz., lyties keitimo operacijų ir pan. Kaip elgtis mažiau akivaizdžiais atvejais - be abejo yra išsamesnės diskusijos reikalas, o galiausiai tai yra Sveikatos apsaugos ministerijos atsakomybė, ką visada labai aiškiai pabrėžiu.

Taip pat pažymėčiau, kad spręsti priemokų klausimą yra numatoma ir 2010 - 2015 metų Sveikatos sistemos plėtros plano projekte.

2. Kuo remiantis buvo apskaičiuoti ir nustatyti reikalingi nemokamam gydymui PSD įmokų dydžiai?
Į šį klausimą gali atsakyti Sveikatos apsaugos ministras ar ministerijos darbuotojai.

3. Kokių įstatymų pagrindu yra įvedamos mokamos gydymo paslaugos, t.y. kokius teisės principus įgyvendinant, įvedamos mokamos paslaugos. Bendras Konstitucijos įtvirtintas principas - laiduojamas gydymas, o nemokamą gydymo teikimo tvarką nustato įstatymai. Kodėl Konstitucija neįpareigoja kurti mokamo gydymo įstatymų?
Mokamos paslaugos privačiose, o atskirais atvejais ir valstybinėse įstaigose, turi teisę egzistuoti Civilinio kodekso pagrindu, ir tai išplaukia iš sutarčių laisvės principo bei Konstitucijos 46 straipsnyje įtvirtinto ūkinės veiklos laisvės ir iniciatyvos principo, o taip pat Jūsų minėto Konstitucijos straipsnio nuostata, kad valstybė rūpinasi žmonių sveikata. Iš to išplaukia vienareikšmė nuostata, kad mokamos paslaugos sveikatoje negali būti uždraustos.

4. Kiek per 2010 metus surinkta PSD?
Į šį klausimą gali atsakyti Sveikatos apsaugos ministras ar ministerijos darbuotojai.

5. Koks 2010 metais buvo PSD surinkimo planas ir kokie lėšų nemokamam gydymui poreikiai buvo 2010 metais?
Į šį klausimą gali atsakyti Sveikatos apsaugos ministras ar ministerijos darbuotojai.

6. Prašome Teisingumo ministro patikslinti, ką jis turėjo omenyje, sakydamas, kad “žmogus turi jaustis gerai ir bendrosios praktikos srityje”?
Aš tokio teiginio nesu sakęs. Žiniasklaidoje mano pozicija dėl kovos su korupcija sveikatos srityje daug kur buvo pateikta ištraukiant teiginius iš konteksto. Kalbant apie šį konkretų teiginį - jis apskritai yra ne mano teiginys ir man lygiai taip pat nesuprantamas. Beje, kalbėdamas apie problemas ir sprendimus, kaip tik sakiau, kad pas bendrosios praktikos gydytoją patenkantis pacientas labiau suvokia, kad nuo paciento pasirinkimo priklauso ir gydytojo atlyginimas bei gerovė, todėl paskatos korupcijai čia yra mažesnės, nei pacientui lankantis pas specialistą. Taip pat atkreipiau dėmesį, kad tai buvo įmanoma pasiekti ir neįvedant priemokų, todėl atitinkamą patirtį siūlau plėsti, o kaip konkrečiai, be abejo turėtų pasakyti Sveikatos apsaugos ministras.

7. Ar Teisingumo ministras diskutuojantis su Sveikatos apsaugos ministru dėl papildomų priemokų įvedimų sveikatos apsaugos srityje jau yra paruošęs pateikti Seimui Konstitucijos 53 straipsnio pataisą “dėl dalinai mokamo gydymo principo valstybinėse gydymo įstaigose įtvirtinimo”?
Kaip minėjau, nemanau, kad priemokų tam tikrose srityse egzistavimui būtinas Konstitucijos keitimas, todėl ir nematau poreikio jų siūlyti. Kita vertus, manau, kad dabartinė situacija reikalauja realių pokyčių, nes nepateisinama yra situacija, kai kas penktas Lietuvos gyventojas per metus yra priverstas duoti kyšį tam, kad gautų geresnę sveikatinimo paslaugą, arba ją gautų greičiau.

Prie atsakymų dar pridurčiau, kad, kaip jau buvo minėta, pagal Konstitucijos 53 straipsnį valstybė privalo rūpintis žmonių sveikata ir laiduoti medicinos pagalbą bei paslaugas žmogui susirgus. Nemokama medicinos pagalba valstybinėse gydymo įstaigose, kurios teikimo tvarką privalu nustatyti įstatymu, tėra viena iš tokios pagalbos teikimo formų.

Atkreipčiau dėmesį į tai, kad 53 straipsnyje neveltui nurodyta pareiga įstatymu įtvirtinti nemokamą gydymą nurodant tik vieną paslaugų teikėją - valstybines gydymo įstaigas. Tai nereiškia nei to, kad sveikatos paslaugas gali teikti tik valstybinės įstaigos, nei to, kad valstybinės įstaigos turi teikti tik nemokamą medicininę pagalbą, nei to, kad nemokamą medicininę pagalbą gali teikti tik valstybinės įstaigos, nei to, kad sveikatos paslaugos gali būti tik nemokamos.

Taip pat noriu aiškiai pabrėžti, kad nemanau nei, kad korupcijos visas problemas išspręs priemokos, nei, kad jas reikia įteisinti visur, kur įmanoma.

Tiesiog reikia pasiekti, kad žmonės galėtų legaliai gauti geras sveikatinimo paslaugas. Kai kuriais (!) atvejais priemokos tam neišvengiamos. Kažin ar būtų buvę įmanoma išgyvendinti priemokas už geresnę palatą, kai visas palatas paversti geromis pinigų nėra, o galimybės legaliai susimokėti už komfortą irgi nėra?

Žinau viena, kad Lietuvos žmonėms dabartinė sistema nėra nei priimtina, nei patogi. O gal kam nors visgi yra?

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komentarai (200) | “Sveikata: negi kyšiai mieli?”

  1.   romualdas rašo:

    Imponuoja autoriaus racionalus požiūris į svarstomą temą. Manau,su nuomone,kad sveikatinimo įstaigose egzistuoja šiurpinančiai išsikerojusi,pastoviai tobulinama ir besiplečianti tiek savo dydžiu,tiek apimtimi kyšių sistema gali nesutikti tam tikra kategorija žmonių.Pirmiausia,tai matyt,visiški daunai.Antra,didesnioji dalis kyšius gaunančiųjų(beje jų tūkstančiai ir dauguma riebūs katinai).Trečia,be abejonės, sveikatos miniseris ir gydytojų asociacijų bei sąjungų vadai su savo palydomis.Vieni gindami mundurą,kiti tiek “užlobuoti”,kad kitaip kalbėti tiesiog negali.Ketvirta,vienetai,kuriems per visą gyvenimą neteko savęs ar artimųjų pas gydytojus tempti.Likusieji ta sistema dalinai šlykštisi,dalinai ją pastoviai maitina ne tiek savo noru,bet dėl netobulai veikiančio kūno, tapdami tos sistemos dalimi.
    Bet būtų nuostabu,jeigu tokia hidra būtų įveikta ir daktarai bei pacientai galėtų bedrauti kaip save gerbiantys žmonės be pakišų ne tik į chalato kišenę bet ir į sąžinę.
    Visokeriopos sėkmės nelenvam kely.

  2.   Lenin rašo:

    Pritariu, kad problema egzistuoja.
    Nesutinku, kad Teisingumo ministro pateiktas vienas iš sprendimo būdų yra pats tinkiamiausias, tačiau tik diskutuojant ir analizuojant įvairius pasiūlymus galima rasti tą tinkantį variantą, nes jis iš pirmo žvilgsnio gali būti net nepastebėtas. Tik analizuojant įvairius variantus ir modelius galima pamatyti teigiamas ir neigiamas puses, nes esant tik vienam variantui, poziuris į problemą iš anksto yra ribotas.

  3.   tomas rašo:

    Truputi ne tema bet… Yra niekam tikus supuvus sistema ir vietoj to, kad padaryti gerai, bandom ją ramstyti kažkokiomis priemokomis. Puikiai matom, kaip gerai veikia privalomojo vairuotoju draudimo sistema. Kodėl to paties nepadarius ir su sveikatos apsaugos sistema. Dabar pradėjus kurti sveikatos privalomojo draudimo įstatymą, po metu paleidus, dar po trijų metų turėtume sveiką, konkurencingą, skaidrią, sistemą. Žinoma tai reikėjo padaryti prirėš 20 na gerai prieš 10 metų.

  4.   Remigijus Šimašius rašo:

    Tomai,

    visi6kai su Tavimi sutinku. Tačiau tam, kad atsirastų normali sistema, reikalingi normalūs jai pamatai. Tam kad būtų ką veikti sistemoje draudimui, būtina žinoti sveikatinimo paslaugų kainas ir sąlygas, kada suteikiamos sveikatinimo paslaugos. Kai žinai kainas (realias), ir žinai kiek realiai jos padengia valstybė (nuo 0 iki 100 proc.), tai skirtumas tampa akivaizdus. Va tada, akd nereiktų priemokos, draudimas yra didelė galimybė.

  5.   Silvestras rašo:

    1. Kaip autorius pakomentuotų argumentą dėl to, jog tai “ne jo daržas” ?
    2. Ar įsivaizduojate situaciją, kai pvz. kultūros ministras viešai aiškintų, kaip žemės ūkio ar energetiokos srityje ?

  6.   tomas rašo:

    Tikrai kad ne mūsų daržas, na bet dar pora diletanto pastebėjimų.

    “sveikatinimo paslaugų kainas”
    Pabandykite gauti kokia nors paslaugą be šeimos gydytojo siuntimo, va ir žinom kainą.

    “ir sąlygas, kada suteikiamos sveikatinimo paslaugos.”
    Šeimos gydytojas sprendžia kokiomis sąlygomis reikalingos man šios paslaugos ar ne.

  7.   Medikas rašo:

    Pilnai pritariu gerb. R. Šimašiui visais jo pasisakomais klausimais. Tai mano manymu pats protingiausias ir sąžiningiausias šios vyriausybės ministras. Todėl norėčiau jam, kaip vadovaujančiam teisėtvarkai ministrui, pasiūlyti, kad jis inicijuotų vyriausybėje ar seime įstatymą, jog ligoninių direktoriai turi būti renkami konkurso tvarka 4 metų kadencijai. Tai labai ryškiai padidintų ligoninių veiklos efektyvumą ir sumažintų korupciją ligoninių direktorių lygyje. Kur tai matyta, kad prezidentą renkame kas 5 metai, seimą kas 4 metai, o ligoninių direktoriai karaliauja ligoninėse kaip savo kunigaikštystėse iki gyvos galvos? Ši aplinkybė labai palaiko korupciją medicinoje. Direktoriai susistato sau parankius gydytojus į vadovaujančius postus, skyrių vedėjus (kaip taisyklė, tikrai ne pačius geriausius, o subinlaižius), kas sukelia baisią stagnaciją tiek medicinos paslaugų kokybės progresavime, tiek ir medicinos mokslo vystymęsi, tiek ir būsimų gydytojų ruošime (medicinos studijose). Tai tikrai nenormalus reiškinys, kurį reikia kuo greičiau likviduoti. Visi postai medicinoje ir ligoninėse turi būti su kadencijomis ir skaidriais rinkimais į juos, pradedant nuo ligoninių direktorių ir baigiant skyrių vedėjais. Kol nebus įgyvendinta ši nuostata (beje, kurios įgyvendinimas nieko nekainuoja ir ją galima tuoj pat įgyvendinti), tol visos kalbos apie kovą su korupcija medicinoje yra tik blefas. Nes ši aplinkybė yra viena iš pagrindinių, palaikančių medicinoje ir baisią stagnaciją ir korupciją.

  8.   Remigijus Šimašius rašo:

    Gerbiamas Medike,

    ačiū už komentarą ir pasiūlymus.

    Gerbiamas Silvestrai,

    savo blogo įrašu dalinai ir mėginau pasakyti kiek tai mano daržas. Sveikata - tikrai ne mano (išskyrus tai, kad esu Vyriausybės narys, galiausiai, pilietis, ir negaliu tylėti), tačiau esu atsakingas už adekvačios kovos su korupcija programos parengimą.

  9.   Anonimas rašo:

    Aš sutinku duoti gydytojams ir duodu, nes jie neuždirba tiek, kiek turėtų, bet man nepatinka duoti tiesiogiai. Aš norėčiau įmesti į aukų dėžutę, o tada visas pamainos kolektyvas tegul dalinasi.
    Reikia uždrausti imti tiesiogiai, o reikia mesti į aukų dėžutes ar sugalvoti kokią kitą aukų ar balų sistemą.

  10.   Gabriel Leonard rašo:

    Nice blog, thanks! I really love it.

  11.   hadrian rašo:

    Man liko neaiškus konstitucinės garantijos į nemokamą gydymą bei PSD suderinamumas. Dalis apie pirmo būtinumo medicinines paslaugas vs kosmetines - aiški ir suprantama. Dalis apie mokamų medicininių paslaugų kūrimo teisėtumą - taip pat aiški ir suprantama.

    Neaišku štai kas: konstitucija garantuoja nemokamą gydymą, tuo tarpu PSD yra privalomas? Negalime nemokamomis vadinti paslaugų, už kurias privalome mokėti - net jei jų nenaudojame! Jei parduotuvė reklamuotų nemokamus saldainius, tačiau juos gautume tik sumokėję įėjimo mokestį (plius mokestis būtų privalomas, net jei saldainių nenorėtume), akivaizdu, tokią reklamą laikytume apgaulinga?

    Ar aš kažka praleidau?

  12.   arturas rašo:

    nieko kito is laisvos rinkos instituto statytinio ir nesitikejau, mazdaug iveskim priemokas o rinka pati susireguliuos. kas penktas duoda kisi? gerai bet likusieji neduoda, tai kodel mazuma turi diktuoti salygas? o uz kysio davima yra baudziama. paziurekim gera pvz policijoje lygiai ta pati situacija ale mazi atlyginimai, bet susireguliavo, kai pradejo istikruju bausti o ne ziureti pro pirstus ar siulyti iteisinti kysio davima policininkui.

  13.   arturas rašo:

    ar jau daktarai tapo barmenais kuriems turi palikti arbatpinigiu? apskritai piniginiu santykiu neturetu buti kur ju neturetu buti, jeigu jau karta susimokejai (mokesciu pavidalu) tai veliau tai skaitosi permoka, as pvz kaip dauguma ar mazuma, koks skirtumas kysio nedaviau ir nieko dar gyvas kaip matot.
    siulau teisesaugau ne sedeti uzmerkus akis o dirbti kai bus pagauti keletas kysiu davusiu ir tai paviesinti, kad kitiems butu pamoka.

  14.   arturas rašo:

    teisingumo ministras jauciu veikti neturi ka tai ir piarinasi kur tik gali. verslo salygas jau pagerino kabutese, tai dabar sveikata sutvarkys. darbstuolis tas musu ministras, kad taip dar tokius i ji panasius tris ar keturis, ziurek ir eura isivesim,..

  15.   romualdas rašo:

    Artūrai,kai baigsi gimnaziją ir bresi gali tekti dažniau bendrauti su daktarais ir ne tik patepant mėlynę atsiradusią nukritus nuo dviračio,o ten žiūrėk ir požiūris į juos pasikeis.

  16.   romualdas rašo:

    Anonimui.Darbštūs,gabūs ir verslūs daktarai uždirba iki keliasdešimt tūkstančių per mėnesį.Daktarai-amatininkai,nevykėliai ir šundaktariai(žinia,ne be jų pasaulis),kelis arba keliolika kartų mažiau.Todėl per daug nesuniveliuokime.Kita vertus,pirmųjų atlygis mūsų skurdžiai visuomenei,manyčiau, yra pakankamai solidus.

  17.   Remigijus Šimašius rašo:

    Gerbiamieji, jeigu nebus įteisintos priemokos varguoliams, sveikatos sistemoje, ketinu pasielgti principingai ir atsistatydinti.

  18.   yurgis rašo:

    Kaip žinia,Lietuvoje 80 procentų piliečių nesuduria finansinių galų.Kaina rinkoje nėra kažkoks pastovus dydis.Kaip yra NT burbulai,taip bus ir medicininių paslaugų burbulai.Ponas Šimašius turėtų žinoti,kad tai yra dėsnis.Pasekmės bus katastrofiškos,ką matome jau dabar.Daugybė žmonių net nesikreipia į medicinos įstaigas dėl lėšų stokos.Nenuvalyti šaligatviai smūgiuoja per ligonių kasų ir sodros biudžetą,nors atrodo,kad mokame didžiulius pinigus už kelių,kiemų ir šaligatvių priežiūrą?KOdėl mano mokamas PVM mokestis nepakliūna į ligonių kasas ir būtinai reikia įvesti dar ir PSD duoklę?Kodėl mano mokamo akcizo neužtenka šaligatvių valymui?Problema juk ne dar viename mokestyje,o valdžios žmonių galvose.Nereikia vogti ir užteks viskam.

  19.   yurgis rašo:

    Ponas Remigijus Šimašius tikriausiai apsimeta nežinąs,kad 14 milijardų biudžeto įplaukų ir sumoka varguoliai.Tik 1 mlrd. sumoka turtuoliai.Neaišku,kokia logika vadovaujantis, varguolius dar reiktų apmokestinti?Kad sviestas būtų dar labiau sviestuotas:)?

  20.   Medikas rašo:

    Gerb. R. Šimašiui,
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  23.   yurgis rašo:

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  24.   Gintaras rašo:

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  26.   Remigijus Šimašius rašo:

    Gerbiamas yurgi,

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  27.   yurgis rašo:

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  28.   Gintaras rašo:

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