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DN Debate. Only if the state takes responsibility for care can queues be cut

International comparisons show that Swedish health care is of good quality and in several areas, results that are among the best in the world. The worse the availability in Sweden is also confirmed in several studies. The long waiting times are not a new phenomenon but a problem that is accentuated in the last five years. Then, in 2014, the number of patients who waited more than 90 days on a visit to a specialist or surgery/treatment almost doubled, from 61 000 to 111 000.

We are convinced that it is basically a capacity problem. Sweden used the 2016 11.0 per cent of GDP to health care, a higher proportion than in the other nordic countries. Several countries where health care is using a smaller percentage of GDP than Sweden for medical care shows a better availability, such as the Netherlands, Norway and the united kingdom. Läkartätheten in Sweden is among the highest in the world and has increased by 20 percent in ten years. However, the number of nurses is relatively low. In a comparison a few years ago showed the emergency hospitals in Sweden a consistently lower productivity than hospitals in neighboring countries.

When the surgeons have, on average, elective surgery of 5-6 hours per week and specialist uses less than a third of their working hours to meet the patient is a system failure.

resource depletion is not the cause of the current kösituationen?

In the report, ”Variable while waiting for medical care” in 2015, it is concluded that the waiting times can be shortened through more efficient use of available resources such as better working practices and more effective rapidly. Not so much specific help, perhaps. A national action plan based on the existing experience should be designed and include the following:

must the number of set visits and surgeries can be reduced. According to the Swedish association of local authorities and regions, SKL, was 20 000 operations in during 2017. The figure can be compared with that in Sweden there are about 41 000 who waited more than 90 days in operation. Reasons were, among others, lack of pre-planning, disruption due to urgent arising needs, lack of specialised skills and that the patient will not/set up with short notice (about 3 000 cases per year). Capio S:t Görans hospital in Stockholm carried out in 2017, about 7 000 planned operations, and only 24 patients did not materialize! In several reports on the operational development, the number of missed visits has been reduced significantly with simple means: the Patient may book their time and then receive an sms reminder the day before the visit.

the it systems that support the care needs to be created. These should by its structure and availability save time, instead of in the day to steal time from health professionals.

The digital solutions can also be further developed by visits/checks more frequently handled through digital communication instead of physical meetings. This has the potential to be medically safer than the current trend with förstakontakter with a ”nätdoktor” without previous patientkännedom.

Further, the specialized labor be used to the tasks only it can perform. When the surgeons have, on average, elective surgery of 5-6 hours per week and specialist uses less than a third of their working hours to meet the patients there is a system error, which should be manageable.

It is also important to ensure that a sufficiently high level of expertise is used at the front of the chain. In emergency medical care decisions with far-reaching impact on how resources, including the beds used. These decisions are made usually run by doctors in training. All of the analyses show that the period of care, emergency as well as planned, with the right initialization improved. At the same time reduces the risk of handläggningsfel committed.

must the care be restructured so that acute and elective care be separated. The planned treatment is disrupted to a significant degree of urgent care needs are given priority. With a breakdown of the specialist care at acute hospitals and production-oriented hospitals without the acute care achieved several advantages. The production can detaljplaneras and implemented without interference from the emergency medical services. Experiences from public. hospitals and private Capio Lundby hospital in Gothenburg shows that the planned volumes and quality can be achieved.

the System with the regions/county councils and municipalities that are customers/clients of the care in which they themselves are the performers, are able to handle the cost management and production monitoring in such a complex field as modern health care. A client with real competency ensures that contractual agreements are adhered to and that remuneration is only given for completed performance. Ordering and utförarrollerna must be separated. This provides opportunities for the development of adequate client competence based on the knowledge of the medical needs and opportunities as well as insight into economic conditions.

possible way to accomplish the above is to give the state responsibility as a financier and a client of all care. This gives you the opportunity to meet sjukvårdslagens requirements on fair access to healthcare for all. Regions and municipalities with very diverse conditions in the population structure lack the ability to accomplish this. By giving regions and municipalities the pure utförarroll transferred responsibility for the availability of health care to the national level. Only then is the opportunity to take responsibility for the equal right of everyone to health care.

the Client state can both develop care's overall structure and determine how the care is divided between public and private providers, for example through the opening.

the efficiency measures that reduces the set of care and ensures that specialized expertise is used in the right way be taken now. Within the framework of a national plan of action should Sverigegemensamma, vårdstödjande it systems are created, acute and elective care are separated and the state be made to the client and to the funder of all samhällsfinansierad care. The current Swedish health care is designed to have and maintain queues. Kömiljarden does not solve the underlying problem. With the state the main responsibility can the required changes be implemented. But to implement this requires political courage.

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