2024-04-27 06:47:48
According to the assessment of the State Sickness Fund (VLK), a nurse can provide nursing services at home to a maximum of 12 patients per day. It is physically impossible to clap anymore. However, judging by the papers, they put on a superman suit and perform miracles.
“You can imagine, 50-60 patients are visited by one nurse per day, in a dozen institutions here it is almost not the norm. The record is 260. It is indicated that one nurse provided so many services at home,” Antanas Matulas, chairman of the Seimas Health Affairs Committee, told the “Question of the Day” program of “Žiniai Radio”.
“They are trying to make money,” the politician stated.
He added that the PSDF budget is maliciously siphoning funds for supposedly provided dental services, such as dentures.
It is not known how much money is embezzled
VLK found that medical institutions from the Compulsory Health Insurance Fund (PSDF) in 2023. illegally used more than 635 thousand euros.
According to A. Matul, this can only be the tip of the iceberg. Last year, VLK performed more than 900 inspections.
“This is less than 1 percent. services. The health fund has no more technical capabilities,” said A. Matulas.
The President of the Lithuanian Medical Movement (LMS) Auristina Garliakienė noticed that not only private but also state medical institutions are abusive.
“I hear a trend that private institutions should be responsible for everything that is wrong in the health system. As if it is a scapegoat. I would think that the reasons are not there at all.
When the reform of nursing services was being created, the payment was increased from 50 to 100 thousand. services. Someone was very happy, but it must be remembered that we have a limited number of nurses and they have not increased.
The increased amount of services creates a precedent for providing them in whatever quantities you want (…) This should require the intervention of the prosecutor’s office and a deeper investigation. Those thousands and millions would turn into other numbers”, guessed A. Gerliakienė.
According to A.Matulo, the ministry should not be blamed for allegedly making assumptions to steal.
“Patient organizations requested that it is not enough to come once a day. Therefore, the amount of services was increased. In order for a person to be comfortable, as in Scandinavia, he should not be hospitalized.
But that doesn’t mean you have to start stealing. If you cannot provide services, then do not write that you provide services to the patient. In the work schedule, it is written that the nurse does not work that day, and the medical institution submits for payment that she provided 200 services per day.
It is very good that we are expanding the services, but it must be said that we did not control their provision”, A. Matulas admitted.
Institutions “forced” to compensate?
Vilnius University lecturer, former Deputy Minister of Health Živilė Simonaitytė noticed that abuse of institutions is not surprising.
“Imagine you’re walking down the street and you find a lost wallet on the ground. Let’s think about what percentage of people would take cash, and how many people would look for its owner based on the documents in the wallet”, Ž.Simonaitytė gave an example.
However, she added that the service rates are not sufficient, “severely unrealistic”. This is evidenced by the fact that 70-80 percent the price of the service consists of remuneration for doctors.
“It is necessary to maintain the buildings, and to have medical equipment, and to provide medicine for the service. Is it the fact that the rates are too low and do not force us to act in such a way that it would be possible to provide at least some service by doubling or tripling it”, wondered Ž.Simonaitytė.
Avoided more than 3 million EUR damage
VLK, which carried out inspections of medical institutions, announced that patients were illegally charged premiums for services they should receive with PSDF funds. This is especially true for day inpatient and day surgery services.
For example, in the activity area of the Vilnius International Airport in 2023 the percentage of services with patient premiums in private medical institutions providing day inpatient services is 42 percent. (compared to public medical institutions – 0.5 percent); providing day surgery services – 49 percent. (compared to 5.5% in public medical institutions), but in some private medical institutions it exceeds 90%, sometimes reaching even 97%.
Last year, during scheduled control procedures at the ILC, it was found that patients unjustifiably paid more than 39,000 PLN to health care institutions that provided services paid for by the PSDF. euros.
The highest number of illegal premiums was found in the provision of day surgery services. Also, patients paid unreasonably when medical specialist consultations, inpatient services, nursing and supportive treatment services, transportation services, etc. were provided. Sickness funds are responsible for ensuring that PSDF funds, which are used to pay medical institutions for services provided, pharmacies for issued compensatory drugs, and other economic entities for various medical instruments and devices, are used legally, transparently and efficiently.
Therefore, checks are carried out every year to see if health care service providers, doctors and pharmacists comply with the established requirements, if they do not comply with them – they determine the amount of illegally used funds, which the medical institutions must return. The contracts of all medical institutions with the ILC include the institution’s obligations to compensate PSDF damage, if any.
Continuous monitoring of business entities and prevention of possible violations gives good results – thanks to the consistent counseling of medical institutions, pharmacies, opticians and other business entities and monitoring of their activities by sick funds, more than 3 million were avoided last year. EUR damage to the PSDF, but the available means do not always achieve the desired effect. Seeing the increasing number of non-compliances and violations every year, VLK advocates the improvement of legal regulation.
2024-04-27 06:47:48