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SLÅR ALARM: Tall som Dagens Medisin har fått fra Norsk pasientregister (NPR), viser at stadig flere pasienter er blitt plassert i kø for utredning, og færre er blitt plassert i køen til behandling, i perioden 2011- 2015. Dette mener fagfolk er alarmerende. Illustrasjon: Annemette Sande

SLÅR ALARM: Tall som Dagens Medisin har fått fra Norsk pasientregister (NPR), viser at stadig flere pasienter er blitt plassert i kø for utredning, og færre er blitt plassert i køen til behandling, i perioden 2011- 2015. Dette mener fagfolk er alarmerende. Illustrasjon: Annemette Sande

Slår alarm om venteliste-rapportering

Nye tall viser at langt flere sykehushenviste pasienter registreres som «uavklarte» og får time for utredning. Slik kan de strykes fra den offisielle ventelisten selv om de ennå ikke har fått behandling. Samtidig unngår sykehusene fristbrudd.

Annons:

Ved å vurdere pasienter til «utredning», kan pasienten tas raskt inn til poliklinikk, og dermed registreres som «ventetid slutt».

«Skjuler faktisk ventetid»
Da unngår sykehuset fristbrudd – og økonomisk straff. Dersom pasienten etter dette må vente på operasjon eller annen behandling, følger det ingen juridisk frist med.

Denne ventetiden kommer ikke frem i offentlig statistikk.

Pasientene skyves inn i det som på sykehusmunne omtales som «intern kø» inne i sykehuset.

Les mer:
15.782 i intern kø – bare ved én OUS-klinikk

“Den rettigheten pasientene tror de får med seg inn, mister de idet de går ut døra fra poliklinikken. Poenget er at ingen tør å si ifra.”

- Lars Vasli, Lovisenberg sykehus

Tall som Dagens Medisin har fått fra Norsk pasientregister (NPR), viser at stadig flere pasienter er blitt plassert i kø for utredning, og færre er blitt plassert i køen til behandling, i perioden 2011- 2015.

Nå ber helseminister Bent Høie (H) Helsedirektoratet om  å finne ut av hvorfor dette har skjedd: - Vi må komme til bunns i hva utviklingen skyldes. Det får Helsedirektoratet i oppdrag å finne ut av, sier han til Dagens Medisin.


Ventelistepress?
I en kronikk skriver juss-professor Marit Halvorsen og kvalitetssjef Per Arne Holman ved Lovisenberg sykehus i Oslo at "Dagens ventelisterapportering skjuler den faktiske ventetiden".

– Dette er en bivirkning av det helsepolitiske presset om å redusere ventelistene, mener Holman og Halvorsen.

De får støtte fra blant andre Lars Vasli, klinikksjef ved Lovisenberg sykehus:

– Man lurer pasientene, ministeren og systemet. Man tror at pasientene får raskere behandling enn før, men det gjør de ikke. Det er selvsagt en del uavklarte pasienter som får hjelp ved første poliklinikkbesøk. Men for mange av pasientene er ting relativt avklart. Poenget er at alle som venter på operasjon, venter på nettopp dette. Ventetiden for pasienten er ikke slutt før vedkommende blir operert, sier Vasli, som allerede i 2013 advarte mot en slik utvikling.

«Ingen fristbrudd»
I sykehustalen i januar fortalte helseminister Bent Høie at «andelen fristbrudd er redusert med en tredel på ett år». Det klare styringsmålet til sykehusene fra helseministeren er: «Ingen fristbrudd».

– Styringsdialogen er veldig ambisiøs fordi målene skulle nås raskt; helseministeren er utålmodig. Men handlingsrommet innenfor et budsjett er begrenset, og det går tregere å snu et helsevesen enn det politikerne tror, sier Per Arne Holman.

– Når man ikke har større forståelse for dem som ikke greier å nå målene raskt nok, begynner folk å endre kodepraksis i det skjulte, tilføyer han.

«Færre har fått behandling»
– I hvilken grad vet man om det er flere eller færre som faktisk har fått behandling siden 2011?

– Ifølge NPR-tall ser vi i 2015 en vekst i både henvisninger og avslag, og det er like stor vekst i avslag som i henvisninger. Da er det ikke flere som har fått behandling. Tvert imot: Justerer man for befolkningsvekst fra 2011–2015, er det færre som har fått behandling, fastslår Holman.

Lars Vasli mener vurderingspraksisen er utbredt.

– Hva tenker du når helseministeren legger frem gode fristbrudd-tall?

– Fristbrudd-situasjonen har man jo løst enkelt: Man tar pasienten inn til poliklinikken og så er fristen innfridd. Men pasienten har ikke fått behandling. Jeg har vært på sykehus der klinikksjefen har sagt at «Nei, fristbrudd er ikke noe problem her. Vi tar dem bare inn på poliklinikken, så er fristen løst». Dette har utviklet seg til en gjennomgående praksis, sier Vasli.

– Tåkeleggende registrering

– Den rettigheten pasientene tror de får med seg inn, mister de idet de går ut døra fra poliklinikken. Poenget er at ingen tør å si ifra. Man er avhengig av goodwill opp i systemet. Vi må begynne å måle behandlingsstart også, og få med de interne køene – og måle tiden mellom første og andre kontakt, sier Vasli.

– Hvis vi kun lover at pasientene skal få starte i tide, men ikke skal ta hensyn til at de får behandlingen eller blir friske i tide, holder vi folk for narr. Da må vi slutte med denne typen tåkeleggende registreringsmetoder, sier Holman.

– Systematisk

Jan Erik Askildsen, professor i samfunnsøkonomi og leder ved Institutt for økonomi ved Universitetet i Bergen (UiB), peker på at den økende tendensen med å vurdere til utredning, er systematisk opp gjennom årene. Han vil imidlertid ikke spekulere i årsaken til dette.

– Men den politiske oppmerksomheten er rettet mot ventetiden fra henvisning til sykehuset, og ikke mot dem som står i kø innenfor sykehuset. Det er tiden du bruker på å nå fristen til det første møtepunktet man har sanksjoner for. For de videre fristene er det ingen straff eller belønning dersom man bryter eller overholder dem.

– Insentivene for sykehuset ligger i å få ned sannsynligheten for å overskride den juridiske fristen, og virker i retning at man får belønning for å oppfylle den første fristen. Dette kan gjøre det formålstjenlig å definere en pasient som uavklart – og dermed henvise til konsultasjon ved poliklinikken, sier Askildsen.

 

NPR-tallene viser:

 I 2011 ble 917.195 pasienter vurdert til utredning, mens 337.904 ble vurdert til behandling.

I 2015 er over 1,1 million pasienter vurdert til utredning – mens 163.355 ble vurdert til behandling. Dette er tall for somatikken.

I Helse Sør-Øst er situasjonen nærmest snudd på hodet de siste fem årene:

I 2011 ble 9684 pasienter vurdert til utredning og 24.355 til behandling. I 2015 ble 25.983 vurdert til utredning – og 9332 til behandling.

Kommentarer

Kontrollspørsmål for kommentarer   3 + 6 =   (legg sammen tallene for å kommentere)
Jeg godkjenner publisering av artikkelkommentaren og Dagens Medisins regler for kommentarinnlegg.


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  • Morten Svendal Hatlen 29.05.2016 18:55:25

    Dette burde ikke overraske noen. Høie pålegger sykehusene å få ned fristbruddene, men bevilger ikke nødvendige midler. Da må fristbrudd unngås på en annen måte. Ellers vanker det som kjent økonomisk straff, og det bidrar heller ikke til økt "produksjon". Dette er innlysende - og burde være det også for en statsråd med to års hotelladministrasjonsstudier.

  • Lege 2 26.05.2016 11:46:17

    Kjære "Forvirret": Du fremstår som den minst forvirrede her. Det er klart og riktig talt fra din siden. Ingen grunn til forvirring; din realitetsorientering holder; det er ledelsene som forsøker å fordreie virkelighetsoppfatningen til hele befolkningen for å få dem til å tro vi har ett godt helsevesen, jf. første kommentar fra lege. Det er selvsagt ressursmangel - i kombinasjon med rigide påbud om unyttig arbeid for helsepersonell- og - dessverre- helsepersonell og foreningene deres som ikke evner å stå samlet solidarisk på pasientenes side. fysioterapeutene i kommunene er også et klart eksempel på helsearbeidere som står feigt å ser på - og endog muliggjør kommunenes lovbrudd ved å nekte pasienter som trenger behandling, behandling, under listig retorikk og journalføring.

  • Forvirret 26.05.2016 11:40:56

    Dette er jo intet nytt under solen, identiske avsløringer kom for flere år siden. Problemet er, etter mitt syn, at det stilles flere og flere krav til helsevesenet uten at det medfølger nødvendige stillinger eller endringer på andre områder. Samlet sett har en lykkes med å systematisk insentivere juks med tallmaterialet som i neste runde skal være premissgivende for videre utvikling av helsevesenet... skremmende.

  • Per 26.05.2016 11:23:45

    Nå har jo styrelederen i OUS vært direktør på et annet stort sykehus her i landet . Om den arbeidsmetoden har blitt brukt der og viderført til OUS er det jo skremmende.

  • Lege 26.05.2016 11:08:22

    Oppdraget for styreledere og direktører i Helsefoetakene er å rapportere fine tall på alle målinger som NPM-systemet krever. Da må en finne tall som er pene, og overse de som ikke er så pene. Lite nytt i dette, annet enn at det blir offentlig kjent.

  • Terje 26.05.2016 10:56:05

    Om Styreleder ved OUS har holdt dette skjult for tre helsministere eller nåværende og tidlegere helsministerene har vist om dette uten og sette inn tiltak da er dette meget alvorlig og en høring må vurderes

  • Lege 26.05.2016 00:52:58

    Jovisst tilsløres realitetene. Det er bl.a. altfor lange tidsintervaller mellom kontrollene som pasientene skal ha, ved poliklinkker, f.eks. for endokrinologiske tilstander, f.eks. diabetes. Legene sliter med at det ikke er kapasitet til å følge opp pasientene så hyppig som de burde, og dette avsløres jo ikke - med mindre legene sier ifra. Da blir det dysset ned. Nyhenviste pasienter prioriteres for at tallene ikke skal bli synlige. Jukset gjelder ikke bare i sykehus, men også i primærhelsetjenesten hos fysioterapeutene med driftstilskudd; de nekter pasienter med behandlingsbehov å stå i kø, nedtoner behandlingsbehov i rapportene, avslutter pasienter som kunne ha effekt av mer behandling. Hvor blir det av tallene for de usynlige pasientene som aldri kommer inn i køene?

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