Dr. Erik Brecelj za GOVSI podkast: Hočem živeti v državi, kjer je zdravstvo dostopno vsem

Dr. Erik Brecelj za GOVSI podkast:  Hočem živeti v državi, kjer je zdravstvo dostopno vsem

V 22. epizodi podkasta Gov.si, ki ga pripravlja Urad Vlade RS za komuniciranje, je voditeljica Petra Bezjak Cirman gostila dr. Erika Breclja, kirurga na Onkološkem inštitutu in vodjo Strateškega sveta za zdravstvo. V pogovoru sta osvetlila ključne izzive in reforme slovenskega zdravstvenega sistema ter vlogo strateškega sveta kot posvetovalnega telesa pri predsedniku vlade.

Osrednja tema je bila novela Zakona o zdravstveni dejavnosti, ki prinaša pomembne spremembe, med drugim vzpostavitev regijskega modela in jasnejšo razmejitev med javnim in zasebnim zdravstvom. Dr. Brecelj je dejal, da je pri vodenju strateškega sveta spoznal, kako se »praktično vse probleme da rešiti – za nekatere potrebujemo leta, druge pa lahko izboljšamo v nekaj tednih«. Poudaril je tudi, da se ob sprejeti noveli zakona o zdravstveni dejavnosti preveč izpostavlja ločitev javnega in zasebnega, čeprav zakon vsebuje številne rešitve, ki so že desetletja čakale na uresničitev.

Posebej je izpostavil pomen ohranjanja dostopnega in kakovostnega javnega zdravstva, ki ga ne smemo jemati za samoumevnega. »Hočem živeti v državi, kjer je zdravstvo dostopno vsem – revnim in bogatim – in kjer ni treba iz žepa plačevati storitev,« je poudaril. Ob tem pa opozoril na nevarnosti modelov, ki temeljijo na komercializaciji zdravstva in pogosto puščajo najranljivejše brez ustrezne oskrbe.

Epizoda ponuja vpogled v delovanje zdravstvene politike v praksi, premislek o dolgoročnih sistemskih rešitvah ter navdihujočo osebno predanost poklicnemu poslanstvu.

Epizoda je na voljo na vseh večjih platformah za podkaste in na gov.si.

[ENGLISH VERSION] 

Dr. Erik Brecelj on the GOVSI Podcast: "I want to live in a country where healthcare is accessible to everyone"

In the 22nd episode of the Gov.si podcast, produced by the Slovenian Government Communication Office, host Petra Bezjak Cirman welcomed Dr. Erik Brecelj, a surgeon at the Institute of Oncology Ljubljana and Chair of the Strategic Council for Healthcare. Their conversation shed light on the key challenges and reforms in Slovenia’s healthcare system, as well as the role of the strategic council as an advisory body to the Prime Minister.

The central topic of discussion was the amendment to the Healthcare Services Act, which introduces important changes such as the establishment of a regional healthcare model and a clearer distinction between public and private healthcare. Dr. Brecelj noted that, through leading the strategic council, he had come to realise that “virtually all problems can be solved – some take years, others can be improved in a matter of weeks.” He emphasised that too much attention has been given to the public-private divide, while the act actually contains numerous long-overdue solutions.

He particularly stressed the importance of preserving accessible and high-quality public healthcare, warning that it should never be taken for granted. “I want to live in a country where healthcare is accessible to everyone – rich and poor – and where people don’t have to pay for services out of pocket,” he said. He also warned about the risks of commercialised healthcare models, which often leave the most vulnerable without proper care.

The episode offers a real-world insight into how healthcare policy is shaped and implemented, a reflection on long-term systemic solutions, and an inspiring look at personal dedication to the mission of public service.

Transcript

Vladni podkast GOVSI

Voditeljica Petra Bezjak Cirman: Dober dan in dobrodošli v 22. epizodi podkasta Gov.si, ki ga pripravljamo na Uradu Vlade Republike Slovenije za komuniciranje. Z vami sem Petra Bezjak Cirman, podkast pa lahko spremljate na vseh kanalih, kjer spremljate podkaste, in se nanj tudi naročite, da ga nikoli ne zamudite. Z mano je danes vodja strateškega sveta za zdravstvo, sicer pa v javnosti znan kot velik borec proti korupciji v zdravstvu, dr. Erik Brecelj. Dober dan.

Gost dr. Erik Brecelj: Pozdravljeni.

Voditeljica: Govorila bova o trenutno eni izmed najbolj vročih tem v Sloveniji, to je o razmejitvi zdravstva na javno in zasebno, sprejeti noveli Zakona o zdravstveni dejavnosti in ostalih spremembah, ki jih vlada sprejema za izboljšanje zdravstvenega sistema. Že od leta 2006 kot zdravnik opozarjate na težave, javnost pa vas pozna kot neposrednega sogovornika brez dlake na jeziku, zatorej brez dlake na jeziku. V kakšnem stanju je trenutno slovensko zdravstvo?

Gost: Ni tako slabo, kot se trudijo nekateri prikazati. Vse države imajo težave z zdravstvenim sistemom, ki je vedno dražji, vedno več ljudi zahteva. V Sloveniji ni tako slabo. Predvsem pa je važno, da se ne slabša, da se ne sesuva, kar si nekateri želijo, ampak da napreduje. To pa mislim, da je na tem.

Voditeljica: Ste tudi vodja strateškega sveta za zdravstvo. To je posvetovalno telo predsednika vlade, ki obravnava ključna vprašanja zdravstvene politike v Sloveniji, kot so čakalne dobe, regionalizacija zdravstvenega sistema in zakonodajne spremembe. Se je zdaj, ko vodite tak svet, vaša percepcija zdravstvenega sistema na eni strani in dela ministrstva za zdravje in vlade na drugi strani kaj spremenila?

Gost: Zelo. Prišel sem samo s tistim splošnim vedenjem, da se nič ne da spremeniti, da je nemogoče, da se ne da, da ne vem, kakšne težave imamo. Tu sem pa spoznal, da se praktično vse probleme da rešiti. Za nekatere res potrebujemo več let, nekatere lahko hitro, v nekaj tednih, mesecih. Ampak marsikaj se v javnem zdravstvu da izboljšati, rešiti, zato da deluje boljše. To sem bil zelo presenečen. Praktično ne morem verjeti, da se da vse to narediti, kar je ministrstvo, vlada, kar smo naredili na tem področju, pa upam, da se bo še.

Voditeljica: Kaj konkretno počne strateški svet, katere tematike obravnava?

Gost: Delamo nekoliko manj, kot smo na začetku. Veliko stvari je ministrstvo pripeljalo do konca. Trenutno zaključujemo temo regionalizacije, organizacije zdravstva na področju regij. To bo zelo pomembno, potem Zakon o zdravstveni dejavnosti se bo mreža zgradila na regijskem območju, se bo praktično upravljalo zdravstvo v regiji, ne iz države. To temo zaključujemo in počasi se bomo lotili česa drugega.

Voditeljica: Ljudje so po navadi, ko govorimo o regijah, zelo, kako bi temu rekla, prestrašeni, ali bodo oni v svoji regiji izgubili bolnišnico, pa ne bo tam, kjer bi si jo želeli.

Gost: To so laži, ki jih je zdravniška zbornica producirala. Namen regij je, postavili so že od prej po zgledu območnih enot NIJZ-ja. Znotraj vsake regije je velika bolnišnica, nekateri imajo še manjše, potem zdravstveni domovi. Naš namen je vse to povezati, zato da bi delovalo boljše, lažje, da bi imeli na primer enotno nabavo, enoten informacijski sistem. Predvsem pa je važno tudi, da se bo znotraj regije spremljalo obolevnost državljanov, regij in na podlagi tega potem tudi urejalo in planiralo razvoj zdravstva, kadrovalo, po potrebi širilo storitve, tako da se nam zdi regija ena taka zaključena enota, na kateri se da marsikaj upravljati, ne pa samo centralno iz Ljubljane.

Voditeljica: Kaj vas je najbolj presenetilo, da se je zdaj spremenilo, pa se prej nikoli ni?

Gost: Vse se spreminja po 30 letih. Mene malo moti, da se govori, da je ta zakon o zdravstveni dejavnosti samo ločuje javno in zasebno. To je samo ena od točk tega zakona, ki mogoče tudi ni najbolj pomembna. Recimo govorimo o regijah. Ministrica obljublja, v enem letu po sprejetju zakona se bo postavila javna mreža zdravstvenega varstva. To se 30 let ni zgodilo. Cel kup stvari je v tem zakonu, ki so zelo pomembne, pa vsi molčijo o tem. Meni osebno, mi smo že pri prejšnjem strateškem svetu pod ministrom Bešičem priporočali, predlagali regijsko ureditev zdravstveno. Zdaj bo pa to prišlo dejansko v življenje.

Voditeljica: Marsikdo tudi reče, da enotna napotnica, ki velja za vedno, če se ne motim, en tak izraz, da je to uspeh te vlade.

Gost: Je, čeprav to je treba še, eno od naslednjih tem bomo imeli, bomo analizirali, kaj je to prineslo, če so kje težave.

Voditeljica: Ampak to olajša pacientom …

Gost: Olajša, tudi manj zaposluje zdravnike, ampak se kažejo tudi nekatere možnosti zlorab.

Voditeljica: Že sami ste omenili, da govorimo zgolj o ločitvi javnega in zasebnega zdravstva. Želela bi, da predstavite, zakaj je pomembno, da imamo v Sloveniji javno zdravstvo. Si ljudje sploh predstavljajo, kako je, če ga ne bi imeli?

Gost: Meni ni treba živeti v državi, ki nima urejenega javnega zdravstva. Tudi ne želim si. Pustil bom medicino, če bo prišel bolnik k meni, tako kot je v Združenih državah Amerike, ki nam jih zdaj skušajo nekateri prikazati kot lep zgled, da pride bolnik v ambulanto, najprej preverim, kakšno ima zavarovanje, in se potem odločim, ali ga bom sploh zdravil. Tega ne želim. Jaz hočem živeti v državi, kjer je zdravstvo dostopno vsem, revnim in bogatim, pa ni treba iz žepa plačevati storitev, in hočem, da imajo vsi državljani pravico do zdravstva, ne da obubožajo ali sploh niso zdravljeni, zato ker nimajo denarja. Če se to zgodi v Sloveniji, naj gre, kamor hoče Slovenija. Naj propade.

Voditeljica: Ste kirurg na Onkološkem inštitutu v Ljubljani, kjer zdravite najzahtevnejše primere in ponavadi so tudi ti najdražji, pa jih verjetno zasebne zdravstvene ustanove ne bi vzele v Sloveniji v obravnavo.

Gost: Težjih bolnikov, ki jih zdravimo zavestno v minus, ne bi zdravili.

Voditeljica: Izbrskali smo podatke ZZZS-ja, da predstavimo ljudem, kaj to pomeni. Najdražje zdravljenje raka je lani znašalo dobrih 17 000 evrov. Takšno terapijo je prejelo deset pacientov, za zdravljenje raka možganov in centralnega živčevja, ki stane 14 301 evro, pa je bilo zdravljenih kar 214 ljudi. Onkološki inštitut je lani za zdravljenje prejel skupaj skoraj 188 milijonov evrov. Se mi sploh zavedamo, kaj bi pomenilo, če bi ne imeli javnega zdravstva in krepili zasebno?

Gost: Večina bolnikov ne bi bila zdravljena, pa tudi zelo malo ljudi v Sloveniji je sposobno iz žepa plačati take terapije. Terapije so dražje, kakor vam je predstavil ZZZS. Velika večina ne bi bila zdravljena, tako da, pa tudi Slovenija, tudi bogatejše države od Slovenije imajo slabšo dostopnost do onkoloških zdravil, kot jo imamo v Sloveniji. Tako da to je biser, ki ga moramo vzdrževati in ohraniti. Če nam to razpade, nam razpade vse.

Voditeljica: Ta vlada je pogosto soočena z novo skovanko davčni primež. Koliko smo obremenili ljudi domnevno z davki, ampak nihče pa ne pove, za kaj vse se porabljajo davki. Eden od teh je tudi javno zdravstvo.

Gost: Zdravstvo žal stane. Je zmeraj dražje, ampak tukaj ne smemo popuščati. Vsak državljan, ki plačuje zdravstveno zavarovanje, mora imeti pravico do zdravljenja in boljše, da na kakšnem drugem področju popustimo, kot da se odpovemo temu.

Voditeljica: Slovenci tudi zelo zaupajo v zdravstveni sistem. To je pokazala zadnja raziskava Ogledalo Slovenije agencije Valicon. Ljudje namreč še vedno najbolj zaupajo reševalcem in gasilcem. Po zaupanju so za njimi medicinske sestre, na petem mestu pa so se z devetega povzpeli zdravniki. Torej trije zdravstveni poklici med prvimi petimi poklicnimi skupinami, ki jim najbolj zaupamo. Kaj vam to pove?

Gost: To me zelo veseli. Pomeni, da ljudje z zdravstvenim sistemom nimajo tako slabih izkušenj, kot se nekateri trudijo dokazati. Upam, da bomo to ohranili naprej.

Voditeljica: Ta stavka, ki se je začela lani ali predlani že in še vedno traja, stavka zdravnikov torej ni omajala poklica zdravnika, torej pomeni, da še obstajajo v Sloveniji ljudje, ki zaupajo zdravnikom.

Gost: Očitno zaupajo. Meni je žal te stavke. Že od začetka je bilo jasno, da iz tega vsega skupaj ne bo nič. Vsaka poklicna skupina potrebuje sindikat. Jaz mislim, da zdravniki ga nimamo več.

Voditeljica: Ste bili član?

Gost: Sem bil, ko sem pa videl, kaj se v ozadju dogaja, kaj Fides počne na nekaterih področjih, sem se izpisal. Še en svetel primer imamo v zdravstvu.

Voditeljica: Na našem uradu smo pripravili kampanjo Javni sektor za vse in pogledala si bova video babice Nuše. Je babica v Mariboru in v tej kampanji predstavljamo različne poklice, ki so del javnega sektorja, in njihova sporočila. Pa poglejva.

Voditeljica: Babica Nuša je dejala: Če imaš srce za ljudi, bo zate to ne le služba, ampak tudi poslanstvo. Kako vi gledate na poslanstvo zdravstvenih delavcev?

Gost: Verjamem, da sva se oba v teh njenih besedah prepoznala. Jaz sem kot mlad zdravnik štiri mesece preživel na oddelku za otroško kirurgijo, med pediatri, in to je bil oddelek, ki je deloval sanjsko. Žal je imel kasneje veliko težav in takrat sem rekel, da si vsi zaposleni na tem oddelku, od čistilke do najvišjega profesorja, zaslužijo dvojno, trojno plačo za to, kar so počeli, kako so reševali uboge otroke, kaj vse so naredili zanje. In vidim v teh besedah sestre, da je oseba, ki razume, kar sem zdaj rekel. Premalo se govori, zelo se prikazuje s strani zdravniške zbornice, denar imamo pravico služiti privatno, ampak premalo se govori, da smo tukaj zaradi poslanstva. Prav je, da smo plačani, in tako slabo tudi zdravniki nismo plačani, ampak naše poslanstvo je zdravljenje ljudi, ne pa borba z ustavnim sodiščem, z odvetniki, ali bomo lahko popoldne delali pri zasebnikih ali ne. Naše poslanstvo je zdravljenje bolnikov.

Voditeljica: Vlada, pa mislim, da je tudi to že v sprejeti noveli Zakona o zdravstveni dejavnosti v državnem zboru, da bi bilo več denarja namenjenega za tiste, ki bodo več delali v javnem zdravstvu. Je to nek način, da se spodbudi ljudi, da ostanejo v javnem zdravstvu oz. da ne odhajajo?

Gost: Saj ne bodo toliko odhajali. Prikazuje se vsakega zdravnika, ki gre ven. Ampak pojdite si pogledat recimo na oddelku za plastično rekonstruktivno kirurgijo, koliko kirurgov je šlo zadnjih 20 let brez tega zakona. Nagrajevati je treba ljudi, ki delajo več. To je tudi zadeva tega zakona, ki jo zdravniške organizacije se zelo trudijo ignorirati, zato da bi se nagrajevalo. Kar pa je zelo pomembno, ne govorimo samo nagrajevanju zdravnikov, ampak vseh, ki delajo v javnem zdravstvu, da bi se jih stimuliralo, nagrajevalo, zato ker so pripravljeni delati več, bolj kvalitetno, več časa. In prav danes sem pisal našemu vodstvu, vodstvu inštituta, kako bi to uvedli v operativnem bloku, kjer delam, predvsem za medicinske sestre, tehnike zdravstvene nege, ki se res zelo trudijo, več imajo popoldne operacij, ampak za to niso nagrajeni. Bomo videli, to bo lep test, kako nam bo to uspelo. Tisti, ki dela več, naj bo nagrajen. Žal zdravniške organizacije v tem ne vidijo kaj dobrega.

Voditeljica: Res je, vsul se je plaz kritik na ta zakon, celo da je neustaven. Kako vi gledate na to?

Gost: Tega ne vem. To bodo povedali ustavni sodniki. Da je tako zelo neustaven, dvomim, ker so zelo dobri pravniki sodelovali pri pisanju tega zakona. Ampak da ponovim, ta zakon ni samo ločitev zdravnikov, ki bodo delovali javno ali zasebno. Da poudarim, mi imamo veliko koncesionarjev, ki delajo pošteno, strokovno in zelo dobro. Imamo pa tudi vmes izjeme, ki so črne ovce med njimi, in ti vodijo to propagando proti zakonu. Jaz sem večkrat tudi koncesionarjem rekel, zakaj ste tiho. Nekdo vas zlorablja, čeprav delate sami v redu in pošteno. Koncesionarji so del javnega zdravstva, so del javne mreže in ni za enačiti, so pa zdaj vsi nestrokovni kriminalci, ne vem, kaj. Velika večina dela zelo dobro. Tudi to mi je žal, da v teh konfliktih se izpostavlja, češ da je pa tu sedaj nek zid med javnim in zasebnim. Gre samo za to, da se postavi pravila igre, kako se bo delalo v javnem, kako se bo delalo v zasebnem. Tudi zdravniki iz javnega bodo lahko delali pri koncesionarju. Nenazadnje bo lahko tudi koncesionar prišel delat v javni sistem, ampak samoplačniške storitve je pa zelo veliko vprašanje, ali spadajo v javni zdravstveni sistem, in tam, kjer je veliko samoplačniških storitev, mislim, da dopoldne javni zdravstveni sistem šepa.

Voditeljica: Kritiki, zlasti zdravniška zbornica in sindikat Fides, opozarjajo, da bo zakon omejil dostopnost zdravstvenih storitev, torej ravno kontra kot midva zdaj govoriva, da bo lahko delal več zdravnik v javnem zdravstvu, in se bodo podaljšale čakalne dobe.

Gost: Jaz sem nekaj časa sledil izjavam zdravniške zbornice in Fidesa o odhajanju, masovnem odhajanju zdravnikov v tujino. Potem smo prosili republiški statistični urad, če nam dajo podatke. Sem bil kar presenečen, kako malo zdravnikov je zapustilo Slovenijo. Vsakega je škoda, ampak ne tisto, kar nam pravijo. In ogromno je izmišljotin, pravljic. Medicina temelji na dejstvih. Te izjave, predvsem zdravniške zbornice, nekaterih zdravniških organizacij, so pa brez analize, brez dokazov, brez vsega in to je žalostno, da zdravniške organizacije uporabljajo take metode. Mogoče bodo kje težave, ampak vsekakor pa naj si samo enkrat, naj se usede zdravniška zbornica pa analizira vse svoje napovedi, kaj se je uresničilo.

Voditeljica: Ministrica je rekla, da bo sistem sprva zanihal ob teh spremembah. Kako vi vidite to?

Gost: Mogoče na posameznih oddelkih, pri večini pa ne. Saj pravim, pojdite pogledat te najbolj izpostavljene oddelke, Koliko ljudi jih je zapustilo v zadnjih 20 letih, pa še ni bilo zakona.

Voditeljica: Pa jih je veliko?

Gost: Zelo veliko.

Voditeljica: Zaradi?

Gost: Ne vem.

Voditeljica: Slabe organizacije?

Gost: Ne, zaradi denarja, bi zaslužili več, tudi zaradi slabega vodenja nekaterih oddelkov.

Voditeljica: Na to ste vi veliko opozarjali, tudi konec koncev za onkološki inštitut. Kako vodstva v bistvu igrajo svojo vlogo v zdravstvenem sistemu?

Gost: Zelo različno. Jaz sem že kdaj rekel, ko smo pisali ta zakon, da če se lahko kdo pritožuje, so to direktorji javnih zdravstvenih zavodov. Nanje bo padla velika odgovornost. Konec koncev jih bodo zaposleni vprašali, kako boste pa nas nagrajevali? Direktor bo moral biti hudičevo sposoben, da bo znal tudi imeti denar, ponuditi drugačno organizacijo dela, da se več naredi, pa imeti denar za nagrajevanje. To bo težko. Manjka še reforma plačevanja storitev iz SPP-jev. Ne vem, kaj se zdaj dogaja na ZZZS-ju s tem, ker nekatere storitve so podplačane in težko bodo potem direktorji stimulirali zaposlene, naj to počnejo, kako sploh, da bi jih nagrajevali. Tako da veliko dela bo za direktorje. Upam, da bo to eden od razlogov, da nesposobni direktorji ne bodo več prihajali v javni zdravstveni sistem, ker ne bodo zmogli, ker jih bodo zaposleni odnesli v enem letu. Bi pa morali, mislim, da več narediti še na nagrajevanju direktorjev, vodstvenega kadra. Zamislite si, tudi direktor Univerzitetnega kliničnega centra Ljubljane, koliko ljudi vodi, kakšna odgovornost, koliko dela. Prav je, da bi bili ustrezno nagrajeni. Nekaj se spreminja, ampak mislim, da še premalo.

Voditeljica: Čakalne dobe. Recimo, ko si bolan, pa se želiš potem z napotnico prebiti do specialista, najprej vidiš čakalne dobe. Ponekod so se skrajšale, ponekod imajo ljudje občutek, pa ne govorim, da se niso skrajšale. Ampak občutek je, da se niso, da dolgo čakajo. Kaj je bilo storjenega na tem področju in bi še morali narediti?

Gost: Samo neposredno ukvarjati se s čakalnimi dobami, treba se ukvarjati s sistemom, ki bo deloval boljše. Je pa seveda vprašanje. Smo zmeraj starejša populacija. Nenavadno je, kako se število napotitev povečuje. Za nekatera področja se človek vpraša, smo res praktično bolan narod, po pravici pa tudi nimamo metodologije spremljanja čakalnih dob. Ni prav jasno, kako jih spremljati. Meni je važno, da sistem deluje, da deluje boljše, potem bodo pa tudi čakalne dobe bolj uravnotežene. Pa pričakujem tudi večjo odgovornost ZZZS-ja, ki bo spremljal storitve, potrebe, kvalitete in tudi tam, kjer se začnejo razvijati čakalne dobe, ukrepal na raznorazne načine, tam, kjer so pa kratke, pa očitno je tudi finančna plat zdravja tako dobra, da izvajalci to delajo raje. Očitno je tudi plus finančno, da se tam reguliran denar, preusmerja tja, kjer so največje težave, tako da to upam, da bo tudi ZZZS v kratkem začel bolj aktivno početi.

Voditeljica: Ja, saj skoraj vsaka bolnišnica, razen ene se mi zdi psihiatrične, ima na koncu potem izgubo.

Gost: Treba je plačevanje storitev analizirati. Ta SPP je že kdaj postavljen, ni se reformiral, ni se spreminjal. Tudi medicina je napredovala. Nekatere storitve so izginile, nekatere so cenejše, večina pa dosti dražjih. Ne moremo pa v eni javni bolnici reči, tega ne bomo delali, ker je podcenjeno, in to ustvarja izgubo. Ampak mislim, da bo. Upam, da se bo pod to vlado tudi to področje uredilo.

Voditeljica: Vi ste sicer z bolnišnice. Kako bi ocenili primarno raven? Govorili smo veliko o pomanjkanju družinskih zdravnikov. Da jih težko dobimo, jih uvažamo iz tujine. So to še vedno izzivi?

Gost: So izzivi. Mi smo se zelo veliko na strateškem svetu na začetku ukvarjali s tem področjem. Mislim, da smo pripravili kar dobre predloge, več kot 70 predlogov. Kar nekaj jih je že prišlo v življenje. Je pa treba še delati naprej. Zopet me moti tu negativna reklama družinske medicine. Kako je slabo, kako jih je premalo, kako so preobremenjeni. Marsikje je res, ampak a ne bi raje zdravniška zbornica pozitivne plati kazala, recimo pri nas katastrofa, če bereš medije. Potem pa je prišla delegacija iz Avstrije in so bili prijetno presenečeni, kako imamo primarni nivo urejen. Marsikaj je bilo narejeno, je še prostor za izboljšave. Tudi kar se tiče, je več zanimanja med mladimi za družinsko medicino in sem presenečen. Marsikateri študent, ki na vajah mi reče, da bi rad postal družinski zdravnik. Uvoz, grdo rečeno, zdravnikov se je povečal, zanimanje, čeprav pravijo, da ga ni več. Po nekdanjih republikah Jugoslavije je veliko. Zavod za zaposlovanje organizira zaposlitvene sejme. Zanimanje zdravnikov in ostalega kadra zdravstvene nege je zelo visoko. Želijo si priti v Slovenijo, so pa v Sloveniji nepotrebne ovire, da se težje zaposlijo.

Voditeljica: Kaj je tukaj jezik problem?

Gost: Jezik. Zahteva se ne vem kakšno znanje, čeprav bi se povprečno inteligenten človek jezika najhitreje naučil, če bi ga dali delati v okolje, kjer ga rabimo, in ga po treh mesecih poslali na izpit oziroma tečaj, ampak se spreminja.

Voditeljica: Zanimanje za delo v Sloveniji v zdravstvu je še zmeraj veliko. Nekje sem imela neko anketo, da so zdravniki prišli nazaj iz tujine zdaj v tem času.

Gost: Tudi prihajajo. Ni tako slabo. Smo imeli specializantko, ki se je vrnila iz Avstrije, in se ne bi vrnila nazaj v Avstrijo.

Voditeljica: Prej ste omenili, da se zdi, kot da je vsak Slovenec bolan. Mislite, da je to na primarni ravni? Napišejo napotnico, se zaščitijo?

Gost: Težko. Samo je treba analizirati. Primar je zlata vreden. Tu dobiš za vložen denar največ. Bolnišnica je veliko dražja za doseči nekaj, kar na primaru z veliko manj denarja. Zato je treba primar financirati, stimulirati, paziti, kaj se dogaja, recimo Zdravstveni dom Tolmin. Težave, ki jih imajo, so zaradi napak iz preteklosti, zdajšnji direktor se zelo trudi. Veliko stavimo na to organizacijo zdravstva po regijah, kjer si bodo potem zdravstveni domovi bolj aktivno pomagali med sabo, postavitvi mreže, kjer se bo dalo planirati glede na starost, upokojevanje, potrebe tudi vnaprej planirati zaposlovanje družinskih zdravnikov, skratka, družinsko medicino je treba poslušati, ker je za tisto, kar da od sebe, daleč najcenejša v zdravstvenem sistemu.

Voditeljica: Zdaj ko ste omenili Tolmin, saj sva že nekaj rekla, dostopnost pa kljub temu bo ostala na enaki ravni do zdravnika? Dostop do zdravnika?

Gost: Zelo se trudijo. Direktor se zelo trudi, tudi iščejo zdravnike okoli, tudi iz južnih republik. Upam, da mu bo uspelo.

Voditeljica: Vam je še kaj takšnega posebnega ostalo, ko ste malce prepletli politiko s svojim operativnim delom pri svetu? Kakšna podrobnost?

Gost: Pa veliko prijetnih zgodb. Zelo veliko ljudi zanimivih sem srečal, veliko sem se naučil. Imamo zelo zanimive posameznike v strateškem svetu. Pripravljeni so nekaj donirati družbi, pustiti nekaj za sabo. Dobre ideje imajo. Ni mi žal. Šlo je nekaj časa, ampak mi ni žal.

Voditeljica: Če se ne motim, ste se tudi povezovali s svetom za prehrano. Tu smo imeli par akcij glede trošarin. Zdaj vidim, da je šlo naprej. Ne veliko, ampak nekaj je bilo. Torej ni vse tako črno, kot se zdi.

Gost: Ne, ni črno, samo se moramo zavedati, da če hočemo to ohraniti in izboljšati, je potrebno veliko dela. Predvsem pa ne smemo za noben denar dopustiti, da se nam ta biser, zdravstvo, sesuje.

Voditeljica: Bi morda še kaj dodali? Kakšno posebno sporočilo?

Gost: Hvala.

Voditeljica: Hvala vam, da ste bili z nami, g. Brecelj. Ostanite še naprej takšen človek, kot ste, s srcem. In hvala vam, da ste bili z nami, gledalke in gledalci, poslušalke in poslušalci. Nasvidenje

[ENGLISH VERSION]

GOVSI, the Government's Podcast 

Host Petra Bezjak Cirman: Hello and welcome to the 22nd edition of GOVSI, prepared by the government's Communication Office. I'm Petra Bezjak Cirman. You can watch the podcast on all podcast channels, and you can subscribe to it so you won't miss it. I'm joined today by the head of the Strategic Council for Healthcare and anti-corruption fighter Dr. Erik Brecelj. 

Guest Dr Erik Brecelj: Hello. 

Host: Hello. We'll discuss one of the most burning issues in Slovenia today, the distinction between public and private helthcare, the approved healthcare amendments, and other changes introduced by the government to improve the system. You've been warning about various problems since 2006, and you're known as a straight shooter. So give it to us straight: What's the state of the Slovenian healthcare system? 

Guest: It's not as bad as some would have it. All countries have problems with it because it's increasingly expensive and requires more people. But it's not that bad. It's important that it isn't getting worse or collapsing, as some would like to see, but getting better, and it is. 

Host: You lead the Strategic Council for Healthcare, the Prime Minister's consultative body, which tackles key healthcare issues, such as wait times, the regionalization of healthcare, and legislative change. Now that you lead the council, has your perception of the system and the work of the ministry changed at all? 

Guest: Very much so. I arrived with a general understanding that change was impossible and that we had insurmountable problems, but I found out that all our probelms have solutions. Some will take several years, while others can be tackled within weeks and months, but many things in public healthcare can be improved. That surprised me. I can't believe that the ministries and the government were able to do so much, and I hope they will carry on. 

Host: What is the council doing now? 

Guest: We're currently working at a slower pace. The ministry has wrapped up many topics. We're finishing up the issue of regionalization. As part of the Healthcare Services Act, we'll establish a network on the regional level, so healthcare will be managed regionally rather than by the state. We're wrapping that up and ready to tackle new problems. 

Host: When regions are brought up, many people are scared that they'll lose their hospital or that it will be moved elsewhere. 

Guest: Those are lies fabricated by the Medical Chamber. The regions already exist and are based on regional units used by the National Institute of Public Health. Each region has a large hospital, while some also have smaller ones, as well as health centers. Our goal is to connect all this and make it function better. For instance, we can have standardized procurement and IT systems. We can also track morbidity statistics on a regional level, which will enable us to manage and plan the development of healthcare, to find personell, and expand our services as needed. We see regions as well-defined units of management to avoid centralization in Ljubljana. 

Host: What changes surprised you where they were once thought impossible? 

Guest: Everything changes. After 30 years, I'm bothered when I hear that the new legislation simply separates public and private healthcare. That's just one provision and perhaps not even the most important one. Regarding regions, the Minister expects a public healthcare network to be set up within a year. That never happened in the past 30 years. This legislation has many crucial aspects that no one is talking about. As part of the previous strategic council under Minister Bešič, we recommended the regionalization of healthcare. That is now going to be carried out. 

Host: Some people say that the standardized, unlimited referral is another achievement of this government. 

Guest: True, but we still need to analyse the results and see if there have been any problems. 

Host: But that makes things easier for patients. 

Guest: It does, and it's less of a burden on doctors, but we're seeing some opportunities for abuse. 

Host: You mentioned that we tend to talk just about separating public and private healthcare. Why is public healthcare so important in Slovenia? Do people know what life without it would be like? 

Guest: I wouldn't want to live in a country without functioning public healthcare. I'd leave this profession... As we see in the U.S., which some would like to see as our role model... ...if I had to check the patient's insurance when he came to my office and then decide whether to treat him. I don't want that. I want healthcare to be accessible to the poor and the rich alike, with no out-of-pocket costs. I want everyone to have the right to healthcare without going broke or being denied healthcare. If that happens in Slovenia, let it go bust. 

Host: You're a surgeon at the Institute of Oncology, where you treat the most difficult cases, which also tend to be the most expensive, so private healthcare providers in Slovenia probably wouldn't take them on. 

Guest: They wouldn't treat our seriously ill patients on whom we lose money. 

Host: According to the Health Insurance Institute of Slovenia (ZZZS) data the most expensive treatment of cancer last year cost more than €17,000. Ten patients received the therapy. Meanwhile, 214 people received treatment for cancer of the brain and the central nervous system, which costs €17,000. The Institute of Oncology received almost €188 million for treatments last year. Do we even realize what would happen if we had no public care and strengthened the private system? 

Guest: Most patients wouldn't receive treatment, and very few people in Slovenia are able to pay out-of-pocket for treatment, which is more expensive that what your insurance data indicates. Even countries richer than Slovenia have more limited access to cancer drugs than we do here in Slovenia. This is an advantage that we need to maintain. If we lose this, we lose everything. 

Host: This government is frequently subject to the neologism "tax wedge," referring to the supposed tax burden faced by people, but no one mentions what taxes are used for. This includes public healthcare. 

Guest: Healthcare is expensive and getting ever more so, but we shouldn't back down. Every citizen who pays for health insurance must have the right to healthcare. It's better if we back down somewhere else instead of giving this up. 

Host: Slovenians have a high degree od trust in the healthcare system. This is evident from the latest Valicon survey. People trust paramedics and firefighters most of all. They are followed by nurses, while physicians have risen from ninth to fifth place. We therefore have three medical professions among the five most trusted professions. What does that tell you? 

Guest: I'm glad to hear that. It tells me that people's experiences with the healthcare system aren't as bad as some would have it. I hope we'll keep this going. 

Host: The strike that began in '24 or '23 and is still ongoing didn't affect the view of the profession. We still have still people who trust medical doctors. 

Guest: Apparently, they do. I regret the strike. It was apparent from the start that it won't have any results. Every profession needs its own union, but we, doctors no longer have one. 

Host: Were you a member? 

Guest: I was, but when I saw what was going on behind the scenes at FIDES, I canceled my membership. 

Host: There is another bright spot in healthcare. Our office prepared a campaign titled "A Public Sector for Everyone," and we'll take a look at a video featuring midwife Nuša from Maribor, as part of our campaign profiling public sector employees and their messages. Midwife Nuša says that if your heart is open to others, your job will also be a calling. How do you see the calling of medical professionals? 

Guest: Her words probably hit close to home for both of us. As a young doctor, I spent four months at the paediatric surgery department. The department functioned perfectly but it later experienced problems. I said to myself that everyone in the department, from the cleaning lady to the professors, deserved double or triple wages for doing so much to help the children. These words by the nurse show that she understands what I just explained. The Medical Chamber talks about money and the right to earn it, but the fact that we have a calling is not mentioned enough. It's right that we're paid, and we're not paid poorly, but our calling is to treat people, not to fight the Supreme Court or attorneys to see if we'll be allowed to work in the private sector after hours. Our calling is to treat patients. 

Host: An amendment to the Healthcare Act in the National Assembly sets aside more money for those who'll work more in the public healthcare system. Will that serve as an incentive for people to stay in public healthcare? 

Guest: They'll keep leaving. Every doctor who goes abroad is brought up, but if you look at the Department of Plastic and Reconstructive Surgery, you'll see how many people left without this law in place. We need to reward people who work more than others. That's a feature of this law that medical organizations are trying hard to ignore. Crucially, this isn't just about rewarding doctors but everyone who works in public healthcare to provide a stimulus for harder, better work and for longer hours. I wrote to the administration of the Institute of Oncology today about implementing this in our department, especially for nurses and health technicians, who work very hard and more, but are not rewarded for it. We will see, this will be a good test. Those who work more should be rewarded. Sadly, medical organisations see no good in this.

Host: Yes, this Act was heavily criticised, even as being unconstitutional. What is your view? 

Guest: I don't know, that's up to the constitutional judges. I doubt that it is unconstitutional, as it was co-written by very good jurists. Again, this Act is not simply about separating doctors working publicly or privately. Many concession holders deliver fair, professional and high-quality care. But there are exceptions, black sheep among them leading this propaganda against the Act. I have often asked concessionaires why they are silent, as someone is abusing them, while they work well and fairly. Concessionaires are part of the public healthcare network, and should not all be lumped in as unprofessional criminals. The vast majority of them work very well. I am also sorry that it is being said that there is a wall between the public and private sector. It's just about defining the rules of work in the public and the private sector. Doctors from the public sector can work with concessionaires, and concessionaires can come work in the public system. There is considerable debate over whether private-pay services should be considered part of the public healthcare system. In areas with many private-pay services, I believe the public system underperforms during regular hours. 

Host: Simply put, doctors will no longer work mornings in one hospital, and then ... 

Guest: They'll be able to work more during regular hours and, I hope, be rewarded. 

Host: We're on the same page. Critics, especially the Medical Chamber and FIDES, warn that the Act will limit access to medical services, so, the opposite of what we are saying, doctors being able to work more in the public system, and that it will even increase waiting times. 

Guest: I followed the statements of the Chamber and FIDES for a while, about the mass exodus of doctors abroad. Then we asked the Statistical Office for data, and I was quite surprised by how few doctors left Slovenia. Each one is a loss, but there aren't as many as they say. There are many fabrications and tall tales. Medicine is evidence-based, while the statements of the Chamber and some medical organisations have no analyses behind them, no evidence, nothing, and it is sad that medical organisations employ such methods. There may be some issues, but the Medical Chamber should analyse all its prognoses once and see how many came true. 

Host: The Minister said that the system will initially sway due to these changes. What is your view? 

Guest: Maybe in certain departments, but not in most. Check how many people have left the most vulnerable departments in the past 20 years, when we didn't have this Act. 

Host: Were there many? 

Guest: Very many. 

Host: Why? Poor organisation? 

Guest: They could have earned more, and some departments had poor management. 

Host: You have warned about this, including the administration of Oncology. How do administrations perform their role in the healthcare system? 

Guest: Variously. While drafting this Act, I have often said that if anyone can complain, it's the directors of public health institutes. They will have great responsibility. Their employees will ask how they'll be remunerated. A director will have to be extremely competent to have the money to offer a different organisation of work and to provide remuneration. That will be difficult. A reform of the diagnosis-related group payment system is still pending. I don't know what the HIIS is doing about that. Some services are underpaid, and it will be hard for directors to incentivise employees to provide them, let alone remunerate them. We are doing a lot for directors. I hope that this will help prevent incompetent directors from entering the public healthcare system, as the employees will get rid of them within a year. We should also do more to improve the remuneration of executive management. For example, the Director of the UMCL, given the number of staff they oversee, the level of responsibility, and the workload, it is only right that they be appropriately remunerated. It is changing, but not enough. There are also directors who do other things as well. I had a director who mostly worked from home, and everything was fine. Some also work in health centres, and after regular hours ... Rules should be implemented. 

Host: Waiting times. For example, when you're ill and trying to see a specialist with a referral, you first encounter the waiting list. In some areas, waiting times have improved, while elsewhere people feel that the wait is still too long. What has been done in this area, and what more needs to be done? 

Guest: Focusing solely on waiting times is not enough. We need to make the whole system function better. But there are issues. We are an ageing population, and it is unusual how the number of referrals is increasing. For some areas, one could ask whether we are basically a sick nation. We also have no methodology for monitoring waiting times. It is unclear how we could monitor them. I want the whole system to work better, which will also make waiting times more balanced. I also expect greater accountability from the HIIS, which should monitor services, needs, and quality. Where waiting times start to increase, action must be taken in various ways. And where they are short, it is clearly also financially beneficial for providers, as they tend to prioritise those cases. This indicates that regulated funds should be redirected to where the problems are most acute, and I hope the HIIS will begin doing so more proactively soon. 

Host: Yes, almost every hospital, except the psychiatric hospital, I think, ends up running at a loss. 

Guest: The payment of services needs to be analysed. The diagnosis-related group payment system hasn't been reformed since its implementation. Medicine has advanced, some services are gone, some are cheaper, most are much more expensive. But a public hospital can't say: "We won't do this, it's undervalued and loses us money." But I hope that this government will also take care of that. 

Host: How would you assess primary care? There has been a lot of talk about the lack of family doctors, that we must import them from abroad. Is this still an issue? 

Guest: Yes. The Strategic Council dealt with that a lot at first. We prepared over 70 fairly good proposals, quite a few of which have already been realised, but we have to keep working. The negative publicity of family medicine bothers me, how bad it is, there are too few doctors, they're overworked ... They often are, but shouldn't the Medical Chamber show the positive side? The media portray our situation as abysmal, but the visiting Austrian delegation was pleasantly surprised by how well-organised our primary care level is. A lot has been done, but there is room for improvement. There is now more interest in family medicine among students. I am surprised by how many students tell me that they want to become family doctors. The interest for importing doctors, so to speak, has increased, although we are told it is gone. There is great interest in former Yugoslav republics. The Employment Service organises job fairs there. The interest of doctors and other healthcare personnel is very high. They want to come to Slovenia, but there are needless hurdles here hindering their employment. 

Host: Is language the issue? 

Guest: Yes, proficiency is required, although a person of average intelligence would learn the language the quickest by working in the area, we need them in, and then taking a course after three months. But the interest for working in healthcare in Slovenia is still great. 

Host: One survey said that doctors have recently been returning from abroad. 

Guest: They are. I have a resident who returned from Austria and doesn't want to go back. 

Host: You said that it seems like every Slovenian is sick. Do you mean at the primary level? They get referrals to be safe. 

Guest: It's hard to say, that should be analysed. Primary care is invaluable, you get the most out of investments here. Hospitals are far more expensive; we can get the same at the primary level with a lot less money. That is why the primary level must be properly funded, incentivised, and closely monitored. For instance, the Tolmin Health Centre has issues due to past mistakes. The current director is making a great effort. We are relying heavily on regional healthcare organisation, enabling health centres to help each other more actively, and the establishment of a network to allow for planning based on age, retirement, and needs, and planning the recruitment of family doctors. Family medicine must be taken seriously, as it delivers the most while being by far the most cost-effective part of the healthcare system. 

Host: You mentioned Tolmin. As we've said, access to a doctor will nevertheless remain at the same level? 

Guest: The director is making a great effort and looking for doctors, including from the southern republics. I hope he succeeds.

Host: Have you taken away anything pleasant from combining politics with your operative work at the Council? 

Guest: Many pleasant stories. I met many interesting people. I learned a lot. There are some very interesting people in the Strategic Council. They are willing to contribute to society and leave a legacy. They have good ideas. I spent some time there, but I have no regrets. 

Host: You also worked with the Strategic Council for Nutrition, no? 

Guest: We launched a few initiatives, including on excise duties. I see there has been some progress. Not much, but something. 

Host: So, it isn't as bleak as it may seem. 

Guest: It isn't, but we must be aware that maintaining and improving this requires a great deal of effort. Above all, we must not allow this jewel of our healthcare system to collapse. 

Host: Would you like to add anything? 

Thank you. 

Host: Thank you for coming, Mr Brecelj, stay in your heart just the way you are. 

Thank you. 

Host: And thank you, dear listeners and viewers.