There was no system in healthcare
15 May, 2014
The Minister told Georgian Journal that certain steps are being taking, including the dismissal of less-qualified staff, to make the Ministry circles coordinated. Sergeenko also stresses that very soon it will be harder for doctors to get a license. When addressing healthcare issues, it is often stated that the system should ensure protection of the people. What was the system like when you became minister? There was no system at all. I am trying to create the system. Well, it does
not mean that nothing was done previously. There was a range of different projects. However, a system means a mechanism that works in coordination. There were diffusive, poorly linked circles in the ministry without any effective management.
What have you done, and intend to do, in order to create such a system that will work in coordination?
I am trying to use rational and time-tested attitudes; there is no need of knowhow. As a rule, there are three types of models: one is diffusive, the second is imperative - when the system is ruled from the single centre with only one decision making individual, and the third, the optimal model , when there is a minister, his deputies, and department chairs having their own obligations. We have the third model. However, there is no effective communication between the levels. So, I am trying to modify the current model.
What changes are required for this modification?
From the beginning, I refrained for any staff reshuffle. I gave certain tasks to the heads of department and their deputies, with certain terms. If the tasks were not fulfilled, I discussed the issues with them. Whether failure was their fault or not, I gave them additional time. However, it is not acceptable to give four and more chances.
The common healthcare system was introduced under you and its positive sides are frequently discussed. I am more interested in what shortcomings the system revealed in the healthcare system?
There are similar shortcomings in terms of private and common healthcare. The priority has always been given to availability of such a service, and this service should cover three aspects: availability, price and quality. As for the shortcomings concerning common healthcare, I would say that the program had to meet the needs of over 2 million beneficiaries. This is a lot of information, and we established a database to this end. The database can process more information than, for example, the Revenue Office and the Public Registry Office together. These huge scales created certain problems in the system and caused certain delays. The second shortcoming from the beginning was the informing of the public, as we did not have much time. I cannot say that the situation is ideal now. Nothing can be ideal. However, both of the problems have been significantly reduced.
There is much speculation in the public regarding doctors’ qualifications, as well as ambulance services that often arrive quite late. How are these problems being addressed?
As for qualification, let me divide the topic into strategic and tactic aspects. The strategic aspect analyses some achievements made by practical and theoretical activities, summarizing them and introducing various guidelines and protocols. As for the tactical aspect, I should say that medicine requires permanent updating and trainings are necessary for healthcare staff in order not to fall behind. Herewith, doctors’ licenses have been permanent up to now, and we are making steps to change this rule. On the other hand, the license tests were known beforehand for doctors. Initially, not to use the collapse, 20% of tests will be unknown. From the following year, the tests will be fully unknown. As for the emergency service, there are various reasons for being late. However, there are major ones. Let us start with Tbilisi. In 60% of the cases the emergency services are called for unnecessary reasons like high temperature, someone needs blood pressure measuring and so on. The reason is less information about the emergency service rules and timetable, less medical education in public and absence of primary healthcare. The second reason for being late is the absence of a methodology on how the decision should be made by the emergency brigade on where to take the patient in case of an accident. This factor has a very clear methodology. However, we face a conflict of interest from clinics that want to receive many patients and try to attract brigades. The same reasons apply to the regions plus one more problem: faulty cars. What is being done: I personally participate in the establishment of a methodology of timely distributing patients to hospitals. We are trying to support primary healthcare and we intend to buy 200 new emergency cars this year. The public should know as well that when there is a family doctor, they can call him during daytime and avoid calling the emergency service for every case.