Senėjant šalies visuomenei, per artimiausius dešimt metų itin išaugs geriatrijos, reabilitacijos, stebėjimo, skubiosios medicinos pagalbos ir dienos stacionaro poreikis. Tai rodo Sveikatos apsaugos ministerijos (SAM) su partneriais atlikta paslaugų ir gydymo įstaigų analizė. Atliepiant besikeičiančius gyventojų poreikius, šalies gydymo įstaigose bus keičiamas bendradarbiavimo modelis, konsoliduojant paslaugas. Pertvarkant paslaugų ir vien gydymo įstaigų struktūrą suplanuotos 417,9 mln. eurų investicijos. Bendra sveikatos sistemos reformoms skirta investicijų suma sudaro 836,76 mln. eurų.
Atlikta gydymo paslaugų analizė apima 2021–2030 m. laikotarpį. Joje išanalizuota kiekvienos šalies savivaldybės dažniausiai gyventojų naudojamų paslaugų poreikio pokytis, atsižvelgiant į gyventojų skaičiaus mažėjimą ir senėjimą. Prognozuojama, kad per artimiausius septynerius metus Lietuvos gyventojų sumažės nuo 2,76 mln. iki 2,58 mln., t. y. 180 tūkstančių. Senėjanti visuomenė ir mažėjantis gyventojų skaičius yra bene esminiai faktoriai, veikiantys sveikatos paslaugų struktūrą.
Kaip teigia sveikatos apsaugos ministras Arūnas Dulkys, sveikatos apsaugos sistema dėl savo ypatumų – visų pirma ilgo medikų ruošimo – turi būti vienu žingsniu priekyje, kad galėtų atliepti besikeičiančius gyventojų poreikius. Kitu atveju, susiduriame su nepasitenkinimu tam tikromis gydymo paslaugomis, tai išvirsta į eiles ir užleistas ligas.
„Vystant sveikatos paslaugas, vienas svarbiausių įrankių yra ilgalaikis planavimas. Šalies sveikatos priežiūros įstaigos yra skirtingo pavaldumo – vienas valdo savivaldybės, kitas valstybė, dar dalis yra privačių paslaugų teikėjų – todėl trūksta koordinacijos tarp paslaugų teikėjų ir aiškios vizijos, kokių paslaugų reikės po penkerių, dešimties metų. Dabar kiekviena savivaldybė gavo gaires, kaip pas juos priklausomai nuo gyventojų pokyčio bei jų struktūros keisis sveikatos paslaugų poreikis. Tiek valstybės, tiek savivaldos lygmeniu atsiranda koordinavimas ir judėjimas vieno tikslo link – reikalingų sveikatos paslaugų užtikrinimo gyventojams“, – teigia ministras.
Bendradarbiavimas – ir rajoniniu, ir regioniniu pagrindu
Pertvarkant gydymo įstaigų tinklą ir paslaugas, siekiama konsoliduoti sveikatos priežiūros paslaugas, nes dėl pirminės ir antrinės priežiūros fragmentacijos gyventojai arba jų negauna, arba tenka laukti ilgai. Siekiant visų pirma patenkinti pacientų poreikius, kuriami sveikatos centrai – jų kūrimas prasidės jau nuo šių metų rugpjūčio mėnesio. Sveikatos centras – tai bendradarbiavimui sutelktos sveikatos priežiūros įstaigos, užtikrinančios dažniausiai vietos gyventojams reikalingas sveikatos priežiūros paslaugas.
Sveikatos centrai apims tokias paslaugas: pirminės priežiūros (šeimos gydytojo, psichikos, slaugos ir palaikomojo gydymo, ilgalaikės priežiūros, odontologijos ir kt.), antrinės ambulatorinės specializuotos, dienos chirurgijos, dienos stacionaro, stacionarinės terapijos, skubios medicinos, visuomenės sveikatos ir kitos paslaugos.
Sveikatos apsaugos viceministrės Danguolės Jankauskienės teigimu, konsoliduotoms gydymo įstaigoms keliamas tikslas, kad bent 80 proc. būtiniausių paslaugų gyventojai galėtų gauti šalia namų – savo arba artimiausioje savivaldybėje.
„Šiai dienai daliai savivaldybių tai sunku įgyvendinti – ir dėl medikų pritraukimo sunkumų, ir tai, kad trūksta investicijų į įrangą ir patalpas bei darbo organizavimo gebėjimus. Ir labiausiai trūksta bendradarbiavimo tarp įstaigų tiek savivaldybių lygiu, tiek tarp jų. Vien konkurencija tarp įstaigų žmonių problemų viešajame sektoriuje nesprendžia. Žmonėms trūksta pagalbos ir patarimų, kur greičiausiai galima gauti kokybišką pagalbą. Savivaldybėms pasiūlyti sprendimai, kaip užtikrinti gyventojų sveikatos poreikių patenkinimą. Savivaldybių lygiu tai bus sveikatos centras, kuris apjungs būtinas paslaugas skirtingose gydymo įstaigose, pasitelks privačias įstaigas, visuomenės sveikatos biurus, sukurs ilgalaikės priežiūros paslaugas, kuri jau puikiai vystosi ir slaugos namuose paslaugos puikiai vertinamos gyventojų.
Kalbant apie antrinio lygio paslaugas, bendradarbiavimas vyks regioniniu pagrindu – su stipria regionine ligonine, kur bus sutelktos visos aukštesnio lygio stacionarinės paslaugos, ir kuri papildys vietos rajoninės ligoninės ir sveikatos centrų paslaugas, kurie dėl gyventojų skaičiaus pokyčių ir paslaugų sudėtingumo negalės išlaikyti kai kurių aukšto lygio paslaugų. Bet pagrindinės, dažniausiai naudojamos sveikatos priežiūros paslaugos turės būti savivaldybėje, arti žmogaus namų“, – teigia viceministrė.
Esminis sveikatos priežiūros paslaugų organizavimas yra projektuojamas penkių regionų principu – Vilniaus, Kauno, Klaipėdos, Panevėžio ir Šiaulių, pagal nusistovėjusius didžiausius pacientų srautus. Siekiant sustruktūruoti sveikatos priežiūros paslaugas, Lietuvos savivaldybės sąlyginai padalintos į tris kategorijas: A, B ir C. A kategorijai priklauso savivaldybės, kur gyventojų skaičius sieks iki 10 tūkstančių; B – kai gyventojų skaičius sieks nuo 10 iki 21 tūkstančio; C – kai gyventojų skaičius sieks daugiau nei 21 tūkstantį.
Savivaldybių sveikatos priežiūros įstaigos turės ne tik užtikrinti pagrindinių sveikatos priežiūros paslaugų teikimą, bet ir bendradarbiauti tarpusavyje, pasirašydamos bendradarbiavimo sutartis.
Visuomenės pokyčiai atsispindės ir paslaugose – kai kurių poreikis išaugs dvigubai
Analizė rodo, kad visuomenei senėjant, bendras ambulatorinių konsultacijų poreikis augs. Jis išaugs nuo 5,27 mln. konsultacijų 2023 m. iki 6,1 mln. – 2030-asiais. Iki 2030 m. labiausiai išaugs dienos stacionaro (59 proc.), geriatrijos (58 proc.), reabilitacijos suaugusiesiems ir vaikams (po 57 proc.), skubios medicinos pagalbos (52) ir stebėjimo paslaugos (44 proc.).
Kalbant skaičiais, reabilitacijos paslaugų suaugusiesiems poreikis išaugs nuo 333,8 tūkst. iki 773 tūkst., skubios medicinos – nuo 391,8 iki 810,2 tūkst., stebėjimo – nuo 123,9 iki 220,7 tūkst., diabetinės pėdos slaugos – nuo 67 iki 112,9 tūkst., dienos stacionaro – nuo 100 iki 244,5 tūkst., dienos chirurgijos – nuo 161,5 iki 186,5 tūkst. konsultacijų.
Sveikatos priežiūros įstaigas pasieks šimtai milijonų eurų
Siekiant pertvarkai suteikti tvarų pagrindą, iki 2030 m. suplanuotos investicijos į sveikatos sistemos pritaikymą, gydymo įstaigų perorientavimą ir paslaugų gerinimą. Bendra investicijų suma sudaro 836,76 mln. eurų, iš jų 417,9 mln. eurų bus nukreipta į pertvarką sveikatos priežiūros tinkle.
„Investicijos pasieks visas grandis – jos paskirstytos pagal prognozuojamus ir reikalingus paslaugų pokyčius, savivaldybių pasiryžimą pokyčiams. Taip bus užtikrintas efektyvus lėšų panaudojimas ir tęstinumas, nesusidursime su atvejais, kai lėšos investuojamos, o po kelių metų įstaigų skyriai uždaromi, paslaugų atsisakoma“, – teigia ministras A. Dulkys.
Pirminei ambulatorinei asmens sveikatos priežiūrai pertvarkyti numatyta 48 mln. eurų, antrinei ambulatorinei ir dienos paslaugoms – 96,5 mln. eurų, skubiosios medicinos pagalbos ir intensyviosios terapijos stiprinimui – 99,09 eurų, infekcinių ligų klasterio sukūrimui – 150 mln. eurų, psichikos sveikatos infrastruktūros stiprinimo krypčiai – 20 mln. eurų, paslaugų teikimo ir organizavimo veiklos pokyčių diegimui – 30,2 mln. eurų.
Pokyčiai bus įgyvendinami Europos Sąjungos ir valstybės biudžeto lėšomis.
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