Sağlık Politikaları Çalışma Grubu

SPÇG’nun Üniversite Hastaneleri ile Sağlık Bakanlığı Hastanelerinin Afiliasyonu Hakkındaki Görüşü

Sağlık hizmeti veren kamu kurumlarının karşılıklı ortak kullanıma açılmasının; bu kurumlar arasında işbirliği yapılmasının; kamu kaynaklarının etkin ve verimli kullanılması amacıyla yatırımların birlikte planlanmasının; bina ve fiziksel alanlar, ekipman ve teknik donanım ile insan kaynaklarının uygun bir planlama ile karşılıklı paylaşılmasının, kamu yönetimi,asistan ve öğrenci eğitimi bakımından son derece gerekli ve bugüne kadar uygulanması çok geç kalınmış bir argüman olduğuna inanıyoruz.

Ancak, Ülkemizdeki sağlık kurumlarının hepsinin tek elden yönetilmesinin ve sağlık hizmetlerinin tekelleşmesinin gerek hastalarımız ve gerekse sağlık çalışanlarımız için çok uygun olmayacağını düşünüyoruz. Tüm hastanelerin bir elden yönetilmesinin, sağlıktaki farklı tarafların, ihtiyaçların, taleplerin, beklentilerin karşılanmasında sorunlara yol açacağını, çeşitliliğin, yaratıcılığın, üretkenliğin azalmasına neden olabileceğini öngörüyoruz. Özel sektör, kamu kurumları, vakıflar, üniversiteler, dernekler gibi farklı özel ve tüzel kişilerin, farklı amaç, misyon ve vizyonlarla, farklı taraflara, farklı ihtiyaçların karşılanmasına dönük, farklı tasarım, yapılanma ve işletme modelleriyle hastane açıp yönetmelerinin ülkemiz için bir zenginlik, hastalarımız ve sağlık çalışanlarımız için çok avantajlar sunan bir çeşitlilik olacağına inanıyoruz.

Üniversite hastanelerinin bazılarının ekonomik sorunları olduğunu biliyoruz. Bunda işletmecilikten kaynaklanan sorunların önemli bir rolü olabileceğini inkar etmiyoruz. Ancak, üniversite hastanelerinin ekonomik sorunlarının, sadece kötü işletmeciliğin bir sonucu olduğu savına katılmıyoruz. Örneğin; bu kurumlara eğitim-öğretim ve bilimsel araştırma faaliyetleri için hiçbir ödenek verilmemesinin; hizmet verdikleri hasta profili dikkate alınmadan yapılan SGK geri ödemelerinin adalet ve hakkaniyete uygun olmadığına inanıyoruz.

Üniversite hastanelerinde aynı rektörlüğe bağlı olmalarına rağmen Başhekim ve Dekan ayrımının yer yer ciddi sorunlara yol açtığı deneyimini ve eğitim, araştırma işlevi ile sağlık hizmetinin ayrılmazlığını (birlikte, aynı zamanda ve aynı ortamda, aynı materyal üzerinde, aynı aktörlerce gerçekleştirilecek olması) dikkate alarak, işletme tarafı ile eğitim/araştırma tarafının farklı otoritelerce yürütülmesinin ciddi sakıncalar doğurabileceğini düşünüyoruz. Rize, Erzincan, Marmara Üniversitesi gibi kurumlarda, tıp fakültesi öğretim üyelerinin yeterli ek ödeme alabilmek için günde 80-90 adet poliklinik hastasına baktığı; sağlık hizmeti vermekten bilimsel araştırma ve yayın yapamadığı; eğitim faaliyetlerinin mesai saatleri dışına kaydırılmasının dile getirildiği, öğretim üyelerinin sadece birer uzman hekim olarak görüldüğü ve bu kategoride hizmet vermelerinin istendiği gibi duyumlar almamız bizi endişelendiriyor.

İşletmeciliği devralmak yerine, Sağlık Bakanlığının başarılı olduğu alanlarda deneyim ve birikimlerini üniversite hastaneleriyle paylaşmasının; insani, fiziki ve teknolojik kaynakların ortak kullanılmasının daha iyi bir seçenek olabileceğini düşünüyoruz. Gönüllülük esasıyla, iyi belirlenmiş ilke ve kurallar çerçevesinde yapılacak mutabakatlarla farklı kurumların farklı kimlik, amaç, misyon, vizyon ve hedefleri korunarak bir işbirliği gerçekleştirilebileceğine inanıyoruz. Tek taraflı öneri ve projeler yerine, Ülkemiz, kurumlarımız ve hastalarımız için daha verimli olabilecek böyle bir işbirliğinin kurgulanması için her bir üniversite hastanesi ile Sağlık Bakanlığının üniversite hastanelerinden sorumlu birimi/yetkilileri arasında bir çalışma yapılabilmesini umuyoruz. Afiliye olmak isteyen kurumların, hangi kaynakları, ne ölçüde ve nasıl birlikte kullanabileceklerini kendilerine özel ve koşullarına uygun birer sözleşme metniyle belirlemeleri gerektiğine inanıyoruz.

Türk Toraks Derneği Sağlık Politikaları Çalışma Grubu

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