Ο "Υγειονομικός Χάρτης" ως μεθοδολογικό εργαλείο λήψης αποφάσεων για την άσκηση εθνικών πολιτικών για την υγεία. Η περίπτωση των Α΄ και Β΄ Υ.ΠΕ (Υγειονομικές Περιφέρειες ) Αττικής. Απο την θεωρία στην πράξη

Abstract

Με την παρούσα εργασία γίνεται προσπάθεια: Α) Προσέγγισης της ιδιαίτερα πολύπλοκης κοινωνικής- οικονομικής- περιβαλλοντικής πραγματικότητας, που ορίζει το το ευρύ φάσμα των παραμέτρων που λαμβάνουν χώρα στην διαμόρφωση των Εθνικών πολιτικών για την Υγεία, με βάση, κατα κύριο λόγο, τις εξελίξεις των τελευταίων δεκαετιών, (ιδίως μετά το τέλος των δύο παγκοσμίων πολέμωμν τού 20ου αιώνα). ειδικότερα, γίνεται προσπάθεια κριτικής προσέγγισης, για την κατανόηση των ανωτέρω μέσω: Β) της αξιολόγησης και παράθεσης σροιχείων απο την καταγραφή και την ανάλυση της χωροταξικής- γεωγραφικής, κοινωνικής, οικονομικής και περιβαλλοντικής πραγματικότητας, που έχει διαμορφωθεί τις τελευταίες δεκαετίες στην γεωγραφική και διοικητική περιφέρεια της Αττικής, όσον αφορά στον τομέα των υποδομών παραχής υπηρεσιών υγείας, σε συνάρτηση με το σχετικό θεσμικό πλαίσιο που έχει αναπτυχθεί για την υποστήριξη αυτών. Για την διερέυνηση του ζητήματος επελέγη ως Μελέτη περίπτωσης η χωρική και λειτουργική ενότητα των Α΄& Β΄Υ.ΠΕ Αττικής . Το μέγεθος της συγκεκριμένης ενότητας, που είναι τελικά και η μεγαλύτερη για τον ελλαδικό χώρο, μας οδήγησε στην επιλογή της Υποπερίπτωσης μελέτης των Παιδιατρικών Νοσοκομείων της Αττικής (και της Ελλάδος τελικά) για την στοιχειοθέτηση και την επαλήθευση των υποθέσεων εργασίας που ετέθησαν εξ αρχής. Οι υποθέσεις εργασίας κινήθηκαν γύρω απο τις ακόλουθες ιδέες/αρχές: - Η χρήση/ αξιοποίηση σύγχρονων χωροταξικών και σχεδιαστικών εργαλείων. - Η χάραξη Εθνικών πολιτικών για την υγεία πρέπει να στηρίζεται κατα κύριο λόγο απο τις βασικές αρχές της δίκαιης κατανομής, της κοινωνικής δικαιοσύνης, της ισότιμης πρόσβασης όλων των πολιτιτών ανεξαρτήτως κοινωνικών τάξεων. - Η ανάπτυξη του Δημόσιου τομέα στην υγεία, δεν μπορεί να μήν λάβει υπόψη την παράλληλη ανάπτυξη του Ιδιωτικού τομέα, ο οποίος γιγαντώνεται τις τελευταίες δεκαετίες. - Ο εκσυγχρονισμός στον τρόπο λήψης αποφάσεων απο το κεντρικό κράτος. - Ο ολοκληρωμένος σχεδιασμός για την χάραξη Εθνικών πολιτικών για την ανάπτυξη των δημοσίων υποδομών υγείας δεν μπορεί να γίνει χωρίς να λάβει υπόψη παράλληλα και την δινατότητα αξιοποίησης των υπολοίπων αστικών και υπεραστικών δικτύων και υποδομών. - Ο τομέας της δημόσιας υγείας οφείλει να γίνει ανταγωνιστικός και να ανταποκριθεί στις σημερινές συνθήκες ασφυκτικής πίεσης που ασκείται απο την παγκοσμιοποίηση των αγορών. - Η ενσωμάτωση των νέων τεχνολογιών στην παροχή υπηρεσιών υγείας θα επιταχυνθεί με την θεωρητική και πρακτική επιμόρφωση των επαγγελματιών υγείας. - Η δημόσια υγεία επικεντρώνεται στην εκτίμηση και αντιμετώπιση των επιπτώσεων στην υγεία απο: το φυσικό περιβάλλον, τις δραστηριότητες της κοινωνικής και παραγωγικής ζωής, τους οικονομικούς παράγοντες που επηρεάζουν την υγεία του πληθυσμού και την προσβασιμότητα στις υπηρεσίες υγείας. Ο Υγεινομικός Χάρτης αποτελεί στις μέρες μας ένα παγκόσμιο υπό επεξεργασία εργαλείο που σκοπό έχει την υποστήριξη των υπηρεσιών υγείας, των επαγγελματιών υγείας καθώς και την αποτελεσματική διαχείριση στην παροχή σύχρονων και αποτελεσματικών υπηρεσιών στον πληθυσμό κάθε χώρας χωριστά, αλλά και του πληθυσμού σε παγκόσμιο επίπεδο, μέσω των διεθνών οργανισμών, με τη χρήση σύγχρονων τεχνολογικών και υπολογιστικών εργαλείων (γρήγορη, έγκυρη και έγκαιρη πληροφόρηση, χρήση ηλεκτρονικών τραπεζών πληροφοριών, στατιστικών μοντέλων, δορυφορικών χαρτών, γεωγραφικών πληροφορικών συστημάτων (GIS) και άλλων επιχειρησιακών εργαλείων. Συνοψίζοντας, ο τομέας υγείας αποτελεί ένα πολυδαίδαλο σύστημα φορέων και οργανισμών όπου σε ένα διαρκώς μεταβαλλόμενο πολιτικά, κοινωνικά και ταχνολογικά περιβάλλον, απαιτείται η άρτια συνεργασία και συμφωνία των φορέων αυτών στην χάραξη πολιτικής, προκειμένου να επιτευχθούν οι εκάστοτε στόχοι πρός όφελος του κοινωνικού συνόλου. Η εκσυγχρονιστική στρατηγική είναι σημαντική για την Ελλάδα,αφού θα επιτρέψει στην χώρα να ανταποκριθεί στις προοπτικές της νέας ευρωπαϊκής κοινωνικής διεύρυνσης και να ανταποκριθεί στις προσδοκίες των πολιτών της.

Αfter many political reforms, the form of the health system in Greece seems to comprise a hybrid, combining mostly elements from the Beveridge as well as the Bismark models. The health care services have a public nature and is provided on a first, secondary and third degree level by the official organs of the government. The Ministry of Health maps out the health policy having as fundamental objective the protection of the public health and the promotion of better living standards. The financing of the health system is based on public payments (taxation and public insurance funds) while the presence of the private sector is intense through the provision of the private insurance cover. On the whole, multiple problems are encountered in all the sectors of the health system among which the administrative law, the financing, the human resources, the material and technical infrastructure etc. Problems that have an impact on the effectiveness of the system both at a financial and social level. The state, through the creation of updating programs of the National Health System and the development of material and technical infrastructures and government machinery, tries to solve the problems but the solutions have, in many cases, the opposite results. A viable health policy requires that the rising unemployment, the declining participation in the production of goods, the use of new technologies, the disparities in the access to the health services etc. all be taken into consideration, while the main objective must be the maximum social and financial efficiency. Of course, the biggest challenge of a viable health system will remain the "updating" of the mentality of the human resources, with the development of professional sense and official meritocracy, so that the health care will be reliable, efficient and able to satisfy those who make use of it. With the present thesis an effort is made to: A) approach the particularly complicated social, financial and environmental reality that specifies the wide spectrum of the parameters that take place in the formation of National health policies, based, primarily, on the developments of the last decades ( especially after the end of the two world wars of the 20th century). An effort is made, particularly, for a critical approach for the understanding of the above through: B) the evaluation and submission of data from the recording and analysis of the land-planning, geographical, financial and environmental reality that has been formed over the last decades in the geographical and administrative district of Attica, regarding the sector of the health service provision, in connection with the related statutory framework that has been developed for their support. For the investigation of the matter the territorial and operational unity of the A and B Health Districts of Attica have been chosen as case study. The size of the particular unity, which is the largest in Greece, has led us to the selection of the Sub study of the Children’s Hospitals of Attica (and eventually of Greece) for the composition and confirmation of the business cases that were presented from the very beginning. The business cases dealt with the following ideas/principles: -the use/exploitation of modern spatial and drawing tools for the reassessment of the criteria for the national policy making in the health field, can contribute to the improvement of the function of the subordinate structures. -the National Policies making concerning the health has to be based primarily on the fundamental principles of the equal distribution, the social justice and equal access to the healthcare services for all the public regardless of social and financial ranking. -the development of the Public Sector in health, and in order to agree with the initial principles of the National Health System, has no option but take into consideration the simultaneous development of the private sector that is growing in gigantic dimensions over the last decades. -the updating of the decision-making process from the central state can be supported decisively- beyond the wooden language of the repeated institutionalizations, the institutions and governments- by the use of new technologies, scientific tools and a planning that will be based on the “basis of the citizens’ society” - a complete planning for the National Policies making for the health and the development of the substructure of the Public sector in health cannot be done without also taking into account the possibility of exploiting the rest of the urban and interurban networks and infrastructures that are decisive for the accessibility, the improvement of the operation and efficiency of the health frameworks. -a complete planning can help the better organizing in the rendering of services, the equal distribution and access and finally the social justice. -the sector of public health that relates to the present thesis should also become competitive and respond to the current situation of the stifling pressure exerted by the globalization of the markets in the field of commerce as well as the simultaneous growth of a private business part in the provision of health care (mostly biomedicine technology). -the incorporation of the new technologies in the rendering of health services will be precipitated with the theoretical and practical training of the health professionals, with the change in the criteria for the staffing of the services, with the updating of the mentality of the human resources, with the development of professional sense and official meritocracy. -Public Health focuses on the evaluation and confrontation of the repercussions in health from: The environment, the activities of the social and productive life, the economic factors that affect the health of the population and the accessibility to the health care services. For the above approach and the support of the business cases raised, the examination of the use of a modern methodological tool was chosen for the decision making called “Health Map”. The “Health Map” is nowadays a global, under working tool that aims at the support of the health Services, the health professionals as well as the efficient administration in the provision of modern and efficient services to the population of each country separately, but also at a global level, through international organizations, with the use of modern technological and calculating tools (quick, reliable and prompt information, use of electronic information banks, statistic models, satellite maps, geographic information system (GIS) and other business tools). The methodology of the thesis was based on: -examination through the bibliography of the historical framework for the development of the phenomenon “health” and “public health” to the present times and of the statutory framework that concerns the way the services of the provision of health work. -search through the internet for ,thematic studies, theses, publications in the governmental newspaper concerning the development of the healthcare services, political announcements and comments, the websites of the health districts of Attica, the websites of the Health Map from other countries (Britain, Australia, America) and the World Health Organization (WHO). -The searching for data by the Hellenic Statistical Authority and local service desks (health district, health map office, children’s hospitals), information gathered through empirical research, visits, journalistic research, publications in magazines and talk with officials and health professionals, political announcements and comments. -The indicative drawing up of the thematic maps with the listing of part of healthcare services to the district understanding with the help of GIS, aiming at the collection of primary territorial information supporting inferences. For the understanding of the above and the composition of the chapters of this thesis the importance of the bibliography has been substantial as it has brought us into contact with the multidimensional subject of “health”, “public health” and the “political health systems”, the wide scientific and philosophical sociological field, the environmental issues and the statutory framework that defines them. The financial studies according to the sector have helped in the understanding of the financial range and the parameters of the production of “health” and “health care services”. However some significant questions and criteria that where raised from the very beginning have been answered- confirmedclarified through empirical research, the contact with several officials and personal experience- point of view from the health professional’s perspective. In all the stages of the thesis, special emphasis was placed on the effort to understand the fundamental issues and circumstances that form and define the everyday practice- activity flow for the efficiency of “health” products, among the interactive groups of people related to all these occupations (production: health professionals, consumption: citizens of all categories) and their critical approach. The simultaneous approach the rich theoretical background with the inevitable consolidated practiced and the current situation, has enabled us to evaluate and confirm the essence of the contribution and the objective that a Public National Health System is called to achieve, even under circumstances of complete depreciation, so as to defend a big part of the security and well being of the citizens of a state regardless of social ranking. To sum up, the health sector forms a labyrinthine system of officials and organizations that in a constantly changing- politically, socially and technologically- environment, the full cooperation and agreement of all these officials is required for the policy making so that each objective can be achieved for the benefit of the public. The updating strategy is important for Greece, since it will allow the country to respond to the prospective of the new European social expansion and to its citizen’s expectations.