From 2011 to 2015 the number of hospital beds in Uzbekistan has been decreased from 139.800 to 129.800. Experts predict their further reduction. Will there be enough hospital beds for those in need tomorrow?
The situation was explained at the Department of Organization, Economics and Health Care Management of the Tashkent Institute of Postgraduate Medical Education.
It turns out that this trend was founded in the state program 18 years ago. Even at that time, the main directions of reforms in the field of health care were clearly defined.
They were located in the following order: primary health care, maternal and child health protection, emergency medical care, specialized medical care, sanitary and epidemiological welfare of population, provision of medicines etc.
The modernized country's health system focuses mainly on outpatient service rather than hospital care, as it was before. Very soon, the right direction of this concept was recognized, and almost everyone, and first of all, the developed countries of the world, began to implement it.
The course of these transformations and the initial results are now actively analyzed in many countries. Most experts say about the positive effect of reduction of beds for development of health system as a whole. However, it is early to make categorical statements. It is necessary to see long-term results of these transformations.
Despite the attractiveness of the further intensification of hospital activity, experts urge to approach the issue carefully not to do harm.
Which beds to be removed and what will replace them? The Head of the Organization, Health Economics and Management Department, Damin Asadov, helped to clarify the situation responding to the questions of "Organization and management of health care" magazine’s chief editor, A. Babadjanov.
Experts believe that unfounded hospitalization should be closely monitored today. A hospital should not hospitalize the patients who can receive adequate treatment in outpatient setting. On the other hand, discharge of undertreated patients from hospital or worsening sanitary and hygienic conditions of hospitals, achieving a high turnover of bed because of hospital work with overload are unacceptable.
There are always patients in hospitals whose treatment could be effectively carried out outside the hospital. It was found, that in ‘therapy’, ‘care for elderly’, and the other specialties, the proportion of unjustified admissions to hospital is more than 20-27%.
The bed days unreasonably spent by sick people are more common than cases of unjustified admissions. The proportion of patients who had hospital treatment that is no longer useful for them is 14.6% in total for all specialties except for psychiatry and obstetrics.
This figure exceeds 60%For the patients receiving treatment in therapeutic and elderly nursing care departments in urban hospitals of general type.
The results of separate scientific researches have shown that, in general, 20%-30% of people receiving treatment in hospitals could receive effective and significantly less expensive medical care in day patient facilities and at home.
Experts also point out to the fact that it has recently become more apparent that the systems providing patient with the opportunity to address directly to the experts in the primary admission (France, Germany, Sweden, USA) show a tendency to higher costs than those systems with a link between patient and physician represented by a general practitioner (Denmark, Finland, Netherlands, UK). Stimulation of activity of the doctors responsible for issuance of appointment cards for hospitalization is more efficient in terms of reducing the number of these cards and promotion of alternative outpatient treatment.
And the money saved at the expense of reducing the number of used inefficiently beds in Uzbekistan are directed to the development of general medical practice system and to implementation of the modern high-tech methods of diagnosis and treatment into health facilities allowing to reduce time required for recovery of patients.