Municipalities are obliged to provide the Ministry with information on the situation in a particular municipality and their proposals for the reform of their health care institutions by 10 December.
However, Mindaugas Sinkevičius, the mayor of Jonava and the head of the Association of Municipalities, says that the reform would affect self-government very unevenly – according to him, there are “dozens of municipalities” most affected by the transformation due to the reduced availability of services.
“The suggestions of some colleagues or the vision of the ministry do not affect whether it would be Kėdainiai, Marijampolė or Vilkaviškis. They are not proposed to be transformed in any way, so they do not mean claims, ”said the head of the Association of Municipalities.
“But there are municipalities, like Jonava, Pakruojis – usually medium-sized or smaller municipalities, whose hospitals face real dilemmas about future prospects,” he said.
According to M. Sinkevičius, it is proposed for smaller municipalities to establish a health center by merging its hospital, primary health care center, health office, to abandon part of the services provided in hospitals, and to ensure them through contracts with the nearest metropolitan institution.
Suggestions are called “destruction”
“In the same Jonava or Pakruojis, not everyone lives in the city, not everyone has their own transport. And even if you go, for example, from Pasvalys to Šiauliai or from Jonava to Kaunas – how long will that senior get from the village? Will he still be able to go to that village in the evening when he comes out of the village in the evening? It is not necessary to look here mechanically, ”M. Sinkevičius discussed.
According to him, Jonava will submit its proposals to the ministry by December 10, but they will be the opposite – to expand medical services, such as palliative care and geriatrics in the hospital.
“We will suggest how to make the society of Jonava healthier, but not by simplifying what we already have, but by expanding it. The ministry will have a very interesting reaction, and then it will probably see: is it a reform of governance, removing some of the “checkers” from the board, or a return to fundamental changes in the health system – strengthening the primary level, quality and accessibility, “the mayor said.
“We will see if the ministry gave the exercise by seeing and waiting for self-destruction, or whether it accepts the suggestions needed by the local community,” he added.
According to M. Sinkevičius, by threatening to stop allocating funding for health services to municipalities, which will not change anything, or to tighten the criteria for allocating funds for services, the Ministry also weighs political risks, ie initiates the transformation itself, but entrusts unpopular decisions to local governments.
“The ministry says: look, you are the founders of health care centers, primary and secondary, you suggest how you want to prepare yourself, what you want to cut yourself – arm, leg? They are handing over the responsibility for undermining the services of their institutions to us, they are doing so because of the deduction, because they will be able to tell all the time – so the district authorities have offered to prepare their hospital (…). “It’s not like negotiations,” the mayor of Jonava said.
Kaišiadorys does not see any major problems
The mayor of Kaišiadorys district Vytenis Tomkus says that the municipal hospital has already gone through “all stages of the transformation”, so in principle no major changes should take place.
He did not rule out that the municipality could be one of the first to carry out pilot transformation projects.
“We have not had a Department of Obstetrics and Gynecology for a long time, there is only a day service, there is a Therapeutic Department, nursing and reception. So we shouldn’t have any big problems. We still have a Pediatric Department, so it seems that we will have to transform into day pediatric services, ie there will be no on-call duty around the clock, ”said V. Tomkus.
According to him, the municipality will strive to maintain therapy and reception services – it is being considered that the hospital could build an extension in order to meet the requirements.
According to the mayor, the main debate is on the merging of medical institutions – also because the reorganization of the network of institutions would not lead to the allocation of funds, and it is necessary to reorganize the services of institutions.
“We have six primary health care centers and a polyclinic in the district so far – everyone agrees that they need to be connected. But the main question is whether to connect to that common center and hospital, or to connect only the polyclinic centers, and the hospital would remain separate, ”said the mayor.
“If the merger helps to maintain services, we will take it seriously,” Tomkus added.
Aim – 1.5 thousand. fewer beds
The project of reorganization of the network of health care institutions prepared by the Ministry of Health envisages reducing the number of active treatment beds, integrating the ambulance system, and promoting cooperation between medical institutions through agreements.
This week, the Minister of Health Arūnas Dulkys announced that although 800 million euros are planned for investments. it will not approve projects just to absorb money. He stressed that funding can be expected primarily by those municipalities that will be the first to join the reform.
According to the model developed by the ministry, by 2030 it will be necessary to reduce about one and a half thousand active treatment beds from the existing more than 16 thousand.
The government hopes to complete this reform during the term, with the first funding agencies expected to reach in the first half of next year.