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Where does all the health money go?

Doctor Tore Næs is critical of the health priorities of health politicians and asks where all the money allocated really goes.


Health care budgets are increasing every year and have been doing so for a long time. In fact, the state's health expenditure per capita per year, which for 2018 is at 64 821, is almost doubled since 2002, when the sum was 32 985. What is this cause? Have we as a population become so much sicker that a doubling of resources in the health care system is required? As a rule, the opposite is argued that the population has never been healthier. It is often pointed out that people are living longer and that this results in a greater proportion of the elderly and the sick who need a lot of medical treatment. But can this explain a doubling in spending of 16 years? Paradoxically, despite these massive increases in budgets, we also receive constant feedback from health workers at all levels about increased work pressure and demands for efficiency. What is really going on?

Dangerously evolved

Without having any statistics to substantiate my assumptions, I sit as a health worker with the feeling that we are spending too much time and resources on patients who, strictly speaking, do not need as much help. At the same time, too many of those who really need help are cut off by too little. One could say that we are spreading health care too thinly across the population, and many of those in greatest need end up as losers in the battle for resources. This can be about old and sick people who are discharged from the hospital before they are healthy enough to manage at home. And that often comes back again after a tiring, degrading and resourceful trip home. Or it may be about people in deep hopelessness, with an urgent need for psychiatric help, who are met with the message that the few places that exist, unfortunately, are busy. One must have almost tried to kill, or threatened to, to get a bed in an emergency psychiatric institution today.

It may seem difficult, almost impossible, to reverse this trend. The responsible health politicians, with good help from eager bureaucrats, are providing desk solutions that, in theory, seem to be able to remedy the problems. For example, by assigning rights to patients, rights to guarantee them the treatment they are entitled to. This development entails a bureaucracy of professionals. The specialist who considers the referrals the general practitioner has written will then have to raise the question "does this patient have the right to be examined?" rather than "does this patient need to be examined?". To think that these two questions can easily be adjusted to delimit the same group is a widespread fallacy. Similarly, there is also a bureaucracy of the general practitioner when patients come up with the "I have a claim" setting instead of "can you help me?" The general practitioner then becomes a concierge, and this also changes the relationship between the patient and the therapist.

The latest addition to this development is the introduction of package programs for patients in the field of psychiatry and intoxication. The package will be implemented during 2019. Again, the intentions are pronounced good, here are plenty of big words and food for party talk. But it's hard to avoid thinking that the road to hell here, like elsewhere, is paved with good intentions.
Næss is a doctor and philosopher. Regular commentator in Ny Tid.

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