The public Healthcare Insurance Fund (FZO) cannot pay out millions of euros annually without checking why the number of heart surgeries has doubled or tripled in recent years, said leading cardiologist Sasko Kedev in an interview with Republika. Kedev recently blew the whistle on the practice of private hospitals who push patients toward expensive heart interventions, such as stent insertion, without there being need for this.
Following this, the Healthcare Ministry formed an expert commission to investigate these claims and recently at a press conference it was announced that 25 cases had been received, and the commission determined that 10 of them had been unnecessarily referred or operated on.
I believe that we have a good development of events, because this is a very serious problem in Macedonian healthcare. I can’t personally guarantee how it will end, because it does not depend on me. I stand behind everything I said and this was confirmed by the Commission. This gives me hope, because the Commission is composed of people with integrity and professional credibility, which is very important. The Healthcare Minister has great support from the Government and personally from the Prime Minister to clear this up. I see that the Minister is motivated to complete it in an objective manner to the final goal. And the final goal is to stop this practice. We must guarantee to the citizens that it will not happen to anyone to undergo unnecessary treatment, whether it’s X-ray radiation, computer tomography, unnecessary stenting and of course unnecessary surgeries. I am optimistic that we will ensure this and that we will return the choice in our healthcare system to the citizens, said doctor Kedev.
He explains in the interview that the current trends in the world are towards primary prevention.
Prevention should start from early childhood, children should be raised and educated in a healthy lifestyle of healthy nutrition and regular physical activity. Then adolescents and adults should be educated in a healthy lifestyle, proper nutrition, physical activity and control of possible risk factors that come with age, such as smoking, which should be eliminated, then diabetes, high blood pressure, high cholesterol. Then come people who have survived a heart attack or stroke, and secondary prevention should continue for them, because we currently have many high-quality drugs for blood clotting, revolutionary drugs in the treatment of diabetes and finally, and this has been officially announced, unnecessary interventions should be avoided. We should be as restrictive as possible on invasive imaging, because invasive imaging, unnecessary, frequent, recruit patients who need to undergo unnecessary interventions, believes Dr. Kedev.
Minister of Health Azir Aliu announced that the names of hospitals and doctors who unnecessarily referred patients to heart surgery will be made public, after the second phase, together with experts from abroad, will analyze the work of all institutions across the country that perform cardiovascular interventions.
It is legitimate to know which clinics performed unnecessary heart surgeries. All of us in healthcare should work to increase patient trust and ensure that patients are sure when they come to us that they will receive care and recommendations based on evidence-based medicine, believes doctor Kedev.
According to him, in the future there will be more and more patients who will not need to have stents, balloon dilation, or bypass surgery.
Most will remain on optimal drug treatment. There will always be patients for both surgery and stenting, but most will be treated with drugs. The global trend is to reduce the degree of invasiveness. What will be done should be decided by a hard team or a team of doctors consisting of an interventional cardiologist, there may be an imaging cardiologist who is more proficient in imaging techniques, an anesthesiologist and a cardiovascular surgeon. That team should decide what is best for that particular patient, Kedev told Republika.
When asked whether he believes there is a systemic problem in the way private healthcare institutions recommend or approve surgeries, Kedev believes that there must be control of the process, and that it must be specialized.
Such controls can only be performed by an interventional cardiologist and a cardiac surgeon. They can assess what was done or not done and whether it should or should not have been done. This means that the fund must engage, at its own discretion, such a category of control. The fund can’t say that the state health inspectorate is in charge here. There are doctors there who are not specialized in these matters, they are not competent to evaluate whether an operation should or should not have been performed. They can check administratively, whether there are referrals, whether there is insurance.
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