{"id":43319,"date":"2017-06-19T13:07:17","date_gmt":"2017-06-19T13:07:17","guid":{"rendered":"http:\/\/www.documentaria.ro\/content\/?p=43319"},"modified":"2017-07-26T06:33:06","modified_gmt":"2017-07-26T06:33:06","slug":"sistemul-romanesc-nu-e-unul-al-sanatatii-ci-al-bolii","status":"publish","type":"post","link":"https:\/\/www.documentaria.ro\/content\/archives\/43319","title":{"rendered":"Vulnerabili"},"content":{"rendered":"

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<\/b>VULNERABILI
\n<\/span><\/span><\/h1>\n
\u00a0<\/span><\/span><\/h5>\n
fotografii de <\/span>Ioana Moldovan<\/strong>
\ntext de<\/span> <\/span>Alexandra Nistoroiu<\/span><\/strong>
\n<\/span><\/span>\u00a0<\/span><\/h5>\n

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apasa pe imaginea de mai jos\u00a0pentru a deschide galeria de fotografii<\/span><\/em><\/span><\/h5>\n

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gliseaza pentru mai multe\u00a0fotografii<\/span><\/em><\/h4>\n

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Sintagma de \u201epacient vulnerabil\u201d \u00een Rom\u00e2nia poate s\u0103 par\u0103 un pleonasm. P\u00e2n\u0103 la urm\u0103, ce pacient din Rom\u00e2nia nu e unul vulnerabil \u00een fa\u021ba unui sistem de s\u0103n\u0103tate corupt, ros pe din\u0103untru de o gr\u0103mad\u0103 de boli cronicizate<\/strong>, mai mult morale dec\u00e2t financiare?<\/p>\n

Cu toate acestea, v\u00e2rstnicii din mediul rural formeaz\u0103 o categorie aparte de \u201epacien\u021bi vulnerabili\u201d. Distan\u021ba fizic\u0103 \u0219i financiar\u0103 fa\u021b\u0103 de serviciile medicale face ca accesul lor la s\u0103n\u0103tate s\u0103 fie greoi, dac\u0103 nu de-a dreptul blocat.<\/p>\n

\u00cen 2015, num\u0103rul de pacien\u021bi care reveneau unui medic \u00een mediul urban a fost de aproape \u0219apte\u00a0ori mic dec\u00e2t \u00een rural. Unul din cinci v\u00e2rstnici din mediul rural locuiesc \u00een sate f\u0103r\u0103 medici<\/strong>. \u00cen satele cu medic, cabinetele sunt dotate cu strictul necesar pentru medicina familiei \u2013 cu excep\u021biile notabile \u00een care mai exist\u0103 c\u00e2te un ecograf la dispensar. Medicii mai noroco\u0219i au avut sprijin din partea autorit\u0103\u021bilor locale -exist\u00e2nd mecanisme clare prin care pot oferi sprijinul medicilor.<\/p>\n

Cei mai mul\u021bi doctori \u00eens\u0103 au \u00eenv\u0103\u021bat s\u0103 se gospod\u0103reasc\u0103, peticeasc\u0103 \u0219i s\u0103 improvizeze singuri.<\/p>\n

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2016 \u00a9\u00a0Ioana Moldovan<\/span><\/h6>\n

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\u00cen Rom\u00e2nia, \u201eaccesul la asisten\u021b\u0103 medical\u0103 este limitat \u0219i inegal<\/strong>. Accesul la \u00eengrijiri de bun\u0103 calitate este afectat de densitatea sc\u0103zut\u0103 de medici generali\u0219ti, de medici speciali\u0219ti \u0219i de asisten\u021bi medicali\u201d, arat\u0103 recomand\u0103rile f\u0103cute Rom\u00e2niei \u00een 2017 de c\u0103tre Comisia European\u0103, \u00een cadrul Semestrului European.<\/p>\n

De\u0219i se confrunt\u0103 de ani buni cu o criz\u0103 de medici \u00een mediul rural, Rom\u00e2nia nu implementeaz\u0103 politici de \u00eencurajare a medicilor s\u0103 se stabileasc\u0103 \u00een sate \u0219i comune<\/strong>, a\u0219a cum fac statele occidentale. Fran\u021ba, de pild\u0103, caut\u0103 s\u0103 combat\u0103 de\u0219erturile medicale, inclusiv import\u00e2nd for\u021b\u0103 de munc\u0103 din Rom\u00e2nia. Astfel, guvernul francez \u00ee\u0219i stimuleaz\u0103 medicii s\u0103 profeseze \u00een comunit\u0103\u021bile izolate, d\u00e2ndu-le aloca\u021bii financiare lunare (de mii de euro) timp de doi ani de la instalarea \u00een localitate.<\/p>\n

M\u0103suri similare sunt prinse \u0219i \u00een Strategia na\u021bional\u0103 de resurse umane \u00een s\u0103n\u0103tate. Preg\u0103tit\u0103 pe final de mandat tehnocrat \u00eens\u0103, aceast\u0103 strategie \u00eenc\u0103 a\u0219teapt\u0103 \u00eentr-un sertar al ministerului s\u0103 fie aprobat\u0103<\/strong>.<\/p>\n

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2016 \u00a9\u00a0Ioana Moldovan<\/span><\/h6>\n

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Datele Institutului Na\u021bional de Statistic\u0103 arat\u0103 c\u0103 pe listele unui medic de familie de la \u021bar\u0103 sunt de la 1.500 de pacien\u021bi \u00een sus. Mul\u021bi (prea mul\u021bi) ajung \u00eens\u0103 la recorduri de peste 3.000 de pacien\u021bi<\/strong>. C\u00e2nd rafturile din cabinetul unui medic de familie sunt \u00eendesate p\u00e2n\u0103 la refuz cu fi\u0219ele medicale a mai mult de dou\u0103 mii de oameni, e de neimaginat c\u0103 va exista suficient timp ca medicul s\u0103 \u00ee\u0219i \u00eendeplineasc\u0103 misiunea p\u00e2n\u0103 la cap\u0103t pacient cu pacient.<\/p>\n

Educa\u021bie, screening, diagnostic, preven\u021bie, tratament, monitorizare. Un proces de triaj se impune. Prima care pic\u0103 la aceast\u0103 prioritizare e preven\u021bia (profilaxia). Laolalt\u0103 cu ea, educa\u021bia pentru s\u0103n\u0103tate. La sat chiar mai mult dec\u00e2t la ora\u0219, accentul cade pe tratament, nu pe prevenirea bolii<\/strong>.<\/p>\n

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2016 \u00a9\u00a0Ioana Moldovan<\/span><\/h6>\n

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Sistemul rom\u00e2nesc nu este unul al s\u0103n\u0103t\u0103\u021bii, ci al bolii. Ceea ce se \u00eent\u00e2mpl\u0103 la nivelul cabinetului de medicina familiei se reflect\u0103 \u0219i \u00een politica de la nivelul macro. Medicina primar\u0103 este acut subfinan\u021bat\u0103<\/strong> \u2013 \u0219i a fost a\u0219a din 1989 \u00eencoace. \u00cen Rom\u00e2nia, s\u0103n\u0103tatea r\u0103m\u00e2ne axat\u0103 pe spitale, exist\u00e2nd prea pu\u021bine servicii de \u00eengrijire primar\u0103 \u0219i ambulatorie, ceea ce are drept rezultat servicii de \u00eengrijire \u00eenvechite \u0219i ineficace (Comisia European\u0103, 2016c).<\/p>\n

\u00cengrijirea v\u00e2rstnicului este un capitol esen\u021bial al politicii de bun\u0103stare \u0219i de s\u0103n\u0103tate ale fiec\u0103rei \u021b\u0103ri. Deseori v\u00e2rstnicii sunt multiplu dezavantaja\u021bi<\/strong>, prin sc\u0103derea resurselor fizice (care nu trebuie neap\u0103rat echivalat\u0103 cu boala), prin diminuarea resurselor financiare sau prezen\u021ba unui handicap psihic\/mental.<\/p>\n

Dar societatea rom\u00e2neasc\u0103 a descalificat v\u00e2rstnicul din lupta sa pentru o existen\u021b\u0103 decent\u0103. Mul\u021bi b\u0103tr\u00e2ni tr\u0103iesc ast\u0103zi sub pragul de s\u0103r\u0103cie<\/strong>, sunt nevoi\u021bi s\u0103 renun\u021be la sursele minime de confort (c\u0103ldur\u0103, energie electric\u0103) din cauza veniturilor mici, \u0219i \u00eengroa\u0219\u0103 r\u00e2ndurile institu\u021biilor de ocrotire social\u0103 \u0219i a cantinelor sociale.<\/p>\n

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\u00a9\u00a0Ioana Moldovan<\/span><\/h6>\n

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\u00centr-un studiu al Consiliului Na\u021bional al Persoanelor V\u00e2rstnice, din 2014, 48,5% din pacien\u021bii v\u00e2rstnici intervieva\u021bi au spus c\u0103 starea lor de s\u0103n\u0103tate nu este \u201eprea bun\u0103\u201d, \u00een vreme ce al\u021bi 13% au etichetat-o direct drept \u201eproast\u0103\u201d. \u00centreba\u021bi ce obstacole \u00eent\u00e2mpin\u0103 \u00een accesarea serviciilor de \u00eengrijire medical\u0103, responden\u021bii au indicat drept principal\u0103 barier\u0103 timpul \u00eendelungat de a\u0219teptare pentru servicii<\/strong> (52,6%), urmat de dificult\u0103\u021bile care intervin \u00een ob\u021binerea unei program\u0103ri la specialist (32,9%). 5% au formulat propriile r\u0103spunsuri, preciz\u00e2nd c\u0103 \u00eent\u00e2mpin\u0103 dificult\u0103\u021bi \u00een achizi\u021bionarea medicamentelor sau din cauza lipsei speciali\u0219tilor \u00een localitatea lor.<\/p>\n

Decalajul dintre boga\u021bi \u0219i s\u0103raci \u00een ceea ce prive\u0219te neefectuarea unui control medical necesar este al patrulea din UE<\/strong>, dublu fa\u021b\u0103 de media UE, precizeaz\u0103 recomand\u0103rile Comisiei Europene din 2017. \u00cen Rom\u00e2nia, exist\u0103 aproape 400.000 de v\u00e2rstnici care supravie\u021buiesc dintr-o pensie de agricultor. Cu greu, media acestor pensii fiind de 403 lei. Dac\u0103 ne raport\u0103m la cei 4.670.000 de pensionari de asigur\u0103ri sociale de stat, pensia medie este de 981 de lei (calcul din luna februarie 2017).<\/p>\n

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2016 \u00a9\u00a0Ioana Moldovan<\/span><\/h6>\n

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\u00cen ianuarie, m\u0103rirea punctului de pensie a fost o veste bun\u0103 pentru majoritatea beneficiarilor, dar una cinic\u0103 pentru acea minoritate care se afla chiar sub plafonul de 700 de lei. Pacien\u021bii care ob\u021bin venituri doar din pensie beneficiaz\u0103 \u00een sistemul public rom\u00e2nesc de compensarea anumitor clase de medicamente \u00een propor\u021bie de 90%.<\/p>\n

Lun\u0103 de lun\u0103, la ridicarea re\u021betei, pacien\u021bii cu pensii de cel mult 700 de lei prezint\u0103 medicului de familie ultimul cupon de pensie \u0219i semneaz\u0103 o declara\u021bie conform c\u0103reia nu \u00eenregistreaz\u0103 venituri \u0219i din alte surse. Doar a\u0219a pot beneficia de un grad mai mare de compensare. Cre\u0219terea pensiei chiar \u0219i cu un leu peste plafonul de 700 de lei face ca gradul de compensare s\u0103 scad\u0103 la 50%. Asta \u00eenseamn\u0103 c\u0103, la fiecare cre\u0219tere a punctului de pensie, sute sau chiar mii de pensionari primesc nu o m\u0103rire, ci o sc\u0103dere practic\u0103 a veniturilor<\/strong>. Intr\u0103 c\u00e2teva zeci de lei \u00een plus la pensie, dar ajung s\u0103 piard\u0103 mai mult dec\u00e2t c\u00e2\u0219tig\u0103 pe re\u021betele lunare de medicamente.<\/p>\n

\u00cen comunit\u0103\u021bile rurale cu medic de familie, acesta r\u0103m\u00e2ne deseori singurul contact cu sistemul medical al pacien\u021bilor s\u0103i. S\u0103r\u0103cia, cultura rezistent\u0103 a \u201eplicului\u201d \u0219i implica\u021biile ei, teama de necunoscut fac ca numero\u0219i pacien\u021bi din rural s\u0103 refuze s\u0103 mearg\u0103 p\u00e2n\u0103 \u00een ora\u0219 la specialist<\/strong>, pentru investiga\u021bii sau tratament specializat.<\/p>\n

Medicii satelor sunt, \u0219i de aceast\u0103 dat\u0103, nevoi\u021bi s\u0103 peticeasc\u0103 \u0219i s\u0103 improvizeze, iar pacien\u021bii… s\u0103 se descurce.<\/p>\n

[\/vc_column_text][vc_empty_space empty_h=”3″][\/vc_column][\/vc_row][vc_row unlock_row_content=”yes” row_height_percent=”100″ override_padding=”yes” h_padding=”0″ top_padding=”0″ bottom_padding=”0″ back_image=”43330″ back_attachment=”fixed” back_position=”center center” overlay_alpha=”50″ gutter_size=”3″ shift_y=”0″ row_name=”TEXT”][vc_column column_width_percent=”25″ position_vertical=”middle” align_horizontal=”align_center” override_padding=”yes” column_padding=”0″ overlay_alpha=”50″ gutter_size=”3″ medium_width=”0″ shift_x=”0″ shift_y=”0″ z_index=”0″ width=”1\/1″][vc_empty_space empty_h=”5″][vc_empty_space empty_h=”5″][\/vc_column][\/vc_row][vc_row row_height_percent=”0″ override_padding=”yes” h_padding=”2″ top_padding=”0″ bottom_padding=”4″ overlay_color=”color-xsdn” overlay_alpha=”90″ gutter_size=”3″ shift_y=”0″ row_name=”TEXT”][vc_column column_width_percent=”70″ overlay_alpha=”50″ gutter_size=”3″ medium_width=”0″ shift_x=”0″ shift_y=”0″ z_index=”0″ width=”1\/1″][vc_column_text]<\/p>\n

2016 \u00a9\u00a0Ioana Moldovan<\/span><\/h6>\n

[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

[vc_row unlock_row_content=”yes” row_height_percent=”100″ back_image=”43340″ overlay_color=”accent” overlay_alpha=”7″ gutter_size=”3″ shift_y=”0″ row_name=”SUS”][vc_column column_width_percent=”40″ position_vertical=”middle” overlay_alpha=”25″ gutter_size=”3″ medium_width=”0″ shift_x=”0″ shift_y=”0″ z_index=”0″ width=”1\/1″][vc_column_text] VULNERABILI \u00a0 […]<\/p>\n","protected":false},"author":10,"featured_media":43406,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[95],"tags":[],"_links":{"self":[{"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/posts\/43319"}],"collection":[{"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/comments?post=43319"}],"version-history":[{"count":29,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/posts\/43319\/revisions"}],"predecessor-version":[{"id":43404,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/posts\/43319\/revisions\/43404"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/media\/43406"}],"wp:attachment":[{"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/media?parent=43319"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/categories?post=43319"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.documentaria.ro\/content\/wp-json\/wp\/v2\/tags?post=43319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}