A panel of key healthcare stakeholders discussed audits of fees, hospitals, and ambulance services, the political reality before the elections, and how to better spend limited resources. They agreed that audits should be more a tool for improvement than a cudgel, and that patient safety must remain the compass. Another key point is a clearer definition of what constitutes the standard covered by public funds and what is above-standard.
Audits and political reality
The ministry has indicated that it will publish the results of the hospital audit within a few weeks, likely in the form of conclusions and proposed measures. According to participants, the audit will not bring shocks, but rather a quantification of known weak spots—from staff utilization to hospital management. Fees are not expected to change fundamentally before the elections; attention is focusing on supplementary clinic hours and on finalizing the discussion about the emergency medical service.
The debate also addressed how to handle the findings: the aim is not quick "layoffs", but performance management and sensible rules. Mentioned were performance indicators for directors, open communication with trade unions, and clear steps for the minister to present. In short: the audit is a tool, not a goal—and the work will begin only after it is published.
Hospitals between efficiency and safety
Discussants agreed that the overly burdensome staffing norms from 2008 need to be updated, but with respect for patient safety. They see untapped potential in underused operating rooms and equipment, in weak planning, and in the fact that not all tasks must be performed by the most highly qualified healthcare professionals. Solutions also include expanding the scope of practice of support staff, greater use of same-day care, and reducing excess beds.
Strong criticism was directed at the relaxed approach to network optimization, which has drifted away from the original idea of concentrating procedures. For low-volume procedures in smaller facilities, worse outcomes are a risk—here, experienced centers and patient safety should take precedence. At the same time, regional accessibility and infrastructure must be considered so that changes do not cut rural areas off from urgent care.
Money, standard, and quality
Without a clear definition of what a citizen "buys" with their contributions, the discussion about multi-source funding goes in circles. Participants are calling for a mechanism that regularly reassesses the standard and the above-standard: new technologies can initially be available for a surcharge and, after prices fall, move into the basic package. Health technology assessment (HTA) should help, both to include useful innovations and to remove outdated procedures.
Insurers can partially measure and incentivize quality where prices are not strictly fixed, but they run into weak digitization and missing clinical data. There were also proposals to allow modest product differentiation among insurers or more competition in premium pricing, which could shape the standard more naturally. A practical limit, however, remains patients' willingness to travel and the need to ensure that solidarity does not disappear beyond the threshold of "small" co-payments.
