Tuesday 16 January 2001

Pic of the day: A bridge to a brighter future? This bridge near Chaos Node sure seems patient enought ... but that's not quite what I mean ...

Patient bridge

I've made some disparaging comments about the Norwegian health care, despite the fact that there are many good people working there and some of them are my friends. There is no way around the fact that something owned and operated by the government is bound to be less than optimal. This comes directly from the way these things work. There is no positive feedback between success and income; if anything, it's the other way around: A successful hospital will be given less money next year while a failed one will be given more. It follows with the divine certainty of natural law that this must go wrong.

Furthermore, our health care is almost completely funded by taxes. People will avoid paying taxes whenever possible, while they would have been more than eager to pay for health care if their lives depended on it. As it does sometimes; but since the connection is indirect, the motivation does not click.

So regardless how much money is shuffled into the health care, and particularly the hospitals, the patients remain patiently waiting in line. The effect of this varies from irritation over severe disability to an untimely death. Though generally the more serious cases are taken first, at least. I guess that's a good thing, instead of people being treated in order of their creditworthiness. I'm not going to concede any points to marxism, however: In a market economy, there would be enough health services for all.

***

As more and more voters are reaching an age where public health care is an important factor in life, politicians have started to think. Or at least act. Last fall a majority in Stortinget (our national parliament, literally meaning "the big thing") set aside 1 billion Norwegian kroner, ca US$ 120 million. This was to buy treatment abroad for those patients that could not be treated in Norway within a reasonable time. The initiative is often referred to as the "patient bridge".

When the time for this approached, several leaders of Norwegian hospitals raised warnings: Patients who were operated abroad may contract bacteria resistent to antibiotics, and may come home and contaminate Norwegian hospitals with these resistent strains, killing themselves and others at worst.

It would be easy to ironize over these horrible news for the 99% of patients in the world that suffer the misfortune of being operated outside Norway. But there is something to it. While there are few signs that more people die after surgery in other developed countries than in Norway, it is a fact that Scandinavians use less antibiotics than most other Europeans, not to mentions Americans. (I know I've taken antibiotics approximately once per decade after I grew up, and I don't think that is extreme in either direction. The Nordic countries are remarkable in this practice.)

When the plans forged ahead despite the "illegal immigrating bacteria" scare, Norwegian hospitals revealed that they actually had excess capacity which they could use if the patients were sent there instead of abroad. This came as a surprise to many, and several politicians reconsidered. It was not a surprise for me, of course: Last spring, when I was one night at the central hospital here in Kristiansand, I noticed that there would have been room for a couple more beds out in the corridor where I and several others were lying...

In addition to rooms and equipment, Norway lacks medical personell. The lack of physicians is improving, but the lack of nurses is worsening. Many nurses leave their work, because they find that it is too hard and the pay is not good enough. Since the beginning pay is approximately on the same level as my own salary after 20 years of work, I suspect that the hard work is the most important factor. A nurse's day is just as likely to be in the night, and there is a huge emotional stress if you actually care about the patients. It doesn't help that many institutions try to keep the number of nurses as low as they legally can, in order to save money.

As we no longer get enough nurses from Denmark and Sweden, we've been scouring Europe and now plan to recruit in the Philipines. Perhaps I should learn Spanish now, just in case I get sick again.

***

All things considered, it doesn't seem like such a stupid idea to send patients abroad instead. But the actual argument for going ahead with the plan is, typically, something else entirely. It is the fear that pumping another billion into the Norwegian economy would increase inflation and harm the economy. Now, that's the kind of thinking I like to hear! Go economists!

(It is worth noticing, however, that the worryingly high inflation in Norway the last few years is best explained by new taxes and fees from central and local government... And that's not the road to a brighter future.)