Hospital District of Helsinki and Uusimaa calls for more surgery patients from abroad

HUS wants to develop the competence of surgeons and to derive income through a private hospital

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By Johanna Tikkanen
     
      The child's head is swollen and bluish as if she had sustained a heavy blow to her head. A long row of stitches runs over the top of her head.
      Latvian infant Mara Gicevica, 1, is lying in her mother’s lap and clasping a wooden toy tightly in her hands.
      ”The child feels well and we are sure that she will recover. The doctor promised that one day she will become a beauty”, says father Andris Gicevics happily.
     
The demanding cranial surgery on Mara was performed at the Töölö Hospital a week ago, and the operation lasted 12 hours.
      ”The cranial bones were separated from each other above the eyes, the back of the head was moved backwards, and the forehead forwards, and the skull was remodelled”, reports surgeon Jyri Hukki.
     
The Hospital District of Helsinki and Uusimaa (HUS) would like to have more surgical patients like Mara from abroad.
      In certain fields of surgery, the aim is to multiply the number of child patients severalfold by 2020.
      For example the pediatric neurosurgery unit plans to receive as many as 300 new surgery patients per year.
      Today, the number of patients is 100, of whom just a few are of foreign origin.
      ”The Finnish population base does not offer us enough patients in order that the surgeons’ expertise could be developed sufficiently”, says Docent Jari Petäjä, Director of the Department of Gynecology and Pediatrics, explaining the growth plans of HUS.
      Another factor behind the plans is an upcoming private hospital, through which HUS plans to derive additional revenue.
     
Today, most of HUS’s foreign surgical patients come from the Baltic States and Russia.
      More patients from that direction are likely to be found. The most remote country from where Jyri Hukki has had a patient is Kuwait.
      The number of patients of foreign origin is likely to grow to some extent, even regardless of HUS's plans.
      "An increasing number of patients are coming into Finland through adoptions all the time. A total of something like 30 adopted Chinese children with a cleft lip and a cleft palate are operated on in Stockholm on an annual basis”, reports Hukki.
     
According to Hukki, new patients are a boon to Finland.
      ”Our operating skills develop, and the Finns themselves get better treatment”, he notes.
      Mara Gicevica had already undergone two cranial surgery procedures in Lithuania, before she ended up in the operating theatre of the HUCH’s surgical team.
      The first operation was performed when the child was only two months old.
      ”Exceptionally, the child’s cranial sutures had been fused together prematurely already when she was born. In order that the skull could expand, some of the cranial bones had to be removed. This is how the child’s brain could be saved - and maybe also her life”, Hukki continues.
      However, her brain grew in the wrong direction, to the side, and the skull began to be malformed. The Latvian doctor sent her to Hukki’s consulting rooms in Tallinn.
     
Last week the child’s entire skull was rebuilt. Now the patient has all the possibilities to develop in a normal way.
      ”Her appearance will be improved in a couple of years, when her bones have grown”, Hukki adds.
     
     
BACKGROUND: Children are being transferred from one clinic to another
      Mara Gicevica’s operation was the last cranial operation performed at the Töölö Hospital. From now on, operations on all cranial patients will be performed in the Children’s Clinic.
      Even the cleft lip and palate operations should definitely be performed in the Children’s Clinic, says Jyri Hukki, the head of the Cleft Palate and Craniofacial Centre at the Department of Plastic Surgery of the Helsinki University Central Hospital.
     
”The Töölö Hospital is an adults’ hospital, and their readiness to take care of child patients is not adequate. In some cases, child patients have had to be transferred by ambulance to the Children’s Clinic for intensive care. I am afraid of what could happen to these children”, Jyri Hukki argues.
      Moreover, there are often problems when it comes to postoperative care.
     
”The first two days after the operation are the most critical, and the patient should not be transferred unnecessarily. But there seem to be no intensive care beds in the Töölö Hospital’s ICU. The patient will have to be moved to the Children’s Clinic, and to be brought back here a couple of days later. There is absolutely no sense in that”, Hukki charges.
      This is what also happened to Mara Gicevica. Her operation was almost cancelled, as there seemed to be no intensive care bed available.
      Hukki hopes that as a surgeon he would not be forced to fight for post-operative care for all of his patients separately.
     
”After all, it is a question of people’s will rather than funds or insufficient space. If no post-operative beds can be guaranteed, we should not even be speaking about increasing the number of foreign patients”, Hukki argues.
      This matter will have to be settled before the potential new children’s hospital is built, Hukki says.
      The hospital is scheduled to be taken into use in 2020 at the earliest.
     
     
COMMENT: Foreigners have been surprised at low prices
      The Hospital District of Helsinki and Uusimaa (HUS) charges EUR 15,000 to 20,000 for a demanding cranial operation.
      The charge is the same regardless of whether the payer is a foreign insurance company or for example the municipality of Tuusula.
     
Patients in other countries have sometimes been surprised at Finland’s low prices, reports Reijo Haapiainen, the head of the operative profit unit of HUS.
      ”When we send an invoice, some foreign people may ask whether it is for the planning stage only, and how high will the actual invoice be”, Haapiainen says.
     
As soon as the HUS private hospital has started its operation, we will be able to increase our prices, says Haapiainen.
      ”This could be one way to get more money for HUS”, he adds.
      Mara Gicevica’s surgery will be paid by the Latvian health insurance fund. In addition, the family will be charged the patient fee of EUR 340, Mara’s father’s hotel accommodation, and one week’s parking fees.
      The patient fee came as a surprise to the parents.
      ”Foreign patients are such a new phenomenon that the payment arrangements are not yet very smooth”, admits surgeon Jyri Hukki.
     
     
Helsingin Sanomat / First published in print 19.1.2012


See also:
  Finnish patients increasingly encounter foreign-born doctors (30.11.2010)
  Helsinki and Uusimaa Hospital District planning patient transfers (15.11.2007)

Links:
  Hospital District of Helsinki and Uusimaa (HUS)

JOHANNA TIKKANEN / Helsingin Sanomat
johanna.tikkanen@hs.fi