Mechanisms to improve treatment standards in neurosurgery, cerebral aneurysm surgery as example.

Abstract

The Department of Neurosurgery in Helsinki UCH in the southern part of Finland has a catchment area of nearly 2 million people. In 1996 there were 1632 operations and the annual budget of the department was 51 534 000 FMK. During the last three years, after I became chairman of the institute, the number of operations and the budget has doubled (in 2000: 3037 operations, the annual budget 103 065 000 FMK). People in the hospital administration, and even in my institute found it hard to understand the steep increase in numbers and costs. The justification of the quantity and even the quality of treatment were questioned. Consequently, I collected figures on the activity in other departments of neurosurgery in Finland and neighbouring countries, especially Sweden and Estonia. This led to hard, and still ongoing fight with administrators and politicians to increase the resources for neurosurgery. An internal scrutiny by the administration, which continued for more than one year disclosed that both the patient selection and the treatment results are adequate. Peculiarly, one of the observations was that our patient profile was the youngest in the whole University Hospital only excluding the Department of Pediatrics! We are continuously concerned about the financial resources for neurosurgery. This department has traditionally had to put up with minimal resources, and saving money has been a virtue exceeding everything else. We are continuously following up our daily work and the fate of our patients, and we are constantly trying to influence upon decision makers.