Zmiany systemowe w ochronie zdrowia

Od redaktora naukowego

Scientific Editors’ Note
Unsatisfactory healthcare in Poland and subsequent plans and initiatives to improve it undertaken by the Polish government require monitoring and scientific evaluation in the light of the experience gained thus far. The experience of other countries also matters as they too struggle, with different success, to solve difficult healthcare problems in the face of growing social needs, constant progress in medical technologies and rising costs of healthcare. This means that more and more public as well as private funds must be raised to finance healthcare. Furthermore, the potential of public and private healthcare providers must be tapped on efficiently.

In this Management Issues, the authors touch on a number of meaningful problems and put forward many proposals for systemic changes, drawing on observations and experiences from other countries as well. Some materials herein were presented at the conference on “Health and Economy” held by the Faculty of Management, University of Warsaw.

This Issue begins with an article by Ewelina Nojszewska, who focuses on the impact of health on the economy, notably on economic growth. She discusses socio-economic determinants of health and the channels of influence of health on the functioning of the economy at the macro and micro levels. From the micro point of view, she characterises the impact on labour productivity, labour supply, education, and the creation of physical and human capital. From the macroeconomic perspective, she presents theoretical considerations and the results of some empirical research. Her study puts forward proposals for the target structure of the Polish healthcare system based on a new design of three baskets of guaranteed medical services. Furthermore, the main challenges currently facing the Polish healthcare system are mentioned.

Małgorzata Paszkowska notes many aspects of the substantial health system reform being prepared by the current Polish government. Against the background of European health models, she presents the current Polish model and makes critical comments about its planned change. The comments relate to, among others, access to services and their financing.

Henryk Mruk states that there are many doubts concerning today’s model of broadly understood healthcare. Current changes will have a multidirectional impact on modifications in existing systems and applied solutions: Europe’s ageing populations generate greater demand for health services, new medical technologies require high spending on the refund of health services, and the development of social media offers new opportunities for improving cooperation with patients. The author points out that the development of behavioural economics and the consequent knowledge about human mind lead to increased effectiveness in managing patients’ health.

Józef Haczyński, Kazimierz Ryć, Zofia Skrzypczak and Jadwiga Suchecka compare physician resources in the healthcare systems of Poland and other European countries in 2005–2015. They attempt to establish the reason for Poland’s distant places on the lists of doctors holding the license and practising per 1000 inhabitants. The basic items of the “inflows” to (medical graduates, immigrants) and “outflows” from (retirement, emigrants, transfers to non-medical professions) the resources of doctors are indicated. The authors also identify the areas in need of systemic changes that may lead to an increase in the resources of practising physicians in Poland.

Justyna Kujawska discusses the position of family doctors/general practitioners in the primary healthcare system and compares the availability of outpatient services in Central and Eastern Europe. All CEE countries also have low spending on health care compared to Western Europe. Family doctors/general practitioners play the role of gatekeepers for access to more specialist and expensive healthcare. Despite family medicine education, there is a shortage of primary care physicians, especially in rural areas. There are barriers to access and continuity of healthcare.

Anna Hnatyszyn-Dzikowska makes a critical evaluation of Poland’s past experience in reducing waiting times for healthcare services financed by public funds compared to selected OECD countries. The time range in the article covers the years 2012–2016 and is based on the statistics contained in the WHC Foundation reports, the OECD Health Data and the Polish NHF data. The waiting time for medical services tended to increase in the period examined, proving the lack of effective actions, which is seen as one of the most serious defects in the healthcare system in Poland.

Viktor A. Snezhitskiy and Marina Yu. Surmach present selected aspects of the health care system in Belarus.

Iwona Laskowska addresses the role of private health insurance in the healthcare system facing predicted demographic changes in Poland. The necessary data for the analysis were sourced from the Polish Central Statistical Office (GUS) and the Polish Insurance Association.

Iga Rudawska explores the nature and strategic forms of the mechanisms and tools dedicated to healthcare integration in selected European countries. She reviews the literature using resources of Web of Science and Ebsco. The search criteria focused on the following key words: integrated health care, care coordination, coordinated care programmes. The time span of the analysis covered the last 20 years from 1998 to 2017. This allowed the author to identify about 40 studies that presented the experience with care coordination and to evaluate them from the scientific point of view.

Integrated, coordinated care is also discussed by Anna Różalska and Marcin Czech, who outline this issue as exemplified by oncology.

Maciej Jewczak and Klaudia Twardowska show the attempts to improve social well-being in relation to health needs, using the results of cross-sectional studies combined with local data at the individual level. Popularisation of GIS (Geographic Information System) tools has enabled monitoring of various system dysfunctions and thus contributes to the identification of actual health needs, thereby improving the quality of health care via, for example, adjusting health policies and changing the goals of public health.

Magdalena Rutkowska and Józef Haczyński offer recommendations on how to reorganise a medical facility that wants to grow in the medical tourism market and effectively attract foreign patients. They use the experience gathered by managing a medical facility that specialised in treating foreign patients and handled more than 1500 patients from abroad. Their work presents the different stages of handling a foreign patient in a medical facility.

prof. dr hab. Kazimierz Ryć
dr hab. Józef Haczyński
doc dr Zofia Skrzypczak

Zawartość numeru

The Impact of Health on the Economy – Applications for the Polish Health Care System (13 pages)

Autor: Ewelina Nojszewska
Słowa kluczowe ang.: health, economy, economic growth, health care
PP. 11 - 24
DOI: 10.7172/1644-9584.69.1
The article discusses the impact of health on the economy, and above all on economic growth. Socioeconomic determinants of health are presented first, because the level of economic development affects the health of individuals and society. Then, the channels of influence of health on the functioning of the economy are described at the macro and micro levels. From the micro point of view, the impact on labor productivity and labor supply, as well as education and the creation of physical capital and human capital, is characterized. From the macro point of view, theoretical considerations and the results of some empirical research are presented. The next section introduces the target structure of the health care system based on a new design of three baskets of guaranteed medical services. At the end, the main challenges currently facing the Polish health care system are mentioned.

Health Care System in Poland – A Change of the Model (16 pages)

Autor: Małgorzata Paszkowska
Słowa kluczowe ang.: system, health care, reform, insurance, taxes
PP. 25 - 41
DOI: 10.7172/1644-9584.69.2
The present government is preparing a major reform of the healthcare system. Currently, Poland has an insurance-based health care model. The payer is the National Health Fund. In 2018, the insurancebased model will be replaced by a budget (tax)-based model. Health care will be financed by the state budget and will be available to everyone. Changing the model of the health care system is a return to the times of the Polish People’s Republic. The article presents possible European models of health care and the current Polish model. The article includes selected critical comments regarding the planned change of the health care model in Poland. The comments relate to, among others, access to services and their financing.

Directions of Changes in Health Care (10 pages)

Autor: Henryk Mruk
Słowa kluczowe ang.: health care, changes in health care, pharmaceutical care, self-care
PP. 42 - 52
DOI: 10.7172/1644-9584.69.3
European societies, including Poland, are aging, and this increases the demand for health spending. The prices of new medicines and medical technologies will also increase. Health insurance funds will not be able to fully cover the growing demand for medical care. States will disclaim responsibility for the health of citizens. The proportion of patients paying for medical services will increase. There will be an increased interest in managing your own health, including self-care. The role of pharmacies in the market will change. As neighborhood facilities, they will be of assistance, providing pharmaceutical care. Patient support will be available in social media, as well as in various mobile applications. It will be helpful to use the achievements of behavioral economics to support the health of patients.

Physician Resources in the Health System – Comparison of Poland and Selected European Countries (13 pages)

Autor: Józef Haczyński, Kazimierz Ryć, Zofia Skrzypczak, Jadwiga Suchecka
Słowa kluczowe ang.: human resources in health-care system, physicians with license, practicing physicians
PP. 53 - 66
DOI: 10.7172/1644-9584.69.4
The aim of the study was to compare physician resources in the Polish health system and other European countries in the years 2005–2015. An attempt was made to answer the question of whether there is a link between the number of physicians and the model of the health-care system in a given country. It was attempted to determine what is the reason for Poland’s distant places on the lists of doctors holding the license and practicing per 1000 inhabitants. The basic items of the “inflows” to (medical graduates, immigrants) and “outflows” from (retirement, emigrants, transfers to non-medical professions) the resources of doctors are indicated. Attention has been paid to the areas in need of systemic changes that may lead to an increase in the resources of physicians in Poland.

Position of Primary Care Physicians in Central and Eastern European Countries (14 pages)

Autor: Justyna Kujawska
Słowa kluczowe ang.: general practitioner (GP)/family doctor, primary health care, access to service
PP. 67 - 81
DOI: 10.7172/1644-9584.69.5
on the Semashko model. It focuses on the development of hospital care and secondary health care, completely ignoring primary care and the role of primary care physicians in the system. For more than 20 years, CEE countries have been trying to reinstitute the due position of family physicians and primary care. The aim of this article is to determine the position of primary care physicians in the health care system, and to compare the availability of basic health services in Central and Eastern European countries. CEE countries have low spending on health care compared to Western European countries. Family doctors play the role of gatekeepers for access to more specialist and expensive health care. Despite family medicine education, there is a shortage of primary care physicians, especially in rural areas. There are barriers to access and continuity of health care. Primary health care systems in CEE countries can be characterized as weak systems.

Waiting Time for Health Care Services in Poland and Selected OECD Countries (17 pages)

Autor: Anna Hnatyszyn-Dzikowska
Słowa kluczowe ang.: health services, public financing, waiting time
PP. 82 - 99
DOI: 10.7172/1644-9584.69.6
The main purpose of the article is a critical evaluation of Poland’s past experience in reducing waiting times for health care services financed by public funds. Moreover, good practices undertaken by selected OECD countries are identified. Selected medical interventions across 43 areas of medicine in Poland have been analyzed. The time range in the article covers the years 2012–2016 and is based on the statistics contained in the WHC Foundation reports, the OECD Health Data and the NHF data. The advantages and disadvantages of the solutions across OECD countries are pointed out on the basis of the literature review. Overall, the waiting time for medical services tends to increase. This fact proves the lack of effective actions, which is seen as one of the most serious defects in the health care system in Poland. Actions taken to reduce waiting times for guaranteed medical services are chaotic, inconsistent and do not contribute to improving accessibility. As a good practice in selected countries (e.g. Great Britain), it is recommended to take coordinated action on both the demand and supply side, preceded by a reliable system diagnosis.

Accessibility of Health Care and Recent Changes in Health System of the Republic of Belarus (16 pages)

Autor: Viktor A. Snezhitskiy, Marina Yu. Surmach
Słowa kluczowe ang.: accessibility of health care, medical personnel, medical services, medical education, health care reforming, health care financing
PP. 100 - 116
DOI: 10.7172/1644-9584.69.7
The accessibility of health care to the population in Belarus is illustrated in terms of indicators of health care provision: medical services personnel density, hospital bed / population ratio and development of medical education. Through the prism of WHO-defined “financial profile” of health care, several aspects of state policy are analyzed. Particular attention is given to the quality of medical education, employment and financial motivation of health care workers. The areas for further health care development in the Republic are specified.

The Role of Private Health Insurance in the Healthcare System Facing Demographic Changes in Poland (12 pages)

Autor: Iwona Laskowska
Słowa kluczowe ang.: demographic changes, healthcare system, private health insurance
PP. 117 - 129
DOI: 10.7172/1644-9584.69.8
The demographic future of the country is becoming a major challenge for healthcare, not only from the standpoint of the public payer, but also regarding the healthcare system’s organisation and efficiency. In the face of constantly changing population structure that entails higher demand for costly medical procedures addressing the needs of the elderly, the only way to make the system efficient and to ensure the accessibility of medical services is to increase the amount of available funding. One of the priorities laid down in the Ministry of Health’s healthcare strategy is to gradually increase public allocations for healthcare, now one of the lowest in the European Union. The healthcare system in Poland could also benefit financially from commercial health insurance. In the article, the role of private health insurance in the Polish healthcare system is discussed in the context of demographic change forecasts.

Towards More Integrated Health Care – The Review of the International Experience (15 pages)

Autor: Iga Rudawska
Słowa kluczowe ang.: health systems, integrated care, care coordination, integration mechanisms, Europe
PP. 130 - 145
DOI: 10.7172/1644-9584.69.9
Most European countries have failed to integrate health care services. This inevitably leads to fragmented health care provision. This fragmentation results in long waiting times and involvement of multiple care providers who offer different forms of care. The lack of integration of health care seems to be one of the biggest challenges in health systems as integration calls for a holistic approach and the implementation of structural changes that are costly. The aim of the paper is to explore the nature and strategic forms of the mechanisms and tools dedicated to health care integration in selected European countries. The literature review was performed using resources of Web of Science and Ebsco. The search criteria focused on the following key words: integrated health care, care coordination, coordinated care programmes, and integration mechanisms. The time span of the analysis covered the last 20 years from 1998 to 2017. Finally, 39 studies were identified that presented the evidence-based experience with care coordination. Several strategic forms of health care integration have been identified, including structural, functional and subject-based mechanisms.

Coordinated Care in Oncology (12 pages)

Autor: Anna Różalska, Marcin Czech
Słowa kluczowe ang.: coordinated care, oncology, changes, oncology package, patient
PP. 146 - 158
DOI: 10.7172/1644-9584.69.10
Coordinated patient care (disease management) has become one of the main topics of discussion in the Polish health care system. The experience drawn from international practices helped to create a basis for managing the process of treatment. Nevertheless, there is still a strong need for changes in the Polish healthcare. The article presents the management of oncological patients within the existing Package of Oncology. The assumptions of this consideration involve the analysis of oncology queue system solutions and their impact on the patients care. The analysis shows that it is difficult to conclude about the effectiveness and cost of the clinical oncology package within the framework of coordination of patient care due to the lack of relevant data at the time of its implementation. Having been subjected to constructive criticism, the oncology package is currently in the phase of changes. The question remains to what extent the criteria for amendment of the reform are important from clinical, social and the payer’s point of view. Moreover, one should not forget about the main assumptions of coordinated cancer care, which are: immediate diagnosis and fast introduction of effective treatment.

Health Needs of the Polish Society and the Willingness to Pay for Health Services (15 pages)

Autor: Maciej Jewczak, Klaudia Twardowska
Słowa kluczowe ang.: spatial diversity, health care, willingness to pay, health needs
PP. 159 - 174
DOI: 10.7172/1644-9584.69.11
Health needs of every person are growing constantly. Attempts to improve social well-being in relation to health needs use the results of cross-sectional studies combined with local data at the individual level. Popularisation of GIS tools has enabled monitoring of various system dysfunctions and thus contributes to the identification of actual health needs, thereby improving the quality of healthcare via, for example, adjusting health policies and changing the goals of public health. GIS can be used for mapping health needs that have been specified by the Ministry of Health. However, as evidenced by research and observed in numerous opinions, it is possible to extend these analyses in terms of regional/local factors, taking into account households’ preferences. The analyses within the research aim were conducted mostly for the level of Polish subregions. The data was collected on the basis of reports from the Local Data Bank of the Central Statistical Office and the Council for Social Monitoring – Social Diagnosis. Spatial statistics and econometric tools were applied, focusing the research attention on patterns of spatial distribution of variables; for that purpose, spatial autocorrelation measures and cluster analysis were adopted.

Practical Aspects of Medical Institution Reorganization and Implementation of the Process of Handling a Foreign Patient on the Basis of Own Experience at Medical Travel Partner (10 pages)

Autor: Magdalena Rutkowska, Józef Haczyński
Słowa kluczowe ang.: medical tourism, foreign patient service
PP. 175 - 185
DOI: 10.7172/1644-9584.69.12
Medical tourism is becoming a new trend in the Polish health care system. The dynamic changes in the market for this type of tourism services are compounded by a variety of economic factors as well as social or cultural transformations and the advancement of medicine and the possibilities of treating various medical conditions offered in foreign institutions. A clinic seeking success in the medical tourism market should define and implement care standards appropriate for patients from abroad and constantly improve their quality. The paper presents practical recommendations on how to reorganize a medical facility that wants to grow in the medical tourism market and effectively attract a foreign patient. This paper present particular stages of the patients flow in a medical center.