Marcin Kautsch

Jednostki samorządu terytorialnego stopnia powiatowego zobowiązane są do tworzenia i realizacji programów polityki zdrowotnej, co wynika z wyznaczonych im zadań w ochronie zdrowia. W artykule poddano weryfikacji, w jakim stopniu powiaty/miasta na prawach powiatu wywiązują się z tych zadań poprzez realizację programów polityki zdrowotnej oraz czy istnieje związek między realizacją takich programów a zamożnością powiatu, wskaźnikami opisującymi stan zdrowia populacji oraz posiadaniem przez powiat własnych podmiotów leczniczych. W wyniku przeprowadzonego badania stwierdzono, że na terenie jednostek, które realizują programy zdrowotne (choroby cywilizacyjne, nowotwory), występują niższe wskaźniki zgonów. Jednocześnie zaledwie 38% powiatów i 70% miast na prawach powiatu faktycznie realizowało takie programy. Za główne powody tak niskiego odsetka powiatów tworzących wyżej wymienione programy należy uznać niewystarczające wsparcie strukturalne (prawo), instytucjonalne (jednostki mogące pomóc w tworzeniu takich programów) oraz problemy z kadrą i braki w know‑how pracowników JST. Do poprawy sytuacji mogłyby przyczynić się: powstanie centralnego rejestru programów, lepsze rozwiązania legislacyjne, modyfikacja lub budowanie innych modeli polityki zdrowotnej (stawiających na profilaktykę i promocję zdrowia) oraz wsparcie edukacyjne dla samorządów.

Background: Due to the significant staff shortages, emigration of health professionals is one of the key challenges for many healthcare systems. Objective: The aim of this article is to explore the estimated trends and directions of emigration among Polish health professionals. Methods: The emigration phenomenon of Polish health professionals is still under-researched and the number of studies in this field is limited. Thus, the authors have triangulated data using two methods: a data analysis of five national registers maintained by chambers of professionals (doctors, nurses, midwives, physiotherapists, pharmacists, and laboratory diagnosticians), and data analysis from the Regulated Profession Database in The EU Single Market. Results: According to the data from national registers, between 7–9% of practicing doctors and nurses have applied for certificates, which confirm their right to practice their profession in other European countries (most often the United Kingdom, Germany, Sweden, Spain, and Ireland). The relatively high number of such certificates applied for by physiotherapists is also worrying. Emigration among pharmacists and laboratory diagnosticians is rather marginal. Conclusions: Urgent implementation of an effective mechanism for monitoring emigration trends is necessary. Furthermore, it is not possible to retain qualified professionals without systemic improvement of working conditions within the Polish healthcare system.

The aim of the article is to present selected issues related to the impact of the pandemic on the universality of e-health services, as well as to show the readiness to use such services by the inhabitants of urban and rural areas in Poland. Several hypotheses are launched regarding the COVID-19 effect in relation to the implementation, use and access to e-health services and the skills needed to use them. The article includes an analysis of the legal and social context accompanying organisational changes in the health care system caused by the presence of the COVID-19 virus, as well as an analysis of the results of quantitative research on the attitude of rural residents to such solutions. Data obtained in a study from the WE Patients Foundation provide some insight into the complexity of factors governing e-health use, showing less differences between city and rural areas than we hypothesised.

This article presents the results of analyzes carried out on all provincial (voivodeship) outbreak action plans in the event of an epidemic in Poland. Voivodeships are obliged to prepare such documents by the law, however, its provisions are imprecise, therefore the content of the plans is diversified. The analytical parts of the documents do not contain basic information (like demographics). The entries are often based on the opinions of the authors and not the data, so the plans are not evidence-based. Although the plans were usually updated before or during the COVID-19 outbreak in Poland, references to the coronavirus are fragmentary. The differences between the plans and their (mostly) poor quality seem to be the result of a mixture of imprecise legislation, lack of ability to write plans, and risk avoidance. This makes the existing documents of little implementation value in the face of the emerging coronavirus threat.

Fixed assets in public and private healthcare in 1999-2018 The presented article deals with the subject of fixed assets in healthcare: their gross value, condition and degree of wear, broken down into the public and private sectors. Above the value grew extremely strongly in the analysed period, particularly impressive in private healthcare. The financing of this growth seems to have the largest share of funds obtained from EU and the EEA Financial Mechanism and the Norwegian Financial Mechanism as well as from public payer funds. The rate of increase of funds in healthcare from other public sources is significantly lower than, for example, the rate of GDP growth, which may indicate the withdrawal of state structures from healthcare financing. The increase in the degree of wear of fixed assets, which took place in the analysed period, may cause some concern.

Możliwości i bariery wdrożenia systemu HB-HTA na podstawie modelu z koordynującą rolą szpitala

Summary: Purpose: To present and discuss the findings of surveys on the profiles of hospital CEOs in Poland, as carried out in 2012 and 2017, involving over a hundred hospital CEOs at various reference levels.Findings: The findings indicate appreciable changes in the group under study. While until recently, a typical hospital CEO was a male physician; presently, there is a fair proportion of women (36%). The majority of CEOs are non‐physicians (63%), whereas previously, they accounted for approximately 63% of them. Mean work experience in public health care for male CEOs tends to decrease, whereas an opposite trend is well manifested with regard to female CEOs. It was also established that hospital CEOs were steadily less keen on improving their professional qualifications through postgraduate courses.Conclusion: These changes may imply a kind of “stabilisation” within the sector itself or a departure from the all‐male, medicine‐centred model of hospital management. They may have been caused by climbing expectations regarding overall management expertise and a higher salary level offered to physicians. Changes in individual work experience seem to indicate that men are more often “transplanted” from other industry sectors, whereas women tend to pursue their entire career path in public health care institutions.

Postgraduate education of hospital directors

The article presents findings of research on e‑health development in four European Union (EU) Member States in the context of public procurement of innovation (PPI). EU policies attempt to make public procurement leverage for innovation by introducing a number of new tender procedures. Policies and practices in PPI, including e‑health, were investigated for Denmark, Great Britain, Spain and Poland. For various reasons, all four countries struggle with the introduction of the European PPI procedures, and with making a transition to outcome‑based tenders. Though they all introduced policies implementing these procedures, Denmark and Great Britain seem to have achieved better results, having well‑established public‑private collaboration. This correlates with a more efficient adoption of e‑health solutions in those countries. With some minor successes, Spain, and particularly Poland, display attachment to traditional procedures despite changes in the public procurement regulations.

Development of e-health in Poland has suffered from multiple setbacks and delays. This paper presents views on and experiences with implementation of e-health solutions of three groups of respondents: buyers, suppliers and external experts with the aim of establishing to what extent and in what way e-health development was taking place in Polish public health care and if there were any national policy targets or European targets influencing this development. It is based on desktop studies and interviews conducted in Poland in the spring and summer of 2015. The interviews largely confirmed findings from the desktop study: legal obstacles were the decisive factor hindering the development of e-health, especially telemedicine, with extensive insufficiency of basic IT infrastructure closely following. Stakeholders were deterred from engaging with telemedicine, and from procuring e-health using non-standard procedures, from fear of legal liability. Some doctor’s resistance to e-health was also noted. There are reasons for optimism. Amendment to the Act on the System of Information in Health Care removed most legal obstacles to e-health. The Polish national payer (NFZ) has started introducing reimbursement for remote services, though it is still too early see results of these changes. Some doctors′ reluctance to telemedicine may change due to demographic changes in this professional group, younger generations may regard ICT-based solutions as a norm. In the same time, poor development of basic IT infrastructure in Polish hospitals is likely to persist, unless a national programme of e-health development is implemented (with funds secured) and contracting e-health services by NFZ is introduced on a larger scale.