|Implemented in this survey?|
In 2005 the Law on public assistance and restructuring of health care institutions was passed to release growing debts. The arrears accumulated under: public law regulation (e.g. contributions to social insurance), civil law (e.g. money owed to medical partners or suppliers), obligations to own employees (rewards imposed by the Parliamentary law, no financial transfers, institutions paid). In 2006 a preliminary report on implementation of the law was issued.
Chaotic changes implemented in the Polish health services system contributed to an uncontrolled increase in (actual) spending. Formally, it was a problem of many, officially autonomous institutions providing services. However, because the institutions were publicly owned their growing obligations were seen as a politically relevant issue. It was one reason why politicians (the Parliament) made the decision to help the institutions and to alleviate the financial burden. It was also intended to prevent the institutions from continuing the same, very loose and rather irresponsible financial policy.
Health care institutions, individual employees, partners in the public system (like insurers), partners in the system (providers of medical services, other providers), patients
|Medienpräsenz||sehr gering||sehr hoch|
Even if debts may occur in health care institutions in many countries there are a lot of specific features which do not appear elsewhere such as rather weak financial discipline and a belief that in oppression "the government will help".
The law was passed when the left-wing coalition dominated. According to its political rhetoric it was ready to assume responsibility for a prospect of the public sector which consisted of institutions governed by either MoH or local governments. At that time debts generated by health care institutions were believed to be the most dangerous factor. Meantime the government changed (result of the Parliamentary election that was held in Autumn 2005). A right-wing coalition took power and felt obliged to continue formerly established duties.
Paradoxically the new government actually revealed more support for the public institutions than its predecessors. Generally, the right-wing coalition is a strong follower of the state's direct involvement in many activities addressing social needs. They believe that institutions governed by the state (state administration) can be more efficient - and people oriented - than institutions belonging to other sectors.
There is no one approved health policy document. However, we may refer to the list of priorities as declared by MoH and presented on the MoH Web site. It was also presented by the Minister in his Parliamentary speech provided in June 2006.
|Implemented in this survey?|
The problem of debts appeared many times in the past and the government felt itself powerless to interfere and help. Many believed that the gap between influx of many - allocated via contracts negotiated by the payer - was too small to balance expenditure generated by health needs (or rather a high number of patients).
Some analysts believed debts to be unavoidable. Nevertheless politicians urged to undertake measures at both the national and institutional level - to contract. Strong pressure exerted by institutions' managers to relieve the situation was felt. Health care institutions were encouraged to apply for relief of their debts, being obliged to meet a set of consented conditions (usually referring to performance). In time when the law was passed debts amounted to 6 086,7 million PLN. At the end of the year the debt was reduced to 5 027 million PLN (reduction of 17.4%).
The approach of the idea is described as:
Else - Many managers of health care institutions lobbied for governmental initiative aiming at improving the financial conditions (by means of money) under which institutions operated. Legal changes resulted from these efforts.
There was very strong pressure from the institutions' employees to solve the problem of debts (especially with regard to individual sums unpaid, but not underscoring public obligations). Also, managers of the institutions were interested in solving problems as they wished to present themselves as efficient executives and to ease conditions in which they operated. The government wants to demonstrate that the health system is functioning properly.
|MoH||sehr unterstützend||stark dagegen|
|(Public) Health care institutions||sehr unterstützend||stark dagegen|
|Employees of health care institutions||sehr unterstützend||stark dagegen|
As commented in the previous report in the very last minute the Parliament changed the draft submitted by MoH.
|(Public) Health care institutions||sehr groß||kein|
|Employees of health care institutions||sehr groß||kein|
Considering formal aspects of the process the results are as follows:
Considering the composition of institutions applying for assistance and restructuring the results are as follows:
The above figures cover institutions applying to both MoH and voievodship authorities.
In most cases health care institutions signed contracts (agreements) including many specific conditions that had to be met by the institutions. Because there was a direct link between institutions' performance and possibilities to acquire subsequent shares of money an internal monitoring mechanism was set up.
Up to now only partial evaluation has been conducted and covers the period between 22 August, 2005, and 7 April, 2006. It focused mostly on formal and quantitative aspects of the process, although actually it was the intention to improve performance of health care institutions. The procedure was finalised in 14 institutions and led to a reduction of 1.12% of the original debts although the global burden was reduced by 17.4%. Supposedly, very relevant will be a set of conclusions drawn from the experience. Some preliminary recommendations were included in the draft amendment submitted to Parliament on 12 April, 2006.
For the time being the final evaluation is not possible. Firstly, because the process of debt release is still going on and therefore ultimate results remain unknown. Secondly, because a comprehensive evaluation has not been worked out (only preliminary comments are available).
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Up to now results of the innovation are not visible. Contracts and agreements have been signed but institutional performance has not improved. Institutions are likely to improve performance if they are pressed to do so. To judge realistically, they must face a risk of being closed down. Because such a prospect is being unfolded one can hope the better performance.