Program on cancer disease prevention

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Law on the National Program against Cancer Diseases for 2006?2015 has been issued on July 1, 2005. The program itself was launched on January 1, 2006. The purpose/outcome of the policy is to lower mortality resulting from cancer diseases through the implementation of European standards (early diagnosis indicators, treatment effectiveness and through the permanent monitoring of effectiveness). The Program obliged the MoH to create a schedule for the year 2006.

Purpose of health policy or idea

The main purpose of the health policy idea is to lower population mortality caused by cancer diseases. The long-term Program established in form of the law from the 1st of July 2005 enumerates its goals as follows:

• stopping the growth of cancer diseases cases;
• implementation of average European indicators in the sphere of early diagnosis;
• implementation of average European indicators  in the sphere of treatment effectiveness;
• creation of conditions to promote progress of knowledge concerning the causes and mechanisms of cancer development and to promote the practical use of this knowledge in oncology;
• creation of a permanent monitoring system for cancer prevention and the effectiveness of combating actions on the national and regional level.  

The law establishes main actions to be undertaken for the realisation of  objectives and it defines the sphere of MoH competencies in this field. It also creates a new organ - the Council on Cancer Diseases, an advisory body to the MoH for the program purposes. The law clearly states that the program is going to be financed both from the central budget and from other sources and decides upon a total sum of financial costs of the program for the whole 14 year period - 3000000000 PLN ( 750.000.000 Euro).

Main points

Main objectives

To achieve general objectives, defined above, the Program against Cancer Diseases enumerates 10 particular goals:

• Progress in primary prevention through better knowledge about cancer causes, especially about smoking and nutrition habits.
• Implementation of early population screening programs, especially concerning breast cancer, cervical, intestine cancer and selected cancer forms among children.
• Access to early cancer diagnosis methods, implementation of proper quality diagnostic and improvement of therapeutic procedures.
• Standardisation of irradiates treatment procedures.
• Purchase of new equipment and exchange of old diagnostic and therapeutic equipment.
• Dissemination and popularisation of complementary treatment methods.
• Development and popularisation of new methods of rehabilitation, long term results of treatment limitation and palliative care in oncology.  
• Development and dissemination of professional training methods, by including oncology education in the first stages of curricula for nurses, midwifes and other health care professionals.
• Improvement of the advanced cancer data collecting system.
• Popularisation of the knowledge on prevention, early diagnosis methods and cancer treatment among the Polish population.

The program is introduced in form of a law creating a long-term plan of multidirectional actions.

The main role in the realisation of the program plays a particular schedule elaborated for each year of its implementation. The MoH delivered the first one for the 2006-year. It contains the description of the particular objectives foreseen for the present year. 

According to the law, the special advisory body called The Council on Cancer Diseases was appointed. The main goal of the Council is to analyse the situation in Poland and to provide recommendations on the best ways to reduce cancer-related mortality. The Council advises on the level of financial resources needed for the realisation of the program as well as on the sphere of necessary Program activities. It also gives the opinion on the requirements for the competition offers.

For the purpose of the activities realisation that are derived from the Program the provisions of the public orders procedures are not applicable.

Type of incentives

As it was mentioned above the law stipulates a total sum of financial resources that should be provided for the program (for the whole 14 year period) - 3000000000 PLN (750000000Euro). It states that for each year about 250000000 PLN (62,500,000 Euro) from the central budget should be provided.

The planned financial input for the realisation of early diagnosis tasks have to constitute:

• 20% of the annual costs for the first and the second year;
• 25% of the annual costs for the third and fourth year;
• 30% of the annual costs for the fifth and sixth year;
• 35% of the annual costs for all the next years until the program ends.

Groups affected

The government (Ministry of Health), cancer patients and their families, medical providers, medical institutes of universities

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

1. The policy introduces a rather new approach and instruments (institutions and mechanisms).
2. There is broad consensus among actors that cancer diseases pose a problem in the Polish society. However, among health professionals the situation may differ.
3. The policy creates a rather new systemic approach. It may save not only many lives but also some money in a long-term perspective. 
4. The new government and MoH are officially interested in a very high level of public visibility. The problem of waiting lists in the field of cancer treatment may be also minimised due to the described policy.
5. The policy strongly depends on the system resources and on the systemic change of the approach as well as on the individual professional's attitude.

Political and economic background

The new government started the program on the 1st of January 2006. The program is an attempt to comply with EU standards (it aims to reach the EU indicators of cancer disease treatment). This health policy concerning cancer diseases problems have been derived from goals formulated in an overall national health policy statement - The National Health Program.

The new government will have to develop the schedules for the next years. It is difficult to foresee at the moment how the policy will be implemented. Only after the first year (2006) of program implementation an evaluation of the process will be possible. However, to develop methods for the assessment of results of long-term actions such as prevention and early diagnosis, long-time research should be provided. The statistical analysis and epidemiological research upon a wide population in a significant period of time would be necessary in this context.

Change of government

Complies with

As it was stated before the Program meets the need to comply with European standards (indicators of early diagnoses, treatment effectiveness and the methods of permanent effectiveness monitoring).

Change based on an overall national health policy statement

The Program creates a change in cancer diseases treatment and is based on goals formulated in an overall national health policy statement - The National Health Program.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea to elaborate the National Program against Cancer Diseases has been inspired by the medical "environment" (medical professionals, Chambers, associations) who discussed the problem for quite a long period of time. A very important role in this field played the researchers (epidemiologists) who indicated a low level of use of preventive methods for cancer treatment in a wide range of analyses. They blamed this situation for the high level of patient mortality due to cancer. This high mortality rate should in turn be regarded as a major reason for the growth of social costs.

The results of scientific medical research, i.e. methods for lowering mortality, were well known at the international level. In Poland the approach toward cancer treatment has to be changed: from mainly providing medical treatment to a preventive approach. The National Program on Cancer Diseases is a clear result of such a change of perspective.

The main driving force of the policy is the government (MoH), it follows not only the research results but the public discussions as well. Compared to the previous policy in this field, the new policy puts a stronger accent on health promotion and prevention, on early diagnosis (screening) and more effective treatment methods. It has been passed in form of a law that aims at the elaboration of the long-term program, the National Program against Cancer Diseases.

Initiators of idea/main actors

• Regierung: The government (the Health Minister) is obliged to develop (in a form of an executive regulation) a particular schedule for each program year. He is the main force responsible for the implementation of the policy established on the legislative level.

• Leistungserbringer

• Kostenträger

• Patienten, Verbraucher

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The government (MoH) is expected to reach goals of the Program due to the competencies in a sphere of provided finance distribution (correspondent to the scheduled prophylactic programmes).

Medical providers were very supportive of the idea.

Patients are obviously interested in a the realisation of the program. Due to the public discussion the population's awareness of preventive methods should grow.

The NHF supports the policy of the government due to possible reductions of treatment costs (good methods of prevention save money that would have to be spent on long-term treatment otherwise).

Actors and positions

Regierung
Ministry of Health	sehr unterstützend		stark dagegen
Leistungserbringer
Medical providers	sehr unterstützend		stark dagegen
Kostenträger
National Health Fund	sehr unterstützend		stark dagegen
Patienten, Verbraucher
Patients and their families	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The ideas stipulated in the National Health Program initiated the legislation process that ended up in form of the described piece of legislation. The implementation of the strategy (realisation of the program objectives) will be reached through the implementation of the mentioned schedules. 

Judging after the proposed prophylactic programs for the year 2006 the original proposal, i.e. the objectives of the law, has not been modified. But to assess the implementation, a post-evaluation of results is needed (it has to be stressed that the evaluation may concern only the "formal" side of program implementation - the amount of money that has been spent, the number of screening actions, tests provided due to the schedules. This evaluation may be possible at the beginning of 2007. As to the long-term results, measured for instance as the mortality rate, an evaluation is only possible after several years.

Legislative outcome

success

Actors and influence

Regierung
Ministry of Health	sehr groß		kein
Leistungserbringer
Medical providers	sehr groß		kein
Kostenträger
National Health Fund	sehr groß		kein
Patienten, Verbraucher
Patients and their families	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The MoH, the payer (NHF) and service providers will be involved in the adoption process towards implementation. The most important means and tools for successful implementation of the described policy are financial resources determined by the new law. A radical improvement of the Polish situation - i.e. lowering the level of cancer disease mortality - might be achieved under the condition of proper management of money and use of effective diagnosis methods. The MoH itself, according to the law provisions, controls the process of implementation, but at the same time it is obliged to report and take the responsibility before the government and the parliament.  An important role is given the Council against Cancer Diseases that functions as an advisory body to the MoH.

Successful implementation depends on many factors. Apart from the financial costs it relies for instance on the health care potentials, patient responsiveness and engagement, patients' awareness of the problem. It is difficult to foresee the results just at the start of the program. Potential obstacles may be situated also on the patient's side - success depends upon them due to the very important role that early screening, self-checking and positive attitude to the treatment process will take in this policy approach.

Monitoring and evaluation

The new law stipulates annual reports on the process of  program implementation. The MoH is obliged to deliver such reports to the parliament no later than on the 31st of May each year (together with the tasks schedule for the next program year) and to submit the dimensions of the program realisation for the subsequent two years.

As it was mentioned before, it is difficult to foresee now how the policy will be implemented. After the first year of implementation (2006), the "formal" evaluation of this stage will be possible. It has to be underlined once again that long-term epidemiological research is needed for the assessment of results of actions such as prevention and early diagnosis. Such research has to be based on statistical analysis and new epidemiological methodology. It should address a wide population in a significant period of time.

Review mechanisms

Halbzeitevaluation

Dimensions of evaluation

Prozess, Ergebnis

Results of evaluation

As it was stated above, evaluation results are not yet available.

Expected outcome

With regard to the objectives the health policy described hereby may be implemented successfully (which means lowering the level of cancer diseases mortality) if the financial resources will be used properly and if the amount of money is adequate to the scale of the problem. Regarding the content of described legislation (the law and the executive regulation of MoH), the goals have been selected properly, taking into account the NHP goals. They correspond to the overall targets of health care policy (emphasis on health promotion, prevention and early diagnoses). The effect on systemic costs should be significant due to the early diagnostic methods. Possibly it will affect also the quality of health services in this field and problem of access and equity.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

• The quality of health care services can improve due to the high level of financial resources provided.
• The equity should increase as the result of more widely accessible health prevention programs.
• Cost-efficiency will improve due to early diagnosis results (savings). It can improve also through the introduction of new technologies, educational programmes, improvement of medical professionals' skills, investments in the health care sector infrastructure (all indicated as parts of the MoH schedule).

References

Sources of Information

• The law from the 1st of July 2005 on the establishment of the long-term "National Program against Cancer Diseases". Published on 26th  of July 2005 in O.J. No 143, clause 1200 (Dz.U. nr 143, poz. 1200).     
• The MoH Schedule for Realisation of Tasks included in the National Program against Cancer Diseases for 2006.

Author/s and/or contributors to this survey

Anna Mokrzycka, Iwona Kowalska

Empfohlene Zitierweise für diesen Online-Artikel:

Anna Mokrzycka, Iwona Kowalska. "Program on cancer disease prevention". Health Policy Monitor, November 2006. Available at http://www.hpm.org/survey/pl/a8/5