|Implemented in this survey?|
In Polish health care, the Emergency system is still one of the most important issues demanding essential systemic solutions. The main purposes of the new Law on a National Emergency System are: creation of an integrated emergency system, establishment of a new medical curriculum (rescuers education) and creation of specialized emergency teams.The expected outcomes focus on increasing the effectiveness of the system (in an institutional, organisational and financial sense).
The major aim of the new Emergency System is to improve first aid procedures and facilities, mainly by reducing the time lag between an accident and hospital admission to 8 minutes within the cities and to 15 minutes outside the cities for 75% of emergency calls, and by developing close cooperation between emergency services, fire brigades and the police.
In 2001, the the policy idea of creating a national emergency system was for the first time transformed into a piece of legislation (Law on a National Emergency System, 25 July 2001). From the very beginning, the main purpose of this legislation concentrated on the question of systemic integration. After the failure of the first Law there were no significant changes in the emergency system - looking at the problem from the patients point of view. The idea of the new legislation on the emergency issue was one of the fundamental ideas of political discussions. The old solutions in this area were inadequate to the changes of the health care system as a whole and to patients' needs and expectations. Moreover they were improper in the context of administrative reform ( the process of decentralisation of competences, changes in the ownership of health care units).
The main objectives of the policy idea is:
The instrument (the Law) is divided into following chapters:
The Law on Emergency system divides the created system of emergency into three pillars:
The Law introduces provisions on emergency services financing that divide responsibilities in this sphere between MoH, voivodships and NHF. On the level on voivodships there are no possibilities for financial decisions undertaking (no professional personnel, knowledge, skills and technical base). Voivods transmit the competencies on contracts agreement to the directors of particular, regional NHF units.
|Medienpräsenz||sehr gering||sehr hoch|
The change introduced by the new Law was absolutely necessary. All engaged in the problem groups were standing for the new solutions seeking process. They also agreed in the sphere of fundamental priorities. Disagreement concerns particular issues: financing, structure, organisation and control. In the discussion however the issue of the reforming (or even establishing) the hospitals net in Poland that would be adequate to the population structure, to the health care needs assessment and to the local specifics have not been recalled. This question is strictly connected to the problem of proper decisions on hospital rescue units creation. The threat maybe caused by not rational nature of decisions but by particular political interests
The change in government in case of the necessity of the emergency system creation played an essential role. The previous legislation from 2001 (adopted by the central - right government) has never been implemented due to the new Ministry of Health (left wing- 2003 elected) decisions: all the financial resources foreseen for the implementation of described Law were directed aiming in the institutional and organisational systemic reform (creation of centralised NHF). For the current government the issue of the emergency system creation became one of the priorities that resulted in a form of legislation. The Law takes into account standards accepted in EU and confirms the possibility to perform the medical rescuer profession for persons qualified (certified in EU or EFTA or in the other country under the condition of acceptance by Poland).
see above point 4
Article 26 of the Universal Service Directive ( Directive 2002/22/ EC of the European Parliament and of the Council of 7th of March 2002 on universal service and user?s rights relating to electronic communications networks and services, OJ of EU No L 108
|Implemented in this survey?|
The idea was generated by previous Ministry of Health (political background described in point 4). The main purpose of the health policy idea, apart from mentioned before, was also the need to comply with EU standards and procedures. To achieve this idea the financial resources and re- organization process of the system are necessary and such changes may be introduced in the form of the Law. The next important question is a proper and compatible with the EU standards education process (medical rescuers). The main actors are: MoH, Minister of Finances, NHF, and indicated groups affected (see point 3.1).
The approach of the idea is described as:
renewed: Comment: The approach in the described Law is renewed, it follows earlier discussions and replaces the old Law that has never been implemented (see also point 4).
The main groups affected are described above. Special importance should be granted to the hospitals that include emergency units. These are the health care system units that have to deal with the patients in very bad health condition (high level of responsibility, a need to undertake action fast, often in a situation of life threatening conditions). The hospitals may be put into a difficult position in case of unsuitable access to the health care services (e.g. specialists). Patients may tend to use emergency "path" rather than to wait in long queue.
|Minister of Health||sehr unterstützend||stark dagegen|
|Hospitals (with emergency units)||sehr unterstützend||stark dagegen|
|Medical rescuers||sehr unterstützend||stark dagegen|
As it was mentioned above the first Law on Emergency System in Poland was enacted in 2001, but it did not come into force. The discussion on the processes of establishing the renewed Medical Emergency System started in 2005, before the last parliamentary election. The new Law on the Medical Emergency System was based on the original proposal from 2001- but only in the sphere of main objectives. There were also several following changes caused, for example, by the implementation of the health care reform in the year 2001 (replacement of Sickness Funds by centralized NHF).
The main actor involved in the legislation process was: MoH, who declared the emergency system construction as a priority of his health policy. The described Law has been agreed between the all parliamentary political parties.
|Minister of Health||sehr groß||kein|
|Hospitals (with emergency units)||sehr groß||kein|
|Medical rescuers||sehr groß||kein|
The main stakeholders involved in the Law implementation process are medical rescue teams and emergency hospital units. Those groups are responsible for the direct contact with the patient and for the first aid actions. The another groups of actors were already mentioned. The most important means necessary to successful implementation are the financial and organisational tools. Quite important is also creation of standardised professional medical rescue education process. The actively participating and directly affected by the process implementation groups are also the police and the fire brigades. It is hard to say haw successful the implementation of the process will be on this stage of it (too short time to evaluate) The main obstacles could be financial or organisational. The budget financing protects the system on one hand, but on the other, under the condition of financial problems the lack of recourses may substantially influence the emergency system functioning. The provisions on system financing are criticised due to the lack of the solution on the specific financing necessity, concerning the permanent readiness of the hospital's emergency units. The mixed financing methods introduced for this units activity (for the readiness and for the health care services provision - both from the central budget) together with the adequate and rational evaluation of the units performance could be the guarantee of the proper functioning and the tool of motivation for the permanent increase of the quality. The main opponent to this policy was the Main Chamber of Physicians that criticised the new Law for being to theoretical and not consulted with the professionals. The medical professionals recall as a weak side of the law the solution concerning the variety of hospitals units. In fact they underline the lack of provisions that would concern different clinical units due to the possibilities of sudden specialised interventions. Such possibilities in practice could be connected to almost all clinical disciplines, starting from the intensive care units. They stress the necessity of cooperation between such clinical units (partly adapted to the sudden interventions) and the rescue teams. The cooperation is understood as the immediate health care services provision.
The Law, in the chapter 3 "Planning and organisation of the system", foresees mechanisms for the regularly reviewing the implementation process, the impact and the overall appropriateness. It divides the control and monitoring tasks into two levels: national and local. The organs responsible for the process are MoH and viovodes. The process of monitoring and control on the level of voivodships includes three main spheres:
The measuring indicators have been determined independently to the introduced Law (they were applied for quite a long period of time): they concern the question of reducing time lag between an accident and hospital admission to 8 minutes within the cities and to 15 minutes outside the cities, for 75% of emergency calls. For the evaluation of the change results and measurement using the above indicators the significant period of time and adequate data are necessary.
Struktur, Prozess, Ergebnis
Results not known due to the "fresh" nature of the Law.
In the expert opinions the policy should achieve the main objectives of the change, but there are also defined above obstacles (especially concerning financial and educational issues) that could disturb the process of gaols achievement. The unexpected and undesirable effects are attributed (mainly by the medical professionals) to the excessive development and establishment of the administrative structure (new centres and posts occupied by persons not qualified in the medical rescue sphere). This can result as higher than expected costs and as the lower quality.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Iwona Kowalska, Anna Mokrzycka