|Implemented in this survey?|
At the end of 2006 a draft law on a ?hospital network? was produced by MoH. The idea ? considered for years ? is composed of many components, a reduction in the number of beds among others. Inefficient and/or small hospitals are encouraged to decrease number of beds as a condition for being included into the network. Hospitals outside the network would be deprived of public financing. The draft was subject to intensive discussions that led to an amended version. The process is still pending.
The majority of hospitals - which formally are autonomous - are administered by self-ruling local governments, and the Ministry of Health (MoH) has no power to influence them directly. Since there exists a surplus of hospital beds, though, the MoH pursues the reduction of beds by using financial disincentives. Ineffective hospitals, or simply small hospitals (less than 150 beds) could be encouraged to disappear from the health scene or decrease their number of acute beds and reduce personnel. An evaluation of hospitals would be produced by special commissions and approved by the Minister.
The refusal by the payer (National Health Fund) to sign contracts with small providers (hospitals) - therefore money cannot be paid to them. Hospitals with no contracts - and money - are likely do be closed down.
Local populations living in areas served by hospitals which can be closed down, especially patients suffering from acute diseases, Health workforce employed in hospitals which are closed down, sacked or reduced in result of liquidation or transformation ? especially physicians and nurses.
|Medienpräsenz||sehr gering||sehr hoch|
The idea of the "Hospitals Network" may become one of the most radical steps in a tangled history of Polish health care reform. For the first time explicit priority seems to be given to efficiency even if it can lead to losses felt by patients. Also interests of local governments and health personnel employed in small hospitals may be overcome. However, it is worrying that the reduction of the number of hospital beds is seen as the main tool to improve efficiency of the health system while ignoring long waiting list (especially in some specialties) and the lack of comfort in health care provision.
The problem of a surplus of hospital beds was diagnosed and raised many times in the course of health care reform considerations. A number of political (who should assess and decide) and technical (how measure needs of care) approaches was also discussed. Many attempts to rationalize hospitals' structure (understood as reduction in number) have been undertaken However, because a very strong opposition was expected, for a long time the problem was seen as too delicate to be formally put forward. It has resulted in a petrification of the old deployment of hospital resources.
In the last parliamentary election (2005) the majority of political parties was very cautious while exposing their views concerning changes ? reductions ? in health infrastructure.
The idea of the "Hospital Network" was presented to the Parliament in the Minister's speech (7 June 2006)
|Implemented in this survey?|
In the past, various governments - regardless of their political color - tried to change the infrastructure in the hospital sector, mostly proposing to downsize the sector by relying on a claim that there were too many hospital beds. The situation has not been studied, waiting times analysed, but simple international comparisons concerning acute beds have been presented (the statistical category of "acute beds" does not exist in Poland). This process took the name of "restructuring" and included a number of specific projects, implemented between 2000 and 2006. It resulted in a minor reduction of hospital beds - a few doctors and nurses quitted to join the private sector - but no substantial change in their number and composition has ever been achieved.
The approach of the idea is described as:
renewed: It reappeared many times but governments never explicitly proposed to reduce significantly the number of hospital beds.
amended: A streamlining and intensification of the process previously initiated under the heading of "restructuring".
Within institution - Under the heading of ?restructuring?, hospitals have been free to reduce the number of acute beds on a voluntary basis.
The MoH was disappointed that it had failed to curb financial operations of hospitals which resulted in growing debts. The MoH came to the conclusion that the complex idea of a "Hospital Network" was the only proper answer to the situation. The idea covered two initiatives: a reduction in the number of hospitals (and beds) and a mechanism to guarantee stable public financing.
The Minister of Health presented the idea of a "Hospital Network" in his parliamentary speech given on June 7, 2006.
|MoH||sehr unterstützend||stark dagegen|
|MoF||sehr unterstützend||stark dagegen|
|people employed in small hospitals||sehr unterstützend||stark dagegen|
|people employed in other health institutions||sehr unterstützend||stark dagegen|
|PHC providers||sehr unterstützend||stark dagegen|
|NHF||sehr unterstützend||stark dagegen|
|patients who can be affected||sehr unterstützend||stark dagegen|
|patients who are not likely to be affected||sehr unterstützend||stark dagegen|
|local governments||sehr unterstützend||stark dagegen|
|coalition||sehr unterstützend||stark dagegen|
|opposition||sehr unterstützend||stark dagegen|
In December 2006 a first draft for the law on the "Hospital Network" was presented to the public. It aroused an intensive discussion, had a significant response in professional circles and journals. An amended version was published on March 7, 2007, and the second phase of the discussion was initiated. The deadline to submit comments by all interested groups and individuals was March 20.
|people employed in small hospitals||sehr groß||kein|
|people employed in other health institutions||sehr groß||kein|
|PHC providers||sehr groß||kein|
|patients who can be affected||sehr groß||kein|
|patients who are not likely to be affected||sehr groß||kein|
|local governments||sehr groß||kein|
At the provincial (voievodeship) level a Hospital Council, affiliated to the governmental administration, is to be set up. At the central level an analogous body is to operate. Members of both councils are to be nominated - in majority - by the government. The councils are expected to plan and coordinate deployment of hospital resources, assess hospitals' performance, and giving opinions on their future. The final decision on the individual hospital's fate is to be made by the Minister.
Institutional changes and especially the closing down of hospitals will be scrupulously monitored and the results - especially with regard to diminishing access to care - scrutinized by state and local administration. Many conflicts with local governments and local communities can be expected as well as pressure exerted by them to abandon the policy.
Halbzeitevaluation, Abschlussevaluation (intern)
The change process is likely to be monitored on a permanent basis. Careful evaluation should help to conduct the change process in a rational way, that is preventing severe conflicts with local governments and communities.
The general number of hospital beds will decrease and a number of hospitals will be closed down. Currently, there are 881 hospitals and 324 of them are smaller than 150 beds. It is estimated that about 200 hospitals can be liquidated, according to official suggestions. It may deteriorate access to care. However, opposition to this policy can be expected that will confine the impact of the new law.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The problem of equity has never been appreciated among health reform leaders despite disparities in health and care utilisation existing for years. There is the risk that inequalities may increase due to the reduction in the number of hospital beds in some areas. It is also possible that the underprivileged regions, where small hospitals operate, may be affected the most.
Health Systems in Transition. Poland, K. Kuszewski, Ch. Gearicke, 2005
www.mz.gov.pl (Icon: Siec szpitali)
Wlodarczyk, W. Cezary
W. Cezary Wlodarczyk, Institute of Public Health, Medical College, Jagiellonian University