Starzenie się człowieka i starzenie się populacji. Podział odpowiedzialności za skutki finansowe w systemie opieki zdrowotnej

The aging of human being and the aging of the population. The division of responsibility for the financial results in health care systemThe adverse consequences of an aging society for the stability of health care financing systems are superimposed on the natural inequality of the distribution of health needs, and consequently, expenditure for health services in the life cycle of man. How long, under such conditions, will financial security systems based on the mechanism of PAYG (pay as you go) be able to guarantee all of its citizens, including the oldest ones, broad access to medical care? The debate brought about by D. Callahan in 1987 on “age-based rationing of benefits” for many years focused on trying to find ethical and economic rationale for limiting the scope of benefits guaranteed to the oldest citizens (eg A.  illimas, F. Breyer, D. Brock, N. Daniels, P. Dabrock). Age-based benefit rationing from public funds, however, may soon become a reality if we do not manage to break ties, within the public system, with the idea of full socialization of the costs of old age at the expense of future generations. Maintaining fundamental fairness towards the future generations requires an equal sharing of the financial consequences of aging, and this means taking on more responsibility of every individual for himself. A good practice of substitute private health insurance in Germany is the mandatory creation of individual financial reserves for old age which allows avoiding an excessive rise of equivalent risk premium in old age. Another solution for social health insurance might be reserves built by each generation, or a general public reserve. The transition from the purely PAYG system to a more capital one, however, will require the construction of functional solutions for the transitional period in which we have yet to build reserves and fund services for older generations who have not yet built reserves for themselves. An apparent increase of the country’s debt seems therefore inevitable, but also present older generations must be held financially accountable through higher premiums or payments for benefits

Konkurencja między „Publicznymi Funduszami Zdrowia”. Przesłanki teoretyczne oraz doświadczenia Niemiec i Szwajcarii

Competition between “Public Health Funds”. Theory and Experiences from Germany and SwitzerlandThe introduction of competition between public insurers within the polish system of social health insurance, announced by the Ministry of Health Ewa Kopacz, is not a new idea. It raises doubts not so much about the potential possibility of using the instrument of competition for increasing the efficiency of the system but much more about the preparatio of the system for such a constitutive change. Competition between public insurers works quite well in the social health insurance system in Germany and Switzerland. The experiences from these systems as well as the theory of health insurance economics show us that there are some preconditions that have to be met in order to realize the positive results of competition. In the first place, the insurers must want to compete. Secondly, they must have instruments for competition. And thirdly they must be kept from developing the risk selection in the form of cream skimming. Showing the constitutive value and character of public  insurers’ competition the author of the article analyses the practical implications of the three mentioned preconditions and their realization in the German and Swiss health systems

Wydatki powszechnego ubezpieczenia zdrowotnego w Polsce na refundację leków w latach 2004-2012

Health insurance expenditures on drug refunds in 2004-2012Drug expenditures in each country account for a large share in total health expenditures. Hence experts, media and societies are becoming very interested in the drug policy in their country, where one of the important components is reimbursement/refund policy. Good governance in the drug sector means not only taking up allocation, redistribution and stabilization tasks that belong to the government, but also taking into consideration differences in interests of different stakeholders on the drug market. If it is disregarded, even ideal theoretical solutions will not work in market reality. This article presents and comments basic facts on development of universal health insurance expenditures on drug refund in the last 13 years in Poland, especially in 2012 after implementation of the new bill on refund policy. This law led to a dramatic decrease in drug refund cost share in total expenditures of the National Health Fund (Narodowy Fundusz Zdrowia, NFZ) from 15% in 2011 to 11.2% in 2012. Still the share of drug refund has already had a decreasing tendency in NFZ expenditures starting from 2005. Available data contradict suspicions that savings on drug refunds in NFZ has led to an increase in patients’ health expenditures on prescription drugs. Costs of substitutive full-price drugs (equivalents for refunded ones) bought by Polish patients in 2012 increased only by 650 mln PLN, while NFZ’s refund expenditures decreased by almost 2 billion PLN, and patients’ copayment in the case of refunded drugs dropped by one billion PLN. However, drug consumption was reduced. Conducted analysis also showed a systematic, and positive for patients, growth in the share of almost fully refunded drugs – drugs with low fixed copayments (from 49% in 2004 to almost 65% in 2012) and lower 30% patients’ copayment in NFZ refunds. Which in fact is in contradiction with the common opinion that NFZ is running a policy of shifting more drug costs on patients. What is concerning are regional discrepancies (between regional – voievodship branches) in refund expenditures per insured person (the difference between the highest and lowest is 49 PLN – 28%)

Zadłużenie publicznych szpitali w Polsce w latach 2005–2014. Nierozwiązany problem zobowiązań wymagalnych

Debts of Polish public hospitals in 2005–2014. The unsolved problem of overdue liabilitiesRunning up debts of public hospitals (independent health care units) constitutes an immanent feature of the Polish health care sector. Even though the introduction of the Public Assistance and Restructuring of Public Health Care Units Act of 15 April 2005 contributed to a reduction of overdue debts from 6.2 billion zloty in the middle of 2005 to about 2.1 billion zloty at the end of September 2014, they still remain quite high. Among units with the highest debts are the biggest and most important for the system central institutes and university hospitals. One can also observe regional variation of debts size. The most indebted are the facilities located in the mazowieckie voivodship though the public financing of hospitals in this region is the highest in the country. Therefore simple increasing of public financing seems not to be the right solution. The most important factors that contribute to the financial imbalance of public hospitals in Poland are rooted in the area of law regulations and health sector governance

Investment in work health promotion in small and medium-sized enterprises in Germany

Economic success of companies is related to the rate of absenteeism and the rate of fluctuation, but also to the subjective experience of the employees. During economic difficult situations, enterprises wanted and had to motivate their employees to maintain their productivity and motivation to work. Investments in work health promotion-measures resulted to be a good way to do this. Workplace health promotion turned out to be a suitable way to boost and/or maintain the motivation of employees. Authors of the article give an overview of work health promotion (WHP) in Germany (especially in small and medium enterprises) and analyze implementation strategies, costs, key-success-factors and obstacles before or during the implementation of WHP-measures

Raport dla WHO o zadłużeniu szpitali

W dniach 30 czerwca–11 lipca 2008 roku odbyła się III Międzynarodowa Konferencja pt. „European Summer University on Medical Law” zorganizowana przez Polskie Towarzystwo Prawa Medycznego przy współpracy Francuskiego Stowarzyszenia Badań i Edukacji w dziedzinie Prawa Medycznego, Wydziału Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum oraz Uniwersytetu im. Paula Sabatiera w Tuluzie. Inicjatywa organizacji międzynarodowych letnich konferencji prawa medycznego podjęta była w roku 2005 w toku IX seminarium prawa medycznego, które odbyło się w Tuluzie we Francji. Rok później w dniach 3–11 sierpnia został zorganizowany pierwszy Europejski Uniwersytet Letni w Tuluzie, przy udziale kilkunastu uniwersytetów europejskich (z Francji, Belgii, Hiszpanii, Włoch, Polski – UJ), a także z Kanady oraz Algierii i Tunezji. W toku jego obrad Komitet Pedagogiczny składający się z przedstawicieli wymienionych uczelni podjął decyzję, że w następnych latach 2-tygodniowe konferencje będą się odbywać każdego roku w dwóch krajach. W rezultacie tego w roku 2007 pierwszy tydzień II Europejskiego Uniwersytetu Letniego odbył się na Uniwersytecie w Tuluzie, drugi zaś na Uniwersytecie w Madrycie. W roku 2008 tradycyjnie pierwszy tydzień konferencji zorganizował także Uniwersytet w Tuluzie (30 czerwca–2 lipca), drugi zaś Instytut Zdrowia Publicznego Wydziału Nauk o Zdrowiu UJ CM (7–11 lipca)