Zielona Księga w sprawie pracowników ochrony zdrowia w Europie – założenia, cele i główne postulaty dokumentu

European Commission Green Paper on the European Workforce for Health – goals and main postulates of the documentGreen Paper on the European Workforce for Health in Europe is a very important document, and decisions made in its light will affect European Union health policy for years to come. Health policies across Europe should be coordinated so that recommended guidelines, designed to reduce inequities, with monitoring to promote their  se in a consistent manner across the EU, particularly but not exclusively by addressing the social determinants of health. Health services are one of the largest groups of employers in most developed countries, and therefore they constitute an important component of national economies. To improve the health of the populations of Europe, and equity of health status, public health education and research need to be a leading part of the health workforce development programme of the EU.EU health systems have to perform a difficult balancing act, firstly between increasing demands on health services and restricted supply; secondly between the need to respond to people’s health needs locally but also to be prepared for major public health crises. There are a number of challenges facing health systems in Europe.1) Policy makers and health authorities have to face the challenge of adapting their healthcare systems to an ageing population. 2) The introduction of new technology is making it possible to increase the range and quality of healthcare in terms of diagnosis, prevention and treatment, but this has to be paid for and staff need to be trained to use it. 3) There are new and re-emerging threats to health, for example from communicable diseases.4) All of this is leading to continually increasing spending on health and indeed is posing major longer-term issues for the sustainability of health systems in some countries.To respond adequately to these challenges requires health systems to have efficient and effective work forces of the highest quality as health services are very labour intensive. Challenges facing the EU public health situation population include ageing, migration, and include infectious and non-infectious diseases, including cardiovascular diseases and cancer, nutritional conditions, disaster preparation, and injury control; along with many other issues of public health, such as management and priorities of health care systems. All are crucial for the future quality of life in Europe. A professional public health workforce is essential for society to be able to meet these public health challenges with high standards of cost-effective intervention

Financing healthcare in central and Eastern European Countries : how far are we from Universal Health Coverage?

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000-2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care

The European hospitals’ functioning determinants with special emphasis on the human resources issue

The aim of the article is to present the scope of determinants influencing hospitals’ functioning in contemporary Europe with emphasize put on the health sector human recourses issue. Multiplicity of the functions realized by the hospitals units relates to the plurality of determinants which influence their present situation as well as long-term transformation processes. The determinants can be categorized into three main groups: these related to the demand side of the hospital services, their supply and determinants being the results of the social and economic changes. Regardless of the differences existing between health systems in specific countries – all European countries are facing similar problems of increasing health care costs, strong need of efficiency improvement and deficits of medical staff. In case of the hospital sector the key issue is number of beds reduction and transformation of the hospitals’ organizational for

Asthma as a psychosomatic disorder: the causes, scale of the problem, and the association with alexithymia and disease control The Twenty-Six-Item Toronto Alexithymia Scale (TAS-26) has been used in this paper courtesy of Dr Ewa Zdankiewicz-Scigala

Background: While psychological factors may play a significant role in the development and course of asthma, the availability of information on the scale of the problem and the factors associated with psychogenic asthma is limited. The aim of the study was to assess the frequency of coexistence of asthma and other diseases considered to be of psychosomatic origin, to assess the impact of stress and strong emotions on the occurrence of acute exacerbations of asthma, to measure the level of alexithymia in asthmatic patients, and to look for its association with acute exacerbations triggered by stress and strong emotions. The level of alexithymia was also assessed in the context of asthma control. Materials and methods: The study was conducted on a group of 54 patients (75.9% females) with a diagnosis of asthma (mean age: 54.37 &#177; 14.52 years) at the Independent Public Central Teaching Hospital in Warsaw, Poland. The patients completed a questionnaire composed of the Asthma Control Test, a list of factors that could trigger an acute exacerbation of asthma, and the Toronto Alexithymia Scale (TAS-26; translated into Polish by E. Scigala and T. Maruszewski). The patients were also asked about any co-morbidities that had been diagnosed by other doctors and that might be caused, at least in part, by psychological and behavioural factors, and co-morbidities that might be associated with stress but are characterised by somatic manifestations. The co-morbidities in question were: irritable bowel syndrome, atopic dermatitis, depression, panic disorder, and anorexia nervosa. In the remainder of this paper these disorders are collectively referred to as &#8216;psychosomatic disorders&#8217;. The statistical analysis was performed using SPSS 14.0 PL at the significance level p 0.05). Stress and/or strong emotions were identified as factors triggering acute exacerbations of asthma in 33 cases (61.1%). Poor, good, and complete asthma control was confirmed in 72.5%, 17.6% and 9.8% of the cases, respectively. No association of asthma control with the occurrence of alexithymia was identified (&chi;2 = 0.358, p > 0.05). No association of asthma control with gender was identified (&chi;2 = 0.605, p > 0.05). Conclusions: The high level of alexithymia in asthmatic patients, the frequent occurrence of disorders considered to be psychosomatic in origin, and the considerable impact of stress and strong emotions on the development of acute exacerbations of the disease confirm that asthma can be considered a psychosomatic disorder.Wstęp: Czynniki psychologiczne mogą odgrywać dużą rolę w rozwoju i przebiegu astmy, jednak dostępność informacji na temat skali problemu i czynników związanych z astmą psychogenną jest ograniczona. Celami badania były ocena częstości współwystępowania astmy oskrzelowej z innymi chorobami uznawanymi za psychosomatyczne, ocena wpływu stresu i silnych emocji na występowanie zaostrzenia astmy, a także pomiar poziomu aleksytymii u chorych na astmę i poszukiwanie jego związku z zaostrzeniami wywołanymi przez stres i silne emocje. Poziom aleksytymii badano także w odniesieniu do stopnia kontroli astmy. Materiał i metody: Badanie przeprowadzono w grupie 54 pacjentów (75,9% kobiet) ze stwierdzoną astmą (średnia wieku 54,37 &#177; 14,52 roku) w Samodzielnym Publicznym Centralnym Szpitalu Klinicznym w Warszawie. Pacjenci wypełniali kwestionariusz złożony z Testu Kontroli Astmy (ACT), listy czynników mogących wywołać zaostrzenie astmy oraz kwestionariusza Toronto Alexithymia Scale (TAS-26, tłum. E. Ścigała, T. Maruszewski). Ponadto zebrano wywiad na temat występujących u pacjenta innych chorób, stwierdzonych przez lekarza, w których etiologii główną rolę może odgrywać obecność czynników psychologicznych i behawioralnych lub są one zaburzeniami związanymi ze stresem, a występującymi pod postacią somatyczną. Zaliczono do nich: zespół jelita nadwrażliwego, atopowe zapalenie skóry, depresję, zespół lęku napadowego i anoreksję. W dalszej części artykułu choroby te są określane łącznie mianem chorób psychosomatycznych. Analizę statystyczną przeprowadzono za pomocą pakietu SPSS 14.00 PL, przyjmując poziom istotności p < 0,05. Do badania zależności między zmiennymi jakościowymi użyto testów nieparametrycznych dla prób niezależnych. Wyniki: W 50% przypadków u pacjentów z rozpoznaniem astmy dodatkowo stwierdzono przynajmniej jedną z następujących jednostek chorobowych: zespół jelita nadwrażliwego (n = 8), atopowe zapalenie skóry (n = 7), depresja (n = 13), zespół lęku napadowego (n = 9). Aleksytymię zdiagnozowano w 11 przypadkach (21,6 %). Korelacja między poziomem aleksytymii a stresem i silnymi emocjami była nieistotna statystycznie (&#967;2 = 0,106, p > 0,05). Stres i/lub silne emocje wskazano jako czynniki powodujące zaostrzenie astmy w 33 przypadkach (61,1%). W 72,5% przypadków astmę źle kontrolowano, w 17,6% &#8212; dobrze, a w 9,8% &#8212; w pełni kontrolowano. Nie stwierdzono związku między kontrolą astmy a występowaniem aleksytymii (&#967;2 = 0,358, p > 0,05). Nie wykryto zależności między kontrolą astmy a płcią (&#967;2 = 0,605; p > 0,05). Wnioski: Wysoki stopień aleksytymii u chorych na astmę, częste występowanie u nich chorób uznawanych za psychosomatyczne i duży wpływ stresu i silnych emocji na występowanie zaostrzenia choroby potwierdzają, że astmę można uznać za chorobę psychosomatyczną

Testing the 2017 PHC reform through pilots: strengthening prevention and chronic care coordination

Numerous official reports have highlighted insufficient provision of preventive services within primary health care (PHC) in Poland. Other identified weaknesses include inappropriate referrals to ambulatory care that contribute to long waiting times for specialist consultations. Since mid-2018, a new model of PHC organization has been piloted and can be seen as an attempt to address some of these weaknesses. It draws on the Primary Health Care Act of 2017 and puts much more emphasis on disease prevention and health promotion within PHC as well as shifts management of common chronic conditions to multidisciplinary PHC teams. The implementation of this model has been supported by a range of financial and non-financial measures, including a special grant that helps PHC practices to adapt their IT systems to the requirements of the pilot. Yet, the overall requirements were prohibitive to most PHC practices and only 42 were eventually included in the pilot. In this paper, we describe the content of this model, the difficulties in its implementation and how they were addressed and discuss its possible effects on PHC and the health system more broadly

Exploring satisfaction and migration intentions of physicians in three University Hospitals in Poland

Introduction: University hospitals constitute a unique group of health care organizations which traditionally link three functions: (1) providing highly specialized services, (2) teaching activities, and (3) conducting research. Objectives: To assess the level of carrier satisfaction among physicians working in three university hospitals in Poland (1); to assess whether the physicians have the intention to migrate and what the main reasons for migration are (2); and to identify the actions that might be taken at the hospital level to mitigate physicians’ intentions to migrate (3). Methods: Cross-sectional study with both quantitative and qualitative components. In the quantitative part, an online questionnaire was distributed among physicians working in three university hospitals. A total number of 396 questionnaires were analyzed. In the qualitative part, in-depth interviews with six hospital managers were conducted and analyzed using thematic analysis. Results: On a scale from one “very dissatisfied” to six “very satisfied”, the mean career satisfaction of physicians was 4.0 (SD = 0.74). The item with the lowest mean concerned salary level (2.8, SD = 1.41). In the sample, 34% of physicians declared intentions to migrate from Poland. The main reasons for the intention to migrate were: Better working conditions abroad, higher earnings, the ability to maintain better work-life balance, better training opportunities abroad, and problems due to a stressful current workplace. Hospital managers considered the actions that can be taken at the hospital level to mitigate physicians’ migration to be specific to those focused on the working environment. Conclusions: Career development opportunities and features related to the working environment are the main factors influencing physicians’ satisfaction and migration intentions that can be modified at the university hospital level