Assessing recent efforts to improve organization of cancer care in Poland: what does the evidence tell us?

Poland has implemented two major organizational changes in recent years to improve cancer care. In 2015, a dedicated ‘fast pathway’ to diagnostics and treatment was implemented for patients suspected of having cancer. In 2019, the National Oncology Network began pilots in four regions of care pathways for cancer at five sites. Neither has been evaluated—no baseline information was collected, and what assessments were undertaken were limited to process measures. While the 2019 initiative was at least piloted, a national rollout has been announced even while the pilot is still ongoing and when concerns about certain aspects of the model have been raised. Given that cancer is the second largest cause of death in Poland and that cancer outcomes are worse compared to Western European averages, there is a particular need to ensure that models of care are informed by the evidence and adapted to the realities of the Polish healthcare system

The devil is in the data: can regional variation in amenable mortality help to understand changes in health system performance in Poland?

The contribution of health systems to health is commonly assessed using levels of amenable mortality. Few such studies exist for Poland, with analyses of within-the-country patterns being particularly scarce. The aim of this paper is to analyse differences in amenable mortality levels and trends across Poland’s regions using the most recent data and to gain a more nuanced understanding of these differences and possible reasons behind them. This can inform future health policy decisions, particularly when it comes to efforts to improve health system performance. We used national and regional mortality data to construct amenable mortality rates between 2002 and 2019. We found that the initially observed decline in amenable mortality stagnated between 2014 and 2019, something not seen elsewhere in Europe. The main driver behind this trend is the change in ischemic heart disease (IHD) mortality. However, we also found that there is a systematic underreporting of IHD as a cause of death in Poland in favour of heart failure, which makes analysis of health system performance using amenable mortality as an indicator less reliable. We also found substantial geographical differences in amenable mortality levels and trends across Poland, which ranged from −3.3% to +8.1% across the regions in 2014–2019. These are much bigger than variations in total mortality trends, ranging from −1.5% to −0.2% in the same period, which suggests that quality of care across regions varies substantially, although some of this effect is also a coding artefact. This means that interpretation of health system performance indicators is not straightforward and may prevent implementation of policies that are needed to improve population health

Wyzwania systemowe stojące przed hematologią onkologiczną w aspekcie starzejącego się społeczeństwa w Polsce

The aging population and the increasing incidence of hematological malignancies is a challenge for the health care system in Poland. New medical technologies offer opportunities for patients above 65 years of age. Their use, however, requires careful research and confirm their usefulness in the context of current therapeutic guidelines. The requirement for patient access to modern medical technologies is to optimize operations and adequate funding of the healthcare system. It appears that the area of oncological hematology can be a model for effective solutions to the system, with the patient, as the subject of the system.Starzenie się społeczeństwa i wzrastająca zapadalność na nowotwory hematologiczne jest wyzwaniem dla systemu ochrony zdrowia. Nowotwory hematologiczne stanowiły około 5% wszystkich zachorowań na nowotwory ogółem w 2012 roku, a połowa chorych miała ponad 65 lat. Nowe standardy leczenia oraz technologie medyczne stwarzają szanse dla chorych, ale ich zastosowanie wymaga wnikliwych badań oraz potwierdzenia użyteczności w ramach praktyki klinicznej. Warunkami adekwatnego dostępu pacjentów w Polsce do technologii medycznych w ramach aktualnych standardów terapeutycznych są optymalizacja i adekwatne finansowanie systemu opieki zdrowotnej. Wydaje się, że hematologia onkologiczna może być modelowym przykładem efektywnych rozwiązań systemowych — z pacjentem jako podmiotem tego systemu

Possibilities of implementing Hospital-Based Health Technology Assessment (HB-HTA) at the level of voivodeship offices in Poland

The Health Technology Assessment is based on the evaluation of the characteristics and effects of health technologies to properly spend resources in healthcare. For the needs of hospitals, a special HTA department, Hospital-Based Health Technology Assessment (HB-HTA), has been established. The objective of the article is to assess the possibility of implementing a functional model with the coordinating role of Health Departments of the Voivodeship Offices with the support of the National Health Fund and the HTA Agency in Poland. Ten semi-structured interviews were conducted with representatives from eight Voivodeship Offices. The interviews consisted of nine questions related to the possibility of introducing a functional model with the participation of the Voivodeship Office. The material was divided into seven codes relating to the questions included in the topic guide. From the perspective of Voivodeship Offices, HB-HTA could contribute to the improvement of the methodology used in the Evaluation Instrument of Investment Motions in Health. The lack of personnel in the Voivodeship Offices was identified as one of the greatest barriers to the implementation of HB-HTA. These public administration units should not be involved in the hospital health technology assessment process

Skill mix in medical and about medical professions

Problemem wielu systemów ochrony zdrowia jest niedobór kadr medycznych, przede wszystkim lekarzy i pielęgniarek. Ich liczba, kompetencje i uprawnienia warunkują dostępność usług medycznych i ich jakość. Zapotrzebowanie na usługi medyczne zwiększa się wraz z postępującym procesem starzenia się populacji, wzrostem liczby zachorowań na choroby przewlekłe i ciągłymi reformami systemów zdrowotnych. Koszty pracownicze w ochronie zdrowia są kosztami najbardziej obciążającymi system, dlatego trzeba tworzyć efektywne zespoły pracowników sektorowych, korzystając z dostępnych zasobów. Wymienione czynniki skutkują racjonalizacją zatrudnienia lub nadawaniem nowych uprawnień medycznych i okołomedycznych nowym grupom profesjonalistów, czego wynikiem jest zjawisko krzyżowania się kompetencji (skill mix). Dobrze przygotowane i wdrożone krzyżujące się kompetencje pozwalają poprawić jakość opieki nad pacjentem, zwiększyć jego zadowolenie i uzyskać lepsze wyniki kliniczne. W procesie krzyżowania się kompetencji dochodzi do zamiany sprawowanych dotychczas ról. Gdy jedni profesjonaliści rozbudowują istniejące role, inni są zobowiązani do przyjęcia niektórych aspektów poprzedniej roli. Przy krzyżowaniu się kompetencji często pojawiają się też nowe role, nowe zawody, których zakres opracowuje się tak, aby pasowały one do obowiązującej praktyki. Najczęściej krzyżujące się kompetencje dotyczą personelu pielęgniarskiego i położniczego oraz lekarzy i ratowników medycznych. Aby przeciwdziałać niedoborowi lekarzy w Polsce, wprowadzono zmiany, których celem jest zwiększenie dostępu do świadczeń medycznych: m.in. pielęgniarki i położne uzyskały prawo do wypisywania recept i ordynacji medycznej, ratownicy medyczni – prawo do wykonywania medycznych czynności ratunkowych i świadczeń zdrowotnych, a fizjoterapeuci – prawo do realizacji samodzielnej wizyty fizjoterapeutycznej. Powstał także nowy zawód – koordynator medyczny.An important problem faced by many healthcare systems is the shortage of medical staff, and in particular doctors and nurses. Their number, competences and qualifications determine the level of availability and quality of medical services. Unfortunately, the demand for medical services is increasing, along with the progressive aging of the population, as well as the increase in the incidence of chronic diseases and frequent reforms of health systems. Employee costs related to healthcare are the most burdensome for the system; therefore, based on the available resources, it is necessary to create effective teams of sector employees. This results in rationalizing employment, or providing new medical and about medical competencies to new groups of professionals, which gives rise to the skill mix phenomenon. A well-prepared and implemented skill mix contributes to improving the quality of patient care, increased patient satisfaction and better clinical outcomes. In the process of mixing of competences, the roles that have been exercised so far are being changed. While some professionals are expanding their existing roles, other employees are required to accept some aspects of the previous roles. In Poland, in order to counteract such negative trends (the shortage of doctors), changes have been introduced to increase access to medical services (e.g., nurses and midwives being vested with the right to issue prescriptions and medical ordinances, paramedics – with the right to perform medical emergency services and provide healthcare services, and physiotherapists – with the right to conduct independent physiotherapeutic visits). A new profession of a medical coordinator has also been introduced