Polnische Regional- und Metropolenpolitik: Kohärenz oder Konkurrenz?

Das Problem der Regionalentwicklung und die Komplexität der Begriffe Region, Regionalisierung und Regionalismus sind immer wieder Gegenstand der Debatten von Theoretikern und Praktikern der Regionalpolitik. Besonders belebt wurde die Debatte im vergangenen Jahrzehnt durch die Sozial- und Wirtschaftspolitik einzelner Staaten sowie des zusammenwachsenden Europas insgesamt. Die Europäische Union fördert eine Politik, die durch Produktivitäts- und Innovationssteigerung die Wirtschaftskraft der Regionen stärken will. Seit Polen 2004 ein Teil der Europäischen Union wurde, hat sich die polnische Regionalpolitik grundlegend gewandelt

The 2015 emergency care reform in Poland: some improvements, some unmet demands and some looming conflicts

Between 2006 and 2015, the Act on the State Emergency Medical System was the key act governing the organization, financing and provision of emergency care in Poland. From the moment it entered into force, it had been heavily criticized. The critique focused, among others, on the lack of provisions allowing for emergency medical services (EMS) to be performed outside the EMS units, the lack of a separate Act regulating the profession of a medical rescuer and the lack of a separate professional organization representing medical rescuers. As early as 2008 a team of specialists was set up to work on amending the Act and these works resulted in the draft Act on the State Emergency Medical System that was submitted to public consultations on 19 August, 2014. This draft was further reworked in 2015 and was signed by the President on 25 September of the same year. The Act addressed some of the shortcomings of the EMS legislation that was previously in place. However, the new Act did not meet the key demands of medical rescuers; namely, it did not introduce a separate legal act regulating this profession nor established a professional organisation representing their interests. An analysis of the vested interests of various groups of medical professionals indicates that these interests are likely to have influenced the final legislative outcome. The Act, as well as its implementing executive regulation from April 2016, may reduce support of certain medical professional groups during the Act’s implementation as well as create tensions between these groups, especially between medical rescuers and nurses

The first attempt to create a national strategy for reducing waiting times in Poland : will it succeed?

The waiting lists package, proposed in March 2014, is the first attempt to create a national strategy to reduce waiting times for specialist care in Poland. The policy proposes a number of measures directed at primary, specialist ambulatory and hospital care with the goal of shifting patients to the lowest possible level of care. Initially, it has been welcomed by the patients and there has been, so far, no strong opposition against the reform from other stakeholders. However, this may be because there is some disbelief that the policy would actually be implemented (due to limited funding available for its implementation) and because some of the proposed changes are vague and have yet to be clarified. One stakeholder group that may obstruct the implementation of the reform, if they are not satisfied with the final shape of the proposed measures, is the primary care doctors. They are directly affected by the reform and enjoy a relatively strong bargaining position compared to other groups of medical professionals. Thus, the future of the reform remains uncertain

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

The 2014 primary health care reform in Poland: Short-term fixes instead of a long-term strategy

AbstractAt the end of 2013, the Minister of Health started legislative changes directly and indirectly affecting primary health care (PHC). The reforms were widely criticised among certain groups of medical professionals, including family medicine physicians. The latter mainly criticised the formal inclusion of specialists in internal diseases and paediatrics into PHC within the statutory health care system, which in practice meant that these two groups of specialists were no longer required to specialize in family medicine from 2017 in order to enter into contracts with the public payer and would be able to set up solo PHC practices—something over which family medicine physicians used to have a monopoly. They argued that paediatricians and internists did not have the necessary professional competencies to work as PHC physicians and thus assure provision of a comprehensive and coordinated PHC. The government’s stance was that the proposed measure was necessary to assure the future provision of PHC, given the shortage of specialists in family medicine. Certain groups of medical professionals were also supportive of the proposed change. The key argument in favour was that it could improve access to PHC, especially for children. However, while this was not the subject of the critique or even a policy debate, the proposal ignored the increasing health care needs of older patients—the key recipients of PHC services. The policy was passed in the Parliament in March–April 2014 without a dialogue with the key stakeholders, which is typical of health care (and other) reforms in Poland. The strong opposition against the reform from the family medicine specialists, represented by two strong organisations, may jeopardise the policy implementation in the future

Implementation of the 2011 Reimbursement Act in Poland : desired and undesired effects of the changes in reimbursement policy

AbstractThe Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices constitutes a major change of the reimbursement policy in Poland. The main aims of this Act were to rationalize the reimbursement policy and to reduce spending on reimbursed drugs. The Act seems to have met these goals: reimbursement policy (including pricing of reimbursed drugs) was overhauled and the expenditure of the National Health Fund on reimbursed drugs saw a significant decrease in the year following the Act's introduction. The annual savings achieved since then (mainly due to the introduction of risk sharing schemes), have made it possible to include new drugs into the reimbursement list and improve access to innovative drugs. However, at the same time, the decrease in prices of reimbursed drugs, that the Act brought about, led to an uncontrolled outflow of some of these drugs abroad and shortages in Poland. This paper analyses the main changes introduced by the Reimbursement Act and their implications. Since the Act came into force relatively recently, its full impact on the reimbursement policy is not yet possible to assess

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area

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