Public Health Policies and Health Care Reform as Complimentary Tools for Better Health in Poland

Public Health Policies and Health Care Reform as Complimentary Tools for Better Health in Poland

Pawel Gorynski, Bogdan Wojtyniak

13th Conference of the International Society for Environmental Epidemiology (ISEE)

National Institute of Hygiene, Warsaw, Poland

62

64

66

68

70

72

74

76

1970 1975 1980 1985 1990 1995 2000 2005

Hungary

Poland

Portugal

EU average

060101 Life expectancy at birth, in years, males

70

72

74

76

78

80

82

1970 1975 1980 1985 1990 1995 2000 2005

Hungary

Poland

Portugal

EU average

060101 Life expectancy at birth, in years, females

Internet address : http://www.medstat.waw.pl

Health for all 2000

Health for all 21

STRATEGIC TARGETImproving the health status of the populationand enhancing the related quality of lifethrough:

1. Creating conditions and developingpersonal motivation, knowledge and skillsto choose healthy lifestyle and undertakingactions for improving own health and thatof the others.

2. Creating environments supportive tohealth, work and education.

3. Reducing inequalities in health and accessto health services.

Evolution of National Health Programme operational targets

1990, 1996 and 2000 versions

• From reduction of incidence, prevalence and mortality of most common causes to health promotion and prevention programmes

• From central steering of programmes to local authority and community actions

OPERATIONAL TARGETS - 18

1. Promoting physical activity among the general population.

2. Promoting healthy diet and improving food quality.

3. Reducing tobacco smoking.

4. Reducing alcohol consumption, changing alcohol consumption patterns,

and reducing alcohol abuse-related health damage.

5. Reducing abuse of other psychoactive substances and drug abuse-related

health damage.

6. Improving efficiency of health education and health promotion

programmes.

7. Promoting mental health and preventing mental disorders.

8. Reducing exposure to harmful factors in the living, working and

educational environment and mitigating their health effects..

Nat

iona

l Env

iron

men

t and

Hea

lth

Act

ion

Pla

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over

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KRAJOWY PLAN DZIAŁAŃ NA RZECZ ZDROWIA ŚRODOWISKOWEGO

Ministerstwo Zdrowia i Opieki SpołecznejMinisterstwo Ochrony Środowiska Zasobów Naturalnych i Leśnictwa

WARSZAWA, MAJ 1999

• Deterioration of the former San - Epid system (environmental monitoring) has been observed since mid nineties and is still continued.

• There is a tendency to shift the environmental health problems from Ministry of Health to Ministry of Agriculture (Food Safety) and Ministry of Environment (ambient air pollution and soil pollution)

• This process have been carried out under umbrella of unification of Polish law and environmental health organisation with EU countries .

OPERATIONAL TARGETS (cont.)

9. Improving sanitation throughout the country.

10. Reducing the incidence of accidents, and traffic accidents in

particular.

OPERATIONAL TARGETS

(cont.)

11. Improving efficiency and effectiveness of emergency

services in life threatening conditions.

12. Improving access to and efficiency of primary health care.

13. Preventing premature births, low birth weight and reducing

related health effects.

14. Improving early diagnosis and active care of persons at risk

of ischaemic heart disease.

15. Improving early diagnosis and treatment of breast and

cervical cancers.

16. Providing better opportunities for people with disabilities

and developing their capacities to lead active lives.

17. Improving prevention of communicable diseases.

18. Improving prevention of dental caries and periodontal

disease in children, adolescents and pregnant women.

HealthTargets

Evaluation

Monitoring

IndicatorsIndicators Indicators Indicators

Performance of taskslisted in timetable - by the

ministers

Evaluation

New tasks formulation Removal of tasks completed

Monitoring

Act

ivit

ies

supe

rvis

ed b

y M

inis

try

of

Hea

lth

Act

ivit

ies

sup

ervi

sed

by

NH

P

Mon

itor

ing

Off

ice

National Health Programme realisation and monitoring

Four important reforms were introduced in the country in 1999

Reform of administrativestructure of the country

(from 49 regions and 2483 counties to16 regions, 308 powiat’s, and 2489

counties

Reform of education system

(from primary, high school, universityto primary, secondary, high school,

collage university

Reform of pension system

(from central system of pensiondistribution to individual pension plan

system and private insurance)

Reform of health carefinancing and organization

(from centrally organized and financedto sickness fund system)

Principles of health care system reform in Poland

• Introduction of “sickness funds”

• Changing of money flow - from Central budget to sickness fund

• From „unlimited services” to services contracted on the basis of health needs and financial resources

• Introduction of independence and privatisation of health care units - clinics and dispanceries

42

ParliamentBudget law

Ministry of Defence

Ministry of InternalAfairs

Ministry ofTransport.

Ministry of Healthand Social Support

Local authority

District budget

Former Health Care Financing System (flow of funds)

Dispensaries

Taxes

Health care unitsDispensaries & Hospitals

Scientific InstitutesTeaching hospitals

Sectors Health ServicesZł

$$$

Citizen

43

Nurses

InsuredPerson

Current System of Health Care Financing

Financing of specialand expensive

medical procedures(e.g. bypasses

transplantation'setc.)

ScientificinvestigationsInvestment

Physicians

HospitalsDispensaries

„ZUS”

SICKNESSFUNDS (17)

Contracting of special health services

Additionalfunds

DonationsRevenue

Taxes

Own expansesfor over -

basicprocedures

Con

tracting

Zł$$$

Results of surveys on health reform perception

• mostly negative opinion - but better in small towns and rural areas

• deterioration of access to the specialists services and to diagnostics procedures

• still present under table money paid for some procedures in hospitals

• better services provided by family doctors and in privatized health units

Still observed in the country

Life expectancy at birth in Poland by regions in 2000

Data of Central Statistical Office

7 8, 0

7 7, 6

7 7, 5 7 8, 5

7 7, 4

7 7, 2 7 8

, 8

7 8, 6

7 8, 2

7 9, 0

7 9, 1

7 8, 1

7 7, 2 7 8

, 6

7 8, 6

7 7, 5

7 7, 5

6 9, 7

6 8, 8

6 9, 6

6 9, 1

6 9, 2

6 7, 9

7 1, 3

6 9, 8 7 0, 7

7 1, 2

7 0, 5

7 0, 6

6 9, 6 7 0, 5

6 9, 2

6 9, 7

6 9, 0

POLSKA

Dolnoś

ląskie

Kujawsk

o-Pom

orsk

ie

Lubels

kie

Lubus

kie

Łódzk

ie

Mało

polsk

ie

Maz

owiec

kie

Opolsk

ie

Podka

rpac

kie

Podlas

kie

Pomor

skie

Śląskie

Świętok

rzysk

ie

Warm

ińsko

-Maz

ursk

ie

Wiel

kopo

lskie

Zacho

dniop

omor

skie

40,0

50,0

60,0

70,0

80,0

Men

Women

MEN WOMEN

3,41 1,97

67,9

71,3Łódzkie

Małopolskie

77,2

79,1Łódzkie

Podlaskie

Data of Central Statistical Office

Malignant neoplasm's mortality in Poland (standardised data)Men + Female -1999

Per 1000 pop..

Mean value of „indicator”

Sickness funds financed activities in the areas with the the worst health situation

Worse value of “indicator”

Best value of “indicator”

Health promotion and prevention programes

• In 1999-2000 over 250 prevention and health promotion programs in Poland has been contracted and monitored by Sickness Funds

• Contractors were – health care units and some of the local authorities

• There is shortage of people in sickness funds with experience to contract and evaluate realised health programmes as well as shortage of such people in local authorities.

• Special World Bank sponsored project for education of health promotion leaders in local authorities was started in 40 of gminas (counties) in two regions of Poland

• Another World Bank educational Program (in Public Health) started in may for Sickness Fund staff

§

This Act can solve problems with organisation, financing and realisation of National Health Programme

Conclusions

• Process of health status improvement after transition needs acceleration especially in some areas like cancer problems or external causes in men.

• Negative public opinion on health care reform should be change through:- step by step increase of money devoted for health care in the country (now

7.75% of individual salary) - intensification of independence of health care units and their

privatisation National Health Programme as a major tool for health policy should be strengthen in

a way of legislation which will enable to dedicate money for health programs at the country and local levels.

Problems with a new Environmental Health Monitoring System require better collaboration between Ministry of Health and Ministry of Environment and new model of San-Epid System should be worked out.

Public health statistics as a source of information for health policy should be given priority and protection from disturbances of the transition period.