Planning Wisely. Working together. Spending resources wisely and focusing on medical staff training. These are some of the first measures that should be taken in the firefighting zone – or as I put it in my last blog post – the current Polish healthcare situation. The government will have a tough nut to crack, as the critical areas are many now. Nothing is impossible, however, and effective planning and implementation of systemic solutions that include all providers is the way forward for the new government. The question is, in a state of permanent war, can the health of the Polish people and the construction of an effective system be free of division? Illnesses, after all, don’t have political colours.
Financing and rational spending
We already know that 27 billion more will be spent on health care in 2024 than in 2023*. This piece of news should be pleasing, but it’s not just the level of funding that’s important here, but making the expenditure more rational. Currently, OSC (outpatient specialised care) and – as far as certain services go, e.g. in the areas of oncology, orthopaedics, cardiology, gynaecology, ophthalmology, and vascular surgery – hospitals also enjoy non-limited financing of services. And while glaucoma surgery or endoprosthesis are generally one-off procedures, the non-limited financing of services in OSC makes you scratch your head. Why? Because it was introduced without any in-depth planning or strategy. The idea behind the solution was that by funnelling extra money into the system for non-limited financing of services, it would solve the problem of queues – both in hospitals and outpatient clinics. And while it worked with surgical procedures, it completely failed to work in outpatient clinics. Patients started to turn up at OSC facilities more frequently, but it didn’t translate in any way into their effective treatment. They went back and forth between doctors and diagnostic rooms, and the result was even longer queues. In theory, the measures introduced were supposed to ease queues. In the case of OSC, the opposite happened. It’s enough to look at the figures. In August 2023, as a patient, you waited an average of 3 months and 21 days to see a specialist at an outpatient clinic, which is slightly shorter than in 2022, but almost a month longer than in 2021 just after the limits were done away with (Watch Health Care Foundation data). The introduction of non-limited funding of services not only failed to reduce queues but also, as doctors themselves admit, resulted in the patient’s OSC treatment pathway becoming longer**.
In contrast to the above situation is the limited funding of long-term care services. OSC facilities ensured that there were no funding limits on, for example, CT or MRI scans, while home mechanical ventilation, home clinical nutrition, or home palliative care remained services with limited funding.
OSC and hospitals therefore become the main beneficiaries of the funds earmarked for services exceeding contracted limits and those with non-limited funding. The questions are whether the consumption of these resources was rational and effective and whether the payer predicted the complexity of the treatment process. After all, it’s paying for effective treatment and performing medical procedures without complications that impact the efficiency of the entire healthcare system.
Perhaps now is the best time to steer away from the hospital-centric vision and analyse the rationality of how the money is spent. Also, it’s worth taking a close look at the valuation of services, which should be changed with the Agency for Health Technology Assessment and Tariff System considering the increasing costs of treatment.
How to make the funding more rational? Above all, there must be collaboration, consultation, and discussion with medical market participants – both doctors and practitioners who see daily where the system should keep capping services and where it should abandon them.
Quality instead of quantity
Adopting the right strategy in health care should consider both rational financing and the human factor, more specifically medical staff. The training of future doctors in recent years has been conducted without an in-depth strategy. We’ve seen it on several occasions, including last autumn, when the number of medical universities increased by 12 for the 2022/2023*** academic year following the decision of the Ministry of Education and Science. The number of students also increased because the then Minister of Health promised that the standard of teaching would be maintained – i.e. the intention was that, say, the Academy of Applied Sciences in Nowy Sącz would have graduates as highly educated as the Jagiellonian University or the Medical University of Warsaw. It only took a few months for this theory to become reality-validated. As a result of this sort of action, in a few years, we may face a situation like Spain, where the percentage of medical students is the highest in Europe. The aftermath is poor salaries and little motivation to work. In the Polish realities, these factors may be compounded by the low qualifications of students at the newly opened medical faculties, which Polish doctors are already concerned about.
The medical training system is only one aspect of educating future medical staff. The second one, equally important, is the nursing staff, which, unfortunately, has been for years facing a serious problem – the age of nurses and midwives. Today it’s an average of 54 years old. The new government therefore has the difficult task of restoring the full prestige of the profession and attracting new candidates. This is already happening slowly but change needs to accelerate. First and foremost, strengthening the financial aspect is key. Today, 72 per cent of nurses receive between 4 and 8 thousand PLN net per month, with the largest group earning between 5 and 6 thousand PLN ****. Good salaries should also be coupled with a change in the role of the nurse, who will focus primarily on coordinating the treatment process. This is most evident in long-term care, where nursing teams are a vital part of the therapeutic process.
Last but not least, I’d like to see a concrete strategy and idea for Polish health care and find out about the priorities that will be the basis for the changes to be introduced, as well as learn about the system of rational distribution of financial resources along with its strong justification. I expect that the new government will also present the results it intends to achieve by implementing a given strategy and distributing funds.
The new Minister of Health has announced that she will provide information on plans and challenges relating to Polish health care to the parliamentary health committee in January. I really am looking forward to it.
