They don’t produce results immediately, but they are effective. They don’t result in the patient being cured in a day, but they significantly protect society from disease in the long term. We are talking about prevention and education.
What went wrong?
For instance, thanks to them, cancer diagnosis is highly effective in Scandinavia. At the same time, in our country, 38 per cent of women have never had a breast ultrasound in their lives, while 62 per cent of men have never had their testicles examined by a doctor*.
We’re at the tail-end of Europe in prevention rankings. Instead, we lead the way in terms of consumption of over-the-counter medicines and obesity among children. Why is this happening? Primarily, there are two reasons – the poor awareness and insufficient willingness of the public to take an interest in their health, as well as the lack of proactive measures on the part of healthcare providers and the state.
An example of this is the famous leaflets with information about free mammography that are placed in mailboxes. How effective is it? Just look at the statistics: over the past two years, only 38 per cent of women aged 45-54 and 65 per cent of those aged 55-64 have had a mammography screening. I’d like to add that this examination detects over 90 per cent of all lesions and, thanks to early diagnosis, breast cancers are practically completely curable. Free mammography is available once every two years for every woman between 50 and 69 years of age.
It’s even worse as far as men are concerned, as they are not only very unwilling to have their testicles examined by a doctor but are also reluctant to have a prostate examination, which should be done after the age of 50. In less than the past 12 months, 26 per cent of men aged 55-64 and 43 per cent in the 65+ group** have had a prostate examination. So, what went wrong in Poland to make our society wary of or unwilling to undergo medical examinations?
Education does matter
The effects of prevention can only be seen in the long term, which is why education in this area should start at an early age. P.E. lessons, designed in a way to encourage pupils to develop their sporting passions rather than discourage physical activity, are an essential element. In addition to exercise, this culture should be based on education on healthy living. From a young age, we must instil in the younger generations that sport and nutritious meals are the key to long-term health. Talking to students about prevention and diseases that may affect them or, even worse, unfortunately already do, should be a compulsory part of the curriculum. Today, we are already seeing the dramatic effects of obesity among the youngest. According to a report by the Institute of Mother and Child, one in three second-grade primary school students is overweight or obese, and the prevalence of overweight and obesity in eight-year-old children has increased from 32.2 per cent in 2018 to 35.3 per cent in 2021***. It’s plain to see that it’s among the youngest that we should start prevention to show them the possible risks that may arise in the future.
Education doesn’t only concern children – it should be pointed out that the group of Poles who are least likely to be examined are those professionally active. Nearly 45 per cent of those aged 30-39 and 37 per cent of those aged 40-49 admit to missing regular preventive examinations****.
The later we act, the more we spend. 40 per cent of healthcare costs are generated by patients over 65 years of age. The annual spend on a patient aged 75-84 is nearly double that on one aged 35-44. Simply put, if we invest in prevention and health education in the early years, we will significantly reduce the financial burden on the system resulting from the treatment of senior citizens. Just to give you an example, 2 per cent of the NHF budget spent on prevention is less than we spend on the five largest hospitals in Poland. Meanwhile, the number of people who participated in at least one prevention programme fell from 15 per cent to 6 per cent between 2016 and 2020.
The need to motivate
So, what could help here? Motivation in the shape of benefits or penalties.
- The benefits could include one health premium free of charge, i.e. paid by from the state, for anyone who, say, completes a set of preventive examinations having reached the age of 40.
- A negative motivator could be, for example, an increase in the patient’s premium if they fail to undergo a set of tests.
While the positive motivation may be discredited by many due to the argument of additional costs, my position remains that to make it cheaper in the future, it’s necessary to pay today or rather to invest in the health of Poles. A patient who undergoes all preventive examinations has a better chance of earlier detection and effective treatment. By following this path, we act prophylactically in the areas of primary care and specialist outpatient care, without burdening hospitals and the entire system with the long-term treatment of the patient.
The positive results of this approach can be seen in places such as Scandinavia, where, although the detection rate of cancer in women is the same as in Poland, the mortality rate is three times lower*****. Regrettably, as far as Polish health care goes, the medical staff doesn’t have a demanding attitude towards the patient. Nor does it teach them to be demanding of themselves and take care of their health.
Benefits as an effective way to encourage prevention
Positive motivation would work well for patients as well as providers. Better valuation of preventive services – and let me stress it: effective preventive services – could affect the entire health system. A doctor or facility that delivers preventive health services, as a result of which the patient does not ultimately end up in hospital but is effectively treated in a primary care and specialist outpatient care centre, receives an additional financial reward from the state budget. This was the premise behind initiatives including the pilot of the KOS-BAR****** programme, which I already mentioned in my earlier post on coordinated care.
A financially motivated doctor will motivate the patient and ensure effective therapy. This would pay off for everyone, as it’s through such a pathway that patient treatment is largely carried out at the level of primary care and specialist outpatient care rather than the hospital, where procedures are correspondingly more expensive.
Effective patient and provider motivation with benefits complemented by education from an early age is a long-term task for Polish health care. As the example of the Scandinavian countries shows, this approach pays off – literally and figuratively – for the patient, the provider and, ultimately, the state budget.
* National Health Test of Poles 2023: https://ocdn.eu/medonet/medonet/Raport_Narodowy_Test_Zdrowia_Polakow_2023.pdf
** Ibid
*** https://drive.google.com/file/d/16KkVCiJyEz8X1g_tR0jivMOoArleoXvG/view
**** E-recepta’s report “Health Habits in Poland”: https://e-recepta.net/blog/nawyki-zdrowotne-polakow-raport-2023/
***** https://www.onkonet.pl/n_n_polki_umieraja_czesciej_na_nowotwory_ginekologiczne.php
****** More in my post on coordinated care.
