Investing in long-term care and focusing on the development of its comprehensive model is key to the transformation that Polish health care needs. Our society is ageing. Today, the average Pole is 42 years old, and in the last 10 years, we have seen over 2 million more people over the age of 60*. Although we are getting older, we live longer, and what this means is an increasing number of patients who are or will soon be receiving long-term care – in outpatient clinics, homes, hospices, or nursing facilities.
Challenges in this respect were discussed at the two-day conference entitled “Long-Term Care in Poland – Today and Tomorrow’, at which I represented Pallmed and the National Association of Mechanical Ventilation Providers. So, what should the new direction of change in health care look like, and to what extent must it involve the development and strengthening of care for patients in homes, hospices, day care units, nursing homes or round-the-clock healthcare facilities?
- The development of telemedicine
Telemedicine is an effective tool that, from the perspective of the patient, medical staff, and the payer, is more cost-effective – both functionally and financially. For patients who want to be better cared for and have access to their results on a regular basis, it is an antidote to the traditional system. It is also tangible support for medical staff. Telemedicine gives the doctor a complete overview of the patient’s condition while allowing them to care for more patients at the same time. The doctor can focus on effective treatment. Their attention is directed solely at the person undergoing therapy and, thanks to well-prepared and properly organised data, they have quick and remote access to the results and entire medical record (e.g. telemonitoring of mechanical ventilation makes it possible to check for how many hours the patient is actually ventilating at home). The payer also benefits from well-developed telemedicine, as it allows the optimisation of costs that come with services such as hospitalisation, which is currently expensive and overused. Effective telemedicine is, to all intents and purposes, a healthier society. However, there is one BUT – for telemedicine to work, money must be invested in it and doctors and patients must be positively motivated. The initial cost will be higher, but the undertaking will become more cost-effective in the long term. This is the path we are following at Pallmed, where we combine professional patient care provided by experienced medical teams with modern technologies that support the patient’s therapy and, at the same time, provide tangible assistance to the medical staff, relieving them of the burden of unnecessary information and administrative duties. - Take an example from those who do it properly
When talking about fixing the health system, it is a good idea to look at those who are doing it right. How about an example? Scandinavia – it is in these countries that a system based on deinstitutionalisation and decentralisation of health care is doing well despite the high proportion of older people. In Denmark, it is the Primary Health Care doctor who is the patient’s “guardian” coordinating their treatment – every Dane goes to their doctor an average of seven times a year, of which nearly one-third of these visits take the form of telecounselling. Importantly, however, only 4 per cent of patients treated in outpatient clinics are hospitalised**. So, it is possible to structure the system in such a way that a significant proportion of treatment, including specialist treatment, takes place on an outpatient basis rather than in a hospital. What else do the Scandinavians do well? Above all, they emphasise coordinated care, and seniors in Sweden, for instance, are provided with extensive community support such as special transport, day centres for preventive care and rehabilitation, temporary residence centres, or secure housing (still the responsibility of the private sector in Poland). - Coordinate medical and community care
This is what the aforementioned Scandinavians have done, but it isn’t only them as our southern neighbours, the Czechs and Slovakia, are also following this lead. Close collaboration between the two systems means more effective therapy and greater financial benefits for the system, as it is these areas that intersect and complement each other. In Poland, however, we see dualism, as it were. It manifests itself not only in the different salaries of staff but also in the levels of knowledge and qualifications. What are the results? There is a complete lack of coordination between these areas, which should actually work together for the continuity and comprehensiveness of patient care. - Last but not least
Funding – I bring up this subject at the end, although in fact, I should have done it at the beginning. Why? Because no good things will happen in the healthcare system (and that includes long-term care) until the issue of payment backlog is closed. For the past eight years, the National Health Service has failed to account for all patients qualified by hospitals for home mechanical ventilation, and the payer owes over 150 million PLN to the current providers. Some cases are being settled in the courts. Meanwhile, a further over 3,000 patients mechanically ventilated at home are still not covered by the contract. The issue of funding is also an issue of education – by showing exactly the positive and long-term effects of the financial decisions made, such as the implementation of a universal blood glucose monitoring system, we can allocate resources in the system more rationally and make it work more efficiently.
Implementing new plans is an ambitious goal and it should be pursued step by step. The foundation, however, is for the payer to account for the debt so that providers offering services to patients have a positive incentive to act. And it is only from this that we can start building new and better long-term care standards in Poland.
** https://politykazdrowotna.com/artykul/system-dunski-jak-dziala-poz/825217
*** Care for seniors in Sweden www.bip.brpo.gov.pl.
