The debate on the state and problems of the health care system recurs with successive governments, which is why at the current post-election stage of the formation of a new government, it is worth asking the question whether politicians will undertake to implement changes in this area. The experience of recent years shows that nobody wants to take responsibility for the health of Polish people. What is more, even Poles themselves are reluctant to do so, as education in this area has also failed badly. Health care today is not an area encouraging a discussion on what more can be done better. It is rather a firefighting zone.
Prudence, experience, knowledge, and skills are what the new administration will have to demonstrate when setting priorities. Setting a roadmap is a key thing to do. To date, action with respect to health care has been taken ad hoc rather than systemically. The strategy of arbitrarily allocating, increasing, and decreasing the limits of funding for health services has worked somehow and been doing very well over the past years. The problem is that its outcome is rather poor.
So, what does the next few years have in store for us?
New direction, old problems
Before any new ideas are put into practice, the current situation must first be carefully analysed. For this to happen, what we need is a consensus of all medical circles, who will jointly look at the condition of Polish health care and calculate what we can realistically afford. For the truth is that before money can be funnelled into new areas, what we currently have must be paid for.
The National Health Fund has already adjusted the financial plan several times this year to patch the hole. 3 billion PLN was poured into the system, mainly to cover the value of services exceeding contracted limits and non-limited services, of which only 25 million PLN was allocated to palliative and hospice care*. The result of these decisions is the paradox of allocating practically all funds to non-limited services in outpatient clinics, instead of, for example, covering the services exceeding contracted limits in palliative care, where enteral nutrition for oncology patients is already covered by the National Health Fund with limits.
The new strategy should therefore focus on unresolved problems – the shortage of medical staff, the phenomenon of new medical universities that fail to provide an adequate standard of education or, finally, the system of non-limited services – largely established on an ad hoc basis and failing to fulfil its role in practice.
We prefer treatment to prevention
In Poland, we prefer treatment to prevention. In Scandinavia and other European countries, however, it has been decided that prevention should come first and treatment later. Do you want to know the results? A healthier population, lower cancer mortality and, above all, more financially efficient health care. This is because prevention and education are cheaper than treatment in the long term, and early detection of the disease means shorter hospitalisation and higher patient survival rates. Another benefit is reduced expenditure on restoring the citizen’s health. It seems obvious, yet it is difficult to put it into practice.
Just look at the Polish statistics. In 2022, only one in five Polish women had a breast ultrasound and one in three had a cytology. As far as mammography goes, it is the same. Only 36 per cent of women aged 45-54 and 64 per cent of those over 55 had this examination in the 2021-2022 period. As far as male prevention is concerned, it is even worse, with over 60 per cent of Poles have never been to the doctor for a testicular examination**. Bearing this in mind, how to go about this area? The answer is – through education, from an early age. Education that is systemic, daily, and positively motivating for both doctors and the public.
What about this innovation thing?
Digitalisation and telemedicine were supposed to make Polish medicine move forward – making doctors’ lives easier and helping to coordinate patient treatment. As a result, we stopped somewhere halfway between theory and reality. The potential of monitoring in diabetology is still far from being fully exploited, and telemedicine has come to be regarded as equal to visits to a specialist – equal and, importantly, equally paid. As a result, currently we have a system that relies heavily on e-prescriptions, e-referrals, and televisits with specialists, which in many cases are held on a one-off basis. And the possibilities here are enormous indeed. What it takes is just a good strategy. Just or as much.
* https://www.bankier.pl/wiadomosc/Tegoroczny-plan-finansowy-NFZ-zwiekszony-o-3-mld-zl-8605280.html
** National Health Test of Poles. Report of 2022. https://ocdn.eu/medonet/medonet%20market/NTZP2022_raport_display.pdf
