Abstract
At the beginning of the article the typologies, expected outcomes and forces aiming at health care integration are discussed. Integration is recognised as a multidimensional concept. The suggested typologies of integration are based on structural configurations, co-ordination mechanisms (including clinical co-ordination), and driving forces. A review of the Polish experience in integration/disintegration of health care systems is the main part of the article. Creation of integrated health care management units (ZOZs) in the beginning of the 1970s serves as an example of structural vertical integration missing co-ordination mechanisms. ZOZs as huge, costly and inflexible organisations became subjects of public criticism and discredited the idea of health care integration. At the end of the 1980s and in the decade of the 1990s, management of public health care was decentralised, the majority of ZOZs dismantled, and many health care public providers got the status of independent entities. The private sector developed rapidly. Sickness funds, which in 1999 replaced the previous state system, introduced "quasi-market" conditions where health providers have to compete for contracts. Some providers developed strategies of vertical and horizontal integration to get a competitive advantage. Consolidation of private ambulatory clinics, the idea of "integrated care" as a "contracting package", development of primary health care and ambulatory specialist clinics in hospitals are the examples of such strategies. The new health policy declared in 2002 has recognised integration as a priority. It stresses the development of payment mechanisms and information base (Register of Health Services--RUM) that promote integration. The Ministry of Health is involved directly in integrated emergency system designing. It seems that after years of disintegration and deregulation the need for effective integration has become obvious.
Highlights
A review of the Polish experience in integrationydisintegration of health care systems is the main part of the article
The sharp split between purchasing agencies, i.e. sickness funds and health care providers set quasi-market conditions, in which providers had to compete over health care contracts and had to attract patients due to their freedom of choice
Many factors and forces contributed to the disintegration of Polish health care in the 1990s
Summary
Integration can be considered from several perspectives and it can serve as a means to achieve several goals. ‘‘The parts of a social system must be brought together in contact with one another, interdependencies understood and organised, and the need for coordinated action resolved’’ Associations are focused on promoting professional standards and values (effectiveness and quality of work, improvement of productsyservices, positive influence on the lives of others) as well as on securing professional interests (providing professional contacts, running conferences, developing skills, lobbying governments, improving job conditions, getting certificates and licences, etc.) w6x. Integration promoted by health professionals is oriented on patients’ needs (easy access to health care and continuity of care, the best possible results of treatment, quick clinical information flow, satisfaction) as well as on extending professional knowledge, improving professional skills, and creating job arrangements and technology that enhance health gains. All three forces play an important role but there is no answer to what extent we should submit health care integration to strict bureaucratic regulations, how much we can rely on market ‘‘invisible’’ mechanisms, and how much on professional values, standards and attitudes
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