Health Services In Poland Research Articles

USE OF ANTIHYPERTENSIVE COMBINATION THERAPY DURING THE COVID-19 PANDEMIC - A CROSS-SECTIONAL, NATION-WIDE STUDY 2019-2021

Objective: To assess changes in the use of antihypertensive drug combinations during the COVID-19 pandemic and the degree of adherence to the recommendations of more frequent use of combination therapy by ESC/ESH 2018 guidelines, data of all patients who filled a prescription for an antihypertensive drug in Poland were analyzed. Design and method: Patients who filled at least one prescription from ATC groups C02, C03, C07-10, C10BX in each of the years 2019, 2020 and 2021 were extracted from the obligatory prescription database of the National Health Service in Poland. This database covers all filled prescriptions in Poland. We have excluded from the analysis patients with diagnosis of heart failure. Combination therapy was assumed if prescriptions of two drugs overlapped for at least 40 days. In the case of the use of single pill combinations (SPC), the combined use of the individual substances included in the SPC was automatically recognized by the database. The frequencies were analyzed for the years 2019, 2020 and 2021 respectively. Results: In years 2019, 2020 and 2021 – 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. One antihypertensive drug was used by 28.5, 28.0 and 28.3% of patients. The remaining patients used two antihypertensive drugs 27.4, 28.1 and 28.0%, three antihypertensive drugs 21.6, 22.2 and 22.1%, four antihypertensive drugs 12.7, 12.8 and 12.7% and 5 or more antihypertensive drugs 9.8, 9.0 and 9.0%. There was a modest increase in two drug SPC, which were used by 28.0, 28.7 and 29.8% of patients. There was an increase in the use of three drug SPC – 2.6%, 2.9% and 3.4% of patients. Conclusions: Although a modest, significant increase in the frequency of SPC use, both based on two and three antihypertensive drugs, was found, the COVID-19 pandemic and the ESC/ESH 2018 recommendations supporting the use of combination treatments, have had little impact on the prevalence of combination treatment in Poland.

USE OF ANTIHYPERTENSIVE DRUG CLASSES DURING THE COVID-19 PANDEMIC. A CROSS-SECTIONAL, NATION-WIDE STUDY 2019-2021

Objective: To assess changes in the use of antihypertensive drug classes during the COVID-19 pandemic, data of all patients who filled a prescription for an antihypertensive drug in Poland were analyzed. Design and method: Patients who filled at least one prescription from ATC groups C02-03, C07-10, C10BX in each of the years 2019, 2020 and 2021 were extracted from the obligatory prescription database of the National Health Service in Poland. We have excluded patients with a diagnosis of heart failure. The frequencies of use of antihypertensive drug classes – beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), calcium channel blockers (CCB), thiazide diuretics (TD), thiazide-like diuretics (TLD), loop diuretics (LD), mineralocorticoid receptor antagonists (MRA) and alpha-blockers (AB) - and their combinations were analyzed for the years 2019, 2020 and 2021 respectively. Results: In the years 2019, 2020 and 2021 – 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. Among the main groups of antihypertensive drugs, the most used drug groups were BB (62.0, 62.8 and 63.7%), ACEi (52.9, 52.7 and 46.8%) and CCB (34.5, 35.2 and 35.9%). ARB were used by 26.8, 27.3 and 28.2% of patients. Diuretics were used by: TD 14.2, 13.9 and 14.1%; TLD 23.3, 22.8 and 22.6%, LD 13.0, 12.8 and 12.9%, AA 8.5%, 8.3%, 8.5%. AB were rarely used (4.5, 4.5, and 4.5%). Among patients taking two anithypertenisve drugs, the most common combination was BB+ACEi 23.5, 19.7 and 18.7%. BB+other anithypertensive drugs was used by 48.6, 46.9 and 45.7% of patients. ACEi/ARB+TD/TLD and ACEi/ARB+CCB combinations were used by 24.3, 23.4 and 23.6% and 17.4, 17.6 and 18.4% of patients, respectively. Among patients taking three drugs, BB+ACEi/ARB+TD/TLD combination was used by 29.8, 26.4, 25.7% of patients, followed by combinations: BB+ACEi/ARB+CCB 21.3, 19.8 and 19.9% and ACEi/ARB+CCB+TD/TLD 15.2, 17.2 and 18.5% of patients. Conclusions: The COVID-19 pandemic had little impact on changes in the frequency of use of individual antihypertensive drug groups. A slight increase in the use of the two and three drugs’ combinations recommended by the ESC/ESH 2018 guidelines was observed in 2021 compared to 2019.

Barriers to accessing health services during the COVID-19 pandemic in Poland: A nationwide cross-sectional survey among 109,928 adults in Poland.

IntroductionThe COVID-19 pandemic has significant socio-economic implications for numerous industries, including healthcare. Disruptions of essential health services were reported by nearly all countries around the world. A detailed assessment of the healthcare uptake is necessary to estimate the potential health effects of the COVID-19 pandemic on the population. This study aimed to assess the prevalence of barriers to accessing health services during the COVID-19 pandemic in Poland as well as to identify factors associated with the disturbed access to healthcare during the pandemic.MethodsThis cross-sectional survey was carried out among Internet users in Poland using the computer-assisted web interview technique. Data were collected between October and December 2021. The questionnaire included 32 questions on sociodemographic characteristics, the COVID-19 pandemic, health status, daily habits as well as the use of healthcare during the COVID-19 pandemic.ResultsData were obtained from 102928 adults, the mean age was 48.0 ± 14.2 years, and 57.2% were females. Most of the respondents had visited a doctor during the past 12 months (70.4%). Almost half of adults in Poland (49.7%) reported barriers to access health services in the past 12 months. Out of 51,105 respondents who had experienced barriers to accessing health services during the COVID-19 pandemic, only 54.3% had visited a doctor in the past 12 months. Long waiting time (39.5%) and temporary closure of healthcare facilities/transformation into a COVID-19 dedicated center (28.8%) were the most common barriers indicated by the respondents. In multivariable logistic regression, female gender, age 18–49 years, lack of higher education, living in cities between 51,000 and 200,000 residents or above 500,000 residents, and having at least one chronic disease were significantly (p < 0.05) associated with higher odds of experiencing barriers to accessing health services during the COVID-19 pandemic.ConclusionsThis study confirmed that the COVID-19 pandemic has worsened access to health services in Poland. During the pandemic, new barriers to accessing health services, such as the temporary closure of healthcare facilities for non-COVID patients were revealed. Findings from this study provided patients' perspectives on barriers to accessing health services in Poland that may be used by policymakers to reduce health inequalities.

A reform proposal from 2019 aims to improve coordination of health services in Poland by strengthening the role of the counties

Numerous attempts have been undertaken over the past two decades to improve the coordination of health services in Poland. These have usually focused on specific groups of patients or conditions, usually encompassing various types of specialist care, with only a few initiatives including a wider range of health services or sectors. These efforts have not been helped by the fragmentation of responsibilities between the various levels of territorial self-government, which are the founding bodies for different types of public providers. In 2019, a new policy initiative of the Ministry of Health proposed the establishment of County Health Centres that would improve integration of primary health care with specialist outpatient care, inpatient care in the county hospitals (hospitals of the 1st reference level), and other services at the level of the county. This would constitute the so-called “core system of health security” and support reorientation of health services towards PHC and the community and away from specialist hospitals. With its focus on health promotion and disease prevention and tailoring provision to the needs of the local populations, the proposal resembles examples of population health models introduced in several other countries, and offers a chance to improve the allocation of resources and to reduce the persisting health disparities across the country.

The impact of the COVID-19 pandemic on the resources and activities of basic occupational health services in Poland

In 2020, the first year of the COVID-19 pandemic, there were a number of factors affecting employees, employers, and consequently, both directly and indirectly, the occupational health service (OHS). The purpose of this publication is to analyze the activity of physicians and OHS units in this period in Poland. The analysis of the number of physicians, OHS units and their activities was performed on the basis of the MZ-35 and MZ-35A statistical forms, which represent obligatory medical reporting. There were 6349 occupational medicine physicians in Poland, who are entitled to conduct prophylactic examinations of employees and provide preventive health care, necessary due to working conditions (less by 248 [3.8%] compared to 2019). At the same time, the number of OHS basic units decreased to 5784 (by 3.2%). In 2020, occupational health physicians reported 4 314 520 prophylactic examinations of employees and job applicants, what is over 1 million 231 thousand (22.2%) less than in the year preceding the pandemic. In addition, they reported the performance of 255 887 prophylactic examinations related to the practical vocational training of pupils, students, participants in qualification vocational training and Ph.D. candidates (less by 157 220 [38.1%]). In 2020, they performed 1 933 355 preliminary examinations (23.9% less), 1 924 929 periodic examinations (25.1% less) and 456 236 follow-up examinations (5.1% more). In 2020, there was also a significant decrease in the number of visits to entire workplaces (from 6437 to 3625) and individual positions (from 46 197 to 26 389) carried out by OHS units. Also in 2020, an almost threefold increase (to 2183) in the number of suspected occupational diseases was reported by OHS physicians. In 2019, the duty to submit an annual report regarding prophylactic activities on the MZ-35A form has been obeyed by only 3607 (56.8%) obliged physicians. The COVID-19 pandemic has significantly affected preventive activities carried out by occupational physicians. Med Pr. 2022;73(1):19-24.

How the COVID-19 Pandemic Affected the Accessibility and Quality of Health Services in Poland

Abstract The outbreak of the COVID-19 pandemic had an impact on the global economy, including the provision of health services, with medical facilities and patients cancelling or postponing medical appointments. An alternative to in-person appointments was through the available forms of telemedicine. Scientific reports around the world have suggested that the accessibility and quality of health services declined. The aim of this study was to investigate the accessibility and quality of health services in Poland and to verify whether there were differences between men and women in this respect. The study was based on the authors’ own survey questionnaire filled in by 265 respondents, including 181 women, 82 men, and 2 persons without a defined gender. The study revealed that during the COVID-19 pandemic, the accessibility and quality of health services declined. Additionally, women were more likely to use general and specialist health services than men, but a comparison of changes in the assessment of accessibility and quality of services by gender revealed no differences in the assessment of accessibility and quality.

Efficacy of home treatment of patients with mental disorders - a research review.

The aim of this study is to review research on the efficacy of home treatment for mental disorders compared to other forms of community-based treatment. The first section describes studies comparing treatment as usual with CMHT (Community Mental Health Team), the second section compares CMHT with more intensive forms of community-based care, such as CM (Case Management) and ACT (Assertive Community Treatment, and the third section focuses on interventions that are alternatives to hospitalization, described as CRT or MCHT (Crisis Resolution Team or Mobile Crisis Home Treatment). The community-based model of psychiatric health care is nowadays recognized as the best systemic solution to improve its organization and functioning. In comprehensive care in the community, home treatment plays an important role. Treatment teams most often take the form of a general Community Mental Health Team - CMHT, which, like community mental health services in Poland, provides a wide range of interventions. There are several forms of treatment within CMHTs: ACT, CM, CRT and MHCT. Home treatment is more effective compared to standard inpatient and post-hospital care. Care under a Community Mental Health Team reduces the number and duration of hospitalizations and is characterized by higher treatment satisfaction. For patients with psychotic disorders, more intensive forms of community-based care - such as ACT, CM, and CRT - are particularly valuable and effective.

Medical tourism in Poland: the perspective and experience of the physicians

Introduction: Medical tourism is gaining popularity all over the world. This term in this paper refers to patients of Polish nationality living abroad but using health services in Poland as well as foreign patients who use health services in Poland.&#x0D; Objective of the paper: The objective of this study was to investigate the magnitude and characteristics of medical tourism in Poland from the perspective of the physicians.&#x0D; Material and methods: a questionnaire-based survey was conducted among 700 physicians in Poland. The questionnaire included 29 questions regarding healthcare services in Poland.&#x0D; Results: Completed questionnaires were obtained from 498 physicians (67.9% females; average age 41.8±10.5 years), with a response rate of 71.1%. Clinical encounter with a Polish patient who resides on permanent basis outside the country was declared by 67.5% of respondents. There were significant differences (p&lt;0.05) in the frequency of domestic medical tourism depending on the medical education level as well as practice type. Most of the participants (72.3%) declared an encounter with a foreign patient who has used health services in Poland. Except the urgent health need, as factors determining domestic or international medical tourism, the doctors mentioned: quality of healthcare services, price competitiveness as well as the possibility of combining treatment with a visit to the family.&#x0D; Conclusions: Most physicians in Poland have had the opportunity to consult a patient who has used health services as part of national or international medical tourism.

Free dietary advice via the Internet as a tool for prevention and treatment of chronic non-communicable diseases - preliminary reports

AbstractIntroductionCurrently, there are no dietary consultations in the health service in Poland, that is why free access to the dietician is often difficult. The use of modern teleinformation technologies in medicine, creates unprecedented possibilities of providing medical services. Therefore, as part of the National Health Program financed by the Ministry of Health, the first digital platform was established in Poland - the Online Diet Center, where everyone with access to the Internet can use the advice of a professional dietitian free of charge.The aim of the study was to obtain information on the characteristics of patients reporting online consultations and identifying their needs.Materials and methodsThe study was conducted among the patients of the Online Diet Center during the 12 months of running a diet counseling (December 2017-December 2018) using the authorial questionnaire that each patient completed after creating an account on the online counseling platform before and after the advice (satisfaction survey). Each advice lasted 30 minutes and was conducted by a trained dietitian.ResultsThe number of patients who created an account on the Dietetic Online Center platform was 10,850, of which 23% were men and 77% women. Most often it was used by residents of large cities (including Warsaw, Krakow, Katowice, Wrocław, Poznań, Gdańsk, Łódz´). Almost 2% of patients were also Poles living abroad (Denmark, Australia, Great Britain, Ireland, Germany, Norway, Belgium, Italy, Spain, Brazil). Almost 1/3 of all registered patients after one consultation had another consultation with a dietitian. The most common disease was obesity (17%). Patients also declare hypothyroidism (15%), hypertension (13%), food allergy or intolerance (6.8%), eating disorders (5.6%) and depression (5%). Only 10% of patients were people who did not report any diseases. Only less than 1% of patients were not satisfied with such a consultation system, explaining that the information provided by the dietician was not useful. The duration of the advice was sufficient for patients.DiscussionA large group of patients who apply to the Online Diet Center were women, which is consistent with the general trend in the area of dietary services. Due to the low frequency of using online dietary advice in small towns, in year 2019 a promotional campaign will be addressed to these places. The low percentage of dissatisfied patients and the willingness to make further advices, testifies to the success of platform of online dietary counseling and the legitimacy of its further development.

Problems and Strengths in Psychiatric Nursing in Poland: Current Legal Regulations and Results of Survey

Introduction: National health resources are considered inadequate to meet the needs of Mental Health services in Poland due in part to insufficient funding. The status of the nursing profession is autonomous and independent, and one that bears much public trust. Nevertheless, psychiatric nursing is in deep crisis.Aim of the study: To determine the strengths and limitations of the psychiatric nursing system in Poland.Method: Participants of a major Psychiatric Nursing Conference in Poland were surveyed in terms of professional job satisfaction and current problems encountered in psychiatric nursing. Results were appropriately categorized and subjected to quantitative analysis.Results: There were 74 subjects, amounting to a 70% response rate who completed the study questionnaire. Problem areas were focused on how the mental health system is organized and on staff working conditions that included terms of employment and salaries. The main reasons for job satisfaction were those issues associated with the treatment process. Two participants replied that they were not satisfied.Discussion: The numerous problems encountered in Polish psychiatry nursing require further debate and the updating of legal regulations to increase funding. Recently introduced regulations on the minimal standards acceptable for nurse/bed ratios have however been postponed until 2021. The issues concerning job satisfaction have also been referred to in previous studies.Implication for practice: The crisis facing psychiatric nursing in Poland requires systemic changes in both legal regulations and financing. Notwithstanding, such professionals and their societies could facilitate the necessary changes through enhancing public debate and stimulating nursing-focused research.

State Hygiene School as a Department of Education in the National Institute of Hygiene in Warsaw

The article presents the history of the establishment of the State School of Hygiene (PSH) in Poland after the First World War. The difficulties faced by the public health service in a country destroyed by war and created after the reunification of the lands, which for over 150 years remained under the control of three powers, were pointed out. It discusses how the foundations of modern teaching in the field of public health were created in the National Institute of Hygiene (PZH) in Warsaw, an institution to which the Ministry of Public Health entrusted tasks related to health education in the country. The State School of Hygiene was built by the Polish Government with a significant financial contribution from the John Davison Rockefeller Foundation. The official opening ceremony took place on 20 April 1926. The State School of Hygiene in Warsaw was the first such school in Europe. It educated professional staff for the health service in Poland, especially sanitary physicians, sanitary inspectors, nurses and staff to work in health offices. The importance and scope of influence of the State School of Hygiene as the Department of Education in the National Institute of Hygiene was constantly increasing, as evidenced by the number of students (about 800 per year) participating in courses, especially in the first years after its establishment. By the end of 1935, 6,389 students had completed the courses, including 1,900 physicians. Apart from the teaching activities, the State School of Hygiene also carried out research work. The State School of Hygiene was supported by the Rockefeller Foundation, which funded scholarships for the employees of the National Institute of Hygiene at university centers in the USA

Technical Efficiency of Polish Independent Public Health Care Centres: Data Envelopment Analysis Approach

In the face of the growing demand for health services, which can be observed in Poland (as well as in many other countries), it is extremely important to make effective allocation decisions in relation to financial resources (at the disposal of health sector decision-makers). The pace of demographic, technological and market changes forces an increase in financial expenditures on health, while at the same time the resources allocated to these objectives are still lacking. The present paper assesses the technical efficiency of 24 independent public health care centers (IPHCCs) in 2010–2014 with the use of the data envelopment analysis method and evaluates changes in the examined efficiency categories using the Malmquist Index. The research has shown that independent public health care institutions in Poland are facing the problem of debt and inefficiency. It has also been established that the level and method of financing health services in Poland contribute to a large extent to the technical inefficiency of IPHCCs, and that the increase in IPHCCs’ revenues leads to an increase in their technical efficiency. The conclusions of this paper provide, on one hand, the basis for in-depth research into the efficiency of public health entities and, on the other, guidance that can be used in the practical management of public health entities and in the shaping of national health care policy.

TELEMEDYCYNA A KONSTYTUCYJNE PRAWO DO OPIEKI ZDROWOTNEJ W KONTEKŚCIE WYKLUCZENIA CYFROWEGO

Artykuł stanowi omówienie konkretnego problemu jaki może powstać w trakcie próby wdrożenia rozwiązań telemedycznych w Polsce. Po pierwsze, ze względu na brak definicji legalnej telemedycyny zostaną przytoczone propozycje znaczenia tego pojęcia wysuwane przez doktrynę przedmiotu oraz organizacje międzynarodowe i pozarządowe, wraz ze wspólnym mianownikiem przedmiotowych definicji. Po drugie, zostanie omówione konstytucyjne prawo do opieki zdrowotnej, które zostało przewidziane w polskiej ustawie zasadniczej w kontekście wymogu równości w dostępie do opieki medycznej. Po trzecie, zostanie przedstawiona prognoza zapotrzebowania na świadczenia zdrowotne w Polsce, bazująca na odpowiednich dokumentach Głównego Urzędu Statystycznego. Po czwarte, zostanie omówione zjawisko tzw. wykluczenia cyfrowego wraz z podaniem jego powodów, skali oraz podstawowego kryterium. Artykuł zakończą konkluzje w przedmiocie rozważań, które zawierają autorskie stanowisko oraz postulaty de lege ferenda dla polskiego ustawodawcy.

Opieka onkologiczna w Wielkopolsce na tle zmian systemu ochrony zdrowia w Polsce – cz. 1. Kompleksowość świadczeń, koszty systemowe i finasowanie

In all countries of the world, an increase in expenditure on health care is recorded. Cancer has become the main health and social problem whose effective solution requires the development of a comprehensive cancer control program. The Law on the National Programme for Combating Cancer is an example of the comprehensive approach in Poland. Treatment of cancer in Poland is based on a network of public full-profiling dozen cancer centers and oncology units located at university hospitals and local government. An example of a systemic approach at the regional level is “Wielkopolski program rozwoju radioterapii i onkologii” adopted by the provincial government.Oncology health services in Poland is financed through the National Health Fund. In recent years, there has been scarcity of resources, due to which hospitals do not receive payment for all the provisions made. Research and cooperation with medical schools play a key role in improving treatment outcomes. Element of the system, requiring modifications, are legal restrictions on the structure of cancer centers that prevent greater share of the research and academic activities.

1985 – Mental heath service evaluation in poland - development of methodology

The past decades has shed new light on the key factors affected mental health service in different country. There is huge need to evaluate mental health service in Poland, but until now we have not any algorithm concerning this matter. To develop a methodology for the assessment and review of the mental health service in Poland. To identify the key factors for quality of mental health services, to test the unique methodology to evaluation of Polish mental health service, to develop the specific recommendations. The research includes: I phase - identification of key factors for quality in mental health services, II phase - testing the methodology, III phase - development of recommendations and dissemination. Three-steps analysis of key factors which have a strong impact on quality of mental health services: 1) literature review of relevant analysis, research and policy, 2) Delphi exercise with national experts, 3) external experts consultations. The phase II covers piloting and testing the evaluation methodology. Development of recommendations is based on research findings and experts consultations. The main result of quality and quantity analyses constitutes a set of key factors for quality of mental health service in Poland. The project is supposed to change the paradigm at Polish evaluation strategy in area of mental health service. In the light of Polish National Mental Health Program (established in Dec 2010) the results may have a great impact on reforms in Polish mental health service.

Prevalence and co‐existence of active components of ‘legal highs’

The results of a study performed on samples of 'legal highs' seized in head shops by law enforcement and health services in Poland between mid-2008 and mid-2011 are presented. In total, 449 preparations which differed in labelling, net masses, forms of distribution, etc., were analyzed. A variety of sophisticated analytical methods, including gas chromatography-mass spectrometry (GC-MS), liquid chromatography-quadropole time-of-flight mass spectrometry (LC-QTOF-MS), high performance liquid chromatography (HPLC), and nuclear magnetic resonance (NMR) were applied for component identification and quantification. The most common ingredients of legal highs were (in descending order): MPDV, caffeine, butylone, TFMPP, lidocaine, 4-MEC, mephedrone, pFPP, BZP, and MDPBP. The scatter of substances changed over time, and piperazines were often ousted by cathinones. Most of the preparations were composed of two or more ingredients. Cathinones and piperazines were mixed mainly within the chemical classes (77.6% and 56.1% of dual links, respectively), caffeine was mixed both with piperazines (24 products) and cathinones (22 products), whereas lidocaine only with the latter class (47 products). A great inconsistency in the qualitative and quantitative composition of products with identical labelling was shown in an example of Coco products seized after August 2010; we found 10 different single component or mixture preparations, and the content of individual ingredients varied from several to hundreds of mgs. This paper summarizes potential dangers connected with the uncontrolled sale of psychoactive substances, and indicates important issues concerning the analysis of legal highs.

Stigmatisation and commercialisation of abortion services in Poland: turning sin into gold

This paper is about the economic consequences of the stigmatisation and illegality of abortion and its almost complete removal from public health services in Poland since the late 1980s. Once abortion left the public sphere, it entered the grey zone of private arrangements, in which a woman's private worries became someone else's private gain, and her sin turned into gold. The most important consequence was social inequality, as the right to health, life, information and safety became commodities on the free market. Women with money, who are more likely to have political influence, find this bearable, while working class women lack the political capital to protest. In the private sector, there are no government controls on price, quality of care or accountability, and almost no prosecutions. With an estimated 150,000 abortions per year, a rough estimate of US$ 95 million is being generated annually for doctors, unregistered and tax-free. Thus, the combined forces of right-wing ideology and neoliberal economic reforms have created reproductive and social injustice. To address this, stigmatisation of abortion must be countered. But a change in the political climate, a less restrictive interpretation of the law, or even a new law would not resolve the problem. Given reductions in public health care spending, abortion would remain excluded from state coverage unless neoliberal health care reforms could be reversed.

Organizational Attachment of Interns in Poland to Healthcare System

Despite the profound structural reform of the health service in Poland, the present organizational system of health care is subject to severe criticism. It is described as unjust and enhancing malpractice as well as migration of young doctors abroad. The commonly expressed disapproval and own observations on the organization and functions of health care are expected to affect future performance of medical interns and suppress their motivation to pursue professional career. The purpose of the study was to evaluate the extent to which the interns approve the present healthcare system as a measure of their organizational attachment. Questionnaire survey was conducted in 992 interns (mean age 26 years) in 2004 and responses were evaluated using a specially designed scale of approval. The majority of interns expressed high disapproval of the healthcare system. This disapproval can be regarded as an indirect measure of the lack of organizational attachment on the part of the interns. These findings may have negative consequences for the future functions of healthcare in Poland. Therefore, measures should be undertaken to promote positive attitudes among medical students and interns. The disapproval of the system is a personal attitude independent of the social and economic characteristics. One should note that the personnel mobility opportunities do not seem to be playing the role of an effective "safety valve" to diminish the disapproval of the system by medical interns.

Provision of ambulatory health services in Poland: a case study from Krakow

This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.

Financing occupational health services in Poland.

Financing occupational health services (OHS) at the regional and basic level is an important issue in view of the transformation process going on in OHS in Poland. The Occupational Health Services Act from 1997, The Public Finance Act from 1999 and The Labour Code Act with amendment have been regulated by the new principles of financing. The organizational structures and the financial system have been changed since 1 January 1998. The process is still being continued. The gaps between information systems of past and present financial data enforced the examination of the current situation in regard to the structure of financing and internal allocation of financial means. The studies of OHS funding were carried out by the Nofer Institute of Occupational Medicine in Lodz. The data were collected and analysed for the period 1998-2000. They included full accessible statistics on OHS funding in Poland. The information on the financing system was collected by a questionnaire mailed to directors of OHS centres, and was supplemented by direct contact with directors. Sources of OHS financing in Poland are as follows: local government, state budget, companies, social health insurance institutions (since 1 January 1999 a social health insurance system has been implemented), OHS providers (as primary units), other sources. Analyses of their structures in a given period were conducted. The role of companies and social health insurance institutions in financing Regional Occupational Health Services Centres (ROHSCs) was considered in relation to the existing law regulation.