Public Health Policies and Health Care Reform as Complimentary Tools for Better Health in Poland

1. Public Health Policies and Health Care Reform as Complimentary Tools for Better Health in Poland Pawel Gorynski, Bogdan Wojtyniak 13th Conference of the International Society for Environmental Epidemiology (ISEE)

2. National Institute of Hygiene, Warsaw, Poland

3. The process of political, social and economic transformations initiated in 1989 creates new opportunities for people but at the same time it brings about new threats to their health.

4. Transition period

5. Transition period

6. Health for all 2000 Health for all 21 Internet address : http://www.medstat.waw.pl

8. Evolution of National Health Programme operational targets1990, 1996 and 2000 versions • From reduction of incidence, prevalence and mortality of most common causes to health promotion and prevention programmes • From central steering of programmes to local authority and community actions

10. Ministerstwo Zdrowia i Opieki Społecznej Ministerstwo Ochrony Środowiska Zasobów Naturalnych i Leśnictwa KRAJOWY PLAN DZIAŁAŃ NA RZECZ ZDROWIA ŚRODOWISKOWEGO National Environment and Health Action Plan (cover page) WARSZAWA, MAJ 1999

11. Deterioration of the former San - Epid system (environmental monitoring) has been observed since mid nineties and is still continued. • There is a tendency to shift the environmental health problems from Ministry of Health to Ministry of Agriculture (Food Safety) and Ministry of Environment (ambient air pollution and soil pollution) • This process have been carried out under umbrella of unification of Polish law and environmental health organisation with EU countries .

14. National Health Programme realisation and monitoring Health Targets Performance of tasks listed in timetable - by the ministers Activities supervised by NHP Monitoring Office Activities supervised by Ministry of Health Indicators Indicators Monitoring Monitoring Evaluation Evaluation New tasks formulation Removal of tasks completed

15. Four important reforms were introduced in the country in 1999

16. Principles of health care system reform in Poland • Introduction of “sickness funds” • Changing of money flow - from Central budget to sickness fund • From „unlimited services” to services contracted on the basis of health needs and financial resources • Introduction of independence and privatisation of health care units - clinics and dispanceries

17. Former Health Care Financing System (flow of funds) Parliament Budget law Taxes Citizen Ministry of Defence Ministry of Internal Local authority Afairs Ministry of Health and Social Support Ministry of Dispensaries Transport. Zł $$$ District budget Sectors Health Services Scientific Institutes Health care units Teaching hospitals Dispensaries & Hospitals 42

18. Current System of Health Care Financing Financing of special and expensive Taxes medical procedures (e.g. bypasses transplantation's etc.) Own expanses Scientific for over - investigations basic Investment procedures Insured Person „ZUS” Additional funds C Donations Zł $$$ o Revenue Physicians n SICKNESS tr a Nurses FUNDS (17) c ti Hospitals n Contracting of special health services g Dispensaries 43

19. Results of surveys on health reform perception • mostly negative opinion - but better in small towns and rural areas • deterioration of access to the specialists services and to diagnostics procedures • still present under table money paid for some procedures in hospitals • better services provided by family doctors and in privatized health units

20. Ineqalities in health needs Still observed in the country

22. Malignant neoplasm's mortality in Poland (standardised data) Men + Female -1999 Per 1000 pop.. Data of Central Statistical Office

23. Best value of “indicator” Mean value of „indicator” Worse value of “indicator” Health promotion and prevention programes Sickness funds financed activities in the areas with the the worst health situation

24. In 1999-2000 over 250 prevention and health promotion programs in Poland has been contracted and monitored by Sickness Funds • Contractors were – health care units and some of the local authorities • There is shortage of people in sickness funds with experience to contract and evaluate realised health programmes as well as shortage of such people in local authorities. • Special World Bank sponsored project for education of health promotion leaders in local authorities was started in 40 of gminas (counties) in two regions of Poland • Another World Bank educational Program (in Public Health) started in may for Sickness Fund staff

25. National Health Programme Act was prepared in 2000 and is waiting for legislation process completion This Act can solve problems with organisation, financing and realisation of National Health Programme

26. Conclusions • Process of health status improvement after transition needs acceleration especially in some areas like cancer problems or external causes in men. • Negative public opinion on health care reform should be change through: • step by step increase of money devoted for health care in the country (now 7.75% of individual salary) • intensification of independence of health care units and their privatisation • National Health Programme as a major tool for health policy should be strengthen in a way of legislation which will enable to dedicate money for health programs at the country and local levels. • Problems with a new Environmental Health Monitoring System require better collaboration between Ministry of Health and Ministry of Environment and new model of San-Epid System should be worked out. • Public health statistics as a source of information for health policy should be given priority and protection from disturbances of the transition period.