BackgroundApart from the health and social burden of the disease, breast cancer (BC) has important economic implications for the sick, health system and whole economy. There has been a growing interest in the economic aspects of breast cancer and analyses of the disease costs seem to be the most explored topic. However, the results from these studies are hardly comparable. With this study we aim to contribute to the field by providing estimates of productivity losses and public finance burden attributable to BC in Poland.MethodsWe used retrospective prevalence-based top-down approach to estimate the productivity losses (indirect costs) of BC in Poland in the period 2010–2014. Human capital method (HCM) and societal perspective were used to estimate the costs of: absenteeism of the sick and caregivers, presenteeism of the sick and caregivers, disability, and premature mortality. We also used figures illustrating public finance burden attributable to the disease. Deterministic sensitivity analysis was performed to assess the stability of the estimates. A variety of data sources were used with the social insurance system and Polish National Cancer Registry being the most important ones.ResultsProductivity losses associated with BC in Poland were €583.7 million in 2010 and they increased to €699.7 million in 2014. Throughout the period these costs accounted for 0.162–0.171% of GDP, an equivalent of 62,531–65,816 per capita GDP. Losses attributable to disability and premature mortality proved to be the major cost drivers with 27.6%–30.6% and 22.0%–24.6% of the total costs respectively. The costs due to caregivers’ presenteeism were negligible (0.1% of total costs). Public finance expenditure for social insurance benefits to BC sufferers ranged from €50.2 million (2010) to €56.6 million (2014), an equivalent of 0.72–0.79% of expenditures for all diseases. Potential losses in public finance revenues accounted for €173.9 million in 2010 and €211.0 million in 2014. Sensitivity analysis showed that the results were robust to changes in the model parameters.ConclusionsThe productivity losses attributable to BC in Poland were a sizable burden for the society. They contributed both to decreased economy output and to public finance deficit.

Objectives: Occupational accidents constitute a substantial health and economic burden for societies around the world and a variety of factors determine the frequency of accidents at work. The aim of this paper is to investigate the relationship between the economic situation and the rate of occupational accidents in Poland. Material and Methods: The analysis comprised data for 66 Polish sub-regions taken from the Central Statistical Office's Local Data Bank. The regression analysis with panel data for period 2002-2014 was applied to identify the relationships involved. Four measures of accidents were used: the rates of total occupational accidents, accidents among men and women separately as well as days of incapacity to work due to accidents at work per employee. Four alternative measures assessed the economic situation: gross domestic product (GDP) per capita, average remuneration, the unemployment rate and number of dwelling permits. The confounding variables included were: employment in hazardous conditions and the size of enterprises. Results: The results of the regression estimates show that the number of occupational accidents in Poland exhibits procyclical behavior, which means that more accidents are observed during the times of economic expansion. Stronger relationships were observed in the equations explaining men's accident rates as well as total rates. A weaker and not always statistically significant impact of economic situation was identified for women's accident rates and days of incapacity to work. Conclusions: The results have important implications for occupational health and safety actions. In the periods of higher work intensity employers should focus on appropriate training and supervision of inexperienced workers as well as on ensuring enough time for already experienced employees to recuperate. In terms of public health actions, policy makers should focus on scrutinizing working conditions, educating employers and counteracting possible discrimination of injured employees. Int J Occup Med Environ Health 2018;31(2):151 -164

Streszczenie: W artykule od strony teoretycznej i aplikacyjnej przedstawione są podstawy uzasadniające wprowadzenie w polskich szpitalach możliwości leczenia pacjentów na warunkach komercyjnych przy zagwarantowaniu bezpieczeństwa zdrowotnego dzięki wprowadzeniu właściwej regulacji prawnej. W pierwszej części na podstawie literatury przedstawiono uwarunkowania efektywnego finansowania szpitali. W drugiej, aplikacyjnej części policzono koszty spowodowane niewykorzystaniem łóżek w szpitalach ogólnych w Polsce, na Dolnym Śląsku oraz na oddziałach chirurgii ogólnej w Polsce. W ostatniej części znajduje się propozycja rozwiązania problemu niewykorzystania dużej liczby łóżek szpitalnych w Polsce.

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