Testing the 2017 PHC reform through pilots: Strengthening prevention and chronic care coordination

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

“…While integration of solo GP practices into group practices (like in Hungary and Slovakia) was not explicitly encouraged, the pilot was more suited to larger practices, e.g., in terms of having established collaborations with specialist and in terms of ICT infrastructure, and few smaller practices, which dominate the Polish PHC landscape, met the formal requirements to join the pilot. The new model put much emphasis on health promotion and disease prevention, not only by including health educators and dieticians in PHC teams, but also by introducing periodic check-ups for qualifying registered patients ( 21 ). It also sought to increase the role of GPs in the management of chronic conditions by introducing DMPs for 11 most prevalent conditions in five areas (cardiology, diabetology, pulmonology, endocrinology, and rheumatology and neurology), including for diseases such as type 2 diabetes, chronic coronary heart disease, asthma, and COPD.…”

Assessing Recent Efforts to Improve Organization of Cancer Care in Poland: What Does the Evidence Tell Us?

“…Cancer prevention could be more effective if it were provided within PHC, but the Regional Coordinating Centres lack any means to influence the provision of services at the PHC level. It is also unclear if this would have made any difference, as PHC providers in Poland are generally not very effective in providing preventive services, and recent plans to strengthen preventive services at the PHC level [ 33 ] have been recently scrapped. Other services, such as oncological rehabilitation, palliative care, and hospice care, are also largely neglected in the draft, however, they are crucial elements of comprehensive cancer care.…”

“…The 2015 reform that introduced the fast cancer pathway also failed to adequately consider the realities of the Polish healthcare system. One example is the intention to increase the role of primary care in cancer diagnosis, which faces the challenge of an already high burden falling on PHC doctors and associated financial and staff shortages [ 13 , 33 ]. The organizational problems that emerged after the reform was implemented, without a proper pilot, and the unforeseen negative effects of the reform, such as the increased fragmentation of cancer care provision described above, provide a warning that ill-designed reforms may not only be hard to implement but also create new problems.…”

The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland?

“…For example, the numbers of physicians, nurses, and items of advanced medical equipment are the highest in Mazowieckie region, containing Warsaw, while they are among the lowest in Opolskie [ 46 ]. Uptake of complex care programmes such as the one for patients after AMI (introduced in 2017) [ 47 ] or the one focusing on strengthening PHC [ 48 ] also varies among the regions, as does the number of stroke wards [ 32 ]. Lodzkie requires specific attention, as the life expectancy of men living in this region has been consistently and markedly lower than that in the other regions, and at 72.5 years in 2019 was 2.9 years shorter than that in Podlaskie, where male life expectancy was the highest [ 31 ].…”