The Systemic Changes to Improve Efficiency in Polish Primary Health Care

Abstract

Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation.

A Polish Pilot Programme of Coordinated Care: A Herald of Change or a Missed Opportunity? A Critical Debate

“…Yet despite the long-standing tradition of publicly financed health care, the Polish system has had serious difficulties for years. It is confirmed in a number of studies, including the Euro Health Consumer Index reports of recent years, in which Poland has been consistently scoring very poorly among 35 European countries: it ranked 31st in 2016, 29th in 2017, and 32nd in 2018 (8)(9)(10). The reasons include insufficient transparency, clarity, and accountability, limited access to diagnostic and treatment options, poor cancer survival rates, a big proportion of private spending on health care in the face of queues to public providers, difficulty accessing prevention, and screening measures in PHC (7,(15)(16)(17), low public health expenditure (4.6% of gross domestic product in 2017) and, last but not least, a small number of practising doctors (2.4 per 1,000 population in 2016 compared to the European Union average of 3.6) and nurses (5.2 per 1,000 population in 2016 compared to the EU average of 8.4) (7).…”

“…Obviously, this cannot be achieved through coordinated PHC alone. As it was often stressed in literature (8,16,59,61), it requires wider structural reforms, a comprehensive look at the entire healthcare system, and a unified strategic vision.…”

“…Although PHC is an entry point to the public system, it is also one of its weakest links. Historically, during the communist era, it was regarded as inferior to inpatient care with its extensive infrastructure and high prestige of specialist physicians (8). As a result, it may be concluded from the available reports that PHC is now not only underfinanced, but also understaffed.…”

“…Although the Polish health care also faces these problems, the integrated care ideas may seem unattainable to Polish patients, healthcare providers, and control institutions alike, who rank the health system as a whole, and PHC in particular, very low (6)(7)(8)(9)(10)(11). Given the alarming NCD trends reported for Poland (12)(13)(14), this is the right moment to try to achieve better health of citizens through PHC.…”

Development of Pharmacy Practice in European Countries—The Polish Perspective

“…The definition of pharmaceutical care had already been introduced to the Polish legal system in 2008, and was described as a documented process in which the pharmacist should work with the patient, the doctor and, if necessary, with other medical professionals in the optimization of pharmacotherapy [ 10 ]. Moreover, there are still many legal and organizational problems which prevent the implementation of effective pharmaceutical care to the Polish pharmaceutical practice, including; (i) disrupted flow of medical information between the doctor and the pharmacist; (ii) lack of separate places in community pharmacies which enable free and private conversation with the patient; and finally (iii) the difficulties associated with the access to confidential information, which undoubtedly includes those concerning patients’ state of health [ 11 , 12 , 13 ]. In the official document provided by the Pharmaceutical Care Section of the Polish Pharmaceutical Society which includes the strategy for Polish pharmacy, it is stated that effective implementation of pharmaceutical services will optimize pharmacotherapy, achieve more satisfactory outcomes, and improve the health-related quality of patients’ lives.…”