How to build a sustainable health care system

The creation of a sustainable health care system, resistant not only to current but also to future crises, is the leading topic of the debate at the 'Rzeczpospolita' salon devoted to the challenges of building such a system in Poland. Several dozen demands were made - from those concerning the system itself to a dialogue with the Ministry of Health with the participation of all interested parties. 'We have to create mechanisms that will maintain balance and structures that interact with each other. The foundations of such a balanced system are integrated care and bridges between its elements. We have been saddling the patient with it, but it is not the patient who should be integrating these elements - said Dr. Małgorzata Gałązka-Sobotka, director of the Institute of Healthcare Management at the Lazarski University in Warsaw.

'The fact that there are, thanks to the strategies we create, frameworks for such a balanced system, mean a move away from selfishness. When a specialist in one field was a minister, this area would be particularly supported at that time. Long-term strategies move us away from such selfishness,' emphasized the deputy minister for health Sławomir Gadomski during the debate.

The challenges facing all stakeholders - patients, doctors, government side - are numerous. From maintaining quality within the system, through the interaction of its elements, to building the system's resistance to new threats. One of the points under discussion was the key importance of making all the elements work together, and not be in separate 'silos', because such silos are bad for both patients and the entire system.

The context of the discussion was the project 'Partnership for the sustainability and flexibility of the health care system', under which experts are to develop solutions for health care systems. The goal is to improve quality, and Poland is one of the eight countries that joined the project.

Change of approach

One of the most important threads of the debate moderated by Marcin Piasecki of 'Rzeczpospolita' was the issue of necessary changes in the health care system and a change in the general approach to introducing these changes. ‘We studied various spheres of health protection: from management through financing to human resources,’ said prof. Iwona Kowalska-Bobko, who participates in the ‘Partnership’ project. ‘One of our recommendations is to strengthen and improve the public health system. Not just institutions such as the State Sanitary Inspection, because - in our opinion - this institution will face major changes. Another issue is the citizens’ perception of public health. We have been used to the idea that patients are the recipients of decisions, but in the sphere of population health, every citizen is a recipient of decisions. That is why general prevention and health promotion are so necessary. Reaching out to every citizen is an important recommendation. We need a system which is both sustainable and resilient,’ said Prof. Kowalska-Bobko.

What is the biggest challenge when building such a system? 'A sustainable system means ensuring that treatment is available at the right time. What is our weakness? Delivering help on time, especially in oncology,' said Dr. Gałązka-Sobotka. She added that another challenge is to guarantee care throughout the country for all citizens, regardless of the region.

Bartłomiej Chmielowiec, the ombudsman for patients' rights, pointed out the necessity of making services available for all citizens and the system's lack of coordination. 'The biggest problem is the question of the availability and coordination of services. From the patient's point of view, a visit to the emergency room is a rational decision. On the same day, they have tests, diagnosis and treatment. When a patient goes to a primary care provider, no-one pays attention to them, especially when it comes to diagnostics and a visit to a specialist. What's more, we view access to doctors and services only from the perspective of large cities,' said Chmielowiec.

He pointed out that in smaller towns, access to doctors and means of transport to reach them can be very difficult.

Human resources issues

One of the key threads of the discussion was the staff, or rather the lack of them. 'This is 30 years of neglect, now being fixed. If we were to compare ourselves with OECD countries, it would turn out that we have the lowest number of doctors per 1,000 inhabitants. Until 2017, the number of students who wanted to be medics was insufficient, but recently there has been a huge increase. One of the most important elements is the perception of the system. In the case of systems positively perceived by citizens, e.g. the Norwegian and Dutch ones, 16% of the population work for the system, while in Poland it is only 6%. This is one of the most important indicators that must be taken into account when building a balanced system. Finally - the matter of salaries, a very important element,' said prof. Andrzej Matyja, president of the Supreme Medical Council. 'Let's not compare ourselves with the Germans, let's look at the Czechs and Slovenes. There, the average salary is 2.4 or 2.5 the national average. If we want to deal with the crisis, we must stop the migration of our doctors to places where they have better prospects of professional development. If we do not do this, we are in danger of an even greater collapse. Attempts were made to remedy this by bringing doctors from the East, but it did not work out,' said prof. Matya.

In his opinion, bringing in foreign doctors has an impact on the safety of patients. 'I cannot imagine that a doctor from Ukraine who has not been working for 15 years would be safe for the patient. In this area, we should work closely with the Ministry of Health,' emphasized prof. Matya.

Mr Gadomski also spoke about the human resources. 'The staff shortage is critical to the system as it makes the system vulnerable. We have many challenges: greater limits, greater resources. But sometimes we hit the wall,' said Mr Gadomski. 'Some projects need time to be implemented, so let us not delude ourselves that the results will be visible tomorrow. But we will always act with limited resources,' he stressed.