Implementation of Family Medicine in Poland

Transcription

1 Implementation of Family Medicine in Poland Zbigniew J. Król MD, PhD Agency for Health Technology Assessment, Warsaw & Institute of Public Health Jagiellonian University, Krakow NDPHS PHC experts group workshop in Kaliningrad

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3 The country, its population & main health system statistics Geographical location: Central Europe Population: Urban population: 61,9% Men 65 years and older & women 60 years and older: 14,3 % Newborn mortality: 7,7 Men life expectancy: 69 years Women life expectancy: 78 years PHC consultations per person: 4,2 Trained Family physicians over all physicians working in PHC

4 Primary Health Care before 1994 Government administration responsible for PHC Traditionally multi-specialist teams of physicians District physicians Big, public out-patients clinics and policlinics Physicians work as state employees and received a fixed, regular salary

5 Origin of the initial changes 1991: Parliament law act Health Care Unit Family Doctor Task Force 1992: College of Family Physicians 1993: MoH act for contracting health services Responsibilities of Polish Family Physicians Training for teachers Establishment of 12 Regional Training Units 1994: Vocational Training (3 years/6 months) First examination 1995: Independent/private practices 1996: First educational journal Lekarz Rodzinny Description: FD i) specialized; ii) independent contractor; iii) list of patients

6 Forces: supporting the changes: Government Local community European Union World Bank WONCA European networks (EURACT, EquiP, EGPRW) University of Utrecht, Manchester, London against the changes: Chamber of physicians specialists

7 Positive impact on health, quality, equity & cost-effectiveness Better access to PHC services Good example of lowering costs improvement FD responsible for coordination, comprehensiveness, continuity of care Return of independent medical practice Higher income for physicians

8 Conclusions: changes in PHC Politicians, patients and medical society should be involved in planning Key changes should be guaranteed by law External support should be aimed at mile stones of changes External support should be given directly to local leaders, avoiding central bureaucracy Many small local projects can better serve the changes then one, big, centralized national project Enthusiasts and key leaders for changes have to be identified and motivated

9 School of Tutors College of Family Doctors in Poland Objectives: Strengthening role of the family doctor in primary care structures through professional qualifications improvement and implementation of the system of continuous quality improvement, particularly in the area of prevention. Adaptation of family doctors professional environment and their practice to the terms of functioning the doctor of similar specialisation in the EU countries, through implementation of the permanent education system, re-certification of specialisation, practice accreditation, system of indicators and criteria describing the quality and progress in the primary health care. Creation of the elite group of researchers being able to carry out the scientific research in the area of the primary health care. Improvement of every-day patient care and continues quality assurance based on primary health care needs. and hidden goals At the source of health

10 Main challenges facing the HC system Doctors, nurses and health care workers level of salaries Excess of hospital beds Hospital networking Basic benefits package Private health insurance Emergency care Information system in HC

11 Public private relations in HC in PL Private practice Contracting services Process of privatization Concessions Contracting management Outsourcing PPP PPC

12 Supporting actions Decentralization Contracting Privatization Legal framework Private capital involvement

13 Motivation for undertaking ppp Involvement the private capital Transferring the risk Delegation of the responsibility Improvement managing Effectiveness and productivity

14 PPP in primary care Part of the privatization process External capital used for renovation or building new facilities and buying equipment Retraining of providers Partners: public local authority; private - companies also established by providers Willingness of involvement this units in public provisions

15 PHC in PPP or PPC Krakow case Need: for modernization and implementation more efficient organization of the delivered services Objective: improvement quality of services, optimalisation of using the resources, getting experience of acting as an independent health care unit

16 PHC in PPP or PPC Krakow case Process: Splitting up specialistic ambulatory services and primary care Investment and implementation plan including contract for delivering services Tender for delivering services Results: reduction of staff needed; quality improvement assessed by the patient satisfaction study; better access; all practices successfully compete on HC local market

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19 Thank you!