This paper analyses the impact of the financing arrangements for planned cross-border health care within the European Union. A financial arrangement is taken to provide a financial incentive but may also involve payment risks and administrative burden. For the pathways given by the Social Security Regulations (883/2004 and 987/2009) and the EU Directive 2011/24/EU, we investigate how the associated financial arrangements act on providers, patients and on publicly funded health insurance. First, the Regulations can induce cross-border health care that will increase domestic health care expenditure and may threaten national health policy by setting an incentive for patients to go abroad for health care not covered by domestic health insurance. Second, the financial arrangement of the Directive may induce cross-border health care which will lower domestic health care expenditure. However, due to considerable payment risks and administrative burden on both pa-tients and providers, these benefits will not be reaped in full. Moreover, in the presence of national cost containment policies, the Directive may provide an incentive for cross-border health care that is too strong. Finally, due to the requirement to pay upfront, the financial arrangement also suffers from a lack of equity of access to health care provision abroad.
Keywords:
financing arrangement cross-border health care national health policy
The aim of the paper was to diagnose and analyse the rates of infections in Polish voivodships, and possible consequences from both economic and social perspectives of the changes in the levels of cases reported. For the analyses, data banks of Central Statistical Office in Warsaw were used, in particular, information on the incidence of infectious diseases and poisonings. The rates of changes and spatial concentration of the phenomena were investigated in the period between 2005 and 2015. For estimates of regional trends, the Shift-Share Analysis was adopted, and the pattern of spatial distribution was defined on the basis of location quotients. Extreme values of location quotients were observed in Warmińsko-Mazurskie for shigellosis, in Lubuskie for trichinellosis, and for AIDS in Dolnośląskie. Location quotient values allowed identifying regions with a higher spatial concentration of infectious diseases incidences, which in turn could indicate areas and cases where preventive actions should be improved or modified. The Shift-Share Analysis resulted in pointing out regions that recorded a positive change in infection rates. The obtained results also demonstrated that in some cases, the impact of structural changes influences the net rates of infections more than the local components. The obtained results directly indicated objects (regions) where attention should be paid to prevention. Especially, the results of spatial distribution and concentration allowed a reliable analysis of the state of population incidence rates, as well as answered questions concerning the origin of rates whether the change derived from structural, local or overall tendencies. Results could be adopted, for instance, in preventive strategies of local governments. The estimates might be beneficial from the perspective of the healthcare system, due to easier predictive scenarios of future infection and possible centres with the increase in incidence.
Keywords:
healthcare-associated infections regional comparisons incidences of infectious Shift-Share Analysis
To model and analyse stroke care and assistance provision in the Portuguese context from the network perspective. We used the network theory as a theoretical foundation for the study. The model proposed by Frey et al. (2006) was used to elicit and comprehend possible interactions and relations between organisations expected to be involved in the provision of care and assistance to stroke patients in their pathway to rehabilitation. Providers were identified and contacted to evaluate the nature and intensity of relationships. Network analysis was performed with the NodeXL software package. Analysis of 509 entities based on about 260 000 entries indicates that stroke care provision in the evaluated context is best captured in the coalition-collaboration setting, which appears to best demonstrate the character of the network. Information from analysis of the collaboration stage was not sufficient to determine the network dynamics. Application of the network theory to understand interorganisational dynamics of the complex health care context. Empirical validation of the model proposed by Frey et al. (2006) in terms of its operationalisation and the way it actually reflects the practical context. Examination and analysis of interorganisational relationships and its contribution to management of compound health care context involving actors from various sectors.
Keywords:
network analysis care and assistance provision stroke
The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.
Keywords:
physician appraisal physician assessment communication skills
The aim of the article is to identify the criteria and methods for the evaluation of medical institutions. The article uses economic analysis, comparative analysis, and methods of descriptive statistics. The analysis of existing regulations, source materials, and the specific business character of health care entities indicates the need to evaluate these units with particular regard to the criteria such as costs, quality of assets (level of consumption, i.e., wear and tear and modernness), employment, financial liquidity or the level of debt. The results of the study are the basis for the evaluation of the healthcare sector. The value of the article is in showing the direction taken by the evaluation of the financial standing of entities. The ability to use specific criteria and methods of evaluation for health care entities in business practice.
Keywords:
financial standing medical institution healthcare sector evaluation
The main aim of the paper is to reveal the outcomes of a research based on the efficiency of primary health care providers. The scientific goal of the mentioned research was the development of an efficiency measurement model and verification of its usefulness in practice. Overall, the research found that it is possible to use the efficiency measurement model for health care providers. Besides, significant differences were discovered in the efficiency of public and nonpublic primary health care providers. The research was conducted in the West Pomeranian Voivodship in Poland. This paper contributes to the widespread debate on public and nonpublic ownership in the field of healthcare. Also, it has practical implications as the research findings may be useful for any healthcare sector stakeholder, from decision makers to patients. The research was based on the literature overview, which allowed to elaborate the efficiency measurement model. The empirical research (based on a form of questionnaires) allowed testing the proposed model. The described efforts allowed drawing conclusions on the efficiency of primary health care institutions in the West Pomeranian Voivodship. The following methods of data analysis are presented in the paper: synthetic measure of development (SMD), Ward’s method, and k-means method. According to the main conclusion of the research, it is possible to measure the efficiency of public and nonpublic health care providers of the Polish healthcare system. The proposed model for measuring the socioeconomic efficiency may be used as one of the tools used to measure the efficiency in the primary care. The verification of the usefulness of the model showed that nonpublic health care providers operating in the field of the public sector, outperformed public providers. The paper contributes to the theoretical field as it reveals a comprehensive approach to the efficiency measurement in the health care sector. The efficiency measurement model is based on the three major pillars of the healthcare sector, namely, income/resources, cost, and the social aspect. The elaborated efficiency measurement model for the healthcare sector was implemented and tested on a group of primary health care providers in the West Pomeranian Voivodship. The research allowed for positive conclusions regarding its usefulness in practice.
Keywords:
public nonpublic healthcare providers efficiency
Development of e-health in Poland has suffered from multiple setbacks and delays. This paper presents views on and experiences with implementation of e-health solutions of three groups of respondents: buyers, suppliers and external experts with the aim of establishing to what extent and in what way e-health development was taking place in Polish public health care and if there were any national policy targets or European targets influencing this development. It is based on desktop studies and interviews conducted in Poland in the spring and summer of 2015. The interviews largely confirmed findings from the desktop study: legal obstacles were the decisive factor hindering the development of e-health, especially telemedicine, with extensive insufficiency of basic IT infrastructure closely following. Stakeholders were deterred from engaging with telemedicine, and from procuring e-health using non-standard procedures, from fear of legal liability. Some doctor’s resistance to e-health was also noted. There are reasons for optimism. Amendment to the Act on the System of Information in Health Care removed most legal obstacles to e-health. The Polish national payer (NFZ) has started introducing reimbursement for remote services, though it is still too early see results of these changes. Some doctors’ reluctance to telemedicine may change due to demographic changes in this professional group, younger generations may regard ICT-based solutions as a norm. In the same time, poor development of basic IT infrastructure in Polish hospitals is likely to persist, unless a national programme of e-health development is implemented (with funds secured) and contracting e-health services by NFZ is introduced on a larger scale.
Keywords:
barriers eHealth Poland telemedicine
The purpose of this paper to identify factors which have a bearing on compliance with medical advice in various age groups. The survey was conducted, using the CAWI method, on a representative sample of 1000 respondents who declared having used healthcare services in the previous six months. Control of competences is one of the strongest factors which is common for the oldest and youngest groups. Interestingly, trust in the integrity and honesty of doctors is significant for the youngest patients, i.e., the higher is the level of trust, the lower is the tendency to non-comply. Another type of trust is related to the benevolence of doctors and is significant to patients of the middle age group. Satisfaction is a significant predictor in the two oldest groups of patients. High levels of satisfaction seem to deter people from non-adherence to recommended treatment regimens. The results of the present study provide knowledge about the nature and diversity of factors behind patient compliance in various age groups.
Keywords:
compliance with medical advice doctor–patient relationship trust satisfaction
The purpose of this article is to evaluate the use of tools of strategic management in hospitals in Lublin region. The study was conducted among 14 medical entities from the area of Lublin Voivodeship. The survey was addressed to economic directors or chief accountants of health care facilities and sent by post. The questionnaire was also helpful in conducting an in-depth interview as it provided a required structure. As part of the interviews with managers of health care facilities, information beyond the questionnaire was acquired, e.g. about the mission. According to studies, most health care facilities develop strategic plans (71.4%). For 21.4% of the studied facilities, the strategic plan is known mainly to management. In contrast, 28.6% of entities do not have a strategic plan. The presented results of the research can increase the effectiveness of activities in each area of the health care facility, continuous process improvement and rapid response to changes in the environment.
Keywords:
medical facilities hospitals strategic management
The purpose of this paper is to analyse different views on interpersonal relations and team composition among managers and medical professionals with respect to the transition of professional roles in healthcare in Poland. To achieve that goal, a description based on a quantitative and qualitative questionnaire was conducted. Since the questionnaire covered various areas of health care, only its small fraction was used for the analysis. The main result is that most of the medical professionals and medical managers consider technology to be the single most important external factor influencing the team work efficiency and team composition in health care, and the managers consider skillset as the crucial factor determining whether a person would be a good team member. Based on the literature on professional roles in health care and their evolution in recent years, one can assume that constant development and lifelong learning would play a significant role in the healthcare systems reform. The findings are an important contribution to the discussion of the healthcare reform and its possible directions in future years as well a reference point for policy makers.
Keywords:
health care professional roles teamwork managers and professionals perspectives
The aim of the study is to analyse changes in the size of the population of nurses in Poland in the years 2004–2014, considering changes in their employment and the phenomenon of ageing. The analysis is based on the data published by the Central Register of Nurses and Midwives of the Central Statistical Office (GUS) and the Organisation for Economic Co-operation and Development (OECD). Nurses are the largest professional group in the healthcare sector. In 2014, only above 70% of licensed nurses were professionally active. The percentage of employed nurses compared to the number of licensed nurses varied between the lowest ratio of 65.1% in 2005 and the highest ratio of 71.7% in 2012. The latest ratio of 2014 was 70.9%, which was slightly lower compared to the highest ratio in 2012. The average age of a Polish nurse in 2008 was 44.19 years, increasing by about six years to 50.1 within the analysed period. The population of nurses aged above 65 years is almost 4.5 times bigger compared to the youngest age group, which is 21–25 years. Thus, 2/3 of the population of nurses are 41–60 years of age and nearly 85% are over 40. For two years (2000 and 2014), the number of practising nurses per 1000 inhabitants places Poland in the fifth bottom position among the European countries, which shows a significant reduction in patient access to nursing services. In Poland, the profession of nurses has no replacement generation. The article presents the shortage of professionally active nurses in Poland. The existing register of nurses does not contain complete information necessary to evaluate the current situation in Poland. There is a strong need to improve the tracking system of the register of nurses to accurately monitor the number of nurses in Poland The shortage of professionally active nurses and their ageing necessitates immediate action to reduce the shortage by increasing the appeal of the profession among young people and by encouraging nurses to return to the profession. It is also necessary to take action to delay the retirement of those nurses who want to work longer and to use their potential. This is also particularly important because of the gap in experience, which is going to become apparent the nearest future.
Keywords:
polish nurses shortage ageing
Over the past decade, theoretical and empirical research on the various aspects of human resources (HR) within the healthcare (HC) sector has grown extensively due to its’ strategic importance in the sector. There is a visible tendency among researchers to pursue an effective human resource management (HRM) strategies, methods, and tools. Countries implement policies which should increase the amount and competences of employees within healthcare. Providers of HC services (i.e. hospitals) tend to enforce modern HRM solutions adapted from business organisations to attract, retain and develop HR. However, these seem not be as effective as they could (Hyde et al., 2013). Because of this, authors approached a researched reality from the point of view of a contextual paradigm, assuming that HRM solutions to be effective should match the reality of HC providers (Pocztowski, 2008). The aim of the research was to detect determinants which might influence the management of medical personnel in hospitals and identify the possible strength of these determinants so a more adjusted organisational and human resource management strategy could be elaborated. The list of possible determinants of hospital operations as the result of meta-analysis was elaborated. The list created the basis for interviews conducted among stakeholders and experts. Respondents were asked to appraise the factors with the usage of numerical scale considering their influence on medical personnel management in hospitals (physicians, nurses and others). In total, there were 28 interviews completed. The general conclusion which can be drawn from the analysis of these data is that hospitals should reorient their HRM practices in such the way that not only the quantitative but also the qualitative aspect of performance would be properly handled. This paper draws from HRM theory (contextual approach), stakeholder theory, and healthcare management theory, adding new insight to each in the context of the HC sector. Identification of most important factors which influence hospitals could allow the providers to elaborate HRM strategy adjusted to external circumstances.
Keywords:
organisational environment human resource management hospitals stakeholders