Adam Kozierkiewicz

From representing views to representativeness of views: Illustrating a new (Q2S) approach in the context of health care priority setting in nine European countries

Governments across Europe are required to make decisions about how best to allocate scarce health care resources. There are legitimate arguments for eliciting societal vales in relation to health care resource allocation given the roles of the general public as payers and potential patients. However, relatively little is known about the views of the general public on general principles which could guide these decisions. In this paper we present five societal viewpoints on principles for health care resources allocation and develop a new approach, Q2S, designed to investigate the extent to which these views are held across a range of European countries. An online survey was developed, based on a previously completed study Q methodology, and delivered between November 2009 and February 2010 across nine countries to 33,515 respondents. The largest proportion of our respondents (44%), were found to most associate themselves with an egalitarian perspective. Differences in views were more strongly associated with countries than with socio-demographic characteristics. These results provide information which could be useful for decision makers in understanding the pluralistic context in which they are making health care resource allocation decisions and how different groups in society may respond to such decisions.

Definition of the “Health Benefit Basket” in Poland

The subject of “health benefit basket” has been hotly debated for years among the Polish public, but until recently the debate has tended to be largely theoretical and abstract and therefore has lacked an effect on public policy. The situation changed in 2004, for two reasons: first the verdict of the Constitutional Tribunal invalidating the existing health insurance law and, second, Poland’s accession to the European Union. The first problem was solved in part by defining a list of specific exclusions in the law and a promise to establish an institution for health technology assessment. The second issue remains open, although to some extend it is being dealt with legally by regulations issued from the Ministry of Health on acceptable waiting times for health services.

The prevalence and direct costs of multiple sclerosis therapy in Poland from 2008 to 2016

Aim of the research: Analysis of prevalence of multiple sclerosis (MS) and direct healthcare costs of patients with MS in Poland between 2008 and 2016. Material and methods: Retrospective analysis of data on healthcare services related to the treatment of patients with MS covered by National Health Fund (NHF) in 2008-2016. The Number of patients with MS, utilization of resources, and direct medical cost were analyzed for each year in 9-year time horizon. Costs were calculated from public payer perspective and reported in EuroPPP (adjusted for purchasing power parity). Results: According to data from the NHF, the prevalence of MS in Poland was 103,06 and 113,06 per 100,000 population in 2008 and 2016, respectively. The annual growth rate of spending’s on MS (+14%) was higher than the growth rate of patients (+1.3%). In the years 2008-2016, the average expenditure per patient increased from 2,800 to 6,900 EuroPPP. The largest group of patients was treated the out-patient setting (36% specialized, 29.3% primary care); however, 84% of funds were spent on hospital care. The main drivers for hospital costs were therapeutic/drug programs, which increased from 59 million in 2008 to 233 million EuroPPP in 2016. Currently, 25% of the MS population has access to publicly funded drug programs. Conclusions: The situation of patients with MS in Poland is systematically improving. Over the past 9 years, both the public payer’s expenditure on treatment of MS patients and the number of patients participating in drug programs funded by NHF have tripled. Streszczenie Cel pracy: Ocena częstości występowania stwardnienia rozsianego (SM) oraz bezpośrednich kosztów leczenia pacjentów z SM w Polsce w latach 2008–2016. Materiał i metody: Analiza retrospektywna danych dotyczących świadczeń opieki zdrowotnej związanych z leczeniem pacjentów z SM, finansowanych przez Narodowy Fundusz Zdrowia (NFZ) w latach 2008–2016. Dynamika liczby pacjenAndrzej Jacyna, Andrzej Śliwczyński, Jarosław Stachurski et al. 10 Medical Studies/Studia Medyczne 2018; 34/

Years of life lost due to deaths in Poland measured with Potential Years of Life Lost (PYLL) and Period Expected Years of Life Lost (PEYLL) indicators in years 2000 - 2014

Use of PYLL and PEYLL to present mortality figures allows for qualitative assessment of the burden on society caused by different causes of death. The figures from Poland, for a 15 year period (2000–2014), show that the number of PYLL (when the cut-off age is 75 years), decreased by 20%, while both the population and the overall number of deaths increased slightly (by 0.59% and 1.94% respectively). At the same time, the number of PEYLL rose marginally (by 0.24%), which resulted from the formulary nature of the measure. Mortality measured by PYLL reveals that the leading causes of premature death among males are diseases of the circulatory system, neoplasms and external causes (mainly accidents), while in females the leading cause of premature death is neoplasms and the second leading cause are diseases of the circulatory system. When calculating PEYLL, the leading causes of premature death in both sexes is due to circulatory diseases.

Efficacy and costs of ovarian cancer therapy in Poland; regional approach

UNLABELLED Ovarian cancer (OC) affects over 3 000 women in Poland annually The efficacy of the therapy remains relatively low due to challenges of systematic improvement in the early detection OC rates. International comparisons indicate a positive correlation between health expenditures and 5-year survival rates of cancer patients. To the best of our knowledge, our study has been the first to present a correlation between the 5-year survival rates (SRs) and the cost of ovarian cancer therapy in particular regions of Poland. MATERIAL AND METHODS The study was based on the National Health Fund (NHF) data, available in the Disease Treatment Registry The analysis included approximately 13,000 OC patients who started their treatment between 2005 and 2008 to allow for the evaluation of long-term therapy results. The 5-year survival rates were analyzed in relation to average NHF expenditures in various regions of Poland, distinguishing the population of patients aged 45-64 years. RESULTS The 5-year survival rate in the cohorts diagnosed in 2005 and 2008 changed marginally from 42% to 43%, maintaining relatively large differences between the regions (from 35% to 53% in patients diagnosed in 2008). The NHF expenditures in particular regions differed significantly: mean cost for the entire treatment cycle ranged from 31.600 PLN do 58.000 PLNperperson among patients diagnosed in 2008. No significant correlation between the survival and the cost was found. CONCLUSIONS SRs of OC patients in particular regions of Poland are not correlated with average treatment cost. Thus, the differences in SRs between various regions of Poland have their source in other factors, e.g., clinical stage at diagnosis, or prevailing treatment patterns in the given region. Further studies may decrease regional discrepancies in patient care and SRs in OC subjects.

Rekomendacje dotyczące zarządzania listami oczekujących w Polsce - wyniki projektu badawczego

An access to health care remains an important social issue for many years. In practice, the access is identified with waiting time and waiting lists for health services. The system working at present, which was introduced by virtue of a set of regulatory documents from years 2004–2005, is contested, mainly as concerns availability to valid and trustworthy information about waiting time to services provided by different providers. In the current paper, based on results of a research project entitles “Analysis of the current waiting lists management system (...)”, commissioned by the Ministry of Health, we present an attempt of systematic assessment and recommendation concerning rules and ways of organisation of the waiting lists system.