Jarosław Plichta

Institutional Drift of the Healthcare System in Poland – the Institutional Approach

The healthcare system in Poland has undergone a series of changes for many decades. For many years the entire system has been in a state of drift. The government has searched for a solution to this situation and a way out of the “path dependence”. Regardless of political aspects, centralisation has numerous disadvantages from the institutional point of view. In spite of the neo-classical approach in healthcare economics prevails in the literature, some scholars and practitioners propose alternative approaches, including institutional economics and its successor, New Institutional Economics. The approach emphasises the institutional environment of healthcare and take consideration of many different stakeholders, including informal institutions, thereby provides a broader view of the national healthcare system. The article attempts to examine the main challenges to the healthcare system in Poland from an institutional point of view. Suggestions are offered for how policy makers and industry players may initiate institutional change in healthcare.

Institutional Conditions for Improving the Efficiency of the Health Care System in Poland

The health care system in Poland requires thorough institutional changes. Problems occurring therein cannot be tracked down merely to a lack of funds. Institutional analysis based on the achievements in various fields can reveal a number of reasons for inefficiency of the system by referring to transaction costs, agency costs and costs associated with the transfer of property rights. This applies not only to relationships and contracts between the patient and the doctor, but also between all the actors involved in the process of redistribution and service. System optimization and reducing inefficiencies should be applied to contract analysis and is based on the comparative approach to indicate the best possible solution in terms of efficiency. It is important to adopt a holistic approach, draw on the achievements of different scientific disciplines, and expand the economic analysis of qualitative factors that relate to the sociological phenomena of human behavior and psychology. The identified institutional shortcomings of the current health care system cannot be remedied without applying complementary solutions that shall reduce the formation of the so-called externalities. Today, it is difficult to talk about the health services market, since many of these services are contracted without taking into account the criterion of quality and the results achieved. The existing health care system’s asymmetry of information reveals a number of opportunistic behaviors and phenomena characteristic of the agency problem. An attempt to identify and assess the magnitude of transaction costs and agency costs seems to be a challenge. However, it seems to be, in addition to the governance structure and managerial competencies, the main source of inefficiency in health care in Poland.

Znaczenie zaufania w handlu elektronicznym - perspektywa instytucjonalna

The issue of trust is has become increasingly important in recent years, both in scientific discussions and social media. The decline of public confidence in financial institutions and the government has contributed to the current economic crisis and shows the importance of this resource not only in a social context, but also economically. Building relationships based on trust is an expensive process that requires effort and resources from the parties of transactions. Trust is associated not only with the creation of conditions for the execution of individual transactions, but also to support general exchange processes for their greater efficiency. Another factor in the changing approach to this problem is the rapid development of information and communication technologies, including the Internet. This increases the demand for trust in electronic capital transactions. A good place to explain the exchange processes based on the trust factor is in the mainstream institutional approach based on the theory of transaction costs, agency theory, and the theory of property rights. This article attempts to clarify certain aspects of the importance of trust in e-commerce in the context of transaction costs.