Michał Zabdyr-Jamróz

The first attempt to create a national strategy for reducing waiting times in Poland: Will it succeed?

The waiting lists package, proposed in March 2014, is the first attempt to create a national strategy to reduce waiting times for specialist care in Poland. The policy proposes a number of measures directed at primary, specialist ambulatory and hospital care with the goal of shifting patients to the lowest possible level of care. Initially, it has been welcomed by the patients and there has been, so far, no strong opposition against the reform from other stakeholders. However, this may be because there is some disbelief that the policy would actually be implemented (due to limited funding available for its implementation) and because some of the proposed changes are vague and have yet to be clarified. One stakeholder group that may obstruct the implementation of the reform, if they are not satisfied with the final shape of the proposed measures, is the primary care doctors. They are directly affected by the reform and enjoy a relatively strong bargaining position compared to other groups of medical professionals. Thus, the future of the reform remains uncertain.

Institutional analysis of health promotion for older people in Europe - concept and research tool

BackgroundEuropean societies are ageing rapidly and thus health promotion for older people (HP4OP) is becoming an increasingly relevant issue. Crucial here is not only the clinical aspect of health promotion but also its organisational and institutional dimension. The latter has been relatively neglected in research on HP4OP. This issue is addressed in this study, constituting a part of the EU project ProHealth65+, engaging ten member countries. This paper is based on two intertwining research goals: (1) exploring which institutions/organisations are performing HP4OP activities in selected European countries (including sectors involved, performed roles of these institutions, organisation of those activities); (2) developing an institutional approach to HP4OP. Thus, the paper provides a description of the analytical tools for further research in this area.MethodsThe mentioned aims were addressed through the mutual use of two complementary methods: (a) a literature review of scientific and grey literature; and (b) questionnaire survey with selected expert respondents from 10 European countries. The expert respondents, selected by the project’s collaborating partners, were asked to fill in a custom designed questionnaire concerning HP4OP institutional aspects.ResultsThe literature review provided an overview of the organisational arrangements in different HP4OP initiatives. It also enabled the development of functional institutional definitions of health promotion, health promotion activities and interventions, as well as an institutional definition adequate to the health promotion context. The distinctions between sectors were also clarified. The elaborated questionnaires provided in-depth information on countries specifically indicating the key sectors involved in HP4OP in those selected countries. These are: health care, regional/local authorities, NGO’s/voluntary institutions. The questionnaire and literature review both resulted in the indication of a significant level of cross-sectorial cooperation in HP4OP.ConclusionsThe inclusion of the institutional analysis within the study of HP4OP provides a valuable opportunity to analyse, in a systematic way, good practices in this respect, also in terms of institutional arrangements. A failure to address this aspect in policymaking might potentially cause organisational failure even in evidence-based programmes. This paper frames the perception of this problem.

Systemowe reformy zdrowotne w Stanach Zjednoczonych. Obamacare versus Trumpcare

The purpose of the article is to present the complexity of the US health insurance system and the changes it brings in Obamacare against the background of reform proposals pushed forward and run by the new US presidential administration (Trumpcare). An attempt will be made to compare the two reform proposals for the health care – Obamacare versus Trumpcare in the light of the assessment of the changes implemented by Barack Obama since 2013 as well as the political implications of the new proposals put forward by current President Trump. The US health care system stakeholders environment is very divided in Obamacare’s and President Trump’s new proposals assessment. The new change is backed by insurance corporations. Meanwhile, the largest American medical association, the American Medical Association, has sent to the leaders of both parties in the Senate a statement stating that it supported Obamacare because it was a significant improvement over its previous status quo. At this stage, presenting the whole formula of a new change is difficult due to unfinished legislative process.

The activities of older people when healthy ageing policy and funding is limited. The institutional and financial dimensions of health promotion for older people in Poland

The presented country profile, based on several national reports, legal acts, international databases, scientific articles and pilot research performed with the use of health care sector templates, outlines the major institutional, organisational and financing challenges for health promotion in Poland, and specifically, health promotion for older adults. Despite the numerous legislative and organisational changes in the health care sector since 1989 and the strengthening of the public health institutions in Poland, the country lacks a long-term, sustainable policy perspective in the public health area. The traditionally higher priority attached to curative care than to public health actions is one of the major reasons for the shortcomings of public health policy and the insufficient resources for health promotion and primary prevention in general, and health promotion for older adults specifically. However, there are also many weaknesses at the organisational level. One of the most important is the weak cooperation between the different levels of territorial self-government, the central government and other institutions when undertaking health promotion actions, which results in the development of both under- and overprovision of health promotion interventions for different population groups and at different geographical locations. Few self-government associations try to improve the cooperation and experience exchange in this field. However there is a need for a greater coordination and information exchange concerning plans and financial possibilities as well as for more competent health educators with better communication skills, less bureaucratic burdens, and better financial conditions.

Health promotion for older people in Hungary: The need for more action

The health status of the Hungarian population is relatively poor, compared to other countries of similar socio-economic development. Unhealthy diet, smoking, alcohol consumption and low physical activity are important risk factors leading to cardiovascular system diseases – the main cause of death in the general population and among people 65+ in Hungary. Yet, the OECD health statistics indicate that Hungary belongs to a group of countries with the lowest per capita expenditure on prevention and public health and that the level of this expenditure is decreasing. In Hungary, there is no legislation specifically dedicated to public health (Public Health Act) and the matters of public health and health promotion are regulated by various legal documents. The directions for public health policy are set in National Public Health Programmes. To address the problem of the ageing population, in 2009 a National Ageing Strategy (2009–2034) was adopted. The Strategy stresses the need to develop programmes for prevention, rehabilitation and health promotion for older people. The main actor in public health policy is the central government, namely its agency the National Public Health and Medical Officer Service. Also, territorial governments play an important role, though they have limited financial capacity to spend on health promotion and they need to rely on external unstable sources of funds when implementing health programmes for older people. NGOs might be important partners for health promotion along with public authorities. However, they require more financial and infrastructural support to be able to perform more activities in the field of health promotion for older people.

Voluntary (NGO) Sector’s Involvement in Health Promotion for Older Population in Europe

Background and objective: The NGO’s (non-governmental organisations’) role in health promotion is very much praised and encouraged. The basic features of this sector, namely social participation, voluntary activity and self-help, are by default considered as beneficial for health promotion for older people. New policy approaches stimulate NGOs involvement in it. This makes questions about this involvement – its role, context and success – increasingly relevant. Method: The research is based on narrative literature review as well as interviews and consultations with informers (practitioners and experts) in selected European countries. Results: Voluntary/NGO sector increases its role as a complimentary or alternative source of health promotion for older people in Europe. Its involvement, roles and functions as well as actual significance, however, depends on a number of factors. It depends on the sustainability of funding, stability of employment, elderly participation rate and recognized availability of services. Those factors are determined by socio-economic and systemic conditions: a country-specific model of third sector, overall social attitudes towards participation and system of governance in health promotion. Conclusion: The sector’s significance is widely acknowledged, however, its impact is often only assumed rather that sufficiently assessed and proven. By its voluntary nature, the sector might not be able to address the problem of health inequalities. Also, various political and economic changes across Europe result in the change of the sector’s performance.

Polityka zdrowotna w programach partii politycznych w Polsce. Wyborczy wyścig po zdrowie

Public debate concerning Poles health, accessibility to health care services, long time waiting lists for the most emerging medical services , namely ontological treatment, as well as many other fundamental health cares system question, due to the hot period of political elections, became much more visible in last months. Politicians have to tackle such issues under Polish citizens pressure however this particular group influence seams to be underestimated. The complexity of problems, differentiated and multiplicity of health needs, accompanied with very intensive development of medical sciences and technologies on one hand and the economical rationalization on second hand constitute the unavoidable conditions in the sphere of choices that can not be disregarded. This difficult and politically risky process, strongly dependent on interrelations between different interests groups – with the political parties amongst them – starts at the stage of political programs creation. The article goal is to describe and evaluate particular political parties programs in this sphere, aiming at the possible future scenario concerning dimensions of health policy and public health in Poland. The paper constitutes an attempt of comparative analysis in the sphere described above, showing the frames of national.

Ocena prewencji przemocy wobec dziecka w Polsce z perspektywy zdrowia publicznego

This article assesses Poland’s performance with respect to the level of child violence prevention applying public health approach, based on an examination of current national policies to support the prevention of violence toward children (0–18 years) in July 2013. The analysis included the child violence surveillance, leadership and capacity, law and its’ enforcement, children’s rights protection, national policies, programmes and strategies, national media campaigns and education that support the child maltreatment, neglect and abuse prevention. The review of law and policy documents, interviews by phone or e-mail with representatives of government departments was conducted. The questionnaire developed in the frame of the European Project TACTICS (Tools to Address Childhood Trauma, Injury and Children’s Safety) was applied. Each policy was assessed on 3-points scale. The following scores were obtained for each of the overarching policies of child violence prevention in Poland (out of possible 100%): 80% in child violence surveillance system and leadership,75% in children’s rights protection, 63% in capacity related to support to the child-victim, and 71% in child maltreatment, neglect, and abuse prevention. Poland is doing a good job at the national level in addressing violence against children in all areas examined. However, the violence area scores indicate that further action is required in most areas, particularly in overarching polices addressing violence against children in the area of capacity related to support to the child-victim, and specific policies for the prevention of child maltreatment, neglect and abuse. Poland has undertaken a number of actions in the area of leadership and infrastructure including an national strategy in child domestic violence prevention. However, the level of child violence control and prevention in other settings is poor and not sufficient. Policies of children’s right protection need further efforts to ensure full implementation. There is a need for Poland to fund and support the implementation and monitoring of existing evidence-based good practices, paying particular attention to vulnerable groups such as children with disabilities, migrant children, children from minority groups (i.e. Romani children) and those in care institutions. There are some good programmes and services available in Poland to develop capacity both for children themselves and their families. However follow-up and monitoring to ensure implementation, particularly for those aimed at kindergartens and schools is needed. The monitoring of implementation of all available resources for school-aged children are required, which result also in decrease of socio-economic inequalities. The government approved the National Program of Domestic Violence Prevention, which does not include other areas of child maltreatment or abuse occurring outside of the domestic setting (e.g., sexual abuse occurring outside the home) and this leaves a gap that should be addressed. The development of national guidance and policy regarding assessment in situations of potential, suspected child maltreatment, neglect or abuse would strengthen existing services. The addition of home visits for new parents that include education on prevention of child violence would not only increase capacity, but would also provide another opportunity to screen for the risk of child violence.