This was discussed by participants at the seminar 'Who governs Polish health? A framework for health policy-making', organised by the Institute for Health and Democracy on 24 May 2023. The discussion was moderated by Grzegorz Ziemniak, IZiD Partner, its participants were:
- Prof. Paweł Wojciechowski, Chairman of the Programme Council of the Institute of Public Finance
- Tomasz Latos MEP, Chairman of the Parliamentary Health Committee
- Tomasz Smura, Member of the Board of the Casimir Pulaski Foundation
- Łukasz Jankowski, President of the Supreme Medical Council
- Jacek Krajewski, President of the Federation Porozumienie Zielonogórskie
- Igor Grzesiak, Vice President of the Management Board of the Institute for Patients' Rights and Health Education
- Adam Jarubas, Member of the European Parliament
"Global mega-trends are strong in every area of life and this has certain consequences, including the impact on economic development. If we look at these mega trends mentioned for a long time in the global debate, they are demography, technological change and climate change. Poland, according to OCED, will have economic growth 0.8 per cent lower than other EU countries in the 2050 perspective -- the reasons are a lack of investment and an ageing population - fewer people working, more dependents, which is crucial for the healthcare system. This fundamentally changes the reality for care services and health policy. According to OECD data, Poland is among the top EU countries in terms of deaths from behavioural causes, and by 2050 we will have the highest mortality rate in the EU after Slovakia," - said Professor Paweł Wojciechowski, Chairman of the Programme Council of the Institute of Public Finance.
He added that the lack of medical staff is not just a question of money. "Medical care should be financed so that it is effective. The problem is that today, when we talk about financing healthcare, we very often forget that the ageing of the population will cause an increase in costs, not in pensions, but in healthcare and long-term care, because the profile of how healthcare works will change, there will be an explosion in costs. We are not able to catch up with the ageing of the population, which is happening much faster in our country than in other European countries, and much more money will be needed. There is talk that the European Union will spend an average of 9 per cent of GDP on health care. For me, the biggest problem is exclusion in healthcare. Those who are queuing are people who cannot afford private healthcare," said Professor Paweł Wojciechowski.
"I am very critical when it comes to the functioning of the WHO. I imagined it differently in terms of pandemics, but also other elements, such as the problems of smoking addiction. Here too, to put it mildly, the WHO is not showing off. This is a topic for an in-depth discussion. My impression is that individual governments have stopped looking to the WHO and are doing their own thing. It is hard to say that this organisation is leading certain changes and trends, which used to be the case. This institution needs a new look and reform". - argued Tomasz Latos, MP, Chairman of the Parliamentary Health Committee.
Mr Latos also referred to the problem of wages in health care and the system for training future medical staff. "Wages in health care have improved significantly in recent times. So there is no reason to leave for economic reasons. In a perspective of five to 10 years, we will have a very large number of doctors, because the number of people on medical faculties has doubled in the last seven years, and the process will continue, because medical faculties are being established at universities in smaller towns, not necessarily reputable ones. This raises a problem for the future. I hope that the requirements in the new faculties will be high. Ultimately, therefore, there will be a lot of staff. A doctor will look for a place to work sometimes at the other end of Poland. It may be that with average results from the baccalaureate exam, it will be possible to get into the medical faculty, and this is where I see the danger. You have to keep an eye on training standards and the level of graduates. There are many difficulties and question marks here," said MEP Tomasz Latos.
Tomasz Smura, member of the Board of Directors of the Kazimierz Pulaski Foundation, emphasised that the US currently has a share of around 20 per cent of the global economy. "China is catching up with them. China's position is growing and this is reflected in the UN and WHO. China after 71 took no position on most issues, today it is the largest contributor to UN agencies. China was building its position at the WHO long before the pandemic, hence the accusations from the US of withholding information about the pandemic. China's problems are also demographics, an ageing and shrinking population. It is in China's interest to gain a strong position in an organisation that deals with demographics. Our diplomacy should be alert to what is going on, check where the solutions are coming from, because they do not necessarily benefit Western countries. We need to have our people on international agendas."
Meanwhile, Łukasz Jankowski, President of the Supreme Medical Council, referred to the problem of staff shortages and the creation of more medical schools in Poland. "Germany, like the Poles, is increasing enrolment in medical schools. Germany's health minister announced that they were ending the doctrine of hiring staff from neighbouring countries, as they could afford to educate their own medical staff, and declared 5,000 more places at medical schools. Immediately, it turned out that a university in Malta was being set up, which declared online education for the first three years, and then signed agreements with hospitals training in Germany, issued a Maltese-German diploma and demanded that this diploma be recognised in Germany, and in a short while these graduates would also come to Poland. As you can see, it is difficult to talk about our issues in isolation from the international market in which we work," - Lukasz Jankowski said. He added that as far as Poland is concerned, increasing enrolment in medical studies is not a bad thing, while quality and accreditation must be watched. "We protest against such situations where a university has a negative opinion from the State Accreditation Commission and yet trains in a conditional mode. Today, it is not the salary that ignites the medical community to protest. The fact is that 85 per cent of specialists earn well or very well, the remaining 15 per cent are paid according to the Minimum Wage Act. Other problems have arisen - we have too few doctors in the public health system. So the question is how to encourage doctors to work in the public sector, how to improve working conditions and safety," - Lukasz Jankowski concluded.
According to Jacek Krajewski, President of the Federation Porozumienie Zielonogórskie, poorly organised primary health care affects the quality of the entire health care system.
"In documents from the European Commission and the OECD in the context of Poland, there is a lot of talk about staff shortages, the problem of cigarette and alcohol abuse, obesity and cardiovascular diseases. The average life expectancy of a Pole is at least three years shorter than that of an EU citizen. It is pointed out that one of the reasons is the focus on restorative medicine. The funds that come to us from the EU are directed largely to investment in hospital infrastructure, but less to primary health care. EU funds should go to PCPs in the form of dedicated funding and this is happening. Additional education, digitisation, infrastructure - these are areas that should be subsidised in POZ with European funds. These tools are being developed and we are yet to find out how these funds can be raised. And it only takes a really small amount to raise the level of the facility providing care at the patient's place of residence. There is a terrible drama when it comes to patient participation in free preventive programmes. Year on year, patient enrolment in these programmes is falling. The implementation of the Prevention 40 plus programme is surprisingly low in terms of attendance. What is needed is for our society to start caring about health rather than treating illness," said Jacek Krajewski.
Igor Grzesiak, Vice President of the Board of the Institute for Patients' Rights and Health Education, talked about the influence of patient organisations on lawmaking and legislation in health care. "I am very happy that we have stopped talking about money and started talking about quality. I would not be afraid of an influx of staff. The average age of a doctor in the PCP is 52, so in 10 years' time we will be facing this problem. Quality will always be valued and a well-qualified doctor will always find a job. Competence will be key and competence should be followed by money. Patient organisations are increasingly seen as a partner to co-create different kinds of solutions. We would like the patients' voice to be heard more. We have limited staff resources. If we have a piece of legislation to consult, we need to get a team of people together who know the legislation and also have experience in this or that disease entity. This is the biggest problem, as well as involving patient organisations in the consultation. Sometimes it happens that there are only four days for consultation - it shouldn't be like that. Often our amendments are not taken into account. These are issues that are worth working on," stressed Igor Grzesiak.
MEP Adam Jarubas recalled that a package of changes concerning the pharmaceutical market was recently presented at EU levels. "I would like to draw attention to the disparities in access to medicines in EU Member States. It is estimated that at the moment in Poland, new medicines are available on average two years later than in Germany, and this does not only apply to reimbursement procedures. Such situations are at odds with the idea of a single market. Another problem is the difficult access to active substances - how to ensure that the majority of active substances are produced in Europe. We expect that the negotiation procedures for the whole package of solutions will start in the autumn and that the work will be completed later in this legislature."
Summing up the debate, Grzegorz Ziemniak, IZiD Partner appealed: "Let's be proactive, let's not be afraid of the international level, and maybe we can heal the framework of health policy making".
The debate was held under the patronage of: Federation of Associations of Healthcare Employers Porozumienie Zielonogórskie, Institute of Public Finance, Supreme Chamber of Physicians, Supreme Chamber of Nurses and Midwives. Media patronages: MarketBrief, ISB Health.