Anna Mokrzycka

The analysis of the driving forces initiating the decentralization/centralization processes.

Decentralization is often presented as a ‘magic bullet’ that can address a wide variety of different problems in health systems. The article explores the main driving forces behind the decentralization and centralization processes and the pro and cons often presented in this respect. The paper goal focuses on the analysis of the potential incentives (driving forces) initiating the processes of decentralization/centralization with the use of the arguments concerning the sphere of sciences in regard to the public administration, political sciences and management theories.

The theoretical perspective offers the three concepts of the driving forces useful for the explanation of relationships between health systems and the realized decentralization strategy: (1) concerning the system’s performance issues; (2) the legitimacy questions, and (3) the self–interests of the given subject. The first category reflects the influence of vision of health systems functioning as organisms that can be adjusted to the new circumstances by the strategists and decision makers. The second perspective concentrates on the legitimacy. It concerns the vision of the organisations representing a particular social culture. Legitimacy and cultural adequacy are the important factors from the decision- makers perspective at all the organisational levels, enabling support and change. Self-interest (the third perspective) focuses on the personal and institutional engagement and real (material) interests as a driving forces for decentralization. It creates the image of health care organisations as politically related systems characterized by the conflict situation rather than unification of goals, plans and strategies.

The Innovative, Multidimensional Tool for the Health Policy and Public Health Policy Assessment – the Evaluation Matrix HPA (Health Policy Assessment). Basic Methodology and the Toll Description

Health policy as a process and as activities in the sphere of public responsibility may cause different evaluation problems but at the same time the proper and reliable assessment should be understood as the essential interest of the engaged stakeholders: government at different levels, payers, providers and patients as well. The paper concerns the problem of difficulties influencing the research focused on the health policy description aiming at the indication of the most important factors, effects, possible development dimensions that may significantly change the health system. The methodology in this case is also a complicated issue: quite often based on the instruments typical for social disciplines but not completely applicable for the presented subject. The paper describes the new innovative and universal tool for the purpose of the analysis aiming at reliable and comparable health policy assessment, it presents the stages and objectives of such evaluation and the perspectives of the HPA matrix development both for research and for didactic purposes.

W bieżącym roku upływa 40 lat od momentu rozpoczęcia przez Prof. Cezarego W. Włodarczyka pracy zawodowej. Pomimo iż pierwsze stanowisko pracy Profesora jako referenta prawnego w zakładzie produkcyjnym nie było związane z dziedziną, która obecnie zdominowała jego naukowe dociekania – czyli z polityką zdrowotną, to jednak do dzisiaj coś z tych prawniczych zainteresowań mu pozostało.

The article focuses on the international concepts, ideas and theories concerning the fundamental functions/services in the sphere of public health. Particularly it concerns the environmental problems, the influence of this functions on the public health priorities identification. The main goals of the work are the international approaches identification and description of the observed frequency of the environmental actions inclusion on the lists of public health functions. The nature and specifics of the analyzed issue as well as the Polish approach are presented in the context of the National Health Program for 2007–2015. The main theme of the paper relates to the basic questions: how and in which way the internationally identified and listed public health functions influence the priorities established in Poland and if the environmental actions are being included?

Injury is the leading cause of death and disability in children and adolescents in Poland. In 2009, 1220 children age 0-19 years died as a result of injury. If the rate of injury deaths in Poland could be reduced to the level of the Netherlands, it is estimated that 703 (58%) of these lives could have been saved.
The aim of this study was to assess child and adolescent unintentional injury prevention in Poland through national law and policy.
The study was based on an examination of law and policies existing and implemented or enforced in Poland which support child safety, including specific injury areas such as road safety, water safety, fall prevention, poisoning prevention, burn and scalds prevention, choking and strangulation prevention. The review of law and policy documents, as well as 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 and law as a marker for specific injury areas was assessed on 3-points scale.
The following scores were obtained for each of the areas of child and adolescent injury prevention in Poland (out of possible 100%): 89% in moped and motor scooter safety, 86% in poisoning prevention, 75% in pedestrian safety, 75% in cycling safety, 75% in water safety and drowning prevention, 64% in burn and scalds prevention, 59% in passenger and driver safety, 59% in choking and strangulation prevention, 50% in fall safety.
Child home safety related to prevention of falls, burns and scalds, choking and strangulation has not received the adequate attention. The greatest gains in injury prevention have been made in road safety and poisoning prevention. It is important to both continue these efforts and give equal attention to injuries occurring in and around the home, sport and leisure environments. There is a need to support and fund good practices injury prevention measures based on community level targeting families with low socio-economic status.

Health policy in political parties in Poland.

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.

„Healing Company”. The Innovative Legislative and Systemic Solution or the Reform Quibble?

The necessity of the hospitals status change in Poland was the hot issue for quite a long time. The problems of hospitals debts, local governments role, state (public) ownership problems, management weaknesses, resources lack, humans resources problems and many others have been stressed in public debates, often by different sides and political parties. The present Ministry of Health from the very beginning proposed the formal status change concerning ownership of health care units, mainly hospitals, as a first step for the system transformation in this respect. The proposal of the new legislation called the Health package included such approach. One of the most important laws in the package was the “Hospitals privatisation”, subsequently vetoed by the President representing the political opposition. The next step toward the transformation was the governmental Plan B, proposed also by Ministry of Health, criticized for the improper legal instruments and infectivity of the proposed strategy. The new legislation, described in this paper, is a consequence of the process and the main issue of the analysis undertaken hereby.