Iwona Kowalska

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 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?

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.