Globalization and offshoring of medical services

The article aims is to analyze the impact of globalization processes on number of professional medical services. Transfer of medical services from high cost countries to lower cost countries brings savings and benefits. Offshoring of medical services and medical tourism has become for some developing countries like India an important sector for economic development.

The role of the state in health care systems. Trends and perspectives.

The aim of the paper is to identify main directions in reforming national health care systems from the point of view of the role of the state as a principal in health care systems (with a special emphasis on EU countries). It is argued in the paper that between 1995 and 2010 in majority of the EU member states a slow but persistent trend of withdrawal of the state from financing health care systems can be observed. Kutzin’s insurance function is being continuously reduced. Among other consequences it leads toward increasing the share of private and out of the pocket expenses in total expenses on health. This relates especially to new EU post communist member states.

The European hospitals’ functioning determinants with special emphasis on the human resources issue

The aim of the article is to present the scope of determinants influencing hospitals’ functioning in contemporary Europe with emphasize put on the health sector human recourses issue. Multiplicity of the functions realized by the hospitals units relates to the plurality of determinants which influence their present situation as well as long-term transformation processes. The determinants can be categorized into three main groups: these related to the demand side of the hospital services, their supply and determinants being the results of the social and economic changes. Regardless of the differences existing between health systems in specific countries – all European countries are facing similar problems of increasing health care costs, strong need of efficiency improvement and deficits of medical staff. In case of the hospital sector the key issue is number of beds reduction and transformation of the hospitals’ organizational form

Voluntary private health insurance– the public discussion about proposals in Poland

The aim of each health care system is to protect citizens from ill health consequences and provide them with health care services they need. There are two main solutions to assure health care - social health insurance system and budgetary model. Despite domination of universal public system, in many countries private solutions develop alongside. Private health insurance (PHI), in contrary to public systems, calculate premium according to individual risk and it is (usually) purchased voluntarily. PHI exists in all EU countries playing different role in each. In Poland PHI is not well developed yet. This article presents main characteristics of PHI and current situation of PHI on Polish health care market. A brief history of attempts to introduce PHI in Polish health care system are described, with special focus on the last bill prepared by the Ministry of Health in March 2011. The latest proposal is analysed in details, based on international experience in PHI. The paper also evaluates possible influence of proposed Polish regulations on main actors in health care sector. Conclusions present key problems and recommendations for the process of introducing/developing PHI in health care system.

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 functioning of modern healthcare organization is determined by the increasing demands of the beneficiaries of health services, budgetary constraints and the need for political consensus. These problems generate increased spending on public health needs and force policy makers to seek effective management instruments. Pro-efficiency solutions for public sector lead healthcare managers to build flexible strategies which mean the necessity of preparation and often redefining the strategic goals and ways to achieve them as a response for stakeholder’s needs. That makes knowledge and learning process about stakeholders an important part of a new public management paradigm.
This paper consists of theoretical part, where on the basis of literature studies problems of organizational learning are presented, as well as practical part which presents some research results being a part of three projects carried out by the Department of Public Management and Social Sciences – Stakeholder analysis in the management of the public organization carried out in 2009-2011, Learning Organizations Survey in public health care units carried out in 2010 and the Organizational culture of public organizations carried out in 2012-2014

Protection of personal data in health care units

A presentation of the regulations concerning the protection of personal data at health care units is a purpose of the work. Medical data i.e. sensitive data constitute the special category of personal details (sensitive ones) which concern medical condition, information about the genetic code or addictions. A general prohibition on the processing of sensitive data exists, except for the situation, when provisions of the law allow it. In the legal status being in force processing both information referring directly to the medical condition of man, and information the average recipient can acquire these data is forbidden. Processing sensitive personal details without the written consent of the person which they concern, is possible only in the objective of protection of medical condition, providing medical services or curing patients by persons being engaged professionally in curing or with providing other medical services, provided there are created full guarantees of the protection such data.. Medical data gathered by the health-service units must be provided with the full legal protection, predicted in the act from 29.08.1997 about the protection of personal data. For creating appropriate conditions of storing medical documentation a manager of the health care unit is held responsible.

Topics and dynamics of the publishing in the field of public health and health services in the years 2000-2012, based on the analysis of the Polish Medical Bibliography

The aim of the analysis is to present the subject-matter and the dynamics of the literature in the field of public health and health services, in the years 2000-2012, through the bibliometric analysis of the literature in 11 subject areas. Research questions: Which areas of public health and health services abound at this period in the largest number of publications? Can we observe in the period 2000-2012 growth in number of publications? Is it possible to see any patterns in the dynamics of publishing in particular areas? In which journals the articles on topics related to public health and health services are published most often?
Method: The thematic areas of public health were identified following the basic functions of the public health highlighted in subject literature, and widened by inclusion of “management and organization of health care” and “health economics”. The Polish Medical Bibliography (PBL) was searched to find all types of publications published in the years 2000-2012, indexed with the major headings (descriptors) corresponding with the selected topics. The data obtained from PBL was processed by especially written computer program.
Results: A total of 24,631 articles on predetermined topics were recorded in PBL, in the chosen period. Dominate publications on “management and organization”, “law regulation” and “health economics”. Together they constitute more than half of all publications. Next, most frequently presented in publications issue was “monitoring the health of the population”. Incomparably less is publications on the prevention of diseases and their causes. During this period, there are only few comparative studies published showing Poland among other countries. Also, very little work is published about the aging of the Polish population seen as a public health problem. From 2000 to 2010, the number of publications in the entire public health area has remained relatively stable. From 2010 begins gradual decrease in the number of articles in almost all fields, with the exception of “disease monitoring”,” prevention of accidents and injuries” and “epidemiological surveillance”. More than half (51%) of the publications were published in 55 journals, of which only 20 deal extensively with issues of public health. Other articles are distributed in more than 300 other bio-medical journals.
Conclusions: Public health and health services fields, as areas of research and professional discussion in Poland are dominated by issues of management, organization, economics and law regulations. Number of publications in all analyzed subjects (public health + management+economics) in the years 2000-2012, shows a weak growth, with significant differences between individual areas and sub-areas. In such areas as “disease prevention”, “management”, “health economics”,” quality of care” issues - the number of publications is falling. Dispersion of publications in hundreds of magazines, mostly bio-medical, probably is not conducive to the consolidation of public health.

Self- assessment of health information literacy by Polish population, in light of the self-efficacy concept. Analysis of the selected results of Polish part of Health Literacy Survey EU

Health information literacy allows people to find, evaluate and apply information regarding health and health services utilisation. The goal of this analysis is to present: the self-assessment of health information literacy done by Poles, socio-demographic determinants of this assessment, and to discuss its possible consequences in light of self-efficacy concept. This knowledge highlights certain aspect of society’s’ health literacy, and can be useful in designing pro-health educational interventions in such a way so they meet the needs and capabilities of target groups.
Method. Direct questionnaire survey with randomly selected, stratified by age and gender group of respondents (+15, n10000, what was 67% of the sample). The study design and the survey questionnaire were developed by the HLS-EU researchers. The survey was conducted by TNS Opinion in July and August 2011 in 8 European countries including Poland. Among 47 questions in HLS-EU questionnaire, 30 questions were selected as those that can serve as indicators of health information competency, 10 question for each of 3 areas of information skills: seeking, evaluation and application. In this study only data regarding Polish population was analysed.
Results. Approximately 38% of Polish population assess their health information literacy as low. Respondents claim that they have difficulty in finding, evaluating and applying health information. Low level of self-assessment can be observed more often among men, elderly and people with low level of education, and also among respondents who see their health status as bad or suffer from at least one chronic illness, and also among these who are in economically difficult situation. Among tasks connected with seeking information most difficult for the respondents were: finding information about political changes that may affect health, information regarding coping with stress or depression, information about vaccinations and health screenings and information on symptoms and treatments of illnesses that concern them. As most difficult to evaluate Polish respondents find the reliability of information about diseases and health risks provided by mass media. In area of application, most difficult to apply is information regarding activities that improve health and well-being in community.
Conclusions. Low assessment of self-efficacy in looking for and using health information by one third of Polish respondents may indicate real deficiency of skills, may demotivate them to undertake such activities, and may hinder educational interventions. Elderly, low educated, ill or assessing their health as bad persons should be in first place the aim of educational interventions to raise their information literacy. This can be beneficial for improving their health literacy.

Media advertising and nutritional behaviour in kindergarten children

The goal of this study is to evaluate the relationship between the time spent in front of a computer or TV and eating habits in kindergarten children.
The study was conducted in May and September 2012 in two kindergartens in Krakow (n=61) and in a kindergarten in Podłęże, a village near Krakow (n=34). The average age of the studied children was 5.02±1.17. 40 parents of boys and 55 parents of girls took part in the study. The differences in responses related to gender and place of living were checked. The analyses of correlations among particular factors, including BMI, were conducted by means of the Spearman rank.
Most of the kindergarten children (60%) spent an hour or less in front of TV. No relation between the time spent in front of TV or computer and gender or place of living or BMI interpretation was noticed. The time devoted to watching TV was connected with the frequency of snacks and fast-food consumption. The higher the education of mothers the less frequently children eat in front of TV. The frequency of sweetened beverages was also linked with the time spent in front of a computer.
The relation between time spent in front of TV or computer and frequency of high energy food consumption among children was confirmed in the study. An effort should be made to educate parents about probable increased risk of children’s obesity connected with watching media advertising.

Dietary habits shaped by school shops as an expression of health policy for children

The purpose of the article was assessment of food products offered in school shops. The article refers to research conducted in Małopolskie, Świętokrzyskie, Śląskie and Opolskie regions concerning the choice of food products offered to students at school shops and highlights the role of children and youth as the target of nutrition-related social campaigns conducted by public authorities. The article also presents statistical data and concepts describing the implementation of a government programme of supplementing social diet and outlines logistic and organisational problems and difficulties encountered when trying to achieve effective results of such programme. Children and their teachers need health education and the school shop assortments should be monitored.

W dniach od 4 do 7 listopada 2012 roku odbywał się w Berlinie XV Coroczny Europejski Kongres ISPOR (International Society for Pharmacoeconomics and Outcomes Research), jednego z największych towarzystw naukowych promujących rozwój farmakoekonomiki, ekonomiki zdrowia, oceny technologii medycznych (health technology assessment – HTA) oraz naukowej oceny wyników leczenia (outcomes research). Spotkanie było zatytułowane Challenging times for health care decisions in Europe: changing models of HTA, price referencing and integrating social preferences.

Stowarzyszenie Szkół Zdrowia Publicznego Regionu Europejskiego Association of Schools of Public Health of European Region – ASPHER jest niezależną organizacją europejską, przodującą w dziedzinie wzmacniania roli zdrowia publicznego poprzez rozwój edukacji specjalistów dla praktyki i badań. ASPHER powstał w 1966 roku i skupia obecnie ponad 90 instytucji kształcących w zakresie zdrowia publicznego z ponad 40 krajów. Podstawowe członkostwo  jest instytucjonalne i przyznawane jest decyzją walnego zgromadzenia po spełnieniu określonych wymogów dotyczących m.in. liczby kształconych studentów, rodzaju prowadzonych studiów i kadry dydaktycznej.
Główne cele stowarzyszenia to promocja europejskiego wymiaru zdrowia publicznego, wspieranie rozwoju zdrowia publicznego jako dziedziny interdyscyplinarnej oraz rozwijanie i wzmacnianie sieci instytucji edukacyjnych. W tym celu ASPHER intensywnie rozwija współpracę ze stowarzyszeniami profesjonalistów zdrowia publicznego w Europie (m.in. EHMA, EPHA, EUPHA) oraz z analogicznymi organizacjami z całego świata, przede wszystkim z: ASPH, APACPH, ALAESP.