The introduction of competition between public insurers within the polish system of social health insurance, announced by the Ministry of Health Ewa Kopacz, is not a new idea. It raises doubts not so much about the potential possibility of using the instrument of competition for increasing the efficiency of the system but much more about the preparatio of the system for such a constitutive change. Competition between public insurers works quite well in the social health insurance system in Germany and Switzerland. The experiences from these systems as well as the theory of health insurance economics show us that there are some preconditions that have to be met in order to realize the positive results of competition. In the first place, the insurers must want to compete. Secondly, they must have instruments for competition. And thirdly they must be kept from developing the risk selection in the form of cream skimming. Showing the constitutive value and character of public  insurers’ competition the author of the article analyses the practical implications of the three mentioned preconditions and their realization in the German and Swiss health systems.

This paper analyzes patient cost-sharing arrangements for prescriptiononly pharmaceuticals in the 27 European Union (EU) member states. These arrangements are matched to the value of prescription-only pharmaceuticals consumption in these countries to search for relationships. Data are collected based on a literature review  nd are analyzed using a combination of qualitative and quantitative research techniques. The results indicate no relationship between the cost-sharing payments arrangements for prescription-only pharmaceuticals and the value of prescription-only pharmaceuticals consumption. The lack of statistically significant results leads to conclusion that the potential implementation of the cost-sharing scheme for prescription-only pharmaceuticals can not base solely on the other countries experience. The different motivation for implementing the cost-sharing should be considered together with the following aspects: willingness to pay, potential effects on equity and detailed assessment of advantages and disadvantages of different pharmaceuticals usage.

Beginning from administrative reform conducted in 1999 three levels of local government function in Poland. Municipalities, counties and provinces, among many other tasks, are responsible for broad range of activities in the field of health care. They are founders of majority of the public health care units, are responsible for creation of the local and regional health policy as well as provision of diverse health promotion and disease prevention services. Expenditures of the local government units on the health care’s activities are diverse not only among different levels, but also among different units from the same government’s tier. They spend from about 1% (municipalities) to even 10% (provinces) of their total expenditures on the activities in the field of health care. Majority of this expenses relate to financing of the health care providers for which local government units are founder institutions. It is general rule in the case of provinces and counties, however when assessing municipalities’ budgets, majority of expenses are appropriated for health promotion activities (alcoholism and drug addiction prevention).

Because of the difficult financial standing of the public payer, independent public health care facilities (SP ZOZ), specially hospitals, are searching the new sources of income. Patients, waiting for admission to hospitals for months, are much more interested in achieving in a lawful way a better access to health services. In view of no offer for additional voluntary insurance provided by our native entities, especially in the area of hospital benefits, foreign insurance companies (registered in the European Union), independently or together with Polish Partners are launching such products on our market. The official standpoint of the Ministry of Health is, that the independent public health care facilities, which have signed contracts with the National Health Fund, are not legally entitled to render health care services for people with additional voluntary insurance in any of the EU Insurance Companies. The  egalsystemic argumentation presented in the above material has proved, that in accordance with the Article 68 of the Republic of Poland  constitution Act and its limitations, as well as the health care facilities and financing health services act within the framework of public funds, spozoz which have contracts with the National Health Fund, are entitled to render health services for people who have own additional voluntary health insurance.

Set of procedures referred to as Health Technology Assessment (HTA) becomes more and more popular among health policy makers in many. There are two factors contributing to this process. Firstly, it is universal access to health services and their guaranteed financing from public  esources.
Secondly, a pressure exerted by manufacturers of pharmaceuticals and medical equipment who looks for profit. The choice which is to be made by decision makers is difficult. If new technologies are implemented too late – there are losses in health and a dissatisfaction of citizens is growing. If they are implemented to hastily, without necessary tests, there are losses in health again and public payer has to pay – and waste – a lot of money. HTA opens a way to make more rational decisions.

Aspiration for health care system improvement can be observed in almost each country. However the health policy activities should be based on comprehensive and reliable information about current health status of population, health care system performance valuation and monitoring, health needs and identification of priorities in the health sector. The information can be efficiently collected and presented in the form of health indicators. The health indicators application in the epidemiology is obvious, but rapid growth of health expenditures in the last years causes considerable increase of interest in the problems of wider usage of health indicators.
If we assume wide health indicators definition they could be divided into four groups, depending on the field they concern: indicators of population characteristics, indicators of individual and population health status, indicators of non-medical determinants of health and indicators of health system performance. The analysis of health indicators indicates their  following functions: information, diagnosis, planning, comparing, prognosis, monitoring, evaluation. Many indicators may perform different  functions, depending on the level of usage and the main aims defined.

Green Paper on the European Workforce for Health in Europe is a very important document, and decisions made in its light will affect European Union health policy for years to come. Health policies across Europe should be coordinated so that recommended guidelines, designed to reduce inequities, with monitoring to promote their  se in a consistent manner across the EU, particularly but not exclusively by addressing the social determinants of health. Health services are one of the largest groups of employers in most developed countries, and therefore they constitute an important component of national economies. To improve the health of the populations of Europe, and equity of health status, public health education and research need to be a leading part of the health workforce development programme of the EU.
EU health systems have to perform a difficult balancing act, firstly between increasing demands on health services and restricted supply; secondly between the need to respond to people’s health needs locally but also to be prepared for major public health crises. There are a number of challenges facing health systems in Europe.
1) Policy makers and health authorities have to face the challenge of adapting their healthcare systems to an ageing population.
2) The introduction of new technology is making it possible to increase the range and quality of healthcare in terms of diagnosis, prevention and treatment, but this has to be paid for and staff need to be trained to use it.
3) There are new and re-emerging threats to health, for example from communicable diseases.
4) All of this is leading to continually increasing spending on health and indeed is posing major longer-term issues for the sustainability of health systems in some countries.
To respond adequately to these challenges requires health systems to have efficient and effective work forces of the highest quality as health services are very labour intensive. Challenges facing the EU public health situation population include ageing, migration, and include infectious and non-infectious diseases, including cardiovascular diseases and cancer, nutritional conditions, disaster preparation, and injury control; along with many other issues of public health, such as management and priorities of health care systems. All are crucial for the future quality of life in Europe. A professional public health workforce is essential for society to be able to meet these public health challenges with high standards of cost-effective interventions