Christoph Sowada

The aim of this study is to explore hospital managers’ opinions on the impact of inflation on the financial situation of hospitals. Specifically, the Focus is on identifying different types of operating costs among hospitals that are at the highest risk of increased costs due to inflation. The author has used qualitative research methods, specifically, structured interviews (conducted with 7 hospital managers; 7 questions were included in the interview scenario) and performed an analysis of quantitative data (using a self-developed table) relating to the most important types of hospital operating costs. The research demonstrates that majority of hospitals are already affected by inflation. The highest cost growths relate to energy, external services (heating, nutrition, laundry), medicines and medical materials. The complicated financial situation of the Polish hospitals is the result of many years of systemic negligence. The act on minimum wages increases the operating costs of units and adds uncertainty to budget planning.

The coronavirus pandemic has contributed to great changes in the functioning of modern societies, not just in the medical dimension. The percep­tion of the health care system and its employees has also changed.

The aim of the article is to analyze the approach of public authorities to combat the spread of SARS-CoV-2 virus in the following countries: Belgium, Bulgaria, Denmark, France, Germany, the Netherlands, Spain, the United Kingdom and Poland. The research material was information available on the website of the European Observatory of Health Systems and Policies (EOHSP) in a special section dedicated to issues related to the prevention of coronavirus pandemic (https://www.covid19healthsystem.org/mainpage.aspx).

The obtained results indicate that the crisis situation caused by the COVID-19 pandemic forced all countries to undertake diversified, non-standard efforts, i.e. the use of their own pharmaceutical sector for the production of disinfectants or acceleration of obtaining licenses by medical practition­ers. In terms of financing one of activity was generation of additional funds for healthcare systems that were financially heavily burdened in the pandemic era.

This paper focuses on HTA, pricing and reimbursement of pharmaceuticals in Germany and Poland. The authors analyzed processes of decision making related to pharmaceutical reimbursement, as well as their transparency. Both Germany and Poland have developed complex processes of pharmaceutical pricing and reimbursement, as well as incorporated HTA into decision making procedures.In Germany the stakeholders involvement and transparency of processes seem to be to higher than in Poland.

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.

Health insurance expenditures on drug refunds in 2004-2012

Drug expenditures in each country account for a large share in total health expenditures. Hence experts, media and societies are becoming very interested in the drug policy in their country, where one of the important components is reimbursement/refund policy. Good governance in the drug sector means not only taking up allocation, redistribution and stabilization tasks that belong to the government, but also taking into consideration differences in interests of different stakeholders on the drug market. If it is disregarded, even ideal theoretical solutions will not work in market reality.
This article presents and comments basic facts on development of universal health insurance expenditures on drug refund in the last 13 years in Poland, especially in 2012 after implementation of the new bill on refund policy. This law led to a dramatic decrease in drug refund cost share in total expenditures of the National Health Fund (Narodowy Fundusz Zdrowia, NFZ) from 15% in 2011 to 11.2% in 2012. Still the share of drug refund has already had a decreasing tendency in NFZ expenditures starting from 2005.
Available data contradict suspicions that savings on drug refunds in NFZ has led to an increase in patients’ health expenditures on prescription drugs. Costs of substitutive full-price drugs (equivalents for refunded ones) bought by Polish patients in 2012 increased only by 650 mln PLN, while NFZ’s refund expenditures decreased by almost 2 billion PLN, and patients’ copayment in the case of refunded drugs dropped by one billion PLN. However, drug consumption was reduced.
Conducted analysis also showed a systematic, and positive for patients, growth in the share of almost fully refunded drugs – drugs with low fixed copayments (from 49% in 2004 to almost 65% in 2012) and lower 30% patients’ copayment in NFZ refunds. Which in fact is in contradiction with the common opinion that NFZ is running a policy of shifting more drug costs on patients. What is concerning are regional discrepancies (between regional – voievodship branches) in refund expenditures per insured person (the difference between the highest and lowest is 49 PLN – 28%).

During the last decades many European governments have introduced patient payments in their public health care system with the aim to improve efficiency of health care provision, contain overall health care expenditure, and also to generate additional resources. In Poland, since 1999 patients have met formal payment obligations when they use dental services. Though introduction of formal patient payments for primary care services, out-patient specialists’ services and hospital services has been discussed, such payments do not exist. Empirical evidence suggests that the successful implementation of patient payments, to a large extent, depends upon public acceptance and political consensus. The paper presents the results of study on attitudes towards formal patient payments for publicly financed health care services, among different groups of Polish health care system’s stakeholders (health care consumers, providers, insurers and policy makers). The data are collected via focus group discussions and in-depth interviews carried out in Poland in June–October 2009 as part of project ASSPRO CEE 2007. The results are used to out-line policy recommendations.

Economic success of companies is related to the rate of absenteeism and the rate of fluctuation, but also to the subjective experience of the employees. During economic difficult situations, enterprises wanted and had to motivate their employees to maintain their productivity and motivation to work. Investments in work health promotion-measures resulted to be a good way to do this. Workplace health promotion turned out to be a suitable way to boost and/or maintain the motivation of employees. Authors of the article give an overview of work health promotion (WHP) in Germany (especially in small and medium enterprises) and analyze implementation strategies, costs, key-success-factors and obstacles before or during the implementation of WHP-measures.

The adverse consequences of an aging society for the stability of health care financing systems are superimposed on the natural inequality of the distribution of health needs, and consequently, expenditure for health services in the life cycle of man. How long, under such conditions, will financial security systems based on the mechanism of PAYG (pay as you go) be able to guarantee all of its citizens, including the oldest ones, broad access to medical care? The debate brought about by D. Callahan in 1987 on “age-based rationing of benefits” for many years focused on trying to find ethical and economic rationale for limiting the scope of benefits guaranteed to the oldest citizens (eg A.  illimas, F. Breyer, D. Brock, N. Daniels, P. Dabrock). Age-based benefit rationing from public funds, however, may soon become a reality if we do not manage to break ties, within the public system, with the idea of full socialization of the costs of old age at the expense of future generations. Maintaining fundamental fairness towards the future generations requires an equal sharing of the financial consequences of aging, and this means taking on more responsibility of every individual for himself. A good practice of substitute private health insurance in Germany is the mandatory creation of individual financial reserves for old age which allows avoiding an excessive rise of equivalent risk premium in old age. Another solution for social health insurance might be reserves built by each generation, or a general public reserve. The transition from the purely PAYG system to a more capital one, however, will require the construction of functional solutions for the transitional period in which we have yet to build reserves and fund services for older generations who have not yet built reserves for themselves. An apparent increase of the country’s debt seems therefore inevitable, but also present older generations must be held financially accountable through higher premiums or payments for benefits.