Katarzyna Dubas-Jakóbczyk

As the process of privatization of the Polish health care sector, launched in 90. is progressing (especially in the out-patient sector), the hospitals remain dominantly public area – in 2008 about 93% of the hospital beds belonged to the public sector. Additionally, according to the Polish law, the non-public hospitals group includes both the private owned hospitals, as well as those owned by the local governments units, but run in a form of companies (mainly limited liability and joint stock companies). The private hospitals functioning in Malopolska region are usually small units, specialized in narrow disciplines – mainly: gynaecology and obstetrics, surgery, nefrology (dialysis units), and rehabilitation. In 2009 majority of them signed contracts with the National Health Fund (public health insurance payer) and delivered services for the public health insurance patients. Specific for hospital services – high costs of both delivery and equipment maintenance are the main reasons for significantly smaller than in out-patient services, contribution of the private sector.

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).

The population aging process is inherent feature of all contemporary societies. It places enormous pressure on all countries health and social systems. The demographic changes lead to both the organizational as well as financial challenges. The aim of the article is to present the scope and diversity of the ‘population aging’ influence on the health care sector – by description of various, related researches, projects and activities conducted within the past several years, in Europe and Poland. The authors provide brief summaries of contemporary researches and analyze the effects of the population aging on the Polish health care system in its: organizational (human resources), financial (costs of treatment, public expenditure) and social (disability, informal care) aspects. The need for comprehensive (combining education, labour, health and social sectors), long-term strategy focused on the population aging challenge is emphasized

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