Stanisława Golinowska

The spatial perspective of health inequality gained in importance as a result of the European cohesion policy, a significant dimension of which is equalization of spatial living conditions, and among them an equal access to the health services. The cohesion policy reflects a new approach to the health policy, in which impact on factors determining health is taken into account, and not only on creating a better health care system for people who already have health problems. In this context, the article is aimed at presenting new directions of both health and spatial European policy and more general strategies of Europe development. It shows new methodological approach in presentation of territorial division and indicators used. It also presents the results of research on health inequalities between regions in the European countries. The article is an expression of a concern for insufficient perceiving in Poland a phenomenon of health inequalities in the spatial dimension, whereas there are possibilities and means to diminish them within the European strategy, European cohesion policy and European funds.

The paper includes considerations on three issues related to the problem of the sources of funds for public health, which are presented in three different parts of the text. In the first part, an overview of the theoretical considerations of the sources of funds for public health activities is provided. In the second part, the authors attempt to identify the sources of funding for public health in Poland, based on the available statistical information. The third part includes the description of proposals and final solutions in the field of public health funding which have been included in the Polish Act on Public Health adopted in autumn 2015. The paper is completed with conclusions on the state responsibilities with regard to indicating the sources of funds for public health and their levels. Despite the diversity in solutions for financing of public health across different countries, they have some common characteristics which have been described in this paper.

The objective of this article is to show the health status of the older population throughout European countries and indicate the data needs for a comprehensive comparative analysis of health status and its risk factors. The article briefly discusses definitions of health status in older age and presents adequate health status indicators. It discusses life expectancy, healthy life expectancy, disability adjusted life expectancy, the main causes of death as well as the prevalence of long-term illnesses, multimorbidity and functional health limitations across European countries, pointing out regional differences of the health status of older people. Next, several behavioural risks of poor health occurring in older age are shown: smoking, alcohol overuse and falls. The article concludes by demonstrating the need for more detailed, comparative and standardized data on the health status of older people across European countries, presenting sex and age-specific morbidity and health limitations as well as health risks.

The article presents the diagnosis of trends in health care sector personnel in Poland, particularly physicians and nurses, and projections of the future personnel taking into account population ageing. The article is based on the NEUJOBS project research performed within the European Commission 7th Framework Programme. The analysis and projections use quantitative data: administrative, Eurostat data and GUS survey results. The density of employment of the health personnel per 1000 inhabitants is lower in Poland than in other EU-countries. In the future the demand for the medical personnel will be growing due to the increased needs for health care and ageing. The projections show that shortages of personnel will be faced by hospitals, particularly for specializations related to treatment of chronic diseases, while this is not the case in primary care. The size of the demand for medical personnel will be subjected to increase in technical efficiency of hospitals.

Informal patient payments are a common phenomenon for the formersocialist countries, though they are reported in other European countries as well. There are various definitions of informal patient payments as well as theories which explain this phenomenon (including fee for service theory, donation hypothesis, governance hypothesis and ethics hypothesis). The definitions of informal patient payments and the theories applied for their explanation determine the measures which are taken in order to eradicate informal patient payments.

The topic of informal patient payments in Poland was discussed within a corruption debate which was neglected for a long time. Since the end of 90s, due to the pressure of the international organizations, presence of corruption generally and informal patient payments particularly have been acknowledged. It resulted in various studies on informal patient payments as well as actions undertaken by governmental and nongovernmental organisations in order to eliminate these forms of payments.

This paper presents the review of empirical studies on informal patient payments and actions which have been carried out in Poland during last two decades. The types, scope and levels of informal patient payments as well as opinions on informal patient payments are analyzed. Time series data allow to study also a dynamics of informal patient payments and to draw some conclusions on the effects of measures which have been implemented by the Polish government to deal with informal patient payments.

This study is carried out under Project ASSPRO CEE 2007 funded by the European Commission under the 7th Framework Programme, Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (Grant Agreement no. 217431). The views expressed in this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission or its services

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.

From among the numerous analyses of the health crisis caused by the COVID-19 pandemic, the authors looked for those that would enable assessment of institutional solutions. They put forward the thesis that good institutions (with appropriate regulations, means and expert support) constitute an essential resource enabling fast, accurate, and effective measures in terms of protection and therapy.

The authors turned to experts from other countries with whom they have been cooperating for many years in the field of public health and used their competences in the field to answer questions about public governance in the first six months of the pandemic outbreak (January to June 2020) when lockdowns were widely implemented and then gradually lifted. Particularly significant for the assessment of health crisis management, the experts chose countries that are diverse in terms of: state of decentralization, social structure, and resources available, as well as healthcare organization and political tradition in dispute resolution.

Reports from Italy, the Netherlands, United Kingdom, Norway, Germany, the Czech Republic, Ukraine, and Canada (with focus on Ontario) – attached as an appendix – were supplemented with direct consultations. The comparative analysis of the obtained information and the exchange of opinions are the subject of this article. In the comparative analysis, we also refer to Polish activities and solutions. The Polish perspective of public management signifies a concern for the neglected area of public health. This article is enriched with the authors’ reflections and generally formulated recommendations.

The aim of this article is to explain the concept of silver economy and present two examples of its implementation into the strategy and regional development programmes in Europe: North Rhine-Westphalia and Małopolska region. The concept of silver economy is based on an assumption that population ageing is not exclusively the burden to the economy but it contributes to its new growth factors. However, it is conditioned by an increased activity of senior citizens in labour, consumption and social fields. Prolonged ability tolead an active life of good quality demands investment in the health of population in general, not only of senior citizens. Healthy ageing requires an early intervention process. In the strategy for Małopolska,(differently than in the case of North Rhine-Westphalia), health sector is plays an important role in the economyas a place of healthy ageing interventions carried out as part of chronic diseases preventions, health promotion, rehabilitation, geriatric medical care and long-term care. It is because of the potential generated by the medical labour resources and rehabilitationfacilities for health-oriented silver economy strategy prepared for Małopolska region.