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Foundation of Health Ombudsman Office

Country: 
Poland
Partner Institute: 
Institute of Public Health, Jagiellonian University Medical College, Krakow
Survey no: 
(14) 2009
Author(s): 
Cezary Wlodarczyk
Health Policy Issues: 
Responsiveness
Reform formerly reported in: 
Law on Patient Rights
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

After an exhausting legislative process the law on patients? rights came into force in May 2009. for the first time all rights, previously dispersed in different acts, have been codified. One of the major guaranties that the rights will be observed is the newly created post of the health Ombudsman whose mission is to strengthen the patients? position. However, his potency seems to be weaker than expected.

Recent developments

In a set of many bills aiming at improving the healthcare system it was proposed to gather all patients' rights which hade been dispersed in many different legal sources in one well defined legal act. An important element of the general concept was to create a post of the ombudsman responsible for patients' interests. The post was to be equipped with many tools to defend patients' rights as they were expressed in the law. Unfortunately, because of the President's veto the law on patients' rights had to be passed for the second time. Due to this act, the post and the Office of the health Ombudsman has been set up.    

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent strongly system-dependent system-neutral
current current   previous previous

It  may be foreseen that the Ombudsman's  position is not sufficiently independent. His independence is not declared by legal norms, the length of the term is not fixed and depends on the Prime Minister's discretion. 

There are also shortfalls in procedures. In some cases - patient's objection to opinions or opinions provided by a physician, which is one of the most controversial problems  - verdicts are left to commissions made up of physicians and no appeal is possible, neither by a patient nor by the Ombudsman. In some cases an investigation and its results depends on written medical documentations, which have been prepared by physicians who are personally interested in the investigation. The Ombudsman must rely on these documents, which may become the dominant source of information.             

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Initiators of idea/main actors

  • Government: Facing the president?s opposition, whose veto paralysed the whole process of reform, the government sought a success. Passing the law on patients? rights and setting up the health Ombudsman Office proved its commitment to the idea of improving the health system
  • Parliament: All political parties supported the idea of patients rights and the creation of the post of health Ombudsman
  • Providers: Providers were against a new regulation but refrained from loud protest and some of them even pretended to cooperate
  • Patients, Consumers: Because the situation was clear, patients were not very mobilized. However, the Institute for Patients? Right was involved in popularising the issue
  • Scientific Community: In opinions presented to Parliament, a number of medical academics as well as a few lawyers criticized the new concept of patients? rights
  • Political Parties: From the very beginning all parties expressed their support for the patients? rights law. Since it was voted on separately, they could approve it

Stakeholder positions

Because the idea of patient's rights has been developed for many years it was well known  - but not in details - and generally accepted. The question was how it was to be formalized and translated into the language of law and how to install a mechanism to guarantee the observation of patients' rights in medical practice. The idea of a health Ombudsman had been included in the law, which was then halted by the President's veto.      

Actors and positions

Description of actors and their positions
Government
Ministry of Healthvery supportivevery supportive strongly opposed
Ministry of Financevery supportiveneutral strongly opposed
Prime Ministervery supportivevery supportive strongly opposed
Parliament
Citizens' Platform (governmental)very supportivevery supportive strongly opposed
Agricultural Party (governmentalvery supportivevery supportive strongly opposed
Right and Justice (opposition)very supportivesupportive strongly opposed
Social Democrats (opposition)very supportivesupportive strongly opposed
Providers
Council of Medical Chambervery supportiveneutral strongly opposed
A few individualsvery supportivesupportive strongly opposed
Medical Trade Unionvery supportiveopposed strongly opposed
Patients, Consumers
Institute for Patients' Rightsvery supportivevery supportive strongly opposed
Other patients? organizationsvery supportivesupportive strongly opposed
Scientific Community
Medical Communityvery supportiveopposed strongly opposed
Individuals from Lawyers Communityvery supportiveopposed strongly opposed
Other scientific communitiesvery supportivesupportive strongly opposed
Political Parties
Citizens' Platform (governmental)very supportivevery supportive strongly opposed
Agricultural Party (governmental)very supportivevery supportive strongly opposed
Right and Justice (opposition)very supportivesupportive strongly opposed
Social Democrats (opposition)very supportivesupportive strongly opposed
current current   previous previous

Influences in policy making and legislation

Originally, the law on improving the healthcare system was passed by Parliament - by the two houses (6 November 2008) - and was to be signed by the President (26 November 2008), thereby becoming binding. Since the law on patient rights was only one component of the package of health system reforms which were to be implemented by this one introducing law, it did not come into force at this point. The President vetoed a few other laws, including the introducing law, and the whole package failed. However, since the law on patient's rights was generally accepted, the it was passed a second time (24 April 2009) and came into force on 21 May 2009. The same day the Ombudsman's Office was set up.      

Legislative outcome

Enactment

Actors and influence

Description of actors and their influence

Government
Ministry of Healthvery strongstrong none
Ministry of Financevery strongvery strong none
Prime Ministervery strongvery strong none
Parliament
Citizens' Platform (governmental)very strongvery strong none
Agricultural Party (governmentalvery strongweak none
Right and Justice (opposition)very strongvery strong none
Social Democrats (opposition)very strongweak none
Providers
Council of Medical Chambervery strongweak none
A few individualsvery strongweak none
Medical Trade Unionvery strongweak none
Patients, Consumers
Institute for Patients' Rightsvery strongweak none
Other patients? organizationsvery strongweak none
Scientific Community
Medical Communityvery strongweak none
Individuals from Lawyers Communityvery strongstrong none
Other scientific communitiesvery strongweak none
Political Parties
Citizens' Platform (governmental)very strongvery strong none
Agricultural Party (governmental)very strongweak none
Right and Justice (opposition)very strongvery strong none
Social Democrats (opposition)very strongweak none
current current   previous previous
Agricultural Party (governmental, Institute for Patients' Rights, Agricultural Party (governmental)Ministry of HealthPrime Minister, Citizens' Platform (governmental), Citizens' Platform (governmental)Social Democrats (opposition), A few  individuals, Other patients? organizations, Other scientific communities, Social Democrats (opposition)Right and Justice (opposition), Right and Justice (opposition)Council of Medical ChamberMinistry of FinanceMedical Trade Union, Medical CommunityIndividuals from Lawyers Community

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

From a formal point of view, the formerly operating Office of Patients Rights, which was a part of the Ministry of Health, was transformed into the Ombudsman of Patients' Rights Office. The health Ombudsman's position is rather strong, it parallels the Ombudsman for the protection of civic rights and the Ombudsman for children's rights. The nomination and dismission of the health Ombudsman are decided on by the Prime Minister. The health Ombudsman reports to the Prime Minister.  

According to the law, competencies of the health Ombudsman cover (among others):

  • carrying out investigation in cases of breaching collective patients' rights, 
  • initiating investigation when individual patients' rights (if notified or from own sources),
  • initiating and/or participation in civil law suits,
  • initiating new legal solution in order to strengthen patients' position.

Monitoring and evaluation

The Ombudsman is obliged to report annually - by 31 July - to the government on initiatives and activities undertaken with regard to patients' rights. After having expressed its opinion, the government submits the report to parliament.

The patients' organizations as well as the media are expected to monitor the Ombudsman activities and how patients' rights are observed.      

Expected outcome

It  is too early to evaluate and judge performance and social efficiency of the new solutions, even if - generally - if they are highly appreciated.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable system more equitable system more equitable
Cost Efficiency very low low very high
current current   previous previous

The practice will prove to be the best test for the solutions adopted. A lot depends on the individual character of a person nominated to the post of Ombudsman. The contents and quality of relationships between patients and medical professionals will be essential for patients rights to be observed. It is to be hoped that thser relationsships will improve.          

References

Sources of Information

  • Law of 6 November 2008 on Patients' Rights and Patients' Rights Ombudsman, The Law Gazette 2009, No 52, item 417, No 76, item 641
  • Law of 24 April 2009 introducing the Law of 6 November 2008 on Patients' Rights and Patients' Rights Ombudsman, the Law on Accreditation in Health Care, the Law on Consultants in Health Care, The Law Gazette 2009, No 76, item 641
  • www.mz.gov.pl

Reform formerly reported in

Law on Patient Rights
Process Stages: Legislation

Author/s and/or contributors to this survey

Cezary Wlodarczyk

Suggested citation for this online article

Wlodarczyk, Cezary. "Foundation of Health Ombudsman Office". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/pl/a14/4