|Status of health care units - Project of Law|
|Implemented in this survey?|
The Law on health care units was blocked by the President in 2008. In April 2009, the Polish government adopted a Plan B called ?Save Polish Hospitals? which entails providing financial support for local governments in case of restructurization of public hospitals into commercial companies. The program was announced in the form of a government resolution entitled "Support for Local Government aiming at Stabilisation of the Healthcare System". It will be realised during 2009?2011.
In July 2009, the Minister of Health signed an agreement with the National Health Fund (NFZ) and the Bank Gospodarstwa Krajowego (BGK) specifying rules for cooperation in carrying out tasks included in the program. The agreement sets forth, for example, requirements for business plans that must be prepared by institutions willing to participate in the program.
The program comes in response to the Presidential veto concerning the introduction of new healthcare laws (health package) and is designed to support conversion into commercial companies (limited-liability company or joint-stock company replacing the form of "independent public healthcare units" (SPZOZ). Such transformation is intended to change the management possibilities for local governments concerning local hospitals (improved organization and financing). Financial support will be given to local governments voluntarily adopting a plan for restructuring healthcare units under their control (establishing a private capital company and submitting a business plan and proposal for the debts of the health care unit management). The local governments must also obtain a positive opinion from the National Health Fund (NFZ) and Bank Gospodarstwa Krajowego (BGK), as well as approval from their regional authority (voivodship). The funds are transferred under agreements concluded between the central government and the local government. Local governments assuming debts of the converted SPZOZ will receive targeted grants from the state budget for this particular purpose. They can also get some other forms of support.
To participate in the program the local government must meet the following conditions:
1. adoption of a reorganization program including:
a. rules and schedule for liquidation of the SPZOZ (including a schedule for the ending date) and establishment of a capital company to operate a non-public healthcare facility (NZOZ)
b. analysis of revenues obtainable from providing healthcare services
c. economic and financial analysis (business plan)
d. financial reports of the SPZOZ for the past three years, along with auditor's reports and opinions
e. proposal for restructuring and payment of the debts of the local government unit arising pursuant to liquidation of the SPZOZ, e.g. settlement of civil-law claims
2. positive opinion from the director of the National Health Found branch.
3. positive opinion from BGK.
4. request form for participation in the program with voivodship.
The Minister of Health will transfer the financial support to the local government unit pursuant to the agreement if all the following conditions have been met:
Local government units implementing the program are required to provide the voivodship with a report concerning the use of the funds by 31 March of each year (after receiving the grant).
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The proposed policy on the legal status of health care units is innovative for the Polish health system. It is also very controversial because of the possibility of SPZOZ privatization or liquidation. According to the new regulation, the local government has the competence to close hospitals operating as new companies in case of new debts.
The impact on the system will in any case be fundamental (the implementation depends on systemic law and other important regulations).
The public visibility of the described regulation has changed compared to the stage of policy planning - it is not so publicly observed at the moment.
|Implemented in this survey?|
The most important role of the described policy plays the Ministry of Health (MoH) who was the main actor initiating and strongly supporting the described regulation. According to the regulation goals, the substantial number of Polish public sector hospitals will go down the commercialisation route. This may bring good news for the private outsourcing services. The change means that hospitals will move from being run by a single appointed chief executive, who is often a political appointee, to a board of directors in a limited company structure with an additional supervisory board for monitoring.
Unfortunately, the interest, position and influence of the scientific community, especially lawyers and public health professionals, has decreased. Lawyers in their expert opinions noticed many legal errors and doubts concerning the resolution as a legal instrument for this particular purpose (not the usual way for such substantial, systemic issues) and warned of unexpected (and not so easy to forecast) legal effects of the proposed changes.
|Ministry of Health (MoH)||very supportive||strongly opposed|
|Prime Minister||very supportive||strongly opposed|
|Ministry of Finance (MoF)||very supportive||strongly opposed|
|Hospital with debts||very supportive||strongly opposed|
|Hospital without debts||very supportive||strongly opposed|
|Private diagnostic providers||very supportive||strongly opposed|
|NHF||very supportive||strongly opposed|
|Patients||very supportive||strongly opposed|
|Public Health Professsionals||very supportive||strongly opposed|
|Health economics specialist||very supportive||strongly opposed|
|Lawers||very supportive||strongly opposed|
|National media||very supportive||strongly opposed|
|Local media||very supportive||strongly opposed|
|Poviat (local authorities)||very supportive||strongly opposed|
|Voivodship authorities||very supportive||strongly opposed|
The program comes in response to the Presidential veto against the introduction of the new healthcare laws package. The original proposal in form of a piece of legislation - Law on Health Care units - has been changed in the sphere of the hospitals participation in the commercialization process. According to the vetoed legislation on health care units, the transformation of state-owned health care units (SPZOZ) into companies governed by the provisions of economic law (limited liability companies or joint-stock companies) was obligatory.
The new proposal - hereby described Plan B - provides that the hospitals may voluntarily participate in the governmental program.
|Ministry of Health (MoH)||very strong||none|
|Prime Minister||very strong||none|
|Ministry of Finance (MoF)||very strong||none|
|Hospital with debts||very strong||none|
|Hospital without debts||very strong||none|
|Private diagnostic providers||very strong||none|
|Public Health Professsionals||very strong||none|
|Health economics specialist||very strong||none|
|National media||very strong||none|
|Local media||very strong||none|
|Poviat (local authorities)||very strong||none|
|Voivodship authorities||very strong||none|
The government expressed deep determination to implement the new policy on the transformation of health care units. MoH estimates that more than 400 hospitals are interested in participating in the proposed program.
Polish experts say that commercialisation will make a huge difference in the field of hospital management. Instead of being individually undertaken by managers (hospital directors), decisions in the transformed hospitals can profit from a group of people designed for decision making process - often with better knowledge, skills and more experience. Commercialised hospitals with their limited ability to borrow money are also much more likely to make hard choices and opt for outsource providers based on cost-effectiveness, rather than retaining the existing structure.
Looking from the overall policy perpective, at this stage it is not possible to evaluate results of the governmemental resolution. It will depend on the scale of the future privatisation process, i.e. the number of applying hospitals, the implementation of the instruments provided etc.
The other aspect of monitoring and evaluation are the instruments provided for the involved institutions (KBG and NFZ) for the evaluation of all the submitted documentation: it concerns business plans, analysis and presentation of main objectives of the restructurisation plan and other required by both institutions. In this respect, NHF adopted the unified rules and published them in a form of particular attachements to its communication. The forms have to follow the instructions that enable the coherent evaluation of applicants.
Based on the findings from the previous HPM reports and having in mind different expert opinions concerning the changes described in this report, the overall assessment of the policy could be limited to the following recommendations:
1. a fundamental recommendation concerns the introduction of a clause on a voluntary transformations of SPOZs
2. the ownership of health care unit (hospital) property should be separated from the newly established company (ie. local authorities should still be the owners of the property).
3. the SPZOZ liquidation process is the preferred method for the reorganization and legal transformation.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The planned changes in the status of health care units are based on the assumption that the process will result in quality improvements. At the current stage the impact on equity and cost-efficiency cannot be judged unambiguously.
Resolution No. 58/2009 of the Council of Ministers dated 27 April 2009 Establishing the Multi-Year Program "Support for Local Government Units in Actions to Stabilise the Healthcare System"
|Status of health care units - Project of Law|
Process Stages: Policy Paper
Dr Iwona Kowalska, lecturer in the Institute of Public Health, Medical College, Jagiellonian University. She graduated in Political Science at the Faculty of Law and Administration, Jagiellonian University. Her main areas of research are: health and social policy, European health policy and healthcare systems.