A debate “Together for health”. The President of the PMMH-RI about the development of highly specialized institutions in Poland

Professor Maciej Banach, the President of the Polish Mother’s Memorial Hospital-Research Institute along with prof. Grzegorz Gierelak, director of the Military Institute of Medicine, led a discussion devoted to highly specialized care within the debate “Together for health”.

The initiator of the debate is the Minister of Health, Łukasz Szumowski. After the decision to increase health care expenditures up to 6 percent. GDP, the head of the Ministry of Health, decided to start a discussion on how to change the system effectively to improve the health situation of Poles and extend their lives in good health.

He asked the most eminent health experts for help who are debating with specialists and patient organizations. Their voices are to be transformed into recommendations presented to the Minister of Health.

On November 29, a meeting dedicated to ownership, management and responsibility in health care was organized in the Hall of the Clinical and Didactic Center of Medical University.
– This debate is extremely important to me, especially from the perspective of preparing the assumptions of long-term changes, but above all, from the point of view of Poles’ expectations. This is not only a matter of the amount of expenditure, although it is undoubtedly very important – said Minister Szumowski opening the discussion.

As a part of it, prof. Maciej Banach together with prof. Grzegorz Gierelak led the panel on highly specialized care provided by units with the highest reference, including research institutes and clinical hospitals. They are to prepare recommendations for the expected changes in the organization of highly specialized care, which is provided by clinical institutes and hospitals.

Professor Banach, opening the discussion on the example of the Polish Mother’s Memorial Hospital, talked about the problems and needs of the most specialized medical facilities in Poland.

One of the most important issues which, in the opinion of prof. Banach, one has to face is the issue of financing highly specialized care. – I would like to point out that a continuation, or the next step related to the six reference levels within the hospital network, must certainly come into force, with units at the highest level having different funding than those at a lower one. Will it be an algorithm, be it indicators, or the correct valuation of procedures for individual reference levels, it does not matter. It is important that this financing is varied. If this is not the case, a hospital like the PMMH-RI will have the same money for a complicated childbirth, as for a physiological delivery. In such a situation, highly specialized hospitals will never be able to function properly – he said.

And he recalled the discussion that began after the disclosure of data from the Central Statistical Office on perinatal mortality. It turned out that in Polish Mother’s there is the highest one in the country. But nobody paid any attention to the fact that this is due to the fact that the PMMH is the institution to which the most complicated cases from all over Poland are sent, and this element significantly modifies the GUS data

According to prof. Banach institutions that deal with such difficult patients should count on an increase in the financing of services funded by the NFZ.

– The growth should be around 20-30 percent – the PMMH’s President enumerated. – So if today in PMMH we have revenues of PLN 224 million annually, we would like to hope for revenues of around 280 million. Then I would know that I am able to implement the most complicated procedures and take care of the medical staff performing them.

Professor Banach also postulates the necessity of introducing commercial procedures. – I am sure that PMMH or The Children’s Memorial Health Institute would be able to earn at least several million zlotys annually by performing treatments that are not financed by the NFZ. But to make it possible, the law should be changed so that public entities can earn in this way.

The last option for highly specialized institutions indicated by the President is scientific research. – Research institutes must form a base of experts who carry out various kinds of expertise and research – emphasized prof. Banach. – If we do not do them, we will not catch up with the most developed countries. And yet we cannot afford to stay behind the developing world.

The head of the PMMH also pointed out the challenges facing the entire healthcare system in Poland. He estimated that with the current number of hospital beds and small financing per capita, the system is not able to protect the staff or the appropriate number of innovative equipment. – Therefore, the question arises whether these beds are properly used, whether there are too many of them, or too few. A question, which is difficult from the organizational and social point of view, should be asked; shouldn’t we decide to close some hospitals so that the funds reach the units that really secure healthcare, and in the other units, for example, create hospitals that respond to the problems of geriatrics, palliative medicine, oncology – he said.

During the debate ‘Ownership, management and responsibility’, the problems of basic healthcare were also discussed. Discussions during which solutions were sought for the POZ problem were led by Andrzej Zapaśnik and Adam Kozierkiewicz. The panel on system management was moderated by Iwona Kowalska-Bobko and Marek Balicki.