In Poland, the time from the first symptoms to the start of treatment is longer than in other countries. Poles go to the doctor much more often than residents of countries that have much higher expenditure on health care, but the number of visits does not mean that we will receive the correct diagnosis and an effective treatment plan will be established – says Dr. Małgorzata Gałązka-Sobotka from Lazarski University. He also advises what the future Minister of Health should do.
Katarzyna Pinkosz, Wprost: After the elections, there are assessments of the health care system by people who could potentially take the position of Minister of Health in the future. There are words about its poor condition, even ruin. Poles also have a negative opinion about health care, especially access to a doctor. What is your assessment as a person who has been participating in debates on changes in health care in Poland for many years?
Dr. Małgorzata Gałązka-Sobotka: I strongly disagree with the thesis that the health care system is in ruins. On a school scale from 1 to 6, I would rate our system today as three. This is not a “good student” or a “very good” student. CBOS research shows that most people were satisfied with the quality of care (37%) in 2007, a similar level of satisfaction was recorded in mid-2020 (36%). However, the system in no country is rated very good or excellent. However, research in Poland shows that after the pandemic, the number of people dissatisfied with the care system has increased significantly. Health debt has mobilized multitudes of patients to take care of their health, and unfortunately the capacity of the system is significantly limited, which results from low expenditure and limited human and organizational resources.
Everyone is talking about queues, is this the biggest problem?
In my opinion, the biggest problem is the organizational chaos felt by many patients. Even though more money is spent on health, we have unlimited access to diagnostic imaging, there are new solutions in oncological and cardiological care, and there is a reform in primary health care, many patients still do not feel the changes. Maybe in individual cases – yes; in specific regions, in branches that are leaders in their segments. However, these are “islands” in the ocean of a system that is still suboptimally organized.
However, we are on the way to better quality. We are not seeing the results yet, but only a few percent of the population use services provided in modern models of coordinated care. But this does not mean that the system is in ruins, because ruin would mean that no change is taking place, no efforts are being made, and the voices of healthcare providers and patients fall completely silent. Meanwhile, projects are being implemented that are intended not so much to restore the pre-pandemic efficiency of the system, but to significantly increase it: more and more patients are treated with modern technologies, the number of health services provided at the level of both primary care and emergency care, as well as hospital treatment, and coordinated care in primary care are being developed. , oncology, cardiology. Psychiatric care for adults and children is being rebuilt, and the system of care for patients with rare diseases is being integrated with the European network. The medical infrastructure is constantly modernized, and the level of digitization is recognized internationally. There is still a lot to do, but I believe that it is not responsible to use the word “ruin”, because thousands of doctors, nurses, paramedics and other medical professionals and administration employees go to work every day, thousands of medical facilities work for the benefit of patients who use care. Of course, the question is how well it is organized and how effectively and efficiently health care in our country creates health value?
However, Poles still complain most about long waits to see a specialist.
Queues to specialists are the result of many phenomena, including the lack of standards in organizing the “path” of a patient with a given disease. Recently, we have had a scandal regarding the incorrect treatment of Lyme disease. Questions arise: Do patients know how to behave in the event of a tick bite? When to see a doctor, and if so, which one? Is the standard of diagnosis and treatment clearly defined? Is the patient properly cared for by his family doctor when disturbing symptoms appear? If not, we should not be surprised that they circulate from specialist to specialist, including a neurologist, rheumatologist, infectious diseases doctor, or end up in the “Lyme disease underground”. Does a patient with symptoms indicating the risk of cancer have a clear diagnostic path consistent with the latest standards, regardless of the facility he went to? Differences in patients’ experiences motivate them to circulate from doctor to doctor, collecting further opinions and making sure that the proposed plan is optimal. The “queue” is the result not only of the excess of demand over the supply of services, but also of suboptimal organization of the patient path, lack of access to information and reliable care of the patient’s health at the primary care level.
Poles go to the doctor much more often than residents of Western countries, which have much higher expenditure on health care and their population is in much better health condition.
We go to the doctor much more often because we do not use preventive measures, and the system of financing services means that making a diagnosis and establishing a treatment plan requires several separate visits to a specialist or a stay in hospital. Poland is one of the countries with the highest rate of hospital admissions for asthma, diabetes and COPD, which we could prevent thanks to better organized primary care. In Poland, you have to take care of your health and wait.
That is: we go to the doctor too often unnecessarily, with no effect, the visits are duplicated, and sometimes tests are repeated unnecessarily.
And the time from the first symptoms to the start of treatment is extended – and this is a parameter that speaks about the effectiveness of the health care system: how much time passes from the first symptoms to the start of treatment. In almost every disease, this time is significantly longer than in other countries. We often talk about a diagnostic odyssey. And this affects the prognosis, chances of recovery and chances of life.
In recent years, there has been more and more talk about quality in health care. But what does this mean for a specific patient?
Quality means primarily that the patient is diagnosed and treated according to a specific standard of care, consistent with current medical knowledge. It must be defined and adhered to; regardless of whether the patient lives in Warsaw, Białystok or Podkarpacie. According to WHO, the likelihood of health services increasing the expected treatment effects is facilitated by the quality of health care, which is nothing else than a process in which we modify medical procedures following the assessment of its compliance with the standard.
Meanwhile, the stories of Polish patients show that the guidelines of scientific societies are very loosely followed. There are no simply described standards of conduct and their legal sanction – I am thinking especially about chronic and frequent diseases. This causes patients to bounce from specialist to specialist, seeking assurance that they are being treated correctly. This increases unnecessary visits and tests, limiting availability for first-time patients.
This year, a pilot program for people with obesity (KOS BAR) qualified for bariatric surgery is underway. In this program, the hospital will actually get more money if the results are better: that is, the patient will lose more weight. Can such programs be used more widely in Poland?
They should. This program clearly defines the diagnostic path, the stage of preparation for surgery, surgery standards and – what is very important – the principles of patient care after surgery. Most often, even after complex procedures, the patient is proverbially “shown out the door”; apart from one follow-up visit, no one is interested in him, there is no supervision, which determines the consolidation of therapeutic effects. The KOS-BAR program offers patients one-year post-surgery care, including rehabilitation, advice from a dietician and psychologist, and constant health monitoring for 12 months.
Crucially, the program precisely defines the indicators that determine the expected effects of treatment: if it is successful, e.g. the patient has lost weight a year after the surgery, the symptoms of sleep apnea, asthma and diabetes have disappeared, the hospital receives a financial bonus.
If you were to advise the future Minister of Health: what are the most important directions of change?
First of all, I advise you not to doubt that the key way to balance the system is to focus on quality and safety. Secondly, it should not stray from the path of outpatient care, increasing its comprehensiveness and coordination, and digitization. Thirdly, to gradually develop staff, reaching the potential of shared competences. Only further increasing the powers of nurses, midwives, pharmacists and other professionals will increase the efficiency of the system. Fourthly, let it persistently strengthen the foundation of the system, which is a modern, comprehensive primary health care center engaged in the prevention and management of chronic diseases and responsible for its population. Let it network medical facilities and motivate them to cooperate to provide the highest quality specialist care. It is necessary to integrate health policy with the policies of other ministries, in particular social policy, education, agriculture, environment, with the support of the Minister of Finance. Health orientation requires inter-ministerial action across political divisions. And finally, I would advise people who will soon take over the helm of the ship that is the Polish health care system to always use dialogue based on data, not emotions. To listen to the voice of patients, but also to benefit from the experience of doctors, nurses and managers of facilities, especially those that stand out for their quality and efficiency – their daily work provides many inspirations and solutions that can and should be scalable to the entire system. However, it is necessary to objectively identify best practices through performance measurement systems and benchmarking, which will make the system more transparent and learning.
Let’s not delude ourselves that all these actions will eliminate queues. They were and always will be. However, our goal is to significantly shorten them.
The way to achieve this is through the popularization of prevention, the development of rapid diagnostics, organizing patient paths by implementing transparent standards of conduct and increasing the role of other medical professionals who can relieve the burden on doctors, creating space to accept new patients. Let us also take advantage of the advantages of modern technologies, including AI and telemonitoring systems, which significantly increase the quality and efficiency of the use of human resources in patient care.
PhD in Economics Małgorzata Gałązka-Sobotka, dean of the Postgraduate Education Center and director of the Institute of Health Care Management at Lazarski University. Since 2015, vice-chairman of the Council of the National Health Fund.