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EN
Healthcare systems in Europe are constantly undergoing reforms which adapt them to social, economic and political requirements. The aim of this article is to examine the efficiency of healthcare systems in 30 European countries in 2014. The Network Data Envelopment Analysis (NDEA) model was used. The efficiency of the countries’ overall health systems and their two main components were examined: the public health system and the medical care system. The models include variables that are out of control of policy makers and the ones that can be controlled by them. The research results show that countries which reformed their healthcare systems achieved higher efficiency more often.
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EN
In the Polish healthcare system, medications (including compounded preparations) are wholly or partially paid for from public funds. Subsidising medications which are either central or incidental to treatment (e.g., when patients are unable to work because of an illness) means that medication costs make up a large percentage of total health expenditure and are a drain on the patients' purse. Medication insurance (or drug coverage) policies are a relatively new product and are featured in business insurance portfolios of only a handful of insurance companies offering coverage for medication costs. This article sets out to discuss and analyze available medication coverage policies.
EN
The main aim of this article is to present the most significant changes for the insurance business that are the result of the reform made by Patient Protection and Affrodable Care Act (commonly known as ObamaCare). The article analyses the specific changes that were introduced into insurance companies activity in order to conform to the requirements of ObamaCare. Moreover, it presents the effects of the changes on the insurers, patients and public institutions.
EN
ObamaCare changes have different influence on diverse healthcare business. Pharmaceutical industry seems to gain on this reform unlike the insurance business. In this article we briefly present the main positive and negative effects of health reform in the US. Then, we point to the impact of ObamaCare on profits, costs and activities of pharmaceutical companies. We discuss changes such as: increase in sales of prescription drugs; new rules of registration of generic drugs; novel tax on sales of original drugs; incentives for pharma to put more attention to specific fields in R&D; bigger transparency in relations between physicians and pharma industry.
EN
Out-of-pocket expenditures are a significant barrier in accessing health services. This paper aims to analyse the structure of financing system in the context of the performance indicators of healthcare systems. The study was conducted for the 28 countries of the former Eastern bloc in the years 2000 and 2013, based on data from the World Health Organization. In the DEA-CCR input-oriented model, inputs are the percentage share of private spending in the total expenditure on healthcare and the percentage share of out-of-pocket patient spending in total private spending. The outputs are life expectancy and mortality rate. A ranking of the countries was created and the differences between the two study periods, as well the desired directions of changes in the financing structure were pointed out.
EN
Life in good health and health security prove the most significant values highlighted by moral philosophy in the time of the environmental crisis. The imperfect operation of healthcare poses a threat for humans. Administrative measures regulate insufficiently medicine and healthcare. They need to be backed up by ethics, which cannot be seen solely as ethics of an individual’s conscience. What is needed is professional, practice-oriented and institutionalized-within-healthcare-organizations ethics. Recently, there have appeared a great number of new international documents setting standards of medical procedures in compliance with the requirements of the new bioethical values. At the same time elements of the ethical infrastructure such as bioethics commissions or committees have been created. In the face of the specificity and the complexity of ethical issues and problems encountered within contemporary medical practice the requirement of high ethical competence of all healthcare workers often fails to be sufficient.
EN
Transformations of independent public healthcare centres (SPZOZ) into limited companies was supposed to improve the effectiveness of the healthcare system. Until the 30th April 2014, 174 entities were subject to organisational and legal transformations, while in the years to come the number of entities that operate as companies is going to increase for sure. Considering the importance of the transformation process to the condition of medical entities, NIK has carried out the audit entitled “Activities of self-governmental hospitals transformed into limited companies”. The objective of the audit was to evaluate the impact of transformations on the number and scope of health services financed from the public funds (by the National Health Fund – NFZ), and on the financial situation of these hospitals in the years 2011-2014.
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Content available remote Rôzne pohľady na zodpovednosť v zdravotníckom systéme
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EN
The science and technology are evolving incredibly fast. Despite that, the healthcare system has a lot of insufficiencies and medical failures happen consistently. In recent years the focus has been on increasing the quality of healthcare. According to statistics from national studies from different European countries, 8 to 10 % of mistakes are being caused by the human factor. In this text I discuss the most fundamental concepts of individual and collective guilt and point out that in healthcare system are individuals often part of a team and it is not possible to determine unambiguously the individual responsibility. In spite of this the dominant culture of guilt tends to penalize the individual. In my opinion, the urgency of this topic in Slovakia and The Czech Republic is emphasized by the increasing number of cases of failure which are being discussed in the media. Therefore I point out even possible impact of media and the guilt culture on the medical professional who fail and simultaneously I conclude that blaming the individual does not make the system safer. Our focus should rather be centred on showing that an individual can be incautious. However when the mistake happens we should appeal to improving the system and a prevention of this type of mistakes. Only this way we can change the culture of guilt to a culture of safety and improve the healthcare.
SK
Veda a technológie idú neuveriteľnou rýchlosťou dopredu. Napriek tomu má zdravotnícky systém veľa nedostatkov a medicínske chyby sa stávajú neustále. V posledných rokoch sa pozornosť upriamuje na zlepšenie kvality zdravotnej starostlivosti. Podľa štatistík z národných štúdií v rôznych európskych krajinách, 8 – 10 % chýb je spôsobené ľudským faktorom. V tomto texte som prebrala najzákladnejšie koncepty individuálnej a kolektívnej zodpovednosti a poukazujem na to, že v zdravotníckom systéme sú jednotlivci častokrát súčasťou tímov a nie je možné jednoznačne určiť individuálnu zodpovednosť. Napriek tomu prevladajúca kultúra viny smeruje k sankciovaniu jednotlivca. Domnievam sa, že aktuálnosť témy na Slovensku aj v Českej republike je posilnená zvyšujúcim sa počtom prípadov pochybení, ktoré sú rozoberané v médiách. Preto poukazujem aj na možný dopad médií a kultúry viny na zdravotníckeho profesionála, ktorý pochybí, a zároveň dochádzam k záveru, že obviňovanie jednotlivca nerobí systém bezpečnejším. Naše zameranie by skôr malo smerovať na preukázanie, že jednotlivec môže byť neopatrný. Ale ak sa už stane chyba, apelovať by sme mali na zlepšenie systému a prevenciu pred rovnakými chybami. Iba takto dokážeme premeniť kultúru viny na kultúru bezpečnosti a zlepšiť zdravotnú starostlivosť.
EN
In this paper I will juxtapose the concept of the veil of ignorance – a fundamental premise of Rawlsian justice as fairness – and solidarity in the context of the organisation of a healthcare system. My hypothesis is that the veil of ignorance could be considered a rhetorical tool that supports compassion solidarity. In the concept of the veil of ignorance, I will find some crucial features of compassion solidarity within the Rawlsian concept of “reciprocity” (actually, not being reciprocity at all) – located between “impartiality” and “mutual advantage”. I conclude that, even behind this “thick” veil, some essential, yet “particular” facts on health and wealth redistribution are available to decision makers. Lastly, I discover that by means of the assumption of self-interest in the original position the veil aims to convert egoism into empathy, thus invoking the solidarity of compassion that in turn could be translated into principles of the organisation of a healthcare system.
EN
The main purpose of this paper is to present the level of new technologies implementation in the healthcare systems in US and Poland. New technologies play a crucial role in everyday life, including healthcare. Medical documentation and easy access to potentially life-changing or lifesaving information are extremely important for all the stakeholders in the healthcare system — its preparation, archiving and effective use in real time upon request may be supported by advanced systems. IT systems may improve security, medical services quality and efficiency of medical treatment, regardless of the type of healthcare system — private in the US and public in Poland. The results of surveys conducted by the American Society of Health-System Pharmacists and the Polish Centrum Systemów Informacyjnych Ochrony Zdrowia [Center of Healthcare Information Systems] have been used in this paper.
EN
The most recent big reform of the Polish health system took place in 2017 and introduced a basic hospital service provision system. Hospitals were able to be included in the network and receive flat-rate financing from the National Health Fund. The current paper aims to assess how the relative situation of hospitals changed between 2015 and 2018. This study is based on multicriteria rankings which take into account the values of profit/loss on sales, the contract with the NHF, the income from health services outside the NHF, the income from rental and lease, the employment of doctors, the employment of nurses, liabilities, operating costs, and interns and residents per hospital bed. The similarity of rankings constructed using different methods is shown. Based on the results of the Chi-squared test, it can be concluded that the inclusion in the network does not affect whether the relative situation of a hospital between 2015 and 2018 improved or not. In the regression analysis, the dummy variable for level 1 hospital was negatively related to the median rank; however, this impact was not statistically significant.
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Content available remote Integrating deep learning, social networks, and big data for healthcare system
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EN
This paper aims to propose a deep learning model based on big data for the healthcare system to predict social network data. Social network users post large amounts of healthcare information on a daily basis and at the same time hospitals and medical laboratories store very large amounts of healthcare data, such as X-rays. The authors provide an architecture that can integrate deep learning, social networks, and big data. Deep learning is one of the most challenging areas of research and is becoming increasingly popular in the health sector. It uses deep analysis to extract knowledge with optimum precision. The proposed architecture consists of three layers: the deep learning layer, the big data layer, and the social networks layer. The big data layer includes data for health care, such as X-ray images. For the deep learning layer, three Convolution Neuronal Network models are proposed for X-ray image classification. As a result, social network layer users can access the proposed system to predict their X-ray image posts.
EN
Local government units (LGU) are nowadays facing the very difficult and complicated task of making reasonable decisions regarding the transforming of SPZOZs into capital companies. First, it seems necessary to carry out a simulation of costs and advantages of the assumed models and solutions together with an analysis of advantages and disadvantages of the new legal and organisational forms. The aim of this paper is to assess whether the process of transforming SPZOZs into capital companies is purposeful and reasonable, and to define a way to prepare hospitals for functioning in an altered legislative environment. The paper draws attention to the fact that transformation itself does not guarantee that the results achieved by the given entity will automatically improve. The transformation can bring financial advantages for the newly created company and the local government, from the subsidies and remissions in accordance with art. 197 of the act on medical activity. Yet the conditions for getting such help are quite restrictive and not in every situation can financial help from the central budget be counted on. Such aid could help improve the financial standing of a hospital considerably. Also, it must be remembered that a hospital transformed into a capital company acquires the capacity to go bankrupt. If the new entity generates a loss, it may result in the owner having to raise the initial capital in order to avoid filing a bankruptcy petition by the company. In practice, the financial consequences for the local government are the same as in the case of having to cover losses. The difference lies in the continuity of the provided medical services.
EN
The most recent big reform of the Polish health system took place in 2017 and introduced a basic hospital service provision system. Hospitals were able to be included in the network and receive flat-rate financing from the National Health Fund. The current paper aimsto assess how the relative situation of hospitals changed between 2015 and 2018. This study is based on multicriteria rankings which take into account the values of profit/loss on sales, the contract with the NHF, the income from health services outside the NHF, the income from rental and lease, the employment of doctors, the employment of nurses, liabilities, operating costs, and interns and residents per hospital bed. The similarity of rankings constructed using different methods is shown. Based on the results of the Chi-squared test, it can be concluded that the inclusion in the network does not affect whether the relative situation of a hospital between 2015 and 2018 improved or not. In the regression analysis, the dummy variable for level 1 hospital was negatively related to the median rank; however, this impact was not statistically significant.
EN
The article’s goal is to study internal and external cost as part of the sustainable development paradigm. To illustrate such a problem the role and a scope of presented costs in the health care system are discussed. The practical example from Opolskie Voivodship — the John Paul II Specialist Hospital in Głuchołazy — is presented. For achievement of this aim a literature review is conducted from the scope of health-care economics and its sustainable development as well as internal and external costs (desk research). An analysis of data (data analysis) is performed on the example of the specific hospital (case study). After such analysis it is possible to state that it is necessary to have knowledge regarding the occurrence of diseases in the population and the total (including external) values of social and economic costs of untreated diseases. In order to achieve this, it is necessary to, first of all, implement educational programs. This also applies to general medical practitioners, because, as practice shows, patients are often diagnosed at the stages of disease when effective treatment is nearly impossible.
PL
Celem artykułu jest analiza kosztów zewnętrznych i wewnętrznych w kontekście wdrażania koncepcji rozwoju zrównoważonego. Dla ilustracji tak postawionego problemu badawczego dyskusji poddane zostały miejsce i rola tych kosztów w systemie ochrony zdrowia w Polsce. Problem badawczy omówiony został na przykładzie pochodzącym z Województwa Opolskiego — Szpitala Specjalistycznego im. Jana Pawła II w Głuchołazach — prezentującego podjęty problem badawczy. Aby osiągnąć cel badawczy zatosowano metody przeglądu literatury z zakresu ekonomii ochrony zdrowia i jej trwałego rozwoju oraz identyfikacji istniejących w systemie ochrony zdrowia kosztów zewnętrznych i wewnętrznych (desk research). Przeprowadzona została także analiza danych (data analysis) na przykładzie wskazanego wcześniej szpitala (case study). W konkluzji badań wskazać można na konieczność posiadania wiedzy z zakresu wielkości zachorowań populacji jako takiej oraz całkowitej wartości (wliczając wartość zewnętrzną) społecznych i ekonomicznych kosztów chorób nieleczonych. W tym kontekście konieczna jest implementacja programów edukacyjnych — dotyczy to także praktyków zawodów medycznych, ponieważ, jak wskazuje praktyka, pacjenci często diagnozowani są w późnych stadiach chorób, w wyniku czego efektywne leczenie jest prawie niemożliwe.
EN
The authors have determined that the healthcare system is on the verge of collapse, as it is unable to meet the population’s growing needs for medical care. An analysis of demographic situation and health indices of the adult population in the north-eastern region of Ukraine (based on the example of the Sumy region) was carried out. The study confirms the number of deaths caused by COVID-19, the growth of new cases of coronavirus, and the excessive burden on primary care physicians and infectious disease specialists. It has been determined that the negative state of the domestic healthcare system is due to the shortcomings of public administration and organisation of this system in terms of COVID-19. One of the most important priorities of public policy should be to preserve and strengthen the health of the population, the development of intersectoral cooperation on the principle of ‘healthcare – in all state policies’, and the priority of the nation itself, i.e. the formation of healthy behaviour.
EN
The purpose of the article. The study brings a comparative analysis between health systems in Poland and Italy. It is aimed at fulfilling the subject literature using economic comparative analyses between different health systems as well as straight comparisons between Polish and Italian health systems. Moreover, another aim of the study is to find out some weak points and to point out some good practices of each of the analyzed health systems. The research question for the purpose of this study is as follows: what changes can be implemented to improve the efficiency of each of the analyzed health systems? Methodology. The study is carried out on the background of health systems' theory. The critical literature review is conducted. A comparative analysis using such indicators as percentage of GDP and GDP per capita spent on financing health systems, healthcare spending components, life-expectancy data or Euro Health Consumer Index indicators are applied and analysed in the study. Results of the research. Health systems in Poland and Italy in the latest decades were transformed in a completely different way. Healthcare in Poland is based mainly on health insurance premiums whereas in Italy financing of healthcare is based mainly on taxes. Among similarities between the systems a high level of responsibility designated to local authorities may be mentioned. The comparative analysis indicates that the situation of the Italian health system seems to be much better as compared to its Polish counterpart. Though, some solutions, aimed at improving health system efficiency, can be transferred from one system to another in case of both analyzed systems.
EN
The demographic future of the country is becoming a major challenge for healthcare, not only from the standpoint of the public payer, but also regarding the healthcare system’s organisation and efficiency. In the face of constantly changing population structure that entails higher demand for costly medical procedures addressing the needs of the elderly, the only way to make the system efficient and to ensure the accessibility of medical services is to increase the amount of available funding. One of the priorities laid down in the Ministry of Health’s healthcare strategy is to gradually increase public allocations for healthcare, now one of the lowest in the European Union. The healthcare system in Poland could also benefit financially from commercial health insurance. In the article, the role of private health insurance in the Polish healthcare system is discussed in the context of demographic change forecasts.
PL
Przyszłość demograficzna Polski staje się wielkim wyzwaniem dla systemu opieki zdrowotnej – zarówno z punktu widzenia płatnika publicznego, jak i organizacji oraz wydolności systemu. Postępujące przeobrażenia w strukturze ludności i związane z nimi zwiększone zapotrzebowanie na kosztowne procedury medyczne dedykowane osobom starszym powodują, że zapewnienie sprawności systemu i zagwarantowanie odpowiedniej dostępności świadczeń możliwe jest tylko poprzez zdecydowany wzrost nakładów na ochronę zdrowia. Jeden z priorytetów opracowanej przez Ministerstwo Zdrowia strategii zmian w ochronie zdrowia stanowi stopniowe zwiększanie publicznych środków na ochronę zdrowia, należących obecnie do najniższych wśród krajów Unii Europejskiej. Do wzbogacenia systemu o nowe fundusze i usprawnienia jego funkcjonowania mogą się przyczynić ubezpieczenia zdrowotne o charakterze komercyjnym. Upowszechnienie dobrowolnych ubezpieczeń zdrowotnych dobrze skoordynowanych z systemem publicznym mogłoby poprawić dostępność i jakość opieki medycznej w Polsce. W artykule poruszono problematykę roli prywatnych ubezpieczeń zdrowotnych w systemie ochrony zdrowia w Polsce w kontekście prognozowanych zmian demograficznych.
EN
The demographic future of the country is becoming a major challenge for healthcare, not only from the standpoint of the public payer, but also regarding the healthcare system’s organisation and efficiency. In the face of constantly changing population structure that entails higher demand for costly medical procedures addressing the needs of the elderly, the only way to make the system efficient and to ensure the accessibility of medical services is to increase the amount of available funding. One of the priorities laid down in the Ministry of Health’s healthcare strategy is to gradually increase public allocations for healthcare, now one of the lowest in the European Union. The healthcare system in Poland could also benefit financially from commercial health insurance. In the article, the role of private health insurance in the Polish healthcare system is discussed in the context of demographic change forecasts.
PL
Przyszłość demograficzna Polski staje się wielkim wyzwaniem dla systemu opieki zdrowotnej – zarówno z punktu widzenia płatnika publicznego, jak i organizacji oraz wydolności systemu. Postępujące przeobrażenia w strukturze ludności i związane z nimi zwiększone zapotrzebowanie na kosztowne procedury medyczne dedykowane osobom starszym powodują, że zapewnienie sprawności systemu i zagwarantowanie odpowiedniej dostępności świadczeń możliwe jest tylko poprzez zdecydowany wzrost nakładów na ochronę zdrowia. Jeden z priorytetów opracowanej przez Ministerstwo Zdrowia strategii zmian w ochronie zdrowia stanowi stopniowe zwiększanie publicznych środków na ochronę zdrowia, należących obecnie do najniższych wśród krajów Unii Europejskiej. Do wzbogacenia systemu o nowe fundusze i usprawnienia jego funkcjonowania mogą się przyczynić ubezpieczenia zdrowotne o charakterze komercyjnym. Upowszechnienie dobrowolnych ubezpieczeń zdrowotnych dobrze skoordynowanych z systemem publicznym mogłoby poprawić dostępność i jakość opieki medycznej w Polsce. W artykule poruszono problematykę roli prywatnych ubezpieczeń zdrowotnych w systemie ochrony zdrowia w Polsce w kontekście prognozowanych zmian demograficznych.
PL
Wstęp. Wprowadzenie reformy systemu ochrony danych osobowych w Polsce jest wyzwaniem dla wszystkich podmiotów leczniczych, które te dane przetwarzają. Istotna zmiana, jaka nastąpiła w zakresie zabezpieczania tożsamości, to wynik przyjętego 27 kwietnia 2016 r. rozporządzenia o ochronie danych osobowych (RODO). Placówki ochrony zdrowia to podmioty pozyskujące, gromadzące i przetwarzające dane osobowe ponad 38 mln pacjentów.
EN
Background. The introduction of the reform of the personal data protection system in Poland is a challenge for all medical entities that process these data. A significant change that took place in the area of identity protection is the result of the RODO adopted on April 27, 2016. Health care facilities are entities that acquire, collect and process personal data of over 38 million patients.
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