Journal of Health Policy,
Insurance and Management


Polityka Zdrowotna

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Polityka Zdrowotna Journal of Health Policy, Insurance and Management X 2012

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Health insurance in the Polish health care system

UBEZPIECZENIA ZDROWOTNE W POLSKIM SYSTEMIE OCHRONY ZDROWIA

Autor

Romuald Holly, Uniwersytet Medyczny w Łodzi, Szkoła Główna Handlowa, Krajowy Instytut Ubezpieczeń

ABSTRAKT

The article presents reflections on utility of (1) an idea of insurance for the Polish health care system – as a rule of organization of solidary effort of the whole society focused on maintenance all members of population with health services and (2) insurance methods – to neutralize health losses (of all members of health risk community/partnerships and/or of these members who voluntary accede to the organization aimed at neutralization of special kinds of health risks). There is presumed that the utility of insurance depends on the model of health security and on institutionalization of this model in the definite shape of health care system; for the role and place of particular health insurances in the system have to fit to its character, goals, tasks. Therefore, health insurance (each of them) can not exist outside of the system; it has to be an integral element complementary to any other element of the system. Then, the process of including of health insurances into the structure of health care system on the way of its restructurization has to be preceded by exact recognition of health insurances abilities, their advantages and disadvantages, profits and costs resulting because of their presence in the system. Taking into consideration all these presumptions as well as character of the Polish health care system its conditions and dependencies, there have been distinguished the two groups of health insurances – morbidal and non-morbidal: annuital, medical, tutelary, accidental. There is also recommended a possibility of including these insurances into Polish health care system as: basic (public, obligatory) and supplementary (voluntary – public, private, mutual).

Słowa kluczowe :

zabezpieczenie zdrowotne, system ochrony zdrowia, typologia ubezpieczeń zdrowotnych, rodzaje ubezpieczeń

health security system, health care system, health insurance classification, types of health insurances


Reorganization of the public payer (NFZ) as a condition favoring the introduction of commercial insurance in Poland

REORGANIZACJA PŁATNIKA PUBLICZNEGO (NFZ) JAKO WARUNEK SPRZYJAJĄCY WPROWADZENIU UBEZPIECZEŃ KOMERCYJNYCH W POLSCE

Autor

Mariusz Tarhoni, Zakład Organizacji i Ekonomiki Ochrony Zdrowia oraz Szpitalnictwa Narodowy Instytut Zdrowia Publicznego – PZH

ABSTRAKT

The transformation of the political system which took place in Poland in 1989 led to the necessary system changes in terms of adjustment of the law, the structure of the government and self-government, and economic transition. The process of reforming health care financing has progressed much more slowly because it is a problem of high social sensitivity, which results in the political decision-makers proceeding extremely cautiously. An extra-budgetary public system of health care insurance was launched ten years after the country’s political system had changed, that is, in 1999.

This paper focuses on the introduction of an efficient system of private health insurance. The structure of financial resources to be used by private health insurance companies is also discussed. The conclusion is that with the present, centrally managed public system it will be very difficult to launch an efficient system of additional health care insurance due to difficulties with the application of financial equalization among insurance companies, the organization of a general supervisory body for solving key problems in the system, and increasing the efficiency of financial management in a centralized system. These would be necessary to ensure better conditions for proposing additional payments or additional health care insurance to the insured.

A model of financial flows for additional health insurance and an institution supervising the system (Healthcare Insurance Supervision Office) are also presented. Two models of public sector financial management which were implemented in Poland, that is, an insurance-budget system (self-governed) represented by Regional Sickness Funds and a centralized system under the National Health Fund (NFZ) are evaluated. Selected Regional Sickness Funds and later NFZ Voivodship Branches are analyzed using actual aggregated financial data as well as simulated data (as if the system had not been centralized in 2003).

The presented suggestions lead to the conclusion that reorganization of the existing public payer in Poland (NFZ) in the direction of a self-governed system will favor the establishment of more efficient commercial health insurance, at the same time creating better conditions for launching public and private long-term care insurance.

Słowa kluczowe :

publiczne i prywatne ubezpieczenia zdrowotne, algorytm wyrównania międzykasowego, przepływy finansowe, alokacja środków w ubezpieczeniu zdrowotnym, modele zarządzania i nadzór nad systemem ubezpieczeń zdrowotnych

public and private health insurance, equalization algorithm for health care insurers, financial flows, allocation of resources in health insurance, models of management and supervision over the health care system


The risk of incapacity for independent living – necessity of social protection

RYZYKO NIEZDOLNOŚCI DO SAMODZIELNEJ EGZYSTENCJI – KONIECZNOŚĆ ZABEZPIECZENIA SPOŁECZNEGO

Autor

Anna Wilmowska-Pietruszyńska, Uniwersytet Rzeszowski,  Wydział Medyczny

ABSTRAKT

The transformation of the political system which took place in Poland in 1989 led to the necessary system changes in terms of adjustment of the law, the structure of the government and self-government, and economic transition. The process of reforming health care financing has progressed much more slowly because it is a problem of high social sensitivity, which results in the political decision-makers proceeding extremely cautiously. An extra-budgetary public system of health care insurance was launched ten years after the country’s political system had changed, that is, in 1999.

This paper focuses on the introduction of an efficient system of private health insurance. The structure of financial resources to be used by private health insurance companies is also discussed. The conclusion is that with the present, centrally managed public system it will be very difficult to launch an efficient system of additional health care insurance due to difficulties with the application of financial equalization among insurance companies, the organization of a general supervisory body for solving key problems in the system, and increasing the efficiency of financial management in a centralized system. These would be necessary to ensure better conditions for proposing additional payments or additional health care insurance to the insured.

A model of financial flows for additional health insurance and an institution supervising the system (Healthcare Insurance Supervision Office) are also presented. Two models of public sector financial management which were implemented in Poland, that is, an insurance-budget system (self-governed) represented by Regional Sickness Funds and a centralized system under the National Health Fund (NFZ) are evaluated. Selected Regional Sickness Funds and later NFZ Voivodship Branches are analyzed using actual aggregated financial data as well as simulated data (as if the system had not been centralized in 2003).

The presented suggestions lead to the conclusion that reorganization of the existing public payer in Poland (NFZ) in the direction of a self-governed system will favor the establishment of more efficient commercial health insurance, at the same time creating better conditions for launching public and private long-term care insurance.

Słowa kluczowe :

stan zdrowia, samodzielność, opieka socjalna, ubezpieczenia społeczne, egzystencja

health status, independence, social care, social insurance, living


The development of the private health insurance and medical services market Poland in the years 2005-2010*

KSZTAŁTOWANIE SIĘ RYNKOWEJ OFERTY PRYWATNYCH USŁUG MEDYCZNYCH I UBEZPIECZEŃ ZDROWOTNYCH W POLSCE W LATACH 2005-2010*

Autor

Romuald Holly, Magdalena Szczepaniak, Uniwersytet Medyczny w Łodzi

ABSTRAKT

The reforms of the Polish health care system in the years 1999–2004, including the reform of health care financing, made it possible for private health care providers and insurers to design and launch a new range of products. By 2004, these products had become sufficiently mature and differentiated to undertake systematic research on the development of this market segment. Thus, the Observatory of the Health Insurance and Medical Services Market started to monitor the number of organizations offering supplementary health insurance coverage and subscription-based medical services, the number and type of products sold to corporate and individual customers, as well as the range, type, and availability of services and benefits. The major parameters of the structure of these products were also examined. The above monitoring gives a clear picture of the determining factors and development of the private health insurance and medical services market in Poland, as well as its impact on the evolution of the health care system in the years 2004–2010.

This paper focuses in particular on those findings which reveal the processes of adjusting health products to the needs and expectations of consumers/patients. Another major interest is how insurers and providers aggregate health risks and segment their clients to make their products not only profitable, but also compatible with the Polish health care system and with its legal and organizational framework to the greatest possible extent.

The results of our research and analyses indicate that risk adjustment methods can be used to design health insurance and medical service products that would be both attractive to the consumers/patients and profitable to the insurers and providers.

 

Słowa kluczowe :

zabezpieczenie zdrowotne, świadczenie zdrowotne, koszyk świadczeń gwarantowanych, prywatne ubezpieczenie zdrowotne, abonament medyczny, rynek ochrony zdrowia

health insurance, health benefits, guaranteed benefit package, private health insurance, subscription-based medical services, health care market


Private health insurance in Poland – current status, legal environment, development scenarios

PRYWATNE UBEZPIECZENIA ZDROWOTNE W POLSCE – STAN OBECNY, OTOCZENIE PRAWNE, SCENARIUSZE ROZWOJU

Autor

Adam H. Pustelnik, Polska Izba Ubezpieczeń, Komisja Ubezpieczeń Zdrowotnych i Wypadkowych

ABSTRAKT

In 2011, Poland will spend over PLN 100 billion on health care. Private spending amounts to over 30% of this amount, with a significant part of it (90%) being out-of-pocket expenses of individual patients. It should be stressed that this form of financing health care needs of society is the most ineffective, and it additionally strengthens inequality in the health care system.

These financial resources might be spent in a more effective and organised way via private health policies. However, due to the lack of any legal regulations regarding private health insurance, private health policies play a marginal role in Poland, in contrary to the majority of EU countries. Furthermore, Polish insurers are losing the battle for clients (patients) with medical networks, which offer prepaid (in the form of a lump sum payment for readiness) medical services to corporate customers.

The new Additional Health Insurance Bill recently proposed by the Ministry of Health (this bill is discussed in the present paper), despite plenty of weaknesses, is a small step in the direction of the rationalisation of private spending.

Changes in the legal environment on the state level and also on the European level are a factor stimulating further development of health insurance. From the perspective of the local legislation, the most important laws are the provisions of the new Medical Activity Act and the new Drug Reimbursement Act. The former undertakes a tentative attempt to incorporate private health insurance into the health care system, while the latter creates a friendly environment for medical co-payment insurance and possibly also for insurance products which could cover expensive specialist therapies.

From the European perspective, the key issue is the practical application of the Third Non -Life Insurance Directive, especially the freedom of services (FoS) principle, and the EU Cross-Border Health Care Directive coming into force in 2013, popularly known as the “patients without borders” directive.

The most important consequence of the Third Non-Life Insurance Directive is absolute freedom of the provision of insurance services by insurers with headquarters (HQ) in the EU, without the requirement to have local branches, which means open competition in the field of health insurance.

The “patients without borders” directive ensures equal access to health care services (public and private) to all European citizens across the entire EU territory, at the same time establishing very transparent costs reimbursement rules (the maximum being the guaranteed levels in the home-country of the patient). This directive applies mostly to ambulatory treatment and prescriptions acceptance.

Over the last couple of years, a new trend has become visible – the growing interventionism of EU countries” governments in the area of health insurance. The most important method of direct intervention is a risk equalisation system consisting of financial transfers from insurers with better risk profiles to insurers with worse-than-average risk profiles (within a given country).

Taking into consideration the previously described changes in the legal environment and the specific Polish political and economic situation, the author presents three scenarios for future improvements in the financing of the health care system in Poland: widespread co-payments, supplementary insurance development and introducing competition among payers and medical providers (mirroring the Dutch and Swiss solutions).

In summary, private health insurance is not a magic panacea for the health care system to function properly, but the right definition of the role, organisation and place of PHI within the basic health care system will increase its functionality and effectiveness, the quality of medical services provided and cost savings.

Słowa kluczowe :

prywatne ubezpieczenia zdrowotne, ubezpieczenia suplementarne, ubezpieczenia komplementarne, ubezpieczenia substytucyjne, współpłacenie, systemy wyrównywania ryzyka

Private Health Insurance (PHI), supplementary insurance, complementary insurance, substitutive insurance, co-payment, risk equalization systems


Impact of the costs of civilization diseases on the health policy in European Union countries and in Poland

WPŁYW KOSZTÓW CHORÓB CYWILIZACYJNYCH NA POLITYKĘ ZDROWOTNĄ W KRAJACH UNII EUROPEJSKIEJ I W POLSCE

Autor

Jakub Gierczyński, Krajowy Instytut Ubezpieczeń, Doradztwo i Ekspertyzy

ABSTRAKT

Diseases of civilization (non-communicable chronic diseases), also known as lifestyle diseases, appear to increase in frequency as countries become more industrialized and people live longer. The causes of lifestyle diseases are based on the general behavior of populations and individuals such as smoking, drug abuse, unhealthy diets, physical inactivity, stress and pollution. They include neuropsychiatric diseases, heart diseases, stroke, diabetes, obesity, alcoholism, chronic obstructive pulmonary disease, asthma, musculoskeletal diseases, some types of cancer, and others. Diseases of civilization result in a loss of independence, long-term disability, or death, and impose a considerable economic burden on the health services. Lifestyle diseases are the leading drivers of health care costs and have a substantial economic impact in the EU today. Comprehensive economic research and an approach to civilization diseases focused on public health should be the solid basis for the European Union’s social, economic and health policies. A comprehensive approach must include the entire EU population.

The EU health policy should be adopted by the member countries as health priorities for their health care systems. National policy measures require sustained political will, well-enforced legislation and effective public health care. Health professionals, media and, above all, politicians, should provide nationwide evidence-based advocacy demonstrating the health, social, and economic benefits of healthy lifestyles and the right health priorities.

Słowa kluczowe :

choroby cywilizacyjne, koszty chorób, priorytety zdrowotne, polityka zdrowotna, wyrównywanie ryzyka, narodowy program zdrowia

civilization diseases, costs of illness, health priorities, health policy, Risk Adjustment, national health program


Effectiveness of health care systems on the competitive health care market – discussion of the article*

SKUTECZNOŚĆ SYSTEMÓW OCHRONY ZDROWIA NA KONKURENCYJNYM RYNKU PŁATNIKA TRZECIEJ STRONY (omówienie artykułu*)

Autor

Barbara Więckowska, Szkoła Główna Handlowa

ABSTRAKT

Due to changes in the demographic structure of societies and medical technology improvement, governments are trying to find more efficient ways of spending public resources on health care systems. This article tries to answer the question of whether the introduction of competition between third party payers (TPPs) in the base health care system will contribute to an increase in the system’s efficiency.

The model defined for analyzing the relationship between the system’s input and output factors indicates that there is no significant correlation between competition among TPPs and the efficiency of the health care system – even with competitive TPPs there are systems with output indicator lower than those expected on the basis of input one.

The increasing average life expectancy is a phenomenon which has been observed almost everywhere in the world. On the other hand, the growth rate of other life expectancy measures such as DALE (disability-free life expectancy) and HALE (healthy life expectancy) is significantly lower,1 which means that the number of potential years in poor health is increasing, as is the expected total spending on per capita treatment. At the same time, not only the quality, but also the variety of health care benefits, as well as, once again, their costs, are increasing with the progress of medical technologies.2 Other problems such as the ageing process and the financial crisis have fueled the debate on the effective use of financial resources in social security systems, especially in those financed on a pay-as-you go basis. The efficiency of the health care system is not a widespread topic of academic research; the efficiency of the providers is investigated much more often. For the purpose of this research, the efficiency is defined as efficiency type X. A base health care system is understood as part of the social protection of health (constituting part of the health care system) in which the household (family) members participate on the basis of an obligation or affiliation (for more detail, see: Szumlicz (2005), pp. 68-70). And the concept of competition between payers is understood as competition for system participants (expected patients), whose choice of a given TPP results in a financial benefit for it in the form of a defined financial “reward” (premium, tax exemptions, subsidy). To analyze the efficiency of health care system answer 29 countries were chosen (27 EU member states plus Switzerland and Israel). Only seven of the analyzed countries fulfill the conditions for the emergence of competition between payers, i. e., (1) a multiplicity of TPPs and (2) the ability of patients to choose their TPP (for details, see: Więckowska (2010), pp. 12-22). These countries are: Belgium, the Czech Republic, the Netherlands, Israel, Germany, Slovakia and Switzerland. For these countries, the input and output factors were created and then theoretical vs. empirical efficiency indicators were analyzed and results for efficiency of system has been described.

Słowa kluczowe :

systemy ochrony zdrowia, rynek usług medycznych, efektywność

health care systems, health care market, efficiency, input indicators, output indicators


Possible approaches to benchmarking voluntary health insurance funds in Bulgaria – discussion of the article*

MOŻLIWE PODEJŚCIA W BENCHMARKINGU DOBROWOLNYCH FUNDUSZY UBEZPIECZEŃ ZDROWOTNYCH W BUŁGARII (omówienie artykułu*)

Autor

 Petko Salchev, Nikolai Hristov, Lidia Georgieva, Medical University of Sofia (Bulgaria)

ABSTRAKT

Following the adoption of the Health Insurance Law in Bulgaria (1999), which provided the legal framework for the development of voluntary health insurance, several health insurance funds were established. While Bulgaria had two licensed voluntary health insurance funds in 2001, in 2003 their number grew to six, and in 2009 this number stood at over twenty. Despite the increasing number of funds in recent years, their share in health care spending remained at 1–1.5%, which is below the European average. To this date, the scientific community in Bulgaria has not produced any serious, in-depth studies in this field. The economic data published by the Commission of Financial Supervision (CFS) conform to EC regulations, but do not allow non-specialists to get a realistic assessment of voluntary health insurance funds (VHIF).

This article introduces a methodology for comparing VHIFs and establishing a complex index (Benchmark Index – BI) based on 5 groups of indicators related to several available variables.

This index is intended as a tool for analyzing the voluntary health insurance sector and managing resources through a set of analytical indicators and variables. It can be used to create a certain type of ranking of VHIFs.

Słowa kluczowe :

dobrowolne ubezpieczenia zdrowotne, rynek, metody porównania, benchmark indeks

voluntary health insurance, market, comparing methods, benchmark index


Human resources management systems in Polish public hospitals

SYSTEMY ZARZĄDZANIA ZASOBAMI LUDZKIMI W POLSKICH SZPITALACH PUBLICZNYCH

Autor

Joanna Sułkowska, Społeczna Akademia Nauk (Społeczna Wyższa Szkoła Przedsiębiorczości i Zarządzania)

ABSTRAKT

Human resources management in hospitals is different from personnel management in enterprises. The purpose of the 2010 research project was comparative analysis of the case studies of four hospitals operating in the Lodz voivodship which differ in terms of their mission, structure, and founding bodies. Although public hospitals have a very clearly defined social mission, they often do not have a formalized strategy. Hospitals have a personnel strategy different from companies. The studied health care entities were characterized by very stable staffing, but there was a clear tendency for a higher turnover of staff in restructuring situations. The personnel policy is petrified and similar to the traditional model of human resources administration rather than to human capital management. The system of human resources administration is extended and formalized. The dominant segment is recruiting according to the division of occupational groups, namely doctors, nurses, and other medical staff. The motivational and reward systems are inflexible, rigid and offer weak incentives. The paper describes the specificity of the models of human resources management in Polish hospitals. The analysis is of theoretical and empirical nature. The empirical part of this study is a pilot comparison of human resources management systems used in four hospitals operating in the region. The research project was carried out based on the methodology of comparative analysis of case studies.

Słowa kluczowe :

zarządzanie personelem szpitali, zarządzanie zasobami ludzkimi szpitala

personnel management in hospitals, human resources management in hospitals


Non-insurance instruments of relationship marketing in business management in the healthcare sector

POZAUBEZPIECZENIOWE INSTRUMENTY MARKETINGU RELACJI W ZARZĄDZANIU PRZEDSIĘBIORSTWEM SEKTORA OCHRONY ZDROWIA

Autor

Edyta Skibińska, Uniwersytet Medyczny w Łodzi

ABSTRAKT

The modern method of explaining consumer behavior puts a new background process of marketing segmentation, or grouping of customers in a relatively one group of divers on the basis of various characteristics (eg demographics, lifestyles, social sobow reaction, needs). The concept of relationship marketing in this context is a huge challenge to marketing strategies. The article suggests that the brand-tingu relationship especially at the stage of the customer to stop use of segmentation, which is based on behavioral variables: (a) long-term customer profitability, (b) the tendency to loyal customer behavior.

Customers segmentation in order to build the most profitable portfolio is extremely important

because it gives you a chance to gain competitive advantage. Analysis of the Lifetime Value (LTV) – lifetime customer value is used to measure customer profitability. This is the best measurement tool, because as the only indicator allows you to pair with each other while the three aspects: retention, revenues and expenses.

Słowa kluczowe :

marketing relacji, Lifetime Value, segmentacja klientów

relationship marketing, Lifetime Value (LTV), customers’ segmentation


"THE SUCCESSES AND DEFEATS OF HEALTH INSURANCE ON EMERGING MARKETS IN CENTRAL AND EASTERN EUROPEAN COUNTRIES - LOOKING FOR THE RIGHT WAY", INTERNATIONAL CONFERENCE IN KIEV, 3-4 NOVEMBER 2011

Autor

Wyboru tez referatów prezentowanych na konferencji dokonała: Dominika Cichońska - Uniwersytet Medyczny w Łodzi

ABSTRAKT

Słowa kluczowe :


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