Journal of Health Policy,
Insurance and Management

Polityka Zdrowotna


Journal of Health Policy, Insurance and Management – Polityka Zdrowotna XI 2012

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Hospital antibiotic policy with the cooperation of the hospital infection control team in the light of new acts of law



Beata Mączyńska, Uniwersytet Medyczny we Wrocławiu


The development of appropriate hospital procedures of antibiotic policy consilient with the binding law and Ministry of Health recommendations, is the duty of hospital, nowadays. The reason of such obligation is not only rationalization of patient’s therapy, but also obtainment of conditions preventing from nosocomial epidemiological outbreaks formation and microorganisms resistance development. Moreover, antibiotic policy allows to control drugs utilization and last but not least – to estimate cost-effectiveness of antibiotic therapy. One of the most important aspects of antibiotic policy is establishment of empiric therapy procedures obligatory in case of severe infected patients. In such situation, the choice of proper antibiotic determines survival of patient and further therapeutic prognosis. Rational hospital antibiotic therapy depends from multiple factors, such as: the knowledge of nosocomial etiological factors, appropriate level of microbiologic tests (determining the local resistance patterns, especially) and carrier – state tests during patients admission, appropriately scheduled drug formulary and well established rules of periprocedural prophylaxis. All above mentioned elements should be a part of comprehensive system serving as efficient tool for the Hospital Infections Control Team in monitoring and prevention of nosocomial infections.

Słowa kluczowe :

szpitalna polityka antybiotykowa, koszty antybiotykoterapii, terapia empiryczna, oporność drobnoustrojów

antibiotics hospital policy, antibiotic therapy costs, empiric therapy, microorganisms resistance

Laboratory diagnostician in medical statistics



Grażyna Dykowska, Uniwersytet Medyczny  w Warszawie


A high number of variables present in the authorization to practice a profession of laboratory diagnostician causes questions with the completeness and quality of statistical data. Against a background of other medical professions, laboratory diagnosticians constitute one of the least numerous professional groups that have the license to practice a profession. In this field, medical statistics ought to be the source of information also for the professional self-government, which has the right to make motions to the Ministry of Health concerning the possibility of gathering specific information that seem to be substantial.


Słowa kluczowe :

opieka zdrowotna, diagnosta laboratoryjny, statystyka medyczna, dostępność, jakość danych statystycznych, podmioty systemu ochrony zdrowia

health care, laboratory diagnostician, medical statistics, availability, quality of statistical data, subjects of the health care system

The perspectives of professional development for laboratory diagnosticians in the light of automation in clinical analytics (opinion paper)



Jerzy W. Naskalski, Państwowa  Podhalańska Wyższa Szkoła Zawodowa w Nowym Targu


A proper diagnosis and treatment require combining of two separate skills: medical approach to patient and his symptoms and appropriate use of laboratory examinations, which extend information about the disease. Specificity of laboratory work effected in the development of professional group, initially called ”clinical chemists”; who performed chemical analysis of biological fluids and microscopic examinations of cells and casts. Professional competence of clinical chemists combined the knowledge of analytical chemistry and the ability to perform microscopy examination of blood, urine, secretions and excretions. However, automation of analytic techniques resulted in the elimination of manual work which formerly in clinical laboratories was considered as the specific skill of clinical chemists. On the other hand automation made possible to increase the number of the laboratory tests performed. This changed the character of work in the clinical laboratory. The realization providing of laboratory tests has become a continuous process and the clinical chemist have to supervise the laboratory work-flow rather then to perform the individual analysis. In effect, laboratory workers main task is now the management of the process, including operation of machines and observing the quality requirements assuring appropriateness of the performed tests is the main goal of laboratory work. This requires a new knowledge which refers to the work management in the laboratory, quality control, cost- benefit analysis of the particular tests performed and the supervision of the preanalytical and postanalytical phases. Another consequence of the automation, which increasingly influences the practical development of laboratory diagnostics, is consolidation. Consolidation is the process of combining analogical tasks and different analysis on common analytical platforms within one organizational structure. Main reasons for the consolidation is cost reduction by a more effective use of human resources ant the laboratory facilities. This is achieved by combining biochemistry, immunochemistry, endocrinology, microbiology, genetics and other specific domains of laboratory medicine in the same laboratory infrastructure. This enables using the same material transportation channels and results transfer of back to ordering physicians. Moreover, location of various laboratories in the same space offers the increase in a work force mobility, which is particularly important for the 24-hour round work of the laboratories. Therefore, the role of the diagnosticians is now focused on the management of various analytical processes in the wide-profile clinical laboratory. This requires a particular education of laboratory staff providing of the ability to work in various work stands and to communicate with physicians and nurses. The consolidation of laboratory services also occurs in many Polish laboratories, in particular in small hospitals, which can not find separate professionals to cover all laboratory positions, and can’t afford to keep multiple specialized laboratories. However, only a few laboratory workers is properly prepared to such work. Therefore there is reasonable to pose a question whether the present form of education in laboratory medicine provides the knowledge that meets requirements of modern laboratory and offers the perspective of successful professional carrier.

Słowa kluczowe :

kształcenie diagnostów, organizacja pracy, zarządzanie procesem analitycznym, zmiany charakteru pracy

formation of clinical chemists, organization of work, analytical process management, work character changes

Changes in the education of medical personnel in respect of legal regulation resulted from legal act concerning laboratory diagnostics



Katarzyna Chmielewska, Departament Nauki i Szkolnictwa Wyższego,Ministerstwo Zdrowia


Before the July 27, 2001, when the legal rule concerning laboratory diagnosticians was established, the job performed by laboratory diagnosticians (clinical chemist) was not legally defined. Lack of legal rules in this area developed the situation when a person with different professional and educational background was allowed to perform the professional activities in medical laboratories. Since the legal regulation act concerning the professional activities in medical laboratories was established, the several fundamental changes in the process of vocational education and training essential for a proper job performance in medical laboratories took place. The legal framework prepared by Polish Parliament has established the leading role of education syllabus offered by Medical Analytics (Laboratory Medicine) Faculty and accepted the standards of education in those Faculties as a model for development of supplementary post-graduate education for such as: biologist, biotechnologist, chemist, pharmacist, doctor of medicine, or veterinary. In this way, the decision made in June 23, 2005 by the Polish Constitutional Court was fulfilled. The Polish Constitutional Court several times indicated that the legal rules concerning the condition for performance of professional activities in medical laboratories cannot limit the freedom of access to the job as long as the employee in medical laboratory is properly prepared for job performance by completing theoretical education and vocational training. The proper qualification of medical laboratory employee confirmed by formal body gives the assurance of consumer protection and safety. In the near future, it is expected that some changes in legal acts regulating of the professional activities of laboratory diagnosticians will take place. The expected changes in legal rules will be considered as a part of Polish Government activities connected with the creation of National Qualification System of university education which will be based on the learning effects as  the principal criteria for acceptance of the level of education sufficient for the certain job performance. That activities have implemented on the base of suggestion of European Parliament and European Council made in April 23, 2008 concerning the implementation of European Frame for Qualification for permanent education during entire life. That rules were accepted in March 2011 by Polish Government in the strategic document “Perspective of education during entire life” which consists the rule of promotion and support of good quality education for different group of citizens in  different forms and places. The system of education and vocational specializations established in the legal act concerning laboratory diagnosticians and the obligation of incessant improvement of vocational education are in good agreement in that strategy. It is necessity for the further promotion and support the process of incessant education of laboratory diagnosticians.

Słowa kluczowe :

kwalifikacje, kształcenie przeddyplomowe, efekty kształcenia, specjalizacja

qualifications, pre-graduate education, effect of education, specialization

The role of scientific societies in laboratory medicine as a clinical discipline



Bogdan Solnica, Uniwersytet Jagielloński-Collegium Medicum


Laboratory diagnostics is present in all clinical specialties, being a separate specialty utilizing its own analytical methodology, measuring instruments, and alsothe rules of standardization or quality assurance.
In Poland, there are two scientific associations active in the field of laboratory medicine: the Polish Society of Laboratory Diagnostics and the Laboratory Medicine College. Laboratory diagnostics  is also in present the activity scope of many other scientific medical associations. Scientific societies play an important role in advancing the methodology of laboratory diagnostics and improvement of professional skills of laboratory diagnosticians and clinicians. Societies also create contact platforms and structures to introduce out research into laboratory medicine. They play an important role in linking science to everyday practice in accordance with the principles of Evidence-based Laboratory Medicine.

Słowa kluczowe :

medycyna laboratoryjna oparta o dowody naukowe, szkolenie podyplomowe, zalecenia praktyki klinicznej

evidence-based laboratory medicine, postgraduate training, clinical practice guidelines

Access to immunization in selected countries of Central Europe - a review of mechanisms of financing and effectiveness



Paweł Grzesiowski, Fundacja Instytut Profilaktyki Zakażeń Warszawa

Katarzyna Wepsięć, Dominik Dziurda, Sławomir Roś, GSK Services


Vaccinations are one of the most important achievements in medicine because through their use on a broad spectrum the incidence of serious infectious diseases is reduced what improve the quality of peoples’ life. National immunization programs in countries with limited health budgets on prevention, provide citizens with free access to basic services in the field of vaccination, and modern technology, such as a combined vaccines require subsidies, making it difficult to access these benefits poorer social groups. In this paper we compare the immunization system in Poland, the Czech Republic, Slovakia and Hungary. Basic factors influencing patients' access to vaccines were diagnosed and the effectiveness of systems in terms of the number of doses of vaccine per one newly born child on selected examples were evaluated. On the basis of the study showed that the main determinants of the percentage of the population vaccinated, is free access to vaccination and obligation to adopt national programs saved. An important role is also public payers co-payment, which facilitates patient access to innovative solutions by reducing the costs associated with them.

Słowa kluczowe :

program szczepień ochronnych, mechanizmy dostępności szczepień, metody finansowania szczepień

immunization program, mechanisms of access to vaccines, immunization financing methods

Laboratory Diagnostics – market of in vitro medical devices (IVD) in 2005-2010 years



Józef L. Jakubiec, Izba Producentów i Dystrybutorów Diagnostyki Laboratoryjnej (IPDDL)


IVD (In Vitro Diagnostics) is the description of goods manufactured by branch of industry produced the equipment and reagents for medical laboratories. Development of IVD market in Poland is necessary for providing the good quality medical service at satisfactory level. The collected data have indicated that from 2005 to 2010 years the dynamics of IVD financing was two times lower then the global financing of health care system in Poland. In comparison to other countries of United Europe (UE) the average financing of IVD / per capita in Poland was 5.2 EUR in 2005 year and elevated to 6.3 EUR in 2009 whereas in other countries of  UE, the average IVD financing / per capita was 19.5 EUR in 2005 and elevated to 23.4 EUR in 2009 year. The percentage contribution of spending on IVD in global financing of health care system in Poland is effects, from 2003 to 2010 the reduction was about 25 percentage points. This trend possesses the negative influence on function
of medical diagnostics in Poland.

Słowa kluczowe :

medical laboratory diagnostics, IVD medical devices, IVD market

medyczna diagnostyka laboratoryjna, produkty IVD, rynek IVD

The value of outsourcing services in the field of laboratory diagnostics



Zenon Jakubowski, Marlena Robakowska, Uniwersyteckie Centrum Kliniczne, Uniwersytet Medyczny w Gdańsku


This article is devoted in majority outsourced services in the field of laboratory diagnostics. Outsourcing in Poland is practiced primarily as a so-called  contested takeover. Before decision of outsource are able to objectively evaluate several factors, min.

- the impact of the decision to outsource for basic hospital activities - NFZ contracts,
- identification of a potential contractor having particularly its availability,

- scope of the proposed service, reliability and stability in the market,

- detailed analysis of the costs of test in both cases, the hospital before the change and the cost
of outsourcing.

It can be a good solution for laboratories which do not meet the quality requirements
or financial loss-making.

Słowa kluczowe :

outsourcing, laboratorium diagnostyczne, koszty, budżet, rynek usług medycznych

outsourcing, laboratory diagnostics, costs, budget, medical service market

The issue of patients’ rights in laboratory diagnostics act



Anna Augustynowicz, Uniwersytet Medyczny w Warszawie

Henryk Owczarek, Uniwersytet Medyczny we Wrocławiu


Constitution of the Republic of Poland is the fundamental legislative act that contains regulations concerning patients’ rights . It guarantees the right to protect life of every citizen, right to protection against medical experiments and what is more, right to protect health.
The essential act that relates to such problems in detail is the act of 6th November 2008
on the patients’ rights and Patients’ Rights Advocate (Journal of Laws: 2009, No 52, item 417 with further changes). A number of regulations concerning patients’ rights may be also found
in laws regulating execution of medical professions for instance, in laboratory diagnostics act
of 27th July 2001 (Journal of Laws: 2004, No 144, item 1529 with further changes). Patients’ laws regulated in the aforementioned act will be the subject of the following analysis.

Słowa kluczowe :

prawa pacjenta, zgoda, tajemnica, odpowiedzialność

patients’ rights, agreement, secret, responsibility

Cultural limitations of entrepreneurship – quality research of Polish hospitals



Łukasz Sułkowski, Uniwersytet Jagielloński, Społeczna Akademia Nauk


The purpose of this article is to identify barriers to entrepreneurship and change, which is a source of organizational culture and identify opportunities to reduce these barriers. Analysis of barriers to entrepreneurship and cultural changes were organized on the basis of empirical studies conducted in the framework of the grant, "Barriers to organizational changes in the culture of Polish hospitals" and the earlier pilot studies (Uniwersytet Jagiellonski, Społeczna Akademia Nauk 2010-2012).

Słowa kluczowe :

przedsiębiorczość szpitali, kulturowe bariery przedsiębiorczości, konserwatywna kultura, kulturowe bariery zmian

entrepreneurship hospitals, cultural barriers to entrepreneurship, conservative culture, cultural barriers to change

Health care systems in Caucasian countries: Armenia, Azerbaijan and Georgia



Barbara Foczpaniak, Społeczna Akademia Nauk


Until 1991 health care systems in Armenia, Georgia and Azerbaijan were the part of Soviet health system, centrally managed from Moscow. Health law in Russia and Soviet Republics, passed in 1964, determined the framework of acting for every republic. Few duties only remained in the hands of local bodies with their role limited only to advise the central authority in the health plan execution. The Soviet health care system created by Nikolai Semashko – the first Soviet Commissar of Health, based on government responsibility for health, universal access to free services, a preventive approach to “social diseases”, quality professional care, a close relation between science and medical practice and continuity of care between health promotion, treatment and rehabilitation. Parallel health care sub-systems were set up for certain industries and ministries and other categories such as party leadership, defence, security, miners etc. As a result there was over – provision of hospital beds as well as the medical personnel. Budget of the Ministry of Health was based on means left over after all other priority areas of the economy, e.g. military, heavy industry. After the collapse of the Soviet Union in 1991 republics became independent what resulted with the destabilization of their economic situation and the need to take immediate reforms concerning the health care system.Nowadays as European Union deepens its cooperation with its neighbours and countries as Ukraine and Turkey are considered as future members of common market, it became important to analyse their health care systems development and their conformity level with European health regulations and principles.

Słowa kluczowe :

systemy ochrony zdrowia, ministerstwo zdrowia, sowieckie republiki

health care systems, Ministry of Health, Soviet Republics

Trends of changes in Polish health care system – needed and real



Jakub Gierczyński, Krajowy Instytut Ubezpieczeń, Doradztwo i ekspertyzy


On 27 February 2012 the seminar "Trends in the Polish health care system-desirable and reasonably" was held at the National Institute of Public Health-National Institute of Hygiene
in Warsaw . The organizers of this project were: the National Institute of Public Health-National Institute of Hygiene and the National Insurance Institute in Warsaw. The session was also attended by representatives of the Ministry of Health, Department of Medicine, Medical University of Rzeszow, experts and decision-makers and health care system.

Słowa kluczowe :

system ochrony zdrowia, opieka socjalna, ubezpieczenie społeczne

health care system, social care, social insurance

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