28 Jun Inside Poland’s Healthcare Industry: An Interview with Prof. Jaroslaw J. Fedorowski
In this article, we interviewed Prof. Jaroslaw J. Fedorowski, President of the Polish Hospital Federation to give us an overview of the Polish Hospital Federation and how their organization helps the healthcare industry in their country. It also features Poland’s healthcare structure and the challenges they face in healthcare service delivery.
Tell us a little bit more about what your organization does and how it helps the healthcare industry in your country.
The Polish Hospital Federation / Polska Federacja Szpitali (PFSz) is a hospital employers’ organization operating under the act for associations and employers’ organizations of the Republic of Poland. PFSz associates directly over 260 hospitals, and by means of signed agreements with smaller local or sectorial hospital organizations functions as a nationwide umbrella federation for the majority of hospital resources in Poland.
PFSz associates hospitals regardless of their ownership structure, size or model of operation. Most member hospitals are part of the national hospital network, but there are also hospital members from outside that network. Over 50 companies, many of these are key players on the healthcare market, are supporting members of the PFSz.
The PFSz is the voice of Polish hospitals on the European level by means of full membership at the European Hospital and Healthcare Federation HOPE and on the global level as the full member of the International Hospital Federation IHF. It is an active participant of the national and international social dialogue in health care.
The Polish Hospital Federation recently celebrated its 10th anniversary, can you give a brief history of how it started and what were the challenges along the way?
This year, the Polish Hospital Federation – Polska Federacja Szpitali (PFSz) celebrates its 10th anniversary. By 2011, there had not been a nationwide hospital federation, just several local and hospital-type specific organizations. The idea came from me, at that time, I was a hospital management company executive, a hospital physician, and a university professor in medicine and management. Together with 13 hospital managers, we initiated the founding meeting of a new organization, in principle associating hospitals regardless of their ownership model, location, specialty profile, or size – so-called federation beyond divisions.
The first years were not that easy for the new federation, but the persistence and patience gradually paid off. The PFSz was admitted to full membership by the European Hospital and Healthcare Federation HOPE, joined the general organization of employers in Poland, and became a part of the tri-party social dialogue process on the national level. The membership increased year by year and within 5 years and PFSz became the organization with the most representative hospitals in Poland.
In 2015, the PFSz organized the summit of the European Hospital and Healthcare Federation HOPE in Warsaw that turned out to be a big success. When the membership exceeded 200 hospitals, the PFSz signed agreements with several local and hospital type-specific associations becoming an umbrella organization for the majority of hospitals countrywide.
The COVID-19 pandemic placed huge pressure on hospitals in Poland, and the PFSz proved to be the strongest non-governmental aid, resource, and representation for hospitals fighting the pandemic. Investment in young healthcare managers paid off by means of the materialization of several projects, like reports on medical start-ups, code of conduct for personal data protection for healthcare institutions, AI in health coalition and congress and so on. Among the scientific projects, one project stands out – the project “tobacco-free hospitals” under a grant from the National Cancer Institute (USA) with results published in an international peer-reviewed journal with impact factor.
The Polish Hospital Federation wants to be active on the global hospital agenda as the full member of the International Hospital Federation IHF – the only worldwide hospital association.
What are the key challenges in healthcare service delivery in your country? How does your organization help address these challenges?
The key challenges facing hospitals in Poland now are: the return of hospitals to normal functioning after the peak of COVID-19, medical staff shortages, insufficient finances, and the new government proposed changes to the hospital system in Poland. There are also ongoing opportunities related to digital development, e-health services, innovative solutions and AI in health care. The PFSz is a leader of important projects related to AI, personal data protection, vaccinations, staff support, medical data donation, medical start-ups, mentoring for hospital executives, coordinated healthcare and member of many working groups and teams in the healthcare sector.
Can you tell us about your organization’s approach to managing through COVID-19? What are some of the specific actions you took in response to COVID-19?
Since the beginning of the SARS CoV-2 pandemic, the PFSz has been implementing aid projects for hospitals, donations and information campaigns for patients, hospital employees and general society. The PFSz has been providing hospitals with the most up-to-date information on market changes, opportunities to obtain innovative medical equipment, providing support for hospital directors in crisis management in times of a pandemic. The PFSz has also prepared several campaigns; the #fearHospitalNOT campaign directed to alleviate the hesitancy of patients to come to the hospital for medical procedures, another worth mentioning is the campaign, #VaccinatePoland aimed to increase the number of vaccinated people, primarily against COVID-19.
What do you wish to improve in the healthcare service delivery in your country?
The main proposal of PFSz is the full-scale introduction and implementation of coordinated health care organizations with competition based on value for patients. The PFSz works in partnership with the Polish Association of Managed Care that was established by the PFSz for the purpose of promotion of integrated care and value-based healthcare. Other important proposals are to strengthen the position of hospital executives, improve hospital organization in the direction of interdisciplinary care areas based on the intensiveness of the level of therapy and increase investments in health care systems, as well as speeding up healthcare innovations.
What’s on your agenda for the next five years and what are your ultimate goals for your organization and the healthcare service delivery industry in your country?
The PFSz is looking for an integrated health care delivery system based on cooperation among its stakeholders with competition for the best value for patients. We are aiming at a resilient and balanced healthcare system with an appropriate position of both governmental and non-governmental organizations. We are supporting a continuous increase in health care financing in order to reach levels proportional and compatible with well-developed nations. One of the important goals is the utilization and development of AI and other innovative technologies in order to use human resources effectively.
Can you give us a brief overview of Poland’s national healthcare organizational structure (e.g., regulation, governance, etc.), financing and organization of the provision of services?
The Polish health care system is based on the public insurance model. The compulsory health insurance contribution is paid for by citizens via the social security administration to the National Health Fund (NFZ) and amounts to 9 percent of earnings indexed to the so-called “basal healthcare contribution rate”. The National Health Fund finances health services delivered to insured citizens by various medical providers, based on the contractual relationship with them.
Social welfare centers are covering for the unemployed, a special fund insures the farmers and the state budget covers the clergy. People insured in the National Health Fund, apart from the insurance premium, do not incur additional costs of treatment. The exceptions include medicines, some of which are available for a lump sum or partial payment: sanatorium care, and adult dental care, some of which are paid for by the patient.
The principle of social solidarity means that regardless of the amount of the contribution paid for health insurance, all citizens deserve the same access to treatment. Each insured person may take advantage of, among others, medical examinations and consultations, if necessary also at home, outpatient and inpatient treatment, medical rehabilitation, and preventive medicine.
Hospital care is the largest sector in the health care system, as far as the size of the workforce, amount of finances and infrastructure are concerned. There is a national hospital network of 590 hospitals with 6 levels of coverage. Care provided by the hospitals is financed by the NFZ by means of pre-assigned budgets for each year. Hospitals report their services to NFZ on the diagnostic related groups model. Outpatient clinics and diagnostic facilities are often located next to the hospitals, they are financed by the NFZ on a fee-for-service model. Some hospitals, especially university hospitals, provide pre-and post-graduate medical education. Medical universities are owners of teaching hospitals.
The coverage levels of national network hospitals in Poland were introduced in 2017. Hospitals are classified into three levels:
- 1st level – hospitals providing health services in four basic medical specialties: internal medicine, general surgery, obstetrics and gynecology, pediatrics as well as intensive care,
- 2nd reference level – provincial hospitals providing, apart from health services in the above-mentioned specialties, services in at least four of the following specialties: cardiology, neurology, dermatology, pregnancy and neonatal pathology, ophthalmology, ENT, trauma surgery, urology, neurosurgery, and pediatric surgery, oncological surgery,
- 3rd reference level covers larger multispecialty hospitals acting on a regional level
There are also three special levels of hospitals: university hospitals and nationwide medical institutes, oncology, and pulmonary care centers as well as children’s hospitals.
The network hospital ownership in Poland is mixed. Most are owned by local county or city governments, but there are also hospitals owned by provincial governments, the ministry of defense, the ministry of interior, churches, private companies and universities. The majority of network hospitals are not-for-profit but there are also for-profit, incorporated ones in the network both publicly and privately owned. Almost all hospitals out of network are private for-profit, mostly providing specialty surgical procedures, sometimes with reimbursement by the NFZ. There are also hospitals belonging to pre-paid care corporations providing care for their clients, usually for less complicated conditions.
Primary care is largely private and is based on individual or group practices of family physicians, internists and pediatricians. They are paid on a capitation model by the NFZ. Emergency medical care outside of the hospitals is almost entirely public as the national rescue and emergency service.
Poland has one of the best and most modern in the EU fleet of emergency rescue helicopters covering the entire country as well as many modern well-equipped ambulances. The total healthcare financing in Poland is below the EU average, currently at 6.8 % of GDP. It has been increasing year by year but not fast enough to keep up with expectations of the society and rising expenses.
About the Polish Hospital Federation
The Polish Hospital Federation is the employer’s organization representing hospital providers. The mission is to continuously improve the situation of hospitals on a nationwide and international level. The portfolio includes the majority of hospitals in Poland, a large number of corporate supporting members matched to a strong team of healthcare executives, including an amazing team of young healthcare managers. The priorities evolve around managed care, value-based healthcare, social dialogue and cooperation among key stakeholders, health investments and innovative medicine. The PFSz is also active on the European and global levels. One of PFSz’s dream plans is to organize the IHF World Hospital Congress in Poland in the next 5 years. www.pfsz.org