Strategy for PHC, strategy for patients

Strengthening the role of primary health care is one of the cornerstones of public health and the conditions for maintaining a stable, effective and safe health care system. Therefore, it is undoubtedly a positive phenomenon that works on development strategy for this sector are being continued. It is said that even a draft report has been prepared.

The information on the content of this report which has thus far been available in a fragmented manner does not allow conclusions to be made about the direction and definitely it will be necessary to wait until the Health Minister discloses the report to fully assess its contents.
It is worth reminding briefly how we arrived at this point of PHC organisation and why we are here. It was only twenty years ago that the physicians working ‘in the district’ (what a terrible phrase, isn’t? ...) carried out their duties within the organisational framework of health care institutions.

However, it was not exactly an integrated form of care due to ineffectiveness and futility of various incentive mechanisms in a purely budgetary system. Introducing and developing a contract-based system that replaced budgetary planning led to rapid disintegration of forms of organisation, whereas in the few places where such organisations managed to defend themselves, their efficiency seems to be far from perfect. The former public health care institutions (Polish ZOZ) quite quickly underwent privatisation, entirely new entities were established, and currently privately owned entities constitute about 90% of the total potential.

At present several trends can be observed to have impact on the organisational forms. Firstly, large networks of health care providers are being developed, although their growth rate seems to be much lower than the growth that can be observed with regard to the pharmacy sector. The process of privatisation of the public entities supervised by the local authorities, especially by the local self- government, has been considerably slowed down. One might risk stating the opposite - that public hospitals began, sometimes successfully, to create their own PHC centres. At the same time, some of the slightly larger private entities started to grow ‘vertically’ by offering services within other scopes of health care benefits, such as advisory clinics, rehabilitation or one-day clinics.

Soon after privatisation took place, exceptionally rapid emergence of organisations defending the interests of these newly established entities could be observed, which was actually a result of the reform attempted in the very beginning of the existence of the Polish National Health Fund (NFZ).
These organisations were effective in attaining their goals, despite changing government coalitions and a wide range of concepts for health care governance – and they did it either by negotiation or by exerting public pressure, or resorting to strike action. Public funding of primary health care increased, not only in terms of absolute but also relative amounts, although, it is honest to say so, as a general rule the scope of responsibility was broadened too.

The announced document, therefore, will be of importance not only for the PHC entities and their staff. Preparing myself to do some research on the subject, I decided to make a checklist:

1. How will the PHC team be defined and will it still be a team? The possible role of a nurse is not the only challenge but certainly the first to be encountered.
2. How will implementing the strategy impact other segments of the health care system? Peer review is an essential part of functioning of every organisation and assessment of specialist care, hospital care or long-term care cannot be avoided.
3. Will development of prevention be included and how will it be done?
4. Will the role of the local self-government be recognised and, if yes, in what ways will it be done? Difficulty in accessing a primary care physician is a strongly diversified problem in terms of geographical location and it would certainly be more effective to support the self- governments on one hand and get them involved in problem solving on the other hand.
5. Will the possible organisational changes, which are likely to quite rightly highlight the need for greater coordination, not cause the competitiveness potential of PHC (possibly being the reason for quite good results obtained in patient satisfaction surveys) to be lost?
6. And the final question, linked to the previous questions, and a fundamental one: how will the new strategy affect the patients? How to convince them that within PHC it is really possible to obtain a majority of needed everyday health care benefits?