Hospital reform. The management of the Ministry of Health about key solutions and changes

The Ministry of Health is preparing for a key hospital reform, the concept of which was commissioned Izabela Leszczyna – prepared by a team of experts. The draft amendment to the Act on health care services financed from public funds, which is to be the foundation of the project, is waiting for consideration Council of Ministers. The ministry's announcement shows that this may happen at one of the next government meetings.

The project involves changing the rules for qualifying hospitals for the so-called system of basic hospital provision of health care services (so-called PSZ) and consolidation of hospitals. During a meeting with journalists on Thursday, Leszczyna and Deputy Minister of Health Jerzy Szafranowicz, appointed to this position in mid-year (an orthopedic doctor who managed medical facilities in the past), presented the key solutions of the reform and changes that they decided to introduce in its assumptions in the final stages.

– Voluntary is the key word – emphasized the Minister of Health. – We guarantee all bodies creating hospitals – starostas and marshals – that they will join our project voluntarily. Its goal is to tailor a hospital to the size of the place where it is located and the needs of the residents there, she declared.

The Ministry of Health has made a diagnosis of today's situation. This is the failure to adapt services to the health needs of society, keeping too many medical teams on standby, lack of places in long-term care units and the debt of hospitals. The reform, according to the ministry's concept, is intended to help solve these problems.

– The structure of hospital wards in Poland does not meet the expectations of our patients. (…) We live longer, but we don't have geriatric wards, we don't have hospices, we don't have long-term care wards, we don't have one-day wards. However, we have 24-hour surgical departments, and there are too many of them. We propose in this reform: directors communicate among themselves. Not every hospital must have all business profiles. If these hospitals are 10-15 kilometers away, divide the departments and change the service profiles. All this is intended to serve financial liquidity – costs are lower – and quality for the patient – explained Jerzy Szafranowicz.

This is also intended to support the “rationalization of human resources management”, i.e. solving the problem of the lack of doctors and other medical staff in a situation where several hospitals next to each other conduct the same activities and compete with salaries for the same employees.

The deputy minister said that more than half of district hospitals in Poland are in debt. He gave the example of a district where the starost goes into debt to parabanks every month to have money for salaries. University hospitals, marshal hospitals and uniformed hospitals are coping, but district hospitals require urgent help, he emphasized.

The reform involves National Reconstruction Plan. Under it, Poland is to receive PLN 17 billion for investments in health care. Part of these funds will be used to modernize departments and improve the quality of medical services in facilities under the Ministry of Health program

– We have PLN 1.5 billion for hospitals that will join the reform – said Szafranowicz. But the starting point for activating these funds will be the presentation by hospitals of recovery plans, which will be assessed by the Agency for Health Technology Assessment and Tariff System and by National Health Fund. The time to present recovery plans was set for the third quarter of next year. The new hospital network (i.e. reform) is to come into force in mid-2027. The condition for joining the network is that the hospital must have had a 24-hour hospitalization unit for at least two years.

The ministry is also working on a solution so that hospitals that enter the network and undertake the implementation of recovery programs can sign an agreement with Bank Gospodarstwa Krajowego. This one will take over his credits. The hospital will repay them, but not on the terms it had to meet when it borrowed from parabanks.

Leszczyna emphasized that the reform does not mean reducing the debt of hospitals. She recalled that this happened in the past and did not change anything – the clinics fell into further debts. But the program is intended to help them get out of the dramatic situation of constant further debt. Although it won't be easy, she said.

The Ministry of Health decided to change the rules regarding the qualification of maternity centers as part of the hospital network. Connecting departments between hospitals will be voluntary. This will be decided by a team of experts under the voivodeship, not the guidelines on the number of deliveries.

– I hope this will calm public fears. There is nothing worse than the fear of women who are afraid of getting pregnant, said the head of the Ministry of Health.

So far, the ministry assumed that only those facilities where a certain minimum number of deliveries were delivered annually would be included in the PES network – the assessment of the regulatory effects of the draft bill included 400 deliveries, although the final number was to be indicated by the Minister of Health. The idea was to guarantee that the mother and child were cared for by appropriately qualified and experienced staff. Then there was another criterion – the distance to the nearest maternity ward – so that women would not be left without a maternity ward within a radius of several dozen kilometers from their home.

Now this is about to change. The minister admitted that these assumptions caused a wave of unrest. She accused the opposition of using the reform project to scare patients. – I believe that our political adversaries took advantage of this situation in an absolutely undignified way, scaring women and scaring patients. The Minister of Health cannot allow people to live in fear that their hospital will be taken away or their maternity ward will be taken away and women will have no place to give birth. (…) That's why I decided to change this tough-sounding provision in the act that the Minister of Health will determine the number of births – she said.

Instead of a numerical criterion, the rules determining where and how many delivery rooms there will be are to be established by teams appointed by voivodes. They will be created by: the voivode and the bodies creating hospitals (starostas, marshals, city presidents, voivodeship consultant for gynecology and obstetrics).

– They have to establish rules for their voivodeship. For one it may be some distance, for another it may be the number of births, but it does not have to be such hard data at all. The team can establish certain rules and agree that the delivery room will be, for example, not in five places, but in three. And such an indication will be binding on the Minister of Health, Leszczyna said.

She emphasized that the merger of departments and hospitals will be voluntary. – The Minister of Health has no right to close any maternity ward, only the establishing body can do it – she said

Towns where maternity wards will be closed are to be provided with additional medical rescue teams. If necessary, they are supposed to take the woman giving birth to the nearest maternity ward.

When asked what would happen to clinics that did not decide to join the network, the head of the Ministry of Health said that she could not imagine that the hospital owner (i.e. the local government) would “insist” on his decision if it would expose patients to danger.