Analysis of changes in cancer health care system in Poland since the socio-economic transformation in 1989

Background: The transformation period in Poland is associated with a set of factors seen as 'socio-economic stress', which unfavourably influenced cancer treatment and slowed down the progress of the Polish cancer care in the 90's. These outcomes in many aspects of cancer care may be experienced till today. The results of the international EUROCARE and CONCORD studies based on European data prove evidence that there is a substantial potential for improvement of low 5-year survival rates in Poland. Since high survivals are related to notably efficient health care system, therefore, to improve organization and treatment methods seems to be one of the most important directions of change in the Polish health care system. Till today, cancer care in Poland is based on a network outlined by Professor Koszarowski in the middle of the last century, and is a solid foundation for the contemporary project of the Comprehensive Cancer Care Network (CCCN) proposed in the frame of CanCon Project. Objective: Analysis of the structure of health care system and the changes introduced within the network of oncology in Poland since the beginning of the post-commuinist socio-economic transformation in 1989. Materials and Methods: This study was conducted based on the CanCon methods aimed at reviewing specialist literature and collecting meaningful experiences of European countries in cancer care, including the main legal regulations. Results: The analysis provided evidence that the political situation and the economic crisis of the Transformation period disintegrated the cancer care and resulted in low 5-year survival rates. A step forward in increasing efficiency of the cancer treatment care was a proposal of the 'Quick Oncological Therapy' together with one more attempt to organize a CCCN. With this paper the Authors contribute to the CanCon Project by exploration, analysis and discussion of the cancer network in Poland as an example of existing net-like structures in Europe as well as by preparation of guidelines for constructing a contemporary CCCN. Conclusions: (1) 'Socio-economic' stress adversely affected the efficiency of oncological treatment, both by reducing safety and slowing down the development of modern oncology. (2) Changing the current system into the contemporary form - CCCN could be an important step forward to optimise the oncological health care in Poland. (3) Introduction of the mandatory monitoring of organizational changes with the use of health standardized indicators could allow for the assessment of the effectiveness of implemented solutions and their impact on better prognosis for cancer patients. (4) Optimising the organization of the health care system is possible only by implementing necessary legislative corrections.

Epidemiology of eye diseases and infrastructure of ophthalmology in Poland.

ADMISSION: Untreated eye diseases are the leading cause of blindness in the world. Most people suffering from visual impairment is in the age group above 50 years of age. As many as 82% of people in this group is suffering from eye diseases. OBJECTIVE: The aim of this work was to present the epidemiology of eye diseases and state of infrastructure of ophthalmology in Poland. MATERIAL AND METHODS: Based on data by WHO prepared review of world and Polish literature on issues in the field of ophthalmology and epidemiology of eye diseases. On the analysis developed epidemiological situation of the most common eye diseases--cataract, glaucoma and AMD--leading to loss of vision in Poland. Using databases CSIOZ, the Central Statistical Office and WHO listed infrastructure resources of ophthalmology in Poland. RESULTS: The main eye diseases leading to blindness indicated cataract, glaucoma and macular degeneration. In 80% of cases, vision loss can be avoided by early detection and treatment. CONCLUSIONS: Prevention and early detection is an essential tool for reducing the incidence of blindness, especially in elderly.

The risk of overweight and obesity in chronic diseases among Warsaw inhabitants measured by self-reported method.

BACKGROUND: Obesity is well known cause of various diseases. However, there are only a few studies which enable to compare directly the magnitude of risk in different groups of chronic diseases. OBJECTIVES: The aim of presented paper was to identify a magnitude of the risk of chronic diseases attributable to overweight and obesity on the basis of data on weight and height self-reported by respondents. MATERIAL AND METHODS: The survey was conducted among 402 Warsaw inhabitants selected by non-random method. Overweight and obesity was measured by Body Mass Index (BMI) on the basis of the data of weight and height reported by respondents. According to WHO criteria the normal weight is defined as BMI 18.5 - 24.9 kg/m2, overweight as BMI 25.0 - 29.9 kg/m2, and obesity as BMI 30 kg/m2 or more. The following groups of chronic diseases were included: cancer, diabetes and other endocrine diseases, mental disorders, cardiovascular diseases, respiratory diseases, digestive diseases, arthritis and allergy disorder. RESULTS: Obesity measured by self-reported method was recognised as significant risk factor for diabetes (OR=9.6, CI: 2.0-152.8), respiratory diseases (OR=10.6, CI: 3,0-333,7), cardiovascular diseases (OR=5.2, CI: 1.9-108.3), arthritis (OR=6.3, CI: 2.4-266.7), digestive diseases (OR=3,8, CI: 1.3-83.6) and mental disorders (OR=5.8, CI: 1.5-29.1), while overweight significantly increased the risk of diabetes (OR=4.4, CI: 1.2-10.8), respiratory diseases (OR=3.2, CI: 1.4-22.2), cardiovascular diseases (OR=2.9, CI: 1.2-6.4) and arthritis (OR=3.0, CI: 1.1-9.6) CONCLUSIONS: Our findings showed that data on weight and height collected by survey method provide some information about the magnitude of the risk regarding particular groups of diseases attributable to overweight and obesity, nevertheless, underestimation of BMI calculated in this way should be taken into account.

"Health 2020"--new framework for health policy. Part I.

The paper presents the new framework for health policy adopted in September 2012 during the 62nd session of World Health Organization (WHO) Regional Committee for Europe as the strategy "Health 2020". Four priority areas for policy action as well as prerequisites for achieving two interlinked strategic objectives; improving health for all and reducing health inequalities as well as improving leadership and participatory governance for health are presented and discussed.

"Health 2020"--new framework for health policy. Part II.

The papers continues presentation of the new framework for health policy related to "Health 2020" strategy adopted in September 2012 unanimously by all member countries of EURO Region during the 62nd session of the World Health Organization Regional Committee for Europe. Four priority areas for action are presented.

The scope and results of selected epidemiological studies conducted at the National Institute of Hygiene in the years 1945-1989.

The authors present the first article in the series concerning the scope ofresearch, scientific, practical, educational and other achievements of the National Institute of Hygiene (PZH) since 1945. This article is limited to discussing selected studies conducted in the field of epidemiology until the year 1989. The selection was based on PZH annual reports on the accomplishment of planned objectives and the literature positins listed in these reports, as well as other documents. The criterion for selection was how the scope of the research matched the epidemiological situation within a historical context. The authors chose research that yielded practical results which made an impact on the epidemiological situation, particularly concerning infectious diseases in Poland. The significance of epidemiological research of non-infectious diseases was also stressed. In addition, research that was considered by scientists in Poland and abroad as contributing to the development of medical methodology was included in the selection.

Determinants of self-rated health of Warsaw inhabitants.

BACKGROUND: Self-rated health is a one-point measure commonly used for recognising subjectively perceived health and covering a wide range of individual's health aspects. OBJECTIVE: The aim of our study was to examine the extent to which self-rated health reflects the differences due to demographic characteristics, physical, psychical and social well-being, health disorders, occurrence of chronic disease and negative life events in Polish social and cultural conditions. MATERIAL AND METHOD: Data were collected by non-addressed questionnaire methods from 402 Warsaw inhabitants. The questionnaire contained the questions concerning self-rated health, physical, psychical and social well-being, the use of health care services, occurrence of chronic disease and contact with negative life events. RESULTS: The analysis showed that worse self-rated health increased exponentially with age and less sharply with lower level of education. Pensioners were more likely to assess their own health worse then employed or students. Such difference was not found for unemployed. Compared to married, the self-rated health of divorced or widowed respondents was lower. Gender does not differentiate self-rated health. In regard to well-being, self-rated health linearly decreased for physical well-being, for social and, especially, for psychical well-being the differences were significant, but more complicated. Hospitalisation, especially repeated, strongly determined worse self-rated health. In contrast, relationship between self-rated health and sickness absence or frequency of contact with physician were lower. Chronic diseases substantially increased the risk of poorer self-rated health, and their co-morbidity increased the risk exponentially. The patients with cancer were the group, in which the risk several times exceeded that reported for the patients of other diseases. Regarding negative life events, only experience with violence and financial difficulties were resulted in worse self-rated health. CONCLUSIONS: Our findings confirmed the usefulness of self-rated health for public health research.

[Willingness of Warsaw inhabitants to cooperate with health service. I. Opinions on health reforms]. / Gotowosc mieszkaniców Warszawy do wspólpracy ze sluzba zdrowia. I. Opinie o reformie zdrowia.

Social participation in undertaking public decisions is one of the main determinants of good governance. Recognizing to what extent people are ready to participate in the process of reforming health care as an active partners seems to be necessary. Therefore, in Health Promotion and Postgraduate Education Department of NIPH-NIH the study aimed at examining citizen's willingness to cooperate with health staff and gathering their opinions on health reform was carried out. The not-addressed questionnaires were conveyed to 1700 households in Warsaw and 402 correct completed were received. Our findings indicate that one of four Warsaw citizens was ready to participate jointly with health workers in health reform. The willingness was higher in women, older people, higher educated and pensioners. From perspective of their own health, respondents perceived the following issues as requiring a change in the time of health reform: easier access to specialist treatment (60,9%), changing the health insurance system (17,3%), reduction in medicines price (14,8%), improving the quality of medical services (14,0%), easier access to diagnostic tests (13,6%) and to primary care physicians (10,7%), improving the health and social security of old people (9,0%), easier access and wider range of preventive examinations (7,4%), facilitate the sanatorium treatment (4,1%) and rehabilitation (3,7%).

[Willingness of Warsaw inhabitants to cooperate with health service. II. Evaluation of health and retirement security]. / Gotowosc mieszkankców Warszawy do wspólpracy ze sluzba zdrowia. II. Ocena bezpieczenstwa zdrowotnego i emerytalnego.

Providing citizens with health security is one of the main challenges for health policy. For the effective modifying the health an social care system it is very important to recognize how citizens themselves perceived their health and retirement assurance. The article presents the analysis of assessment of health care system, out-of-pocket payments for treatment, and retirement system by Warsaw inhabitants in relation to demographic characteristics and health indicators. Data were collected using not-addressed questionnaire. Our findings indicated that women, people aged 30-64 years, those having vocational education and unemployed, the others out of work as well as employed more negatively assessed health care system in comparison to the other demographic groups. The youngest and oldest people, those having elementary education and those who were economically inactive relatively frequently declared bearing very high expenses for treatment. The retirement system was more negatively assessed by women, people under 45 years, unemployed and the others out of work. The analysis of the relationship between perceived health and out-of-pocket payments for treatment and selected health indicators showed that people, who positively assessed existing health care and declared low expenses for treatment, higher evaluated their health, less frequently stayed at home because of ill-health, less frequently were in contact with physician and rarely were treated in hospital. Such differences were not noted (except one) for retirement security.

[Evaluation of health systems]. / Metody oceny systemów ochrony zdrowia.

Article presents problem of healthcare systems evaluation. Definitions of health system and healthcare system are introduced in the first part, which is followed by presentation of basic principles of healthcare systems evaluation, and commonly used and recommended indicators. Specific examples of healthcare systems evaluation methods implemented in selected European countries are described in the last part.

[Changes of hierarchy among causes of death in some European Union countries]. / Zmiany hierarchii przyczyn zgonów w niektórych krajach Unii Europejskiej.

Mortality from malignant neoplasms and diseases of circulatory system in the countries of European Union is on decline, though this trend is much slower in the case of neoplasms. In some EU countries the mortality from neoplasms is already higher than mortality from diseases of circulatory system, which until recently occupied the first position in the cause of death hierarchy. This trend is more significant among males and in France, the Netherlands and Spain where malignant neoplasms became the first cause of death. The forecast for next years predicts the continuation and deepening of this tendency.

[The Tallinn Charter: health systems for health and wealth]. / Systemy zdrowotne dla zdrowia i dobrobytu--Karta z Tallina.

The article presents main issues of Tallinn Charter (2008) that concerns functioning health systems, theirs influence on health and wealth of society. Health systems are diverse, but share common set of functions. Theirs effective performance contribute, not only to improving health, but also to participation in labour market and socioeconomical development of country.

[Direct and indirect treatment cost of patient with ischaemic heart disease]. / Bezposrednie i posrednie koszty leczenia pacjenta z niestabilna choroba niedokrwienna serca.

Authors of this paper attempted to evaluate the cost of treatment of hypothetical patient with ischaemic heart disease during the period 16 years. The medical costs (costs of medicines, diagnostic procedures, coronary angioplasty and bypass surgery) and indirect costs of lost productivity have been estimated.

[Epidemiology of chronic non-infectious diseases in Poland in the second half of 20th century]. / Epidemiologia chorób niezakaznych w polsce w drugiej polowie dwudziestego wieku.

The development of epidemiology of non infectious diseases in Poland during the second half of 20th century has been presented. Epidemiological studies of chronic non specific respiratory diseases, cardiovascular diseases, cancer, diabetes, conditions related to the environmental pollution, psychiatric conditions and rheumatic diseases and complaints have been discussed.