Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework.

BACKGROUND: This study examined non-financial aspects of the organizational performance of public hospitals from the perspective of hospital physicians; the obtained results were analyzed to identify the necessary improvements in organizational performance. METHODS: This was a cross-sectional study of multidisciplinary public hospitals on a group of 249 randomly selected physicians from 22 in-patient departments or clinics operating in the Warsaw region. The study data was collected using the structured World Health Organization questionnaires (to be filled out by respondents) assessing the hospital's organizational performance variables qualified according to the McKinsey 7-S Framework. Epidata software version 3.1 was used for data entry, and the analysis was carried out in the SPSS software, version 19. The results of the organization evaluation are presented in the McKinsey 7-S Framework diagram. Key elements of the performance factors were grouped into 'stens', and the sten values were expressed as arithmetic means. Normal distribution of the stens was validated with the Kolmogorov-Smirnov test. 95% confidence intervals were calculated. The significance of differences between the analyzed stens was compared with the paired Student t-test. The interdependence of the variables was determined using the Pearson's correlation coefficient. RESULTS: The results revealed a significant difference (p <0.05) in the respondents' assessment of social (a mean score of 2.58) and technical (a mean score of 2.80) organizational aspects of the hospital operation. Scores for all variables were low. The social elements of an organization with the lowest score included 'staff', and in it the aspect - 'efforts are made to inspire employees at the lowest levels of the organization', 'skills' involving the learning style followed by the management/managerial staff, and 'management style' (average scores of 2.38, 2.56, 2.61, respectively). CONCLUSION: Consistently with the existing literature, social factors were shown to play a more significant role in the management and they therefore deserve careful attention and more recognition when identifying and improving the key aspects affecting the organizational performance of public hospitals. Technical elements (strategy, structure, system) are important, but were demonstrated to have limited effect on the organizational operations geared towards ensuring effective functioning of a public hospital.

Motivation factors affecting the job attitude of medical doctors and the organizational performance of public hospitals in Warsaw, Poland.

BACKGROUND: This paper examines the relationship between selected motivation factors that affect the attitude to work among medical doctors at public hospitals and the organizational performance of hospitals. METHODS: This study was based on World Health Organization questionnaires designed to estimate motivation factors according to Herzberg's motivation theory and to measure the level of organizational performance of hospitals by using the McKinsey model. A survey was conducted among physicians (n = 249) with either surgical (operative) or nonsurgical (conservative) specialty in 22 departments/units of general public hospitals in Warsaw, Poland. The relationship between the chosen job motivation factors and organizational effectiveness was determined using Spearman's rank correlation. Furthermore, 95% confidence intervals were calculated. The independent samples t-test was used to confirm statistically significant differences between the independent groups. Normality of the data was tested by the Kolmogorov-Smirnov test. RESULTS: The survey revealed that motivation factors related to "quality and style of supervision" have the highest effect on the organizational performance of hospitals (Spearman's rank correlation coefficient = 0.490; p < 0.001), whereas "performance feedback" has the lowest effect on organizational performance according to the surveyed healthcare professionals (54% of physicians). CONCLUSION: The principles of Individual Performance Review should be incorporated into strategies designed to improve the organizational performance of hospitals (with NHS serving as a potential role model) in order to establish specific rules on how to share performance feedback with individual physicians. The present study contributes to literature on human resource management in the healthcare sector and highlights the importance of nonfinancial aspects in improving the organizational performance of hospitals.

Health related quality of life in patients with diabetic foot ulceration - translation and Polish adaptation of Diabetic Foot Ulcer Scale short form.

OBJECTIVES: Diabetic foot ulcer (DFU) is a common complication of diabetes and not only an important factor of mortality among patients with diabetes but also decreases the quality of life. The short form of Diabetic Foot Ulcer Scale (DFS-SF) provides comprehensive measurement of the impact of diabetic foot ulcers on patients' health related quality of life (HRQoL). The purpose of this study was to translate DFS-SF into Polish and evaluate its psychometric performance in patients with diabetic foot ulcers. METHODS: The DFS-SF translation process was performed in line with Principles of Good Practice for the Translation and Cultural Adaptation Process for patient reported outcome measures (PROMs) developed by ISPOR TCA group. Assessment of the reliability and validity of Polish DFS-SF was performed in native Polish patients with current DFU. RESULTS: The DFS-SF validation study involved 212 patients diagnosed with DFU, with 4.4 years of DFU duration on average. The average ulcer size was 5.5 sq. cm, and generally only one limb was affected. Men (72%) and type 2 diabetes patients (86%) prevailed, with 17.8 years representing the mean time since diagnosis. The mean population age was 62.5 years. The internal consistency of all scales of the Polish DFS-SF was high (Cronbach's alpha ranged from 0.82 to 0.93). Item convergent and discriminant validity was satisfactory (median corrected item-scale correlation ranged from 0.61 to 0.81). The Polish DFS-SF demonstrated good construct validity when correlated with the SF-36v2 and showed better psychometric performance than SF-36v2. CONCLUSIONS: The newly translated Polish DFS-SF may be used to assess the impact of DFU on HRQoL in Polish patients.

Health technology assessment of public health programmes in Poland, years 2010 and 2013.

BACKGROUND: In Poland, among other responsibilities, local governments are obliged to organize public health activities for local communities. To fulfill their obligations in this respect, authorities can organize preventive care in the form of health programs. Prior to their implementation, local governments must seek however opinion of the Polish HTA (Health Technology Assessment) agency. HTA recommendations do inform final decision making process but are not obligatory to be followed. OBJECTIVE: Firstly, It was to provide an insight into what extend local governments utilize health programs in their endeavors and the scope of health topics included. Secondly, it was to elicit recommendations for future authors of health programs in order to increase the chances of positive HTA recommendation. METHODS: The retrospective analysis of HTA recommendations issued by the Polish HTA agency (AHTAPol) in 2010 and 2013 was conducted. RESULTS: There were 67 and 294 HTA recommendations issued in 2010 and 2013 respectively of which 47.8% and 34.4% were negative. Among authors, city councils and communes dominated. Vaccinations were the most commonly chosen target health intervention. In total, six key recommendations for local governments interested in the implementation of health programs were elicited. CONCLUSIONS: To increase the chances for positive HTA recommendations, the health program has to be designed for health problems supported by sound clinical evidence which is not covered by the scope of reimbursement offered by National Health Fund. The targeted health intervention has to be supported by the evidence of proven clinical efficacy and safety and utilize available epidemiological data.

ANALYSIS OF TRENDS IN LIFE EXPECTANCIES AND PER CAPITA GROSS DOMESTIC PRODUCT AS WELL AS PHARMACEUTICAL AND NON-PHARMACEUTICAL HEALTHCARE EXPENDITURES.

Life expectancy is a common measure of population health. Macro-perspective based on aggregated data makes it possible to approximate the impact of different levels of pharmaceutical expenditure on general population health status and is often used in cross-country comparisons. The aim of the study was to determine whether there are long-run relations between life expectancy, total healthcare expenditures, and pharmaceutical expenditures in OECD countries. Common trends in per capita gross domestic products (GDPs) (excluding healthcare expenditures), per capita healthcare expenditures (excluding pharmaceutical expenditures), per capita pharmaceutical expenditures, and life expectancies of women and men aged 60 and 65 were analyzed across OECD countries. Short-term effect of pharmaceutical expenditure onto life expectancy was also estimated by regressing the deviations of life expectancies from their long-term trends onto the deviations of pharmaceutical and non-pharmaceutical health expenditures, as well as GDP from their trends. The dataset was created on the basis of OECD Health Data for 34 countries and the years 1991-2010. Life expectancy variables were used as proxies for the health outcomes, whereas the pharmaceutical and healthcare expenditures represented drug and healthcare consumption, respectively. In general, both expenditures and life expectancies tended to increase in all of the analyzed countries; however, the growth rates differed across the countries. The analysis of common trends indicated the existence of common long-term trends in life expectancies and per capita GDP as well as pharmaceutical and non-pharmaceutical healthcare expenditures. However, there was no evidence that pharmaceutical expenditures provided additional information about the long-term trends in life expectancies beyond that contained in the GDP series. The analysis based on the deviations of variables from their long-term trends allowed concluding that pharmaceutical expenditures significantly influenced life expectancies in the short run. Non-pharmaceutical healthcare expenditures were found to be significant in one out of four models (for life expectancy of women aged 65), while GDPs were found to be insignificant in all four models. The results of the study indicate that there are common long-term trends in life expectancies and per capita GDP as well as pharmaceutical and non-pharmaceutical healthcare expenditures. The available data did not reveal any cause- effect relationship. Other factors, for which the systematic data were not available, may have determined the increase in life expectancy in OECD countries. Significant positive short-term relations between pharmaceutical expenditures and life expectancies in OECD countries were found. The significant short-term effect of pharmaceutical expenditures onto life expectancy means that an increase of pharmaceutical expenditures above long-term trends would lead to a temporary increase in life expectancy above its corresponding long-term trend. However, this effect would not persist as pharmaceutical expenditures and life expectancy would converge to levels determined by the long-term trends.

Using a lean management approach in acute ischemic stroke management: a systematic review.

Purpose: Stroke is the second leading cause of death worldwide with an annual mortality rate of 6.55 million, which accounts for 11.6% of the total number of deaths. Early diagnosis is crucial for improving treatment outcomes. Lean management is an approach originating in the car manufacturing process derived from the Toyota Production System, which healthcare providers have recently adapted. The objective is to examine the use of lean practices in managing AIS in hospital settings. Methods: A systematic literature search was performed using MEDLINE and SCOPUS databases, including publications from 1st January 2000 to 20th September 2022. Results: A total of 13 studies fulfilled the predefined inclusion criteria. The recombinant tissue plasminogen activator (rtPA) was used in 11 studies, in 2 studies in combination with mechanical thrombectomy (MT). MT alone was used in the other 2 studies. The value stream mapping was used in all included studies to analyze workflow in acute ischemic stroke (AIS) treatment. Outcome measures include mostly door-to-needle (DTN) time for rtPA treatment and door-to-puncture (DTP) time for mechanical thrombectomy. DTN time was assessed in nine studies and reached statistically significant results in five. DTP was examined in three studies; in two, statistically significant decreases in DTP were observed. Conclusions: Lean management can be a useful method for achieving key performance indicators in AIS, consistent with current guidelines. The results of this systematic literature review show that value stream mapping may improve the process of AIS treatment by reducing in-hospital delays. The field of research that focuses on implementing lean management tools in healthcare is increasing, with more publications appearing in recent years.

Importance of public participation in decision-making process in healthcare system illustarted with an example of the development of American and Polish scope of health benefit basket.

UNLABELLED: The process of the development of health benefit basket may serve as a good example of decision-making process in the healthcare system which is based on public participation. OBJECTIVE: Comparative analysis of development and implementation of health benefit basket in Poland and the USA. MATERIAL AND METHODS: On a basis of the literature review, following questions were studied, i.e.: What is the origin of health benefit basket development in the USA and Poland? What was the role of pubic opinion in determining the range of health benefit basket in both countries? What criteria were employed to determine the range of health benefit basket in both countries? What conclusions can be drawn for Poland from the USA experience of determining the range of health benefit basket? RESULTS: Irrespective of the similarities in the origin of health benefit basket development, both countries approached this issue differently. In the USA, the approach based on social dialogue and patient's perspective was selected while in Poland the perspective of public payer predominated. CONCLUSIONS: The transparency of principles and social dialogue constitute the fundamental elements of effective process of health benefit basket development and implementation which is both required and generally unpopular modification.

The capacity to implement Lean Management in the healthcare system in Poland - results of a public consultation.

BACKGROUND: Lean healthcare management is an innovative approach to process management in healthcare organizations. Despite that the Lean principles have been increasingly recognized worldwide as a tool to boost organizational performance, improve the quality of care and curb waste, the Lean methodology can be difficult to implement in some countries. This study seeks to identify the facilitators of and barriers to the implementation of Lean in the healthcare system in Poland. MATERIAL AND METHODS: A public consultation was held among 318 representatives of stakeholder groups in the healthcare system in Poland. Data was collected using validated self-administered questionnaires. Statistical analysis was performed using the IBM SPSS Statistics 25 software. RESULTS: The study revealed that a large share of respondents believed that the awareness of the existing organizational deficiencies in work practices among stakeholders can greatly facilitate the implementation of Lean in the healthcare system in Poland (50.9%, p < 0.05). The main barriers to the deployment of Lean include lack of awareness of the Lean methodology and its benefits (76.1%, p < 0.001); insufficient institutional support (43.7%), and lack of funding for Lean solutions (32.4%). CONCLUSIONS: Gaps in the medical curricula and education programs for healthcare professionals concerning the latest process management solutions in healthcare should be addressed in order to raise awareness of the benefits of cooperation with and the active involvement of Lean experts in applying "lean" ideas to improve the organizational performance in healthcare. It is also necessary for policy makers to be aware of the benefits of contemporary process management in healthcare and to support its implementation. Med Pr. 2023;74(1):1-8.

[Cost of lost productivity in pharmacoeconomics analysis. Part II. Survey in the expert group]. / Koszty utraconej produktywnosci w analizach farmakoekonomicznych. Czesc II. Badanie opinii w grupie ekspertów.

The aim of the survey was to collect data on practice and preferences of decision-makers and experts in health economics concerning the role of indirect costs in Poland. The questionnaire contained 18 questions covering the need for indirect costs calculation in economic evaluations and measures used to calculate indirect cost. Fifty four respondents related to health economics returned completed questionnaires. Mean age of respondents was 33,3 years; mean experience in health economics 4.7 years; 43% (23/54) of responders had non-economic background; 30% each were users and doers of health technology assessment reports. All (excluding one) responders indicated that indirect costs should be calculated in pharmacoeconomic studies. Twenty three (i.e., 43%) responders indicated human capital approach as the best method to estimate costs from societal perspective; friction cost method came second best 11%; 42% respondents had no opinion. The doers of economics evaluations pointed to GDP per capita (61%, 11/18), average salary (61%, 11/18), and costs of sick pay or injury benefit (61%, 11/18) as measures which could be used to value production losses. Indirect costs are considered important component of economic evaluations of healthcare interventions in Poland. The lack of widely accepted methods for indirect cost evaluation support further research.

[Cost of lost productivity in pharmacoeconomics analysis. Part I. A systematic review of the literature]. / Koszty utraconej produktywnosci w analizach farmakoekonomicznych. Czesc i. Przeglad systematyczny pismiennictwa.

The inclusion of indirect costs of illness in economic studies is still a subject of considerable debate. The aim of the systematic literature review was to present the Polish economic practice concerning indirect costs evaluation of healthcare interventions. MEDLINE, EMBASE, Cochrane Library and Polish Medical Bibliography (PBL) were searched. Cut-off dates were set to February and March 2009. The main specific keywords were 'indirect costs' or 'costs and cost analysis'. Nineteen studies fulfilled the inclusion criteria for this review, of a total of 2300 references. Seventeen out of 19 studies were cost of illness studies, 2 were economic analyses. Methods of indirect costs evaluation were all based on human capital approach. The work absenteeism unit time measure used to value productivity loss were average salary (9/19), Gross Domestic Product (GDP) per capita (7/19), Gross National Product per capita (1/19), GDP per active worker (1/19), sold production of industry per active worker (1/19). Mean indirect costs were ca. 58% of total costs (range: 16%-98%). In 5 studies transfer payments were added to productivity loss category. Indirect cost is rarely included in the economic analyses in Poland. Various methods of indirect costs calculation limit comparison between studies and support the need for development of robust and widely accepted methodology.

Sources of Information on Medicinal Products Among Physicians - A Survey Conducted Among Primary Care Physicians in Poland.

Introduction: Primary care physicians need to have access to up-to-date knowledge in various fields of medicine and high-quality information sources, but little is known about the use and credibility of sources of information on medicinal products among Polish doctors. The main goal of this study was to analyze the sources of information on medicinal products among primary care physicians in Poland. Methods: A survey was conducted among 316 primary care physicians in Poland. The following information was collected: demographic data of participants, type and frequency of using data sources on medicinal products, barriers to access credible information, assessment of the credibility of the sources used, impact of a given source and other factors on prescription decisions. Results: The most frequently mentioned sources of information were medical representatives (79%), medical journals (78%) and congresses, conventions, conferences, and training (76%). The greatest difficulty in finding the latest information about medicinal products was the lack of time. The surveyed doctors considered clinical guidelines to be the most credible source of information, and this source also had the greatest impact on the choice of prescribed medicinal products. Conclusion: The study showed that clinicians consider clinical guidelines as the most credible source of information with the greatest impact on prescribing medicinal products. However, it is not the source most often mentioned by doctors for obtaining knowledge about medicinal products. There is a need to develop strategies and tools to provide physicians with credible sources of information.

[Indirect costs in health technology assessment]. / Koszty posrednie w ocenie technologii medycznych.

In the health technology assessment it is crucial to define the perspective of the analysis. When the societal perspective is chosen it is necessary to include all the costs incurred by the society, also the costs of lost productivity resulting from absence of sick employees from work or their reduced efficiency at work. The aim of this article is to present the notion of indirect costs, their importance in health technology assessment and the methods of calculation. The economic literature has been reviewed for the state of knowledge on indirect costs. Three methods of calculation are described: human capital method, friction cost method or health state valuation. Indirect costs in Western European countries can amount to more than half of total costs attributed to the illness and its treatment. In the literature there is no consensus regarding the proper method of indirect costs calculation. It is necessary to conduct further theoretical and empirical research in the area of indirect costs and enhance discussion among Polish pharmacoeconomists.

[Educational standards of the Polish Pharmacoeconomic Society]. / Standardy Edukacyjne Polskiego Towarzystwa Farmakoekonomicznego.

The objective of creating Educational Standards of the Polish Pharmacoeconomic Society (Polish Chapter of the International Society for Pharmacoeconomics and Outcomes Research) was to define and establish a scope of knowledge and skills needed for people conducting and interpreting pharmacoeconomic analyses as well as health technology assessments. A Working Group of the Society identified target groups and divided the requirements into 3 groups: basic, intermediate and advanced. The document reflects conditions of the Polish healthcare and educational systems and is harmonized with international regulations in the field of pharmacoeconomics, outcomes research and health technology assessment. The standards may also serve as guidelines for educators in this area.

Exploring factors underlying the attitude of community pharmacists to generic substitution: a nationwide study from Poland.

BACKGROUND: Generic uptake will increasingly be promoted by governments in the face of increasing healthcare costs and global economic uncertainties. OBJECTIVE: The purpose of this study was to investigate attitudes towards generic substitution among community pharmacists, with a focus on the perception of the efficacy, knowledge of the generics characteristics, as well as the willingness to recommend generic substitution. SETTING: Community pharmacies in Poland. METHOD: The survey was conducted in 2013 by telephone interviews with 802 holders of an MSc degree in pharmacy working as community pharmacists. Stratified sampling was implemented to make the study representative in geographic terms. MAIN OUTCOME MEASURE: Pharmacists' attitudes towards generics drugs. RESULTS: The study showed that only 40 % of pharmacists always inform patients about their right to choose a generic substitute. It was also shown that the less time a pharmacist has been practising, the less likely they are to invite consumers to choose between generic and innovator products. The likelihood of informing was not affected by pharmacist's sex or age, or by pharmacy location or status (chain vs. independent pharmacy) (p > 0.05). Pharmacists varied in their approach to their statutory obligation to inform about a generic; a more or less equal share of respondents were either in favour or against it. Approximately 60 % pharmacists were shown to be familiar with the definition of a generic medicine. Pharmacists with shorter time of practice proved to know more about generics. However, more than 30 % respondents failed to choose the correct statement on generic versus reference medicine dosage. The majority of respondents (67 %) believed there are no differences in efficacy between generics and innovator drugs, whereas 31 % claimed that original brands could be more effective. A significant correlation was demonstrated between the views of pharmacists on the therapeutic efficacy and their willingness to substitute for generics whenever permitted by a physician. CONCLUSION: It is important to address all concerns pharmacists may have over generics, for example by implementing comprehensive awareness-raising campaigns. Also, pharmacotherapy monitoring systems (i.e. provided in a framework of pharmaceutical care) could be considered to identify any safety or quality concerns that may arise.

Predictors of generic substitution: The role of psychological, sociodemographic, and contextual factors.

BACKGROUND: Escalating pharmaceutical costs have become a global challenge for both governments and patients. Generic substitution is one way of decreasing these costs. OBJECTIVE: The aim of this study was to investigate factors associated with patients' choice between generic drugs and innovator drugs. METHOD: The survey was conducted in June 2013, 1000 people from across Poland were chosen as a representative population sample. The outcome (a preference for generics/a preference for innovator pharmaceuticals/no preference) was modeled by multinomial logistic regression, adjusted for several variables describing patients' sensitivity to selected generic features (price, brand, and country of origin), to third-party opinions about generics (information on generics in the mass media, opinions of health professionals (i.e. physicians, pharmacists), relatives/friends), as well as patients' personal experiences and income per household. RESULTS: The results supported the predictive capacity of most independent variables (except for patient sensitivity to the country of origin and to the information on generics in the mass media), denoting patients' preferences toward generic substitution. Patient sensitivity to recommendations by physicians, generic brand, and household income were the strongest predictors of the choice between generic and innovator pharmaceuticals (P < 0.001). The probability of choosing generics over innovator drugs was significantly higher among respondents with the lowest income levels, in those who were indifferent to generic brand or their physician's opinion, as well as in respondents who were sensitive to recommendations by pharmacists or attached a greater value to a past experience with generics (their own experience or that of relatives/friends). CONCLUSION: In consideration of the foregoing, awareness-raising campaigns may be recommended, supported by a variety of systemic solutions and tools to encourage generic substitution.

Potential impact of the implementation of multiple-criteria decision analysis (MCDA) on the Polish pricing and reimbursement process of orphan drugs.

BACKGROUND: The objective of this study was to assess the potential impact of the implementation of multiple-criteria decision analysis (MCDA) on the Polish pricing and reimbursement (P&R) process with regard to orphan drugs. METHODS: A four step approach was designed. Firstly, a systematic literature review was conducted to select the MCDA criteria. Secondly, a database of orphan drugs was established. Thirdly, health technology appraisals (HTA recommendations) were categorized and an MCDA appraisal was conducted. Finally, a comparison of HTA and MCDA outcomes was carried out. An MCDA outcome was considered positive if more than 50% of the maximum number of points was reached (base case). In the sensitivity analysis, 25% and 75% thresholds were tested as well. RESULTS: Out of 2242 publications, 23 full-text articles were included. The final MCDA tool consisted of ten criteria. In total, 27 distinctive drug-indication pairs regarding 21 drugs were used for the study. Six negative and 21 positive HTA recommendations were issued. In the base case, there were 19 positive MCDA outcomes. Of the 27 cases, there were 12 disagreements between the HTA and MCDA outcomes, the majority of which related to positive HTA guidance for negative MCDA outcomes. All drug-indication pairs with negative HTA recommendations were appraised positively in the MCDA framework. Economic details were available for 12 cases, of which there were 9 positive MCDA outcomes. Amongst the 12 drug-indication pairs, two were negatively appraised in the HTA process, with positive MCDA guidance, and two were appraised in the opposite direction. CONCLUSIONS: An MCDA approach may lead to different P&R outcomes compared to a standard HTA process. On the one hand, enrichment of the list of decision making criteria means further scrutiny of a given health technology and as such increases the odds of a negative P&R outcome. On the other hand, it may uncover additional values and as such increase the odds of positive P&R outcomes.

Exploring the opinions and experiences of patients with generic substitution: a representative study of Polish society.

BACKGROUND: Generics have the potential to contain drug therapy costs; successful implementation of generic substitution policy largely depends on consumers' willingness to choose generics. OBJECTIVE: This study aims to analyse the opinions, experiences and preferences of Polish patients towards generic medicines. SETTING: The study was performed in Poland. METHOD: The survey was conducted in June 2013 by means of face-to-face interviews. Respondents were drawn from the general population according to a population structure. The study covered a representative sample of 1,000 Poles; the results can be generalized to apply to the Polish population at large. RESULTS: Fifty-two percent of respondents declared to be more often choosing generics, twenty-three percent did not have any specific preferences, and twenty-five percent were more willing to choose brand-name medicines. Past experience with cheaper generic medicines, secondary or lower education, low income and residence in specific regions of Poland were all significantly associated with an increased willingness to choose generics. Respondents' attitudes towards generics were mostly influenced by the opinions of doctors and pharmacists. According to respondents, attitudes towards generics among doctors, pharmacists, family and friends, and in the mass media were mostly positive. There was no relationship between the preference of respondents for generics and factors such as their age, life stage, gender, household size or urban/rural locality. As a result of substituting a brand-name drug with its generic equivalent, 72 % of respondents reported that they had not noticed any difference in drug effectiveness; 21 % had experienced a reduced effectiveness of treatment or increased side effects at least once; and 7 % claimed the generic worked better. The majority of respondents who used cheaper substitutes claimed that generics represented good or very good quality. CONCLUSION: The study demonstrates that, when choosing medicines, Poles rely mainly on the opinions of their doctors and pharmacists. Therefore, it is recommended that: (1) the option of using generics be promoted when writing prescriptions, and (2) the obligation on pharmacists to inform customers of their option to purchase generics be enforced.

Solution-driven approaches to generic substitution challenges - a survey among international experts.

The main objective of this study was to explore the perception and understanding of economic, legal, and social barriers that may restrain generic uptake among recognized international experts in health care, and to identify and verify recommendations on how to streamline generic substitution (GS) at no expense of therapeutic safety. A questionnaire survey was devised, and experts with world-renowned expertise in the field of generic medicinal products were selected. Almost 3/4 of respondents claimed that all drugs that satisfy bioequivalence criteria represent similar efficacy and adverse effects, and 1/4 of respondents believed that some differences could be reported. The majority of experts supported (i) the right of patients to refuse GS, (ii) the right of physicians to veto GS, and (iii) the introduction of a statutory obligation to provide patients with access to the cheapest generics available on the market. The main obstacles to more general uptake of generics were as follows: (i) perception of generics as lower quality products, (ii) absence of a transparent policy governing GS, and (iii) disincentives to pharmacists and physicians. Among the most popular recommendations were as follows: (i) introduction of various measures to aid physicians in generic prescribing, (ii) setting clear guidelines specifying when GS is not advisable, (iii) supporting competition on the generic market. The views of experts and the resulting recommendations were strongly affected by their opinion on the bioequivalence of generics. From this analysis, we have selected several principal recommendations which could help shape successful healthcare policies regarding GS.

Institutional framework for integrated Pharmaceutical Benefits Management: results from a systematic review.

OBJECTIVES: In this paper, we emphasised that effective management of health plans beneficiaries access to reimbursed medicines requires proper institutional set-up. The main objective was to identify and recommend an institutional framework of integrated pharmaceutical care providing effective, safe and equitable access to medicines. METHOD: The institutional framework of drug policy was derived on the basis of publications obtained by systematic reviews. A comparative analysis concerning adaptation of coordinated pharmaceutical care services in the USA, the UK, Poland, Italy, Denmark and Germany was performed. RESULTS: While most European Union Member States promote the implementation of selected e-Health tools, like e-Prescribing, these efforts do not necessarily implement an integrated package. There is no single agent who would manage an insured patients' access to medicines and health care in a coordinated manner, thereby increasing the efficiency and safety of drug policy. More attention should be paid by European Union Member States as to how to integrate various e-Health tools to enhance benefits to both individuals and societies. One solution could be to implement an integrated "pharmacy benefit management" model, which is well established in the USA and Canada and provides an integrated package of cost-containment methods, implemented within a transparent institutional framework and powered by strong motivation of the agent.

Effects of DRG-based hospital payment in Poland on treatment of patients with stroke.

A prospective payment system based on Diagnosis Related Groups (DRGs) presents strong financial incentives to healthcare providers. These incentives may have intended as well as unintended consequences for the healthcare system. In this paper we use administrative data on stroke admissions to Polish hospitals in order to demonstrate the response of hospitals to the incentives embedded in the design of stroke-related groups in Poland. The design was intended to motivate hospitals for the development of specialized stroke units by paying significantly higher tariffs for treatment of patients in these units. As a result, an extensive network of stroke units has emerged. However, as it is shown in the paper, there is no evidence that outcomes in hospitals with stroke units are significantly different from outcomes in hospitals without stroke units. It is also demonstrated that the reliance on the length of stay as a major grouping variable provides incentives for regrouping patients into more expensive groups by extending their length of stay in stroke units. The results of the study are limited by the incompleteness of the casemix data. There is a need to develop information and audit systems which would further inform a revision of the DRG system aimed to reduce the risk of regrouping and up-coding.