Legal regulations on occupational health system in Poland.

Occupational health care has a long tradition in Poland. It has evolved from the industrial health care system established in the post-war period to a modern system defined in the Occupational Health Services Act of 1997. When the process of political and economic transformation began in Poland in 1989, the reforms of the workers' health care became inevitable. The process of introducing and implementing new legal regulations comprised three phases: 1. Introduction of amendments to the Polish Labor Code, according to which employers are now committed to provide their workers with occupational health services (OHS) appropriate to given working conditions. 2. Incorporation into the 1991 Health Care Institutions Act the provisions which allow for the establishment of alternative non-public structures responsible for the health care of the working population. 3. Adoption of the Occupational Health Services Act in 1997, the most important law providing grounds for establishing a most comprehensive system of occupational health services. The Occupational Health Services Act introduces, for the first time, the concept of the OHS system that encompasses the whole working population. The Act outlines a broad range of OHS competences; defines individual tasks; and provides the up-to-date definition of the OHS structure with its two organizational levels, consisting of primary and regional occupational health centers. In addition, the Act specifies the sources of finance for the accomplishment of the defined tasks. Pursuant to the provisions of the Act, OHS units co-operate with employers and employees, bodies supervising working conditions and other organizations involved in occupational health that become their partners in activities aimed at protecting and promoting health of workers. In order to further develop the workers' health care system its constant adaptation to changing conditions is absolutely necessary through: developing modern training for specialists in the field of occupational medicine; establishing an efficient system for controlling the quality of services provided by the occupational health care centers; and implementing more effective forms of health protection and promotion at workplace, especially for those self-employed.

[Reasons for difficulties encountered in diagnosing and certifying occupational disease reported by some regional centers of occupational medicine]. / Przyczyny trudnosci diagnostyczno-orzeczniczych w patologii zawodowej w opinii wybranych wojewódzkich osrodków medycyny pracy.

Observations about kinds of and reasons for difficulties encountered in diagnosing and certifying occupational diseases, made during the analysis of over 3,000 medical history files, were verified with the opinions of the personnel employed in the 14 selected regional centres of occupational medicine. The evaluation of the body of workers, the diagnostic basis, kinds of diagnostic and certification difficulties and their causes, the data on diagnosed occupational diseases, and appeals against certifications which negate the grounds for diagnosing occupational diseases were surveyed and the results presented. The results obtained indicate convergent causes of incorrect decisions taken by those involved in the Institute, and by directors of regional centres of occupational medicine. This provides the basis for developing measures aimed at eliminating the mistakes made in the process of diagnosing and certifying occupational diseases.

[Internal control of working conditions as a form of occupational health and safety management--experience of Western European countries and the situation in Poland]. / Samokontrola warunków pracy jako forma zarzadzania bezpieczenstwem i zdrowiem pracujacych--doswiadczenia panstw zachodnioeuropejskich a sytuacja w Polsce.

Good occupational health and safety management not only protects workers from hazards and health impairment, but also contributes to the success of the enterprise as a whole. The internal control of working conditions in an enterprise, carried out by an employer, is one of the forms of occupational health and safety management implemented widely in many western countries, for example in Scandinavian countries and Ireland. This method may serve employers as an useful tool for stimulating and developing programmes aimed at improving working conditions and supporting workers' health protection against various hazards occurring in the work environment. The experience of the western countries in developing and implementing the internal control system, and the adaptation of the principles of this system to suit Polish conditions helped the authors to produce a set of general rules and guidelines addressed to employers who decide to use the method of internal control in their enterprises.

Polish approach to the quality assurance system in occupational health services.

The most important factors which influence the quality of Occupational Health Services in Poland are discussed. The legal regulations, the system of specialist education, guidelines and standards in occupational medicine, and the role of regional specialists supervision system are presented. The audit of medical documentation revealed the 'sub-populations' of doctors who are concerned about the quality and those who are not. Keeping relatively moderate prices of services by some OHS units, even at the cost of their quality, has become a side-effect of competition. The establishment of an accreditation system in OHS is postulated, basing on the existing elements of such a system.

The present state of occupational medicine in Poland.

Occupational medicine in Poland has a long tradition, dating back to the establishment of the first health-care institutions for industrial workers at an early stage of Poland's industrialization. Legal foundations of the industrial health-care system, based on the Soviet model, were enacted in 1953. During its most dynamic period of development (1970s and 1980s) the industrial health-care system provided medical services to about 6 million workers. The process of the political and economic transition in Poland began in 1989, and since 1991 there have been numerous transformations in the structure and function of industrial health services. The present article describes the main stages of the transformation process, occupational health training, research, advisory bodies, and the system for setting of hygienic standards.

[Section of occupational hygiene in the state sanitary inspection service--organizational situation-personnel and activities in 1993]. / Pion Higieny pracy panstwowej inspekcji sanitarnej--sytuacja organizacyjno-kadrowa i dzialalnosc w 1993 r.

The authors discuss the organization, staff matters and activities of the occupational hygiene section of the Polish sanitary and epidemiological services in 1993. The analysis is based on reports produced by the Ministry of Health (form MZ-50), descriptive reports and inspections at occupational hygiene sections. The authors focused on these three components as they give rise to many problems and difficulties, particularly in regard to monitoring of working places. An attempt is also made to suggest solutions to certain problems. The need for training of persons involved in occupational hygiene as well as for developing different forms of upgrading professional qualifications among workers with secondary education is emphasized.

The sanitary inspection in the conditions of social and economic transformation in Poland.

A great number of small, privately-owned companies appeared in Poland during the last five years as a result of the transformation process of the whole national economy. Continuous economic changes determine new requirements for the occupational hygiene branch of the State Sanitary Inspection which is designated to exercise control and sanitary supervision over working conditions in individual companies. The Sanitary and Epidemiological Stations are not capable now of ensuring permanent monitoring of various harmful agents even at those workposts which create true risk of health impairment. Lack of adequate legal regulations poses a significant problem in preparing a list of companies to be supervised. The majority of newly-formed, privately-owned companies not only fails to be subjected to any working-environment assessment procedures but also to be kept on any file. One of the crucial problems to be solved in the nearest future is to develop the efficient system for the supervision of working conditions and, at the same time, to find the ways how to improve them. Courses to train occupational hygiene specialists and to advance the skills of occupational hygiene workers seem to be equally important.

Present principles of workers' health care organization in Poland and directions of future changes.

The present-day legal regulations on workers' health care are far from satisfactory. The work on the modification of the occupational health service has been carried out for the last two years although the preparatory activities started much earlier. In May 1991, under the initiative of the Nofer Institute of Occupational Medicine in Lodz, the bill on the Labor Code has been amended so that it would regulate the employer's responsibilities with respect to providing health care for workers and to participating in respective costs. These activities have overrun the more general ones pertaining to the reform of the national health service in Poland. Under conditions of the growing free market economy the previously operated organizational system of health care for workers has become out-of-date and needs immediate modification to adjust it to the new economic situation. Evidently, the trends and rate of the policy in this respect have been considerably influenced by the more general activities to make Poland associated with the European Community and hence to develop an occupational health care system which would take into consideration the principles of the Charter of Social Rights of the EEC as well as of the ILO Conventions.

[Evaluation of the need of specialization of physicians in the field of occupational medicine]. / Ocena potrzeb w zakresie specjalizowania lekarzy w dziedzinie medycyny pracy.

Analysing the trends in obtaining specialization in occupational health during last 15 years an evident deterioration of formal qualifications of physicians employed in occupational health service (OHS) was observed. These data were confronted with the needs resulting both from the present model of workers health care as well as with those arising from ratification of ILO Convention No 161 of 1985. It was stated that discrepancy between the need for specialists and the actual possibilities of their training cannot be removed without radical reform of the Polish health care system in general and health service reform in particular.

[Necessity of changes and trends in the health care system for the workers in Poland]. / O potrzebie i kierunkach zmian w systemie opieki nad zdrowiem populacji pracujacej w polsce.

Authors define current organizing conditions and work effects of the industrial health service in Poland. They indicate these elements of diagnosis which effect the poor effectiveness of this health care unit. They also discuss the tasks assigned for health service in plants which were imposed by the ILO compact No 161 in 1985, and declare prompt implementation of the tasks in Poland. Suggestions concerning health insurance operative for all economic subjects are presented. The implementation of this kind of insurance would be one of indispensable modifications in the health care system of the working population. The range of free medical services available within this insurance would include a complex of preventive measures and medical assistance in case of disasters and life-threatening circumstances.