[Coordinated heart failure care in Poland: towards optimal organisation of the health care system]. / Coordinated heart failure care in Poland: towards optimal organisation of the health care system.

Heart failure has becoming an increasing medical, economic, and social problem globally. The prevalence of this syndrome is rising, and despite unequivocal positive effects of modern therapy, reduction of mortality has been achieved at the cost of more frequent hospitalisations. Unlike in many European countries, in Poland heart failure is usually recognised later, at a more advanced stage of the disease, leaving less time for ambulatory treatment and resulting in a high number of hospitalisations. The current paper presents the most important data regarding morbidity and mortality due to heart failure in Poland. The experts in the field focus on the key source of high costs of therapy and highlight several critical organisational deficits present in the Polish health care system. This background information builds a basis for a concept of coordinated care for patients with heart failure. The paper discusses the fundamental elements of the system of coordinated care for patients with heart failure necessary to enhance the diagnosis, improve therapeutic effects, and reduce medical, economic, and social costs.

[Efficacy and costs of ovarian cancer therapy in Poland--regional approach]. / Skutecznosc i koszty leczenia raka jajnika w PoIsce--ujecie regionalne.

UNLABELLED: Ovarian cancer (OC) affects over 3 000 women in Poland annually The efficacy of the therapy remains relatively low due to challenges of systematic improvement in the early detection OC rates. International comparisons indicate a positive correlation between health expenditures and 5-year survival rates of cancer patients. To the best of our knowledge, our study has been the first to present a correlation between the 5-year survival rates (SRs) and the cost of ovarian cancer therapy in particular regions of Poland. MATERIAL AND METHODS: The study was based on the National Health Fund (NHF) data, available in the Disease Treatment Registry The analysis included approximately 13,000 OC patients who started their treatment between 2005 and 2008 to allow for the evaluation of long-term therapy results. The 5-year survival rates were analyzed in relation to average NHF expenditures in various regions of Poland, distinguishing the population of patients aged 45-64 years. RESULTS: The 5-year survival rate in the cohorts diagnosed in 2005 and 2008 changed marginally from 42% to 43%, maintaining relatively large differences between the regions (from 35% to 53% in patients diagnosed in 2008). The NHF expenditures in particular regions differed significantly: mean cost for the entire treatment cycle ranged from 31.600 PLN do 58.000 PLNperperson among patients diagnosed in 2008. No significant correlation between the survival and the cost was found. CONCLUSIONS: SRs of OC patients in particular regions of Poland are not correlated with average treatment cost. Thus, the differences in SRs between various regions of Poland have their source in other factors, e.g., clinical stage at diagnosis, or prevailing treatment patterns in the given region. Further studies may decrease regional discrepancies in patient care and SRs in OC subjects.

["Baltic Declaration"--telemedicine and mHealth as support for clinical processes in cardiology. The opinion of the Committee of Informatics and Telemedicine of the Polish Society of Cardiology and Telemedicine Clinical Sciences Committee of the PAS]. / "Deklaracja Baltycka"--telemedycyna i mHealth jako wsparcie procesów klinicznych w kardiologii. Opinia Komisji Informatyki i Telemedycyny Polskiego Towarzystwa Kardiologicznego oraz Zespolu ds. Telemedycyny Komitetu Nauk Klinicznych PAN.

For several decades we have observed the development of data transmission technology on an unprecedented scale. With the development of such technology there has also appeared concepts on the use of these solutions in health care systems. Over the last decade telemedicine has been joined by the concept of mHealth, which is based on mobile devices mainly to monitor selected biomedical parameters. On 10 October 2014, during the conference Baltic Electrocardiology Autumn - Telemedicine and Arrhythmia (BEATA), a debate was held with the participation of physicians, politicians, businessmen, and representatives of the Government (Ministry of Health, National Health Fund, Social Insurance Institution) concerning the use of telecardiology services in daily practice. During the meeting issues were discussed such as: telemedicine solutions available throughout the world, analysis of their effectiveness based on clinical trials, funding opportunities, their legal status, and the development perspectives of telecardiology in Poland. The result of the meeting was a document called the "Baltic Declaration". The declaration is a call for proven and profitable technologies to be introduced into clinical practice. The declaration also indicates that the variety of available technological solutions are merely tools, and the utility of such tools stems not only from their modernity, but also primarily from matching their functionality to the features of the health interventions that are to be improved.

Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012--nationwide AMI-PL database.

BACKGROUND AND AIM: Nationwide data on acute myocardial infarction (AMI) are available for some Western but not for Central and Eastern European countries. We performed a study on nationwide data of all Polish AMI patients in 2009-2012 to assess incidence, quality of care, and cardiovascular events during 1 year following AMI. METHODS: The database of the only public, obligatory health insurer in Poland (National Health Fund) together with data from the Central Statistical Office were used. AMI cases were selected based on primary diagnosis ICD-10 codes I21-I22. For years 2009-2012, index hospitalisations (n = 311,813) in a given year and death records were analysed. Additionally, data on hospitalisations, procedures and deaths during 1 year follow-up were obtained for 2009. RESULTS: Age-adjusted incidence of AMI in Poland in 2009 was 196 cases per 100,000 population (176 per 100,000 were hospitalised), with a decreasing trend over time. The incidence was 2.5 times higher in men than in women. The median age was 63 years in men and 74 years in women. The proportion of ST elevation myocardial infarction (STEMI) decreased from 59% to 48% in 2012, and the proportion of patients receiving invasive treatment increased from 72% to 81%. Age-adjusted case fatality rate was equal in women and men. In 2009, the number of patients with AMI was 75,054 (61% men, 39% women) and 83% of them were treated in cardiology units. Invasive strategy was used in 77% of patients with STEMI and 66% of those with non-STEMI, thrombolysis in 1% and coronary artery bypass grafting in 1.9% of patients. Invasive treatment was used less frequently in women and the elderly patients. When all hospitals where a patient was treated until the final discharge were taken into account, in-hospital mortality was 10.5%. The lowest in-hospital mortality was noted among patients treated invasively (6.3%). The total number of readmissions within 1 year following AMI was 84,718, of which 61.9% were due to cardiovascular causes. The most common causes were stable coronary artery disease (27%), heart failure (7.9%), recurrent infarction (7.0%), and unstable angina (6.8%). Within 1 year after AMI, only 22% of patients participated in a cardiac rehabilitation programme. Total 1-year mortality was 19.4% (invasive treatment 12.3%, non-invasive treatment 38.0%). CONCLUSIONS: Standards of care and early outcomes in AMI in Poland are similar to Western countries. The major cause of higher mortality due to AMI in the Polish population is a high incidence of AMI, indicating a need for intensification of primary prevention programmes. Secondary prevention is also underused, especially in the field of cardiac rehabilitation.

The definition of prices for inpatient care in Poland in the absence of cost data.

The health reform of 1999 in Poland introduced market-like relations in the health care sector. The oligopsonic and the current monopsomic position of the payer makes prices for health care products purchased in this quasi-market low and does not usually take into account the costs of production. Despite a long history of cost calculation in the system, a systematic and reliable assessment of costs is still lacking which would help in setting up fair financing. At the same time providers complain about the dictatorship of the National Health Fund (NHF) yet they rarely resign from contracts with the NHF when they have the chance to conclude one.

Definition of the "health benefit basket" in poland.

The subject of "health benefit basket" has been hotly debated for years among the Polish public, but until recently the debate has tended to be largely theoretical and abstract and therefore has lacked an effect on public policy. The situation changed in 2004, for two reasons: first the verdict of the Constitutional Tribunal invalidating the existing health insurance law and, second, Poland's accession to the European Union. The first problem was solved in part by defining a list of specific exclusions in the law and a promise to establish an institution for health technology assessment. The second issue remains open, although to some extend it is being dealt with legally by regulations issued from the Ministry of Health on acceptable waiting times for health services.