Future healthcare professionals on working conditions in Poland: perspective of medical university students.

BACKGROUND: Students of medical universities, future employees, will have an impact on the shaping healthcare system. It is important to know and understand their opinions on the factors affecting working conditions and, consequently, changes necessary to improve effectiveness of health care. Students' expectations can contribute to the changing working conditions for graduates and bring added value to health system redefinition. MATERIAL AND METHODS: The study used factor analysis to check whether its use was justified. Reliability analysis was performed and structure indicators were determined for each question. The anonymous survey was conducted from September 2017 until March 2018; 1205 students were randomly selected for the sample. RESULTS: Eighty percent of the students declared interest in healthcare changes, >50% reported that the main factors influencing the work were competencies, financing, medical equipment and organization. Over 90% of the respondents indicated too long wait times for an appointment with a specialist and admission to hospital as the reason for the low efficiency of healthcare, whereas >80% of the survey participants considered insufficient funding to be a barrier. The need for changing the financing scheme was underlined by >90% of the students, and of health priorities by about 80%. Approximately 71% of the respondents were in favour of limiting the role of government in decision-making processes and introducing changes into the education system. CONCLUSIONS: Students' views on organizational and financial factors of working conditions can contribute to improvement in systemic solutions at both micro and macro levels. Limiting the role of politicians in planning and implementing reforms can motivate employees to be more creative and decisive. Analysis of opinions can bring added value to health policy and systemic changes and should be extended by further research results after the COVID-19 pandemic. Students' interest in healthcare reform encourages reflection on enriching education with managerial skills. Med Pr Work Health Saf. 2024;75(4).

Indirect and Direct 65+ Patient Reporting of Non-Steroidal Anti-Inflammatory Drug-Induced Adverse Drug Reactions as a Source of Information on Polypharmacy and Polypharmacy-Related Risk.

Background and Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs), which have anti-inflammatory and analgesic properties, are commonly used in the treatment of various, particularly frequent, as well as chronic, conditions in older patients. Due to common polypragmasia in these patients and a high risk of adverse drug reactions (ADRs) and drug interactions, pain management poses a therapeutic challenge. This study describes the importance of ADR reports in the identification of polypharmacy and the ensuing interactions. Materials and Methods: Both healthcare professionals (HPs) and non-healthcare professionals (non-HPs) reports collected in the EudraVigilance database of NSAIDs, including most commonly co-reported medications and reported reactions, were analysed and differences between HPs and non-HPs reports were identified. Results: In the analysed period and group, non-HPs reported more reactions but indicated fewer drugs as suspect or concomitant. The outcomes of our analysis indicate more HP engagement and more detailed reports of serious ADRs when compared to non-serious individual case safety reports (ICSRs) by non-HPs, which appeared more detailed. Such reactions as kidney failure and increased risk of bleeding are known adverse reactions to NSAIDs and common symptoms of their interactions, which were described in the available literature. They were much more frequently reported by HPs than by non-HPs. Non-HPs more frequently reported reactions that may have been considered less significant by HPs. Conclusions: The differences between healthcare professionals' (HPs) and non-healthcare professionals' (non-HPs) reports may result from the fact that the reports from patients and their caregivers require a professional medical diagnosis based on symptoms described by the patient or additional diagnostic tests. This means that when appropriately classified, medically verified, and statistically analysed, the data may provide new evidence for the risks of medication use or drug interactions.

[Directions of organizational and economic changes in occupational health services as a response to the COVID-19 pandemic - challenges to the health crises]. / Kierunki organizacyjno-ekonomicznych zmian ochrony zdrowia nad osobami pracujacymi jako odpowiedz na pandemie COVID-19 ­ wyzwania wobec kryzysów zdrowotnych.

The COVID-19 pandemic caused not only short-term organizational and economic changes in the functioning of occupational health services, but also enforced to include them in the formulation of a strategic systemic approach to this link of the health care system. The aim of the article is to identify and describe the organizational and economic changes in occupational health services during the pandemic. On this basis, the directions of further research on the improvement of the activities of health care entities of working people in response to future health crises have been formulated. The review covered legal acts relating to organizational and economic changes, Polish and foreign expert publications, full-text Polish and English-language scientific articles included in the PubMed database, publications beyond the specified period, consistent and useful in explaining the concepts of organization, management and economics. The changes in occupational health services presented in the literature during the pandemic consisted of: introducing additional organizational forms of providing health care to employees including occupational medicine leaders, strengthening supervision over working conditions, interdisciplinary cooperation for managing the health of working people, participation in pro-vaccination campaigns, activities in the field of rehabilitation after COVID-19 and new-quality cooperation with public and private health stakeholders. As the result of the review, problems were formulated for future research, which included ensuring the security of occupational medicine entities in terms of resource availability, adjusting the allocation of resources to new financial needs during and after a pandemic, evaluation of organizational and economic changes introduced during the pandemic and the legitimacy of their maintenance in subsequent periods, the development of economic and organizational instruments for the time of crisis, the scope and principles of cooperation with health care stakeholders and the introduction of medical technologies based on a medical and economic assessment according to Health Technology Assessment. Med Pr. 2022;73(6):471-83.

[Organizational and financial changes in the work of primary health care workers during the COVID-19 pandemic in Poland]. / Zmiany organizacyjno-finansowe w pracy personelu medycznego podstawowej opieki zdrowotnej w okresie pandemii COVID-19 w Polsce.

Following the outbreak of the COVID-19 pandemic, the objectives of the health care system had to be adapted to the changing circumstances, in order to meet the health needs of patients, but also the expectations of medical workers related to ensuring safe working conditions in the crisis situation. The activities of medical staff are greatly affected by organizational and financial changes in health care systems, which affect both the health care systems all over the world and the functioning of all forms of health care. The article examines the organizational and financial changes resulting from the introduction of regulations affecting the conditions of primary health care (PHC) workers in Poland from the beginning of the COVID-19 pandemic to May 8, 2021. The findings regarding measures taken to ensure the stability of PHC functioning during the pandemic highlight that the public health emergency exposed a significant need to introduce organizational and financial changes in PHC. The changes arising from legislation and good practices of medical, organizational and financial character resulted in health care system modernizations in Poland. It is worth stressing, however, that there is a great need to maintain coherence when implementing organizational and financial changes affecting the fluidity and effectiveness of the actions taken by PHC personnel, and thus their working conditions, when implementing future responses to public health emergencies. Such changes should be based on an analysis of the solutions introduced since the beginning of the pandemic in Poland: these include organizational changes such as housing conditions, organization of work and workplaces, flow of information and way of supplying the patient, and financial changes involving mobilization of additional financial resources. The article presents a list of future research questions that merit consideration when setting problems and priorities: these can be used to guide the introduction of permanent modifications to the functioning of PHC in Poland and to facilitate possible future adaptation in times of emergency. Med Pr. 2021;72(5):591-604.

Informal Dementia Caregivers: Current Technology Use and Acceptance of Technology in Care.

(1) Background: Given the increased social isolation caused by the COVID-19 pandemic, the challenges faced by informal dementia caregivers have increased. An increasing use of technology, both in care and dementia clinical trials, depends upon caregivers' abilities as a user. Accordingly, the aim of our study was to verify the current technology (smartphone and computer) use and acceptance in care, regarding socio-demographic variables; (2) Methods: Questionnaires were distributed to 102 dementia caregivers, mostly of patients with moderate dementia; (3) Results: The majority of participants were women (63%), and large number of them used technological devices such as a smartphone (91%) or computer (81%). Results revealed differences between age, gender, and education level on technology acceptance. Interestingly, smartphone use and acceptance seemed to be feasible, regardless of age, whereas computer use was negatively correlated with age. Technology was perceived by respondents as most useful for patients' activities including locomotion, toileting, and meals; (4) Conclusions: The future of technology use in dementia care should indicate solutions tailored to individual characteristics such as new technology solutions (GPS trackers, smartphone apps, dietary intervention, and meal planning apps).

Priority Setting in the Polish Health Care System According to Patients' Perspective.

Identification of health priorities is concerned with equitable distribution of resources and is an important part of strategic planning in the health care system. The aim of this article is to describe health priorities in the Polish health care system from the patients' perspective. The study included 533 patients hospitalized in the Lodz region. The average age of the respondents was 48.5 years and one third (36.6%) had university education. Most of the respondents (64.9%) negatively assessed the functioning of the health care system in Poland. Most of them claimed the following aspects require improvements: financing health services (85.8%), determining priorities in health care (80.3%), the role of health insurance (80.3%), and medical education (70.8%). Over 70% of the respondents agreed the role of politicians in designing and implementing health system reforms should be limited. The fact that the respondents so negatively assessed the Polish health care system implies there is a need for full discussion on redefining health priorities.

The Importance of Direct Patient Reporting of Adverse Drug Reactions in the Safety Monitoring Process.

All medicinal products authorized in the European Union are subjects of constant drug-safety monitoring processes. It is organized in a pharmacovigilance system that is designed to protect human health and life by the detection, analysis and prevention of adverse drug reactions (ADRs) and other drug-related problems. The main role of the aforementioned system is to collect and analyze adverse drug reaction reports. Legislation introduced several years ago allowed patients, their legal representatives and caregivers to report adverse drug reactions, which caused them to be an additional source of safety data. This paper presents the analysis of EudraVigilance data related to adverse drug reactions provided by patients, their representatives, as well as those obtained from healthcare professionals related to medicines which belong to M01A anti-inflammatory and antirheumatic products, a non-steroid group. The objective of the study was to identify the changes in the number and structure of adverse reaction reporting after the introduction of pharmacovigilance (PV) obligations in EU. A review of scientific literature was also conducted to assess the differences in adverse reactions reported by patients or their representatives and by healthcare professionals. We also identified other factors which, according to literature review, influenced the number of adverse reaction reports provided by patients. Analysis of data collected from the EudraVigilance showed that from 2011 to 2013 the number of reports made by patients and their caregivers increased by approx. 24 percentage points, and then, from 2014, it constituted around 30% of the total of reported reactions every year, so patient reporting is an important part of pharmacovigilance system and a source of drugs' safety information throughout their use in healthcare practice. Additionally, there was no interrelationship between the seriousness of reported adverse reactions and the overall number of patient reports when compared to reports form healthcare professionals.

[Occupational health services as the insurance product and insurance economic instruments]. / Swiadczenia medycyny pracy jako produkt ubezpieczeniowy i ubezpieczeniowe instrumenty ekonomiczne.

BACKGROUND: One of the most controversial issues in restructuring the Polish health insurance system is the implementation of private voluntary insurance and creation within it a new insurance product known as occupational health services (OHS). In this article some opportunities and dilemmas likely to be faced by providers and employers/employees, when contracting with insurance institutions, are considered as a contribution to the discussion on private insurance in Poland. The basic question is how private insurance institutions could influence the promotion of different preventive activities at the company level by motivating both OHS providers and employers. MATERIAL AND METHODS: The descriptive qualitative method has been applied in the analysis of legal acts, scientific publications selected according to keywords (Pubmed), documents and expert evaluations and research project results. RESULTS: Taking into account the experiences of European countries, described in publications, international experts' opinions and results of research projects the solution proposed in Poland could be possible under the following several prerequisites: inclusion of a full scope of occupational health services into the insurance product, constant supervision of occupational medicine professionals, monitoring of the health care quality and the relations between private insurers and OHS provider and implementation of the economic incentives scheme to ensure an adequate position of OHS providers on the market. CONCLUSIONS: The proposed reconstruction of the health insurance system, comprising undoubtedly positive elements, may entail some threats in the area of health, organization and economy. Private voluntary health insurance implementation requires precisely defined solutions concerning the scope of insurance product, motivation scheme and information system.

[Occupational health service management--the concept and application of lean management]. / Zarzadzanie podmiotami sluzby medycyny pracy--koncepcja i zastosowanie lean management.

One of the most effective management systems is the so-called lean management (LM) aimed at loss minimization of institutions' activities while maximizing value and satisfaction to the clients. The system implementation comprises not only typical business areas but also health care sectors. The aim of the article is to present the concept and opportunity of improving the management of occupational health units. Due to its multi-profile nature of tasks and diverse relations with the environment occupational health could be a good institutional example of LM implementation. Operational perspective consists of five guidelines: describing values expected by final clients, setting value flow eliminating needless elements, creating the integrated, coherent and smooth sequence of valuable activities, offering the values to clients, and aiming at continuing improvement. LM could be implemented in occupational health units in the following areas: timing and tasks coordination, leaning some tasks and expanding others in order to maximize clients' value, cost rationalizing, improving the quality of services by eliminating mistakes, avoiding repetition of activities.

[Occupational health protection in business economics--business plan for health intervention]. / Ochrona zdrowia pracowników w ekonomice przedsiebiorstwa--biznesplan przedsiewziec zdrowotnych.

INTRODUCTION: One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics. MATERIALS AND METHODS: The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity. RESULTS: The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company. CONCLUSIONS: Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees' health.

[Return on investment for occupational health: review of methods and recommendations]. / Rentownosc inwestycji w zdrowie w przedsiebiorstwie--przeglad metod i zalecenia.

The impact of the population health on the national economy, occupational risk factors and economic consequences of workers' behaviors in the workplace are the subject of health economics studies. Conditions and behaviors at work are recognized as one of the major economic factors. These relations are analyzed and evaluated with use of methods that combine economic consequences of working conditions, management and enterprise finances. The methods of assessing this impact are well known but the ability to implement them in practice is still limited. There are two main types of methods: methods for measuring economic relations between the work environment and enterprise management and methods for the economic analysis of investments in the work environment and occupational health. Methods for assessing economic effectiveness of working conditions limited to measurements of costs of absenteeism at work are also used. One of the methodological options in this regard is return on investment (ROI) for occupational health. ROI has been applied in many firms all over the world. Depending on the analytical assumptions and the scope of research, the ROI value ranged between more than 1 and 13. This means that the increase in return on investment for occupational health has been observed. There are examples that the return on invested resources cannot be always obtained. ROI accounting gives employers an opportunity of increasing effectiveness. Evidence of the real value of health investment enables to provide the platform of discussion among managers and other persons responsible for occupational health management. The results of the studies cannot be overestimated as an element of economic incentives system. Based on the review of the methods and results of their implementation some recommendations can be formulated.

[Motivating instruments behind occupational health activities and their efficiency in expert judgment]. / Skutecznosc instrumentów motywacyjnych w ochronie zdrowia pracuj cych w opinii ekspertów.

BACKGROUND: The aim of the study was to analyze and compare economic incentives practices in occupational safety and health (OSH) in the chosen EU countries and the USA, based on expert judgment. MATERIAL AND METHOD: The information for the analysis was collected by using a questionnaire filled by experts from international organizations. It was supplemented by direct consultations with experts and experts' reports. RESULTS: Economic incentives in OSH do exist in each country under study. The institutions engaged in providing economic incentives are as follows: social insurance, disability pension private insurance, state institutions supervising occupational health, health insurance, state institutions providing regulations, accident insurance. Experts evaluated the influence of state and insurance institutions on economic incentives promotion, as medium, and that of employers' organizations and trade unions as weak. They also confirmed a particular role of cost/benefit analysis. CONCLUSIONS: Economic incentives are considered as a managerial instrument enabling individual and flexible health protection management at different levels in enterprises as opposed to the legislation that only provides for the observation of minimum standards. Economic incentives can be used faster and more effectively. Legal regulation is a slow process and proves to be a less effective tool.

[Cost-benefit analysis of the program on early detection of pulmonary diseases]. / Ewaluacja kosztów i efektów programu wczesnego wykrywania chorób ukladu oddechowego.

BACKGROUND: Economic evaluation of costs and effectiveness of the program aimed at early detection of lung diseases was the subject of the study. The scope of the study is related to the European tendency of creating information resources for public resources management. MATERIAL AND METHODS: The study covered more than 14 000 people divided into three age groups, living in 11 localities in the Lódz region. The program aimed at lung diseases detection was conducted in three steps: first specialist examinations, X-ray examinations, second specialist examinations. Costs and effectiveness of the program were compared by cost/effectiveness and incremental ratios. RESULTS: The results of the study were formulated in the following areas: costs of the program by age groups and groups with suspected diseases, effects of the program, costs per one detected case and incremental ratios. DISCUSSION AND CONCLUSIONS: The results of the study show that economic evaluation conducted from ex post perspective could be useful in building decision scenarios. Sensitivity analysis allows for investigating how different assumptions of variables influence the study results. Variables useful for the scenarios of early lung diseases detection programs were identified for further studies.

[Financial incentives in workers' health management]. / Bodzce ekonomiczne w zarzadzaniu zdrowiem pracujacych.

In the countries of the European Union, several million workers meet with an accident every year. In the national economy, the costs of accidents at work and occupational diseases are born by different institutions in different proportions, and they are estimated at several percent of the gross domestic product of each of these countries. The issue concerning economic consequences of occupational diseases and accidents at work has been emphasized in the section on health and safety at work of the Community Strategy for 2007-2012. Bearing this in mind, the need have arose to strengthen the efficiency of legal instruments and economic stimuli to motivate actions aimed at improving work conditions. Economic stimuli and legal instruments complement each other in the process of motivating various institutions. The following kinds of economic stimuli have been distinguished: subsidies, grants and financial assistance of the state and stimuli incorporated into tax and insurance systems. Economic evaluation at the information, allocation and educational levels, being an economic tool, may support policymakers who can use this tool to asses economic efficiency of decisions made in the area of health and safety of workers as well as to asses economic consequences of the functioning of legal instruments. The aim of the project, implemented under the Seventh Framework Program by the Nofer Institute of Occupational Medicine, is to promote the system of economic stimuli understood as an incentive to undertake actions for the improvement of work conditions. Owing to this project the discussion forum, addressed to relevant and interested social partners, will be established, and experts in the field will assist in determining directions of further actions aimed at advancing motivation systems.

[Models of workers' health and safety insurance in the selected European Union member states: certain economic problems]. / Modele ubezpieczen w zakresie zdrowia i bezpieczenstwa pracujacych w wybranych krajach europejskich. Wybrane problemy ekonomiczne.

BACKGROUND: The project entitled "An analysis of insurance models in the selected European Union (EU) member States" has recently been accomplished in the Nofer Institute of Occupational Medicine in the section concerning the health and safety of the working population. One of the aims of the project was to identify differences between EU and Polish models, which may provide the basis for a possible involvement of insurance providers (existing and/or created on purpose) in the implementation of tasks in the area of the workers' health protection in Poland. MATERIAL AND METHODS: Documents and publications issued in Poland and elaborated by international organizations were used in the analysis. Of the existing models, those which differ in the solutions concerning the limitation of growing costs of insurance systems, the level of centralization of insurance system management, and the range of cooperation between public and private insurance providers were selected for the analysis. RESULTS: The results of the analysis show that the functioning of insurance systems in the countries under study has been the subject of constant modifications and improvements. Their major aims are to limit the growth of costs of social insurance systems, to shape new qualitative relations between private and public insurance institutions, and to take account of new forms of work regarded as a factor contributing to changes in insurance systems. DISCUSSION AND CONCLUSIONS: The conclusions arising from the analysis of European insurance systems in the area of workplace accidents and occupational diseases, as well as a possible direction of insurance system transformation in Poland address the following issues: the scope of centralization of insurance system management and the role of the state, the degree of independence of insurance institutions and their priority actions for prevention, motivation mechanisms targeted at employers, participation of employers in the consequences of occupational diseases and workplace accidents, as well as the role of additional voluntary workers' health insurance.

[Costs of occupational diseases and accidents at work in Poland]. / Koszty chorób zawodowych i wypadków przy pracy w Polsce.

BACKGROUND: The costs of occupational diseases and accidents at work in the state members of the European Union keep at a level of several percent of their gross national product (GNP). Employees, employers and the society as a whole have to incur this financial burden. Therefore, all social partners should be involved in the improvement of health and safety in the work environment through their concerted efforts. It should be pointed out that information in the field of economy is an inherent instrument of all activities. It allows to estimate economic consequences of occupational diseases and accidents at work as well as to formulate future strategies. The aim of this study was to estimate and assess the range of the expenditure of money on occupational diseases and accidents at work in Poland in 2004. MATERIAL AND METHODS: The algorithm for estimating economic consequences of occupational diseases and accidents at work was developed, taking into account, e.g., the selected components of the costs, the estimation of economic consequences for the national economy, and the costs incurred by employers and social insurance institutions. In addition, the model for estimating economic consequences and defining the range of expenditure of money on occupational diseases and accidents at work relative to indicators of socioeconomic situation of the country was constructed. Economic consequences are understood as costs incurred by the health care and social insurance systems in Poland, institutions, companies, and individual employees. RESULTS: The following cost components were estimated: the average-annual costs of lost production, sickness benefits, social insurance benefits and those incurred by enterprises related with accidents at work and occupational diseases. CONCLUSIONS: Due to the lack of complete, reliable information essential for estimating economic consequences, a number of assumptions and study limitations were accepted. The range of identified and estimated costs of occupational diseases and accidents at work was set relative to GNP and to the value added in the national economy. Bearing in mind that the costs of occupational diseases and accidents at work are underestimated, it can be concluded that their share in values characteristic of the national economy do not depart from average values recorded in European countries.

[Costs of intensive care of premature infants]. / Koszty intensywnej opieki nad noworodkami przedwczesnie urodzonymi.

UNLABELLED: It is often pointed that hospitalizations of premature infants generate high costs. It is particularly bothering with reference to neonatal intensive care units (NICU). OBJECTIVE: Since there is lack of desirable data in Poland, a study was launched in the city of Lódz in order to estimate exact costs of intensive care of premature infants. METHODS: The study consisted in collecting data cocerning all resources (drugs, materials, medical equipment etc.) used during the hospitalizations of the neonates. It was constructed in a retrospective way, which means that data was collected from the first day of each patient's hospitalization till his or her discharge. The study lasted from 03.10.2004 to 06.04.2005. The study population were neonates borned before 37 week of gestation, who were treated in the Intensive Care Unit of Paediatric University Hospital, Medical University of Lodz. The population consisted of 30 patients borned between 23-36 week of gestation and birthweight between 600g and 3300g. RESULTS: The structure of costs shows that the most expensive was medical care which constituted 51% of total costs. 90% of neonates costed no more than 30,000 zl and the average cost was 17,633,76 PLN. CONCLUSIONS: Total cost of hospitalization depends mainly on the length of stay. Among recovered patients hospitalizations lasted from 6 to 125 days. The longest stay costed 90,780 PLN. Detailed analysis is needed to consider if there is feasible possibility to limit time of hospitalizations in order to decrease costs.

[Calculation of workers' health care costs]. / Kalkulacja kosztów ochrony zdrowia pracujacych.

In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials.

[How to measure efficiency of health investments in enterprises: selected issues]. / Wybrane problemy pomiaru efektywnosci inwestowania w zdrowie w przedsiebiorstwie.

BACKGROUND: World trends and international organization recommendations point out the necessity of OHS economic appraisal methods improvement in order to ensure effective resources management in companies. MATERIALS AND METHODS: Published world literature on economic appraisal results, recommendations of international organizations, results of the own studies on economic appraisal in the field of health and safety at work in the companies in Poland were the background of the economic appraisal model for Polish companies. Several project assumptions have been adopted. The model of the return of the investment, model based on the company participation and some elements of the net costs formula are recommended for Polish companies in order to appraise efficiency of the health investment. The basic ratio in economic evaluation should be cost/benefit ratio. The project of the economic evaluation algorithm has been elaborated. RESULTS AND CONCLUSIONS: The economic analysis of the health protection and safety at work should include clear division between the internal and external costs. The proposed model could be used for the companies management needs in two directions: to microeconomic efficiency appraisal of investment in programs/intervensions in health and safety at workplace and to analyze the influence of the costs of accidents and occupational diseases and costs of preventive programs on finance management on the company level.

[Calculating costs of premature infants' intensive care in the United States of America, Canada and Australia]. / Liczenie kosztów intensywnej opieki nad noworodkami przedwczesnie urodzonymi w Stanach Zjednoczonych, Kanadzie i Australii.

Although advanced neonatal care technology has contributed to significant decline in mortality of premature infants, it has also resulted in rising costs of hospitalization. Premature infants constitute 4% to 6% of all newborns treated annually in Neonatal Intensive Care Units (NICUs) and that is why the cost of prematurity determines considerable financial burden on health care in each country. In Poland research concerning costs of neonatal intensive care have not been conducted so far. The object of this paper is to review world-wide literature on that subject, particularly taking into consideration methods of estimating costs and economic analysis, such as cost-benefit analysis, cost-effect analysis and cost-utility analysis. The results of studies undertaken in the United States of America, Canada and Australia have been presented. Results of review indicate the strong relationship between high costs and small gestational age or low birth-weight of newborns. As no research in this area has been conducted in Poland so far, it seems to be crucial to estimate costs of neonatal intensive care of premature infants in Poland. Precise analysis of main factors determining high costs may be helpful in searching for significant savings. It would be a useful decision-making tool both for the NICU and the hospital managers.