Quality criteria for health checks: development of a European consensus agreement.

OBJECTIVE: Health checks may empower individuals to take better care of their health, but they may incorporate risks of incorrect test results, overdiagnosis and overtreatment as well. Some health checks are strictly regulated, such as in many of the national screening programs, but the ones offered outside such programs and in the commercial domain, are not. We developed a European consensus agreement for quality criteria. METHOD: Quality criteria were developed with the contribution of 43 experts from 16 European countries and 8 European organizations. A working group drafted a proposal, which was revised in several rounds of internal and external review by a multidisciplinary group of experts. RESULT: The quality criteria address the provision of information, communication and informed consent, predictive ability and utility of the test, and quality assurance. CONCLUSION: The consensus agreement on the quality of health checks aim to enhance informed decision making in clients and protects the affordability of the health care system. The criteria can be developed further into a formal standard and regulation if such authority is warranted.

Determining the use of health care services by obese inhabitants of Warsaw. A preliminary study.

BACKGROUND: The excessive use of health care services by obese people constitutes a serious financial burden to all highly developed countries. As yet however, this has not been recognised to be a problem in Poland. OBJECTIVE: To provide a preliminary analysis of Warsaw inhabitants in their use of and quality of received health care by comparing obese subjects with those of normal weight. MATERIALS AND METHODS: Study subjects were fifty three obese (BMI > 30) and one hundred eighty one normal weight (18.5 < BMI < 25) inhabitants of Warsaw, who had taken part in a study on social participation in health care reforms. The use of health care services covered: visits to public health care physicians, hospitalisation and visiting private physicians. Assessing health care quality was by evaluating overall the health care system and the family doctor as well as out-of-pocket treatment expenses and any difficulties in accessing physicians. RESULTS: Obese subjects perceived their health to be significantly worse than those of normal weight and significantly more of them never attended private practice. Consultation with public health physicians was also frequently, but not significantly, higher in the former whilst hospital admissions were the same in both groups. Obese subjects gave considerably lower general assessments of the quality of the health care system and more often perceived their medical expenses as being very high, nevertheless, both these differences were statistically insignificant. CONCLUSIONS: The obtained findings have allowed us to formulate new recommendations for future research. These will examine various uses of health care services by the obese, i.e. family doctors and other specialists of public primary health care, out-patient clinic physicians and private physicians (according to their defined specialisations), hospitals according to location and rehabilitation centres. Account will be taken of visiting frequency, admission waiting time for physicians, length of visits, amounts of prescribed medication, out-of-pocket payment for treatment and medication, frequency of surgical interventions, satisfaction with given treatments and physician attitudes towards obese patients. Moreover, the socioeconomic status of the obese will be investigated as a potential obstacle to using health care services.

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

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

Determinants of self-rated health of Warsaw inhabitants.

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

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

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

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

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

[Willingness of Warsaw inhabitants to cooperate with health service. III. Use of different types of treatment]. / Gotowosc mieszkanców Warszawy do wspólpracy ze sluzba zdrowia. III. Korzystanie z róznych rodzajów leczenia.

BACKGROUND: The global economic crisis led to the need to reduce the public expenditure, including health care. In a situation of reduction of the publicly guaranteed benefits, some services may be available only in private physicians for particular patients. Therefore, there is a need to examine factors determining the use of both types of health care. OBJECTIVES: The aim of the study was to assess the association between the use of free treatment of general practitioner and the use of private physician services on one hand, and health and its disorders, assessment of physician, and expenditure on treatment of the Warsaw inhabitants on other hand. MATERIAL AND METHODS: The data were collected from 402 Warsaw inhabitants by not-addressed questionnaire elaborated in Health Promotion and Postgraduate Education Department of the National Institute of Public Health-National Institute of Hygiene. RESULTS: Our findings showed that the majority of respondents used the both types of health care. Males, people from the youngest and the oldest group, those having elementary education, students and unemployed were more likely to use only free treatment from general practitioner, whereas people aged 30-44 years, higher educated, employed and those depending on other people were more often treated only by private physicians. The beneficiaries of only private physician services higher evaluated their health, physically felt better, perceived stronger social support and rarely remained at home due to illness. Private physicians were evaluated more positively in comparison with general practitioner practicing in public health care, nevertheless, the difference was not large. With respect to their own financial situation, the people using private physician services did not find higher medical expenses than those using only the general practitioner of public health care. CONCLUSIONS. Our research indicates that uncontrolled development of private medical services market may increase inequality in access to health care, if not protected by appropriate access to public health care.

[Five-year relative survival rates in Swietokrzyskie voivodeship (Poland) on the basis of the Swietokrzyskie Cancer Registry data]. / Wzgledne wskazniki 5-letnich przezyc na nowotwory zlosliwe w województwie swietokrzyskim na podstawie danych Swietokrzyskiego Rejestru Nowotworów.

The aim of the study was to evaluate the 5-year relative survival rates of patients with all malignant cancers in the Swietokrzyskie Voivodeship who were diagnosed with cancer during the period 1995-2007, which is when the Swietokrzyskie Cancer Centre began and developed its comprehensive oncological care in the region. 41,104 patients from the Swietokrzyskie Voivodeship who were registered in the Swietokrzyskie Cancer Registry in that period of time were included in the analysis of the survival rates. Relative survival was calculated using the Hakulinen and Brenner methods. These methods are recommended by the European Network of Cancer Registries for the population-based cancer registries where cause of death is unknown. The results were referred to the European average of relative survival rates calculated for all malignant cancers combined, as well as selected cancers calculated within the EUROCARE-4 project. The survival rates of patients diagnosed from 2003 to 2007 do not differ significantly from the European average, and are even higher for both sexes combined (56.0% v. 48.3%), and cancers of cervix and corpus uteri, as well as lung cancer for men and women combined. The 5-year relative survival rates for all malignances of patients in the Swietokrzyskie Voivodeship diagnosed from 2003 to 2007 increased by 9.7 percentage points in comparison to previous years 1995-2002. A significant improvement was seen in prostate cancer (28.1 percentage points), rectum cancer (13.1) and colon cancer (11.0). The improvement of the survival rates reflects the improvement in curability due to the development of the Swietokrzyskie Cancer Centre.