Regional integration of health services in Poland--an ambitious pilot project.

A new and very important feature of the health care reform in Poland is a set of initiatives emerging locally and striving for decentralisation of the management structure. The most promising manifestation of this process consists in the ambition to set up regional systems of integrated health services, guaranteeing provision of comprehensive care and run efficiently by competent managers. The direction of reform has been strongly encouraged by the Ministry of Health and Social Welfare, but still faces many barriers, mainly because of the misuse of the concept of integration by former health politicians. In the seventies and eighties integration was implemented in a very formal way, neglecting both medical professional attitudes and managerial abilities of decision makers. A major mistake was the resignation of inclusion of the rich 'parallel systems' within the services available to the general public. In the new political circumstances regionalised services, or health consortia as they are called, are a deliberate response to the need for decentralisation and efficient use of scarce resources. Three regions which volunteered to start an extensive experiment were selected through a formal competitive process. They include more than six million inhabitants and almost one quarter of the territory of the country. New organisational arrangements, networks of contracts and agreements, channels of financing and quality control programmes will be monitored in pilot areas to make them applicable all over the country.