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波兰:卫生系统评估

Poland: Health System Review.

作者信息

Sowada Christoph, Sagan Anna, Kowalska-Bobko Iwona, Badora-Musial Katarzyna, Bochenek Tomasz, Domagala Alicja, Dubas-Jakobczyk Katarzyna, Kocot Ewa, Mrozek-Gasiorowska Magdalena, Sitko Stojgniew, Szetela Anna Maria, Szetela Przemyslaw, Tambor Marzena, Wieckowska Barbara, Zabdyr-Jamroz Michal, van Ginneken Ewout

机构信息

Jagiellonian University Medical College.

European Observatory on Health Systems and Policies.

出版信息

Health Syst Transit. 2019 Jun;21(1):1-234.

PMID:31333192
Abstract

This analysis of the Polish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In late 2017, the Polish government committed to increase the share of public expenditures on health to 6% of GDP by 2024. If the GDP continues to grow in the years to come, this will present an opportunity to tackle mounting health challenges such as socioeconomic inequalities in health, high rates of obesity, rising burden of mental disorders and population ageing that put strain on health care resources. It is also an opportunity to tackle certain longstanding imbalances in the health sector, including overreliance on acute hospital care compared with other types of care, including ambulatory care and long-term care; shortages of human resources; the negligible role of health promotion and disease prevention vis-a-vis curative care; and poor financial situation in the hospital sector. Finally, the additional resources are much needed to implement important ongoing reforms, including the reform of primary care. The resources have to be spent wisely and waste should be minimized. The introduction, in 2016, of a special system (IOWISZ) of assessing investments in the health sector that require public financing (including from the EU funds) as well as the work undertaken by the Polish health technology assessment (HTA) agency (AOTMiT), which evaluates health technologies and publicly-financed health policy programmes as well as sets prices of goods and services, should help ensure that these goals are achieved. Recent reforms, such as the ongoing reform of primary care that seeks to improve coordination of care and the introduction of the hospital network, go in the right direction; however, a number of longstanding unresolved problems, such as hospital indebtedness, need to be tackled.

摘要

对波兰卫生系统的这一分析审视了组织与治理、卫生筹资、医疗服务提供、卫生改革及卫生系统绩效方面的近期发展情况。2017年末,波兰政府承诺到2024年将卫生方面公共支出的占比提高至国内生产总值的6%。如果未来几年国内生产总值持续增长,这将带来一个机会,以应对日益严峻的卫生挑战,如卫生方面的社会经济不平等、高肥胖率、精神障碍负担加重以及人口老龄化,这些都给卫生保健资源带来了压力。这也是解决卫生部门某些长期存在的失衡问题的契机,包括与其他类型的护理(如门诊护理和长期护理)相比,过度依赖急性医院护理;人力资源短缺;健康促进和疾病预防相对于治疗护理的作用微不足道;以及医院部门糟糕的财务状况。最后,实施重要的正在进行的改革,包括初级保健改革,非常需要额外的资源。这些资源必须明智地使用,并且应尽量减少浪费。2016年引入了一个特殊系统(IOWISZ),用于评估需要公共资金(包括来自欧盟资金)的卫生部门投资,以及波兰卫生技术评估(HTA)机构(AOTMiT)所开展的工作,该机构评估卫生技术和公共资助的卫生政策项目,并设定商品和服务价格,这应有助于确保实现这些目标。近期的改革,如正在进行的旨在改善护理协调的初级保健改革以及引入医院网络,方向是正确的;然而,一些长期未解决的问题,如医院债务,需要加以解决。

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