The Sejm has finally passed a bill reforming hospitals. New regulations are expected to improve finances.

• At Tuesday's (August 5) session of the Sejm, MPs finally passed an amendment to the regulations aimed at improving the functioning and finances of Polish hospitals. Finally, because the previous three attempts at this regulation proved to be a false start, the bill will now go to the Senate.
• The experts interviewed by Portal Samorządowy agree that the amended act still requires changes and additions.
• The new regulations provide, among other things, for easier mergers and changes in hospital profiles, as well as for their operation by associations of local government units.
• "This is a good direction. However, it's a shame that the law doesn't provide financial incentives for implementing such changes," says Jarosław Fedorowski, president of the Polish Hospital Federation.

On Tuesday (5 August), the Sejm (lower house of parliament) passed an amendment to the Act on Healthcare Services Financed from Public Funds and the Act on Medical Activity. Two hundred and thirty-one MPs voted in favor of the bill, 203 against, and two abstained. The bill will now move on to the Senate.

The key goal of this regulation is to reform the operation and financing of hospitals . The new regulations are also intended to improve the economic situation of, among others, district hospitals, whose debt currently reaches approximately PLN 8 billion. The total debt of all hospital facilities in Poland already exceeds PLN 27 billion.

Let us recall that this was the fourth attempt to pass this amendment (the previous three government bills did not even reach the Sejm), for which not only hospital directors, but also local governments running them, have been waiting for many months.

The act adopted on Tuesday is intended, among other things, to make the system of basic hospital health care services (PSZ, i.e. the so-called hospital network) more flexible, facilitate the change of profiles of hospital departments and the merging of hospitals by local governments in accordance with the actual needs of residents of a given region and demographic conditions.

In addition, recovery plans for indebted facilities are to be implemented. The hospital law recently passed by the Sejm is one of the milestones of the National Recovery Plan (KPO).

The Sejm was originally scheduled to adopt this bill at its session on July 25 this year. However, the Left blocked the bill, announcing it would abstain from voting.

This law, which ostensibly modernizes the system, in practice opens the way to the commercialization of hospital activities, centralization of decisions in the hands of the president of the National Health Fund and short-sighted cost-cutting at the expense of patients

- explained Joanna Wicha, a Left MP, in July.

The decision to support the hospital reform (prepared by the previous Minister of Health, Izabela Leszczyna) was made on Monday, August 4, at a meeting of the Left party's parliamentary caucus, according to Rynek Zdrowia. This followed a lengthy conversation between the new Minister of Health, Jolanta Sobierańska-Grenda, and the deputy head of the ministry, Wojciech Konieczny of the Left party.

"We maintain our position that this bill is imperfect, but recognizing the need to quickly rescue funds from the National Health Fund (KPO)—the PLN 10 billion that this bill will unlock for hospitals—we simply recognize the overriding necessity for this money to flow into our healthcare system. With the caveat that we will continue working on this bill in the future," Łukasz Michnik, spokesman for the Left, told Rynek Zdrowia.

Will the solutions introduced in the amended regulations actually improve the operation of hospitals in Poland, including those run by local government units? We asked, among others, Professor Jarosław Fedorowski, president of the Polish Hospital Federation.

From the perspective of hospitals, as well as local governments, some provisions of this act may indeed provide them with additional opportunities. Primarily, it allows for the creation of associations of local government units to combine and jointly operate hospitals, both in the form of independent public healthcare facilities (SPZOZs) and jointly owned companies.

- says President Fedorowski in an interview with the Local Government Portal.

He adds: - Of great importance, of course also for patients, will be the possibility of more flexible operation of surgical departments, including one-day procedures.

Professor Jarosław Fedorowski, who is also a cardiologist, considers the planned strengthening of hospital specialist clinics and the planned provision of more services on an outpatient basis instead of hospitalizations to be a beneficial solution.

Which provisions are still controversial among hospital managers and – according to the medical community – will require changes in the near future?

However, the facility's recovery plans stipulated in the act are still to be subordinated primarily to financial performance . This clearly shows that the therapeutic effect—which should be the foundation of every healthcare entity's operations—is only a derivative of economic calculation under these regulations. Instead, it should be the other way around.

- our interlocutor points out.

At the same time, he points out that in this matter, further powers for the Agency for Health Technology Assessment and Tariff System (AOTMiT), which deals, among other things, with the valuation of services financed by the National Health Fund, will be very important.

"We can only hope that throughout this entire system, we will remember that the fundamental role of hospitals and other medical facilities is, above all, effective patient treatment. And this should be at the forefront of all recovery processes," says Professor Fedorowski.

It also points to the facilitations provided for in the amended act in changing the profiles of facilities - so that they actually take into account regional/local demographic and epidemiological conditions - among others, by means of combining hospital departments and entire clinics by local governments.

In Professor Fedorowski's opinion, it's good that the amended law includes such solutions. "Unfortunately , it lacks financial incentives to create associations of local government units that would provide a more comprehensive healthcare organization than the current one," our interlocutor emphasizes.

These should be incentives in the form of preferential funding for healthcare consortia that care for patients not only at the smaller county level , but also in partnership with larger cities and large hospitals with higher levels of security. This will ensure continuity of patient care.

- explains the expert.

"Furthermore, the act lacks financial support for hospitals and local governments, which will prepare and implement effective recovery programs for these facilities. However, we believe that the new Minister of Health, Jolanta Sobierańska-Grenda, who has extensive experience in hospital restructuring, will strive to amend the act accordingly ," concludes Professor Jarosław Fedorowski.

Bernadeta Skóbel, legal advisor at the Association of Polish Counties, also pointed out the threats related to the new hospital law in a recent interview with the Local Government Port.

- The authors of the act intend to encourage, among others, counties to consolidate their hospitals, for example in the form of associations of local government units or through companies running them - the expert reminded.

Let us remember, however, that no sensible district board or starost would make such a decision if they were to merge their facility with a hospital that, for example, is in a much worse economic situation.

- she added.

"No one will risk such consolidation by taking on the additional financial problems of a neighboring hospital. Indeed, such risks can be shared, as the law allows for the possibility of agreeing which party is responsible for specific liabilities. However, this does not solve all the problems, as certain financial burdens will still exist after the consolidation of the facilities," noted Bernadeta Skóbel.

* * *

• strengthening the hospital system by consolidating resources and rationalising costs for healthcare entities in situations where there is overlap or inefficient dispersion of staffing and infrastructure potential;
• rationalisation and more flexible functioning of the system of basic hospital health care services (PSZ), i.e. the so-called hospital network ;
• implementing solutions enabling the consolidation of hospitals and strengthening the supervision of the entities creating them over the implementation of recovery programs;
• introducing a regulation enabling, at the request of a hospital, the resignation from implementing a specific facility profile - with the consent of the President of the National Health Fund;
• the possibility of establishing and running independent public health care facilities (SPZOZ) - as well as hospitals operating in the form of capital companies and budgetary units - by associations of local government units as founding entities ;
• creating and approving recovery programs developed by SPZOZs that experienced a net loss.

The regulations also stipulate that the development of a recovery plan will be preceded by analyses of operational and management efficiency, economics, quality, operations, medical activities, and the activities of individual hospital organizational units. The analyses also cover the current situation of the given SPZOZ.