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Professionalism and Responsibility
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Donata Kurpas, Andrzej Steciwko HEALTH CARE AND FAMILY MEDICINE IN POLAND General practice is the easiest job in the world to do badly, but the most difficult to do well. Professor Sir Denis Pereira Gray
Health Care System (HCS) in Poland is in continuous process of transformation. Before 1989 we had a system based on hospital, near-hospital specialist centres and local specialist units. There was no Family Medicine/General Practice specialists at all – the role of general practitioners (GPs) was played by team of internal medicine specialist and paediatrician (sometimes with laryngologist, gynaecologist, dentist etc.). Patients were assigned to the nearest health care unit and couldn’t choose a doctor. Almost all health care units were a public property [1–4]. The growing number of non-public primary care practices especially family doctor practices is due to the transformation of the National Health Care system in Poland which started in 1998, giving independence to health care practices, forming and strengthening the structure of the health care organizational body as well as them undertaking the contracting out of health services by means of negotiations with non-public practices as well. Further stages of reforms to the health system were to further strengthen the role of family medicine and the promotion of family doctors who were able to bid competitive offers for providing health services [4]. The aim of reforming the Polish national health service is to improve the general health of the public and the effective running of the health service, as experience from western European countries and Poland shows, it is advantageous for the development of family medicine The goal is a number of 20.000 family medicine specialists per 40 mln population of Poland. Pharmacies, dental practices and a quite a lot of primary and secondary care units are private. Most of the hospitals are still public (local government’s) property [1–4]. 1. Primary care in Poland Primary care in Poland is to be provided by family medicine specialists. The insured patient chooses a doctor (signs a declaration). Family doctors are contracted on capitatation fee and they are responsible for population reported on their list (max 2500 patients), differently from specialists who have fee for service system. Family doctor signs a contract for one year with Regional Department of National Health Fund (public health insurance unit) and gets capitation fee monthly. For now we have no certification/re-certification system in family medicine [1–4]. 2. Availability of primary care A family practice is open five days a week (from Monday to Friday) with working hours usually between 8 a.m. and 6 p.m. Out of hours patients report to the Emergency Care Unit. The out of hours services are different in different parts of our country. There are 3 general models: a) services provided by emergency units, b) services provided by family doctors/specialists on additional contracts with GP in special “out of hour” centres, c) services provided by GPs themselves at their own practices. There is a document, written by authorities of family physicians in Poland which describes all duties of family practitioners – it gives a wide range of competences in hands of family practitioners. It is a reference document in constructing of undergraduate and postgraduate training program in family medicine. But, in fact, the real duties of GP depend on a signed contract. Each year family doctors negotiate with National Health Funds conditions of contracts and payment (for now it's around 20 Euro per person per year) [1–4]. 3. Secondary care in Poland We have referral system to specialist’s care. It is required for the patient to be referred to the specialist excluding the following: ophthalmologist, gynaecologist (obstetrician), oncologist and psychiatrist. Collaboration between GPs and specialists is rather difficult because of low availability of specialist care, a long waiting list to consultation, a lack of good system of information exchange concerning referred patients. There are three levels of secondary care – provided by local specialist care, provided by specialist centres (mainly situated by large specialist hospitals) and university/medical school centres. Specialists also sign contracts with the public fund – they have fee for service payment system (but there is a maximal number of medical procedures during a contracted period). A patient who has a referral from GP can choose a secondary care unit to take care of her/him. The most expensive procedures (e.g. cardiosurgery, chemotherapy) are paid directly from central budget of the Ministry of Health [4–5]. 4. Undergraduate education in Family Medicine At present, there is no nationally agreed syllabus for GP/FM training at an undergraduate level in Poland. Some local schemes plan their own curricula, covering various aspects of knowledge, skills and attitudes appropriate to GP/FM (usually during 6th year of studies, including seminars and skills labs). Goals are to provide the students with an overall view of the most important aspects and the complexity of FM, to promote FM as a career to medical students, to motivate them to work in the community as family doctors [1]. 5. Postgraduate education in Family Medicine Postgraduate training in FM for trainees without any specialisation lasts 4 years, what means two years in hospitals and outpatient specialist clinics and 2 years in a family practice. During the education a wide range of teaching methods are used: tutorials, seminars, clinical skills lab, communication skills training, participating in the clinical work of the practice. An exam is taken after the 4 years. If a doctor pass the exam and get the FM certification – in Poland it is equal to any other specialisation and there is no recertification system. Moreover of training there is a wide availability to participate in postgraduate training in different fields of medicine. The FM doctors take part in a lot of projects including clinical researches and trials, also as members of international groups such as EUROPREV, EURACT, EQUiP and others [3–5]. After receiving the certification, it is possible to take the exam for opening one of the three kinds of specialisation: Balneology, Gerontology and Palliative Medicine [1–3]. 6. The role of family doctors According to the WONCA 2002 Definition of European GP/FM, general practitioners/family physicians are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness. They care for individuals in the context of their family, their community, and their culture, always respecting the autonomy of their patients. They exercise their professional role by promoting health, preventing disease and providing cure, care, or palliation [1–3]. There are very few relationships as important as those which bind a family doctor with a patient. To find a qualified doctor worthy of the patient confidence, requires time and effort. It is worth while, since this will give years of quality life, or even sometimes save the life. In addition to a great integrity, several factors and qualities must be joined together so that a patient will be completely satisfied with the choice [6]. Choosing one doctor as our primary health care professional is our best insurance for better health care. By letting this doctor coordinate health care needs, the patient can be assured of the highest quality care. This means the doctor will know the complete health history, what kinds of medications the patient is on, how a new medication might interact with existing medications, and, if necessary, what kinds of specialists he may need. With this knowledge, the doctor will be better equipped to make the best recommendations when the patient need care especially – specialist consultation or diagnostic [2]. REFERENCES 1. Steciwko A. (ed).: Practice of the family practitioner. Organisational, law and finance aspects, Wrocław Medical Academy, Wrocław 1998. 2. Targets for health for all, The health policy for Europe,1991, WHO, Copenhagen 1991. 3. Kurpas D., Gryko A., Oleszczyk M.: Health care and family medicine in Poland. Junior Doctor Project for the WONCA Region Europe u Amsterdam, 31.05–01.06.2004. 4. Mierzecki A., Januszewski A. (ed).: Management of a family practitioner practice, Szczecin-Wrocław 1999. 5. Luczak J.: Family practitioner and his patient in a changing environment, Health and management 1999, 1, 5. 6. Barrett S.: To choose your physician. Quackwatch, http://www.quackwatch.com, http://www.quackwatch. com/04Consumer Education. |
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Aby cytować ten artykuł/To cite this article: Kurpas D., Steciwko A., Health care and family medicine in Poland , [in:] Niebrój L., Kosińska M., Health Care: Professionalism and Responsibility, Katowice: Wyd. ŚAM 2005, s. 141-144 |
