Perchaluk: Categorizing hospitals in times of crisis is like sticking a stick in an anthill – Puls Medycyny

The deadline for the implementation of the announced hospitality reform, scheduled for next year, has been postponed to at least 2024. – The biggest flaw of the project is introducing the classification of hospitals based only on their financial result – says Władysław Perchaluk, president of the District Hospitals Association in an interview with Puls Medycyny of Silesia Voivodeship.

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I don’t want to criticize large hospital centers, but it’s no secret that residents there are often reduced to the role of secretary – assesses Władysław Perchaluk.

Photo Archives / Association of Provincial Hospitals of the Silesian Voivodeship

Medicine pulse: What’s wrong with this law? Why did such a wave of criticism fall on her? It has long been said that the state of hospitals in Poland is not good. So it seems that the reform of this area is necessary, not to say necessary.

Wladyslaw Perchaluk: Changes are needed, this is not questioned by anyone. But good solutions are made in consultation with the people who operate in the area, not against it.

My entourage, since the first information about the direction of the reform appeared, and also after the draft law modernizing and improving the efficiency of hospitality was submitted for consultation, indicated that this was not a good plan. We emphasized that it was forgotten that Poland is different and that each region has its own needs – and that health policies must be developed in response to them. This included serving made maps of health needs that have probably been omitted entirely. This was also missing in the revised version of the bill.

In addition, the conditions under which the law would be implemented are – to say the least – unfortunate for hospitals.

What do you mean?

The main assumption of this reform was to divide hospitals into four categories based on their financial situation. Doing this during the pandemic crisis and the war in Ukraine is like sticking a stick in an anthill. The past two years have had a significant impact on hospital budgets; It is also uncertain how stable the second half of this year will be. There is also concern about the challenge that the entry into force of the Minimum Wage Act in Healthcare on July 1. Hospital managers still don’t know how the funds needed to fund the increases will be distributed; where, when and with what amount they will strike. The law does not make this clear.

Taking all this into account, it is difficult to agree that the current financial situation provides an objective picture of which institution is good and which is badly run.

But the problem with this reform isn’t just whether hospital categorization will be based on the bottom line for this year or next. The fundamental flaw of the project is the mere introduction of categorization based only on the financial result.

So what should hospital reform be about?

If the aim of the reform is to split hospitals, then more data should be taken into account to make this assessment more objective. Taking into account, for example, human resources, certificates obtained by a particular clinic. Without it, we have the effect that only a handful of hospitals qualify for category A, which is, shall we say, the best, and most fall into the lowest rated category – C and D. And there may be hospitals that really provide high-level services, but have recently made major investments, for example.

Finally, it must be said that hospitals cannot be judged on their economic situation if the applicable rules for financing healthcare are bad.

Today it can be said that only highly specialized procedures are well priced, while the rest are underestimated. Many hospitals don’t have a chance to provide these high-paying services – I mean poviat hospitals, which tend to focus on securing basic, lower-value services such as neurological stroke, basic surgery, or inpatient hospital services. In the latter area, benefits are so low that many hospital managers are faced with the dramatic decision to maintain a cost-generating unit, which could affect the liquidity of the entire facility. And this is where hospital reform should start – by making health services valuations more realistic.

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I have the impression that the drafters of the law have forgotten that hospitals are not screw factories that can stop or speed up production. That the purpose of their business is not to make a specific profit.

Another comment about the project is that, in line with the policy pursued there, institutions that fall into categories C and D will lose their independence in making decisions and that the local authorities that have guided them so far have the real power over them will lose to the Hospital Development Bureau. While some changes might need to be made to these entities (and many hospitals are already implementing recovery plans), in my community’s view, this should not be done centrally, as no one understands the needs of the local community better than the police self-government.

So the delay in the entry into force of the changes is relieved by poviat hospitals?

It is good that this reform has not yet been implemented. This gives hope that the Ministry of Health will improve it even further.

The health minister announced that the ministry was working on a design change to residential training, which provides that residents will receive part of the training program in poviat hospitals. Special incentives should be prepared. Is this a good initiative?

Many poviat hospitals, including those associated with the Association of Poviat Hospitals of the Silesian Voivodeship, have been granted permission to conduct residencies and have been successfully performing this task for a long time. Here much depends on the decisions of advisers: provincial and national in a particular area. Nevertheless, I have to admit that poviat hospitals have long tried to “receive” residents more broadly, which is of course related to the staff shortages in the health care system. This gives an opportunity to convince young doctors to work in these entities later on. And here I can assure you that many poviat hospitals are perfectly prepared to conduct residencies. In addition, I can say that not long ago, when I was running a large hospital with a clinical department, I had the opportunity to meet both students and residents – and they highly praised the facility. They admitted that they were teaching practical medicine, not “paper” medicine. I don’t want to criticize large hospital centers, but it’s no secret that residents there are often reduced to the role of secretary. But it is precisely in smaller institutions that they have the opportunity to actually meet the patient – under the supervision of a specialist, of course – and here they acquire practical skills.

With the staff shortages in the market and the financial capacity of community hospitals to attract specialists to the market, this initiative seems valuable.

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