Title : Program of integrated primary health care in Poland – Organizational and economic perspective of first stage of the implementation

Background: The coordinated care program in primary healthcare (POZ) in Poland has been formally operational since 2021. Providers can join it on a voluntary basis. Currently, approximately 40% of all primary healthcare providers have joined the program by signing agreements with the National Health Fund, resulting in approximately half of the Polish population being covered by coordinated care. The introduction of this new solution in Poland aims to reverse the pyramid of benefits in the healthcare system by changing the structure of services provided.

Method: Legal regulations and other documents related to the implementation of coordinated healthcare in primary care were analyzed. A comparison was also conducted of best practices for coordinated care in primary care clinics, compiled by the Ministry of Health. The results of the competition for good practices in outpatient care organized by the Supreme Medical Chamber were also considered.

Results: Coordinated care expands the existing diagnostic and treatment options provided by family physicians, primarily for patients suffering from the most common chronic diseases. A primary care physician can refer patients for tests that were previously only available to specialists, such as those in diabetology, endocrinology, cardiology, pulmonology, or nephrology. A primary care physician can utilize the support of specialists in a given field of medicine by referring their patients to them for consultations or by consulting with them themselves instead of referring patients to specialist clinics in the Outpatient Specialist Care Center (AOS). Consultations between a primary care physician and a specialist can be conducted using IT systems or teleconsultation. In addition to additional diagnostic and therapeutic options, coordinated care in primary care introduces new principles of patient care, ensuring that patients ultimately receive comprehensive, clinically effective, and cost-effective care. Coordinated care, provided to a lesser extent by primary care providers who have signed agreements with the National Health Fund (NFZ) solely for coordination, is financed within the capitation rate established for the coordinator. Broader coordinated care is financed from the entrusted budget, which the entity performing medical activities receives from the National Health Fund. The second source of financing is the entrusted budget allocated for diagnostic services in the form of laboratory tests.

Conclusions: However, barriers to the development of coordinated care have emerged, including difficulties in recruiting specialists, a reluctance to take on additional responsibilities, low levels of funding within the budget entrusted to primary care providers, a complex system for contracting and billing healthcare services, and a lack of indicators for assessing the quality of coordinated care as a basis for payment for performance. Some of these barriers may indicate varying degrees of maturity among primary care providers in implementing organizational and economic systemic changes.

Dr. Izabela Rydlewska-Liszkowska is an health economist specializing in financing, cost calculations and management in health system. She holds PhD and MoE in Economics from University of Lodz, Poland.  She has worked in Nofer Institute of Occupational Medicine in Lodz, Poland. She has completed courses at foreign universities in health economics, cost management, national health accounting, pharmacoeconomics, and research on the effectiveness of public health interventions (including AMC Amsterdam, OECD Paris, University of Aberdeen, University of York, and European Chemical Agency Helsinki). She served as a temporary WHO expert , member of Socio-Economic Analysis Committee in European Chemical Agency, Helsinki and as an expert for the Ministry of Health in Poland.