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Objectives: Oral health can affect quality of life in all course of life, which is a key factor of general health. Dental caries, periodontitis and oral cancer are of the highest burden of oral diseases. Rising prevalence of soft drinks and alcoholic beverages consumption due to easy access and socio-demographic altering has increased the concerns on oral health. In this review our purpose was to show effects of the most consumed beverages on oral health in people older than 15 years. Methods: The review was based on papers published in last 10 years, searched with combined key words related to types of drinks and specific oral health problems. We included 4 older studies due to lack of newer studies on subjected topics. Results: Sugar-free soft drinks are found less cariogenic and erosive than regular versions in limited number of studies. Alcohol consumption is shown as one of the risk factors of prevalence and severity of periodontitis and is proven to have synergistic effects along with tobacco on oral cancer risk. Consumption of soft drinks and alcoholic beverages was related with tooth loss whether dental caries or periodontal diseases. Conclusion: There is good evidence for association between soft drinks and oral health problems, but still no clear answer exists about strength of association between sugar-free soft drinks and dental caries. Also the knowledge about influence of alcohol is inadequate. Since consuming style affects erosive potential of drinks manufacturers should be required to add some recommendations on labels about drinking style.

Background: Autoimmune thyroid diseases are the most common diseases in humans. Their pathogenesis is complex. Patients are searching for ways of coping with them condition, including diet modifications. The aim of this study was to assess the role of medical personnel in shaping eating habits in patients with autoimmune thyroid disease based on experiences declared by patients. Methods: There were 208 people that took part in the study, of which 205 were qualified for final analysis. The results showed that patients most often choose online sources, while medical personnel rank second as the source of information on dietary recommendations.Results: People with thyroid disease are statistically more likely to use dietitian advice than people without thyroid disease. The highest percentage of respondents decided to modify their nutrition due to their own initiative. In addition, patients with autoimmune thyroid disease are statistically more likely to consider changing their diet to improve their well-being. The connection between the source of advice and modification of eating behaviour was also noted.Conclusion: Thanks to the joint effort of medical staff, patients can receive reliable knowledge about their disease, treatment and nutrition adapted to their needs.Trial registration: approved by the Bioethics Committee of Medical University of Silesia in Katowice (opinion no.: PCN/0022/KB1/80/2).

Background Although multiple systematic reviews indicate that various determinants (barriers and facilitators) occur in the implementation processes of policies promoting healthy diet, physical activity (PA), and sedentary behavior (SB) reduction, the overarching synthesis of such reviews is missing. Applying the Consolidated Framework for Implementation Research (CFIR), this meta-review aims to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings. Methods A meta-review of published systematic scoping or realist reviews (k = 25) and stakeholder documents (k = 17) was conducted. Data from nine bibliographic databases and documentation of nine major stakeholders were systematically searched. Included reviews (72%) and stakeholder documents (100%) provided qualitative synthesis of original research on implementation determinants of policies promoting healthy diet or PA or SB reduction, and 28% of reviews provided some quantitative synthesis. Determinants were considered strongly supported if they were indicated by ≥ 60.0% of included reviews/stakeholder documents. Results Across the 26 CFIR-based implementation determinants, seven were supported by 66.7–76.2% of reviews/stakeholder documents. These determinants were cost, networking with other organizations/communities, external policies, structural characteristics of the setting, implementation climate, readiness for implementation, and knowledge/beliefs of involved individuals. Most frequently, published reviews provided support for inner setting and individual determinants, whereas stakeholder documents supported outer and inner setting implementation determinants. Comparisons between policies promoting healthy diet with PA/SB policies revealed shared support for only three implementation determinants: cost, implementation climate, and knowledge/beliefs. In the case of healthy diet/PA/SB policies targeting school settings, 14 out of 26 implementation determinants were strongly supported. Conclusions The strongly supported (i.e., systematically indicated) determinants may guide policymakers and researchers who need to prioritize potential implementation determinants when planning and monitoring the implementation of respective policies. Future research should quantitatively assess the importance or role of determinants and test investigate associations between determinants and progress of implementation processes. Trial registration PROSPERO, #CRD42019133341

Background Existing studies indicate obesity and diseases associated with diet and sedentary lifestyle as leading health problem in Poland that cannot be solved without explicit public intervention. The purpose of this study is to evaluate actions to create a healthy food environment, undertaken by public authorities in Poland. Methods We used the Food Environment Policy Index (Food-EPI) to describe the Polish national food environment policy. We analysed available government documents, studies, reports, legal acts and other relevant materials to compile a evidence document, which has been then validated with government officials. In the next stage (March 2020), national policies will be subject to assessment in reference to international best practices by independent experts through an online Delphi study. Results of the survey will be then used during a national workshop (April 2020) in order to formulate and prioritize actions. Results For 15 out of 47 indicators we found no evidence for government actions that would meet the criteria set out in the Food-EPI definition. In case of the other 6 indicators it was observed that the existing solutions are non-binding and result from government-independent policies. The lack or limits of government involvement was observed in particular in the domains related to food promotion, food provision, food in retail, and Health in All Policies. Results from the online study and the workshop will be presented during the conference. Conclusions The preliminary results obtained through the review of the evidence point to the need for intensified government activities in the area of shaping food policy in Poland. Full conclusions will be formulated after the study is completed. Preliminary findings of the Food-EPI project suggest the need for strengthening food environment policy in Poland.

Background European Union (EU) Member states' food environments are shaped by both national and EU policies. To date however, studies assessing food environment policies developed and set by the EU are scarce. The aim of this study was to assess the strength of EU policies to improve food environments as well as to assess the extent these policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. Methods We compiled evidence on the EU policies for each of the Food-EPI 47 indicators. A European panel of independent, non-government experts (N = 30) specialized in nutrition, obesity or chronic diseases, using the Food-EPI evidence, rated the strength of EU policies to improve food environments during an online survey in February-March 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve EU food environment policies, which were prioritized during a follow-up online survey. Results The overview of EU-level policies resulted in a 79-pages document, describing policies (or the lack thereof) for each of the 47 Food-EPI indicators. This document has been verified for completeness and accuracy by EU governmental officials. The evidence document shows that the EU has mainly binding legislation on the food labelling whereas policies on the other Food-EPI domains are mostly voluntary. Results from the online survey and the formulated prioritized actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to EU officials and public health advocates in their efforts to improve the food environment policies set by the EU.

Demographic transitions that occur in decreased dynamics of natality and rising number of elderly in population structures constitute a challenge for all national economies. Another global phenomena are large-scale migration processes driven by intensification of globalization process, development of technologies, and telecommunications. Although both these phenomena were vastly addressed in many ways in scientific literature, a notifiable fact is that there are only few researches that would investigate them in connection and consider migration of older people and its consequences, especially for health systems. Despite the fact that generally the likelihood of migrations reduces along with age, in some countries a higher share of migrants older than 65 years in reference to the entire group of migrants are being observed. It is the more essential that groups of seniors represent an increasing percentage of people. There are also differences in between standard reasons for migrations in young people and the factors affecting migrations in elderly ones. Many variables can influence migration decisions among older people, and they can be affected by seniors' health conditions, levels of health care within the target countries they migrate to, and the living standards. Such factors as population aging, reduced fertility, and international migration have affected the changes in demographic profiles of many countries. The consequence of migration decisions in the group of seniors is, among others, the impact on health care systems of single nation states, which are more and more important elements of economic, social, and financial systems.

Background The implementation of public policies requires special attention from public authorities to ensure their transparency, effectiveness and efficiency. For this reason, efforts to evaluate the abovementioned politics gained attention and importance. Similar processes, by their very nature, are also noticeable in the area of health policy, however, the nature of the solutions used raises questions about the extent to which they allow to capture the assessed phenomenon in a holistic way. The current approach to the problem of evaluating health policy shows a tendency to break down this phenomenon into components including policies, programs or projects. The purpose of this publication was to assess the main methodological approaches used in evaluation studies in terms of their usefulness and limitations in conducting overall assessment of health policy. Main body The publication divides evaluation methods based on three main criteria identified in the literature—time, purpose and scope of evaluation. Methodological approaches to evaluation activities detailed on this basis are discussed from the point of view of their characteristics, usefulness and limitations in the creation of comprehensive health policy assessments. The growing awareness of the need for a different approach to evaluation, which was confirmed by the course of the discourse on evaluation in public health, was also pointed out. Conclusion Given the complexity of the matter making up the health policy, attempts aimed at its overall assessment should be based on an approach integrating many approaches, while ensuring coordination of evaluation activities that should be subject to common assumptions.

The aim of the article is to compare health system outcomes in the BRICS countries, assess the trends of their changes in 2000-2017, and verify whether they are in any way correlated with the economic context. The indicators considered were: nominal and per capita current health expenditure, government health expenditure, gross domestic product (GDP) per capita, GDP growth, unemployment, inflation, and composition of GDP. The study covered five countries of the BRICS group over a period of 18 years. We decided to characterize countries covered with a dataset of selected indicators describing population health status, namely: life expectancy at birth, level of immunization, infant mortality rate, maternal mortality ratio, and tuberculosis case detection rate. We constructed a unified synthetic measure depicting the performance of individual health systems in terms of their outcomes with a single numerical value. Descriptive statistical analysis of quantitative traits consisted of the arithmetic mean (xsr), standard deviation (SD), and, where needed, the median. The normality of the distribution of variables was tested with the Shapiro-Wilk test. Spearman's rho and Kendall tau rank coefficients were used for correlation analysis between measures. The correlation analyses have been supplemented with factor analysis. We found that the best results in terms of health care system performance were recorded in Russia, China, and Brazil. India and South Africa are noticeably worse. However, the entire group performs visibly worse than the developed countries. The health system outcomes appeared to correlate on a statistically significant scale with health expenditures per capita, governments involvement in health expenditures, GDP per capita, and industry share in GDP; however, these correlations are relatively weak, with the highest strength in the case of government's involvement in health expenditures and GDP per capita. Due to weak correlation with economic background, other factors may play a role in determining health system outcomes in BRICS countries. More research should be recommended to find them and determine to what extent and how exactly they affect health system outcomes.

Dietary behaviours have an important impact on rising prevalence of noncommunicable diseases responsible for 71% of deaths globally/year. Dietary behaviours also have a growing impact on quality of life, disabilities, as well as economic stability of health systems. In order to overcome the growing impact, many countries are looking for instruments to modify dietary habits of individuals. In the study presented here, we looked at solutions implemented in different countries in terms of junk food taxation, with regard to the political processes related to their implementation, adopted models of taxation, as well as their impact on social and economic reality. Throughout the world, several countries have adopted dietary taxes, such as sugar, fat, salt and soda taxes, while the other are planning or considering doing so. So far there is only one example of withdrawal from the tax that has been implemented. There are different models of taxation, including flat rates, percentages of the basic price and progressive rates on the amount of the component being subject to taxation. These solutions continue to be controversial and subject to intensive discussions in many countries. Nonetheless, the existing evidence shows that the impact on dietary habits seems to be positive.

Issue/problem Noncommunicable diseases are the main contributor to the global mortality, being responsible, as estimated, for 71% of deaths each year. About 80 of dietary dependent diseases has been identified so far, and their prevalence tends to exceed 30% in some populations. Description of the problem The growing prevalence of these diseases, along with impact on the quality of life, disabilities, as well as rising direct and indirect economic costs, constitute a basic foundation for emerging efforts to develop and implement new solutions within national health policies aimed at modifying dietary behaviours and reducing their negative impact on health status of individuals and populations. To address these problems the Joint Funding Action “Effectiveness of existing policies for lifestyle interventions - Policy Evaluation Network (PEN)” has been initiated, in which 28 research group across Europe are collaborating. Results The primary aim of the presented study will be to discuss the usage of the PEN instrument to identify best practices in food policies, including sugar sweetened beverages and junk food taxation. Previous examples of the instrument implementation will also be presented, including New Zealand, Australia and Canada, along with the results of current works on its development within the project. The second basic aspect for the study is to discuss and assess examples of food policies implemented in selected countries in terms of their effectiveness in modifying unhealthy behaviours. Lessons The time that has passed since the implementation of the evaluated solutions is too short to assess actual impact on health. Nonetheless, the existing evidence, including data from countries being the most successful examples of junk food taxation, like Mexico and Hungary, suggest that their impact on consumer choices, health literacy and also food industry in terms of food products composition, is positive.

The aim of this article is to present the course of privatization of spa companies in Poland during the period 2001-2011. We discuss assumptions of the privatization process, as well as actual implementation, having identified the process as chaotic and inconsistent with prior legal provisions. We found that in its applied form the process resulted in limitation of the therapeutic potential of spas, and reduction of the State's ability to implement health policy in a legally determined form. We also found that privatization potentially improved spa infrastructure standards and increases the tourist potential of spa resorts. We recommend that clear eligibility criteria are applied to institutions in the privatization process, as well as the provision of legal guarantees for access to spa services financed from public resources. Such guarantees should be made a public obligation, to ensure the availability of services for insured persons, and there should be an obligation to maintain a specific part of a given institution's potential for the needs of patients funded by public health insurance.

The article deals with the financing of spa undertakings through the health insurance system. The analysis is based on the financial statements of 28 spa undertakings operating in the Slovak Republic, their contracts with the individual health insurance companies and secondary data sources (accommodation statistics of these undertakings, the number of medical stays paid by clients themselves and of those covered by public health insurance, the spa treatment expenditure of the health insurance companies, the percentage of this expenditure out of the total expenditure spent by the health insurance companies on health care). The still significant percentage of revenues from the health insurance companies out of the total revenues of spa undertakings shows the prevalence of the medical nature of spa care. At the same time, it reflects the current tax measures related to the spa industry and shows that the introduction of a recreation allowance might influence the future development of spa care.

The effectiveness of health systems is an area of constant interest for public health researchers and practitioners. The varied approach to effectiveness itself has resulted in numerous methodological proposals related to its measurement. The limitations of the currently used methods lead to a constant search for better tools for the assessment of health systems. This article shows the possibilities of using the health system synthetic outcome measure (SOM) for this purpose. It is an original tool using 41 indicators referring to the epidemiological situation, health behaviors, and factors related to the health-care system, which allows a relatively quick and easy assessment of the health system in terms of its effectiveness. Construction of the measure of health system functioning in such a way allowed its presentation in dynamic perspective, i.e., assessing not only the health system itself in a given moment of time but also changes in the value of the effectiveness measures. In order to demonstrate the cognitive value of the SOM, the analysis of the effectiveness of health systems in 21 countries of Central and Eastern Europe during the transformation period was carried out. The mean SOM values calculated on the basis of the component measures allowed to differentiate countries in terms of the effectiveness of their health systems. Considering the whole period, a similar level of health system effects can be observed in Slovenia, Croatia, Czech Republic, Slovakia, Poland, Macedonia, and Albania. In the middle group, Hungary, Romania, Latvia, Lithuania, Georgia, Estonia, Bulgaria, Belarus, and Armenia were found. The third group, weakest in terms of achieved effects, was formed by health systems in countries like Ukraine, Moldova, and Russia. The presented method allows for the analysis of the health system outcomes from a comparative angle, eliminating arbitrariness of pinpointing a model solution as a potential reference point in the assessment of the systems. The measure, with the use of additional statistical tools to establish correlations with elements of the external and internal environment of a health system, allows for conducting analyses of conditions for differences in the effects of health system operation and circumstances for the effectiveness of reform processes.

Purpose: To investigate whether the Polish Marshal Offices use instruments for social media marketing activities in the field of health promotion. Methodology: Fourteen Polish Marshal Offices participated. The Computer-Assisted Web Interview and Computer-Assisted Telephone Interview were used along with a proprietary questionnaire. Standard statistical methods were employed. Findings: The number of people using the Internet and social media in Poland is steadily growing. The majority of the offices (93%) performed health promotion activities. The authorities collaborated with other units of local government and non-governmental organizations in these activities. According to respondents, the most convincing form of health promotion is direct communication (46%). More than half of the surveyed offices (56%) did not use portals or social networking sites in health campaigns. The rest of the offices indicated using Facebook (25%) or YouTube (6%). Half of them did not apply the tools of social media marketing. The other half was involved in discussions on health-related online forums (moderation or consulting). Relatively few offices use social media and social media marketing in health promotion campaigns. Value: The use of social media by the Marshal Offices may result in a potential increase in effectiveness of the pro-health campaigns. It is recommended that Polish Marshal Offices recognize the potential benefits of social media marketing campaign instruments in the field of health promotion in order to reach out the digital recipients.

Gwarancja prawa do zdrowia przeszla ewolucje zbiezną z historią nowozytnych ustrojow panstwowych: od ujecia indywidualistycznego az po postrzeganie przez pryzmat podstawowych potrzeb socjalnych. Celem pracy jest przegląd konstytucji polskich w aspekcie unormowan determinujących ksztalt polityki zdrowotnej panstwa. Zakreślono ewolucje treści odnoszących sie do zdrowotnego aspektu zabezpieczenia spolecznego, a takze źrodla regulacji charakteryzujących dzisiejszy model ustrojowy. Polskie regulacje odnoszące sie do zdrowia w ograniczonym zakresie pojawily sie w Konstytucji Marcowej, by ulec degradacji na mocy Konstytucji Kwietniowej. Bylo to zbiezne z ewolucją modelu ustrojowego, gdzie druga z wymienionych konstytucji stanowila przejaw ciązenia ku autorytaryzmowi niechetnemu gwarancjom praw jednostkowych. Poszerzenie skali regulacji odnoszących sie do polityki zdrowotnej nastąpilo w 1952 r. Konstytucja obecnie obowiązująca kontynuuje ujecie zapoczątkowane w poprzednim modelu ustrojowym, jednak wykazując znamiona ewolucji w strone ujmowania zdrowia przez pryzmat jego środowiskowych i behawioralnych determinantow. Nalezy oczekiwac dalszych zmian w tym kierunku.

The main aim of the paper is to outline the perspective for future developments of the spa treatment in light of demographic transitions characterized by the increasing number of seniors, as well as changing expectations and health needs of younger population. We made a systematic review of literature referring to the experience of Poland, and similar experiences of other countries in Central Europe. Based on the existing knowledge we conclude that spa treatment should become one of the preferred directions of development of health systems in European countries. Moreover, we state that a desirable direction to modify the therapeutic paradigm used in spa treatment is to put a far-reaching greater emphasis on the provision of innovative health promotion, which is justified by both its effectiveness, and strongly good foundation for its provision in spas. For this purpose it is necessary to extend the specialized health sector personnel with qualified health educators, which will enable an effective implementation of health promotion actions and their proper alignment to the specific target groups. Developing this category of specialists will also enable other professionals to concentrate on therapeutic activity fitting their competence.

The Internet has become a common and global medium. It contains vast information resources and a wide range of communication instruments. One of the communication channels are social media, which increasingly are also used in the business field. Social media combined with mobile technology introduced new challenges to marketing activity. This trend is also observed on specific and highly regulated drug market. The aim of this article is to describe the perspectives for the use of social media in e-pharmamarketing. We find that this require personalized communication, the use of online promotion tools, in order to perform advertising in contact with a demanding client. Currently pharmaceutical companies use social media to communicate basic information on their life, but they still do not appreciate it sufficiently as a tool to build the image of company or products. It is therefore considered that these companies should attach greater importance to the presence in this type of media, especially in the light of dynamic changes in the way people communicate.

Social security system currently face a number of difficulties arising of changes in the demographic structure of societies, like the decrease in fertility, lengthening of life expectancy and unfavorable change in the proportion of the population receiving retirement benefits to the population in working age. In result social security systems are being subjects to transition aimed ad securing their financial stability, part of which is a tendency to rise the retirement age and eliminate all the incentives to prematurely exit the labor market. On the other hand, this process of transition, as observed in Poland, is being driven mainly by political processes and due to economic reasons, while lacking public health evidence. This rises a danger that in final result the financial savings will be illusory only, and that the final configuration of the system will be inconsistent with the actual social needs of the population and will not efficiently protect against the social risks. In the article we present arguments for using the Healthy Life Years indicator in analyzes relating to the performance of social security systems, so that its construction will reflect differences in health status of different professional groups and system’s solutions in terms of both risk protection and prevention might be adjusted to conditions characterizing these groups.

The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders.

Background After the fall of communism, the countries of Central and Eastern Europe started the process of political, economic, and social transformation. In health system the reform directions were often similar, despite differences in transition dynamics and the degree of government determination to implement reforms. Nonetheless, for most post-communist countries, there is a gap in evidence regarding the effectiveness of implemented reforms and their impact on health system performance. The presented study attempts to analyse and evaluate the results of health reforms in CEE countries with regard to their influence on health system outcomes. We also analysed the external and internal health system environments during the transition period to determine the factors affecting the effectiveness of health reforms. Methods We compared the indicators of population health status, lifestyle, occupational safety issues and health system resources in 21 post-communist countries between sub-periods across the entire transition period at the aggregate level. The dynamics of change in health system outcomes in individual countries, as well as between countries, was also compared. Finally, we analysed the correlations between health system outcomes gathered into one synthetic measure and factors considered as potential determinants affecting the effectiveness of health reforms. The analyses were performed based on one-dimensional, two-dimensional and multidimensional statistical methods. The data were retrieved from the international databases, such as WHO, World Bank, International Labour Organization, World Value Survey and the European Social Survey. Results Among the factors positively stimulating improvements in health system outcomes were the total expenditure on health and a lower financial burden on patients, but primarily they were determined by the broader economic context of the country. Another finding was that better initial position positively determined health system outcomes at later stages, but did not affect the degree of improvements. Countries that embarked on comprehensive reforms early on tended to achieve the greatest improvements in health system outcomes. Conclusions Poorer countries may have only limited ability to improve health system outcomes by committing more financial resources to the health system. Progress can still be made in terms of health behaviours, since policies to address these have so far been insufficient or ineffective.

Armenian healthcare reforms have been carried out since independence in 1991, but achieved their full scale starting in 1995–1996. Although the healthcare system has already been modified and changed for 10 years, there is a lack of research in this regard. This paper aims to present the organization of the healthcare system in Armenia, its changes and challenges throughout the reform process. This paper is mainly based on a review of the relevant professional literature, a review and interpretation of legal acts in the healthcare field, and a review of research and assessment works done by several international and local organizations. There are still large numbers of elements typical for the Soviet Semashko model in Armenian healthcare structures. Implemented reforms have separated the institutions of the public payer and the providers, but did not manage to change the model of financing to be based on compulsory insurance. The level of financing is similar to the average in Central and Eastern Europe, but is based mainly on out-of-pocket payments contributing to about 80% of all system resources. The informal payments reach even 45% of expenditures. The structure of hospital beds remains ineffective, and there are still no mechanisms of increasing the quality of services. Privatization has been applied, but the role of private providers is still limited. The reforms have not caused satisfactory improvement in healthcare performance, although the health indicators are better than at the beginning of the transformation period. The stability of the reforming processes in previous years as well as the engagement of international institutions is a chance for positive changes in the near future.

In Poland, the new regulations establishing a decentralized system based on the regional sickness funds were implemented in 1999. However, the inconsequence of central government policy in Poland caused a significant reorganization of the model in 2001 towards the opposite direction. The objectives of this article are to analyze the organizational shape of the health care system in Poland after its reforms, separate the consequences of both reforms, and provide a possible generalization of the findings. The authors applied a modified decision space map based on a model by T. Bossert. The types of decentralization are according to Rondelli et al. Assumptions of both reforms, and their consequences, are based on political documents and reports and articles published in international and Polish scientific journals. The comparison of reforms shows that in 2001 the main changes referred to the institution of payer and financial matters. In both cases incorrect preparation of the political process and legislative faultiness were noted. Decentralization in 1999 was not followed by instruments needed for increasing the efficacy of the system; in the second case reorganization of the payer appears to be missing the expectations of health system participants. The comparison of reforms may suggest that decentralization is a better solution in the context of increasing organizational and financial efficacy of the health system, but because of numerous additional factors and specifics of political conditions in Poland generalizations are not possible.

Background The EU Directive on the application of patients’ rights in cross-border healthcare provides rules for facilitating access to cross-border healthcare and promotes cooperation on healthcare between member states, which brings many changes both in the organization and financing of health care. The aim of this paper is to assess whether providers in Poland are prepared to function within the single European market and what may be the impact on the …

The paper discusses the question of privatisation of the in-patient care sector in Poland. The references to the general reforming processes are made, as well as the legal context of ownership changes is presented. First part of the article describes the forms of privatisation applied in Poland, such as privatisation of the management, partial privatisation, functional privatisation and total privatisation. The basic data concerning legal regulations currently being in force is also included. Legal status is an important obstacle for the process of privatisation, since the regulations are incoherent and ambiguous. The project of Commercialisation and Privatisation of Independent Public Health Care Facilities Law was presented in 2001, but the political situation was unfavourable for such a regulation. The paper discusses also the potential profits that may be gathered during the privatisation, which may be proved by the experiences in the field of out-patient care, as well as the examples of other countries. It is stated that success of privatisation depends on changes in the structure of sources of financing health care system. The last part of the article describes the previous course of privatisation processes of in-patient sector. Presently about 18% of hospitals in Poland are private facilities, but their role in the system is marginal. The case of hospital in Wiecbork, which was the first bankrupt private hospital in Poland, is presented as the example of dangers caused by the invalid law. The final conclusion is that there is an urgent need in Poland to create clear and coherent legal frames for the privatisation of hospitals, as well as harmonisation of the changes with general reforms of the health care system.