Sixth edition. Resilient and stable healthcare system – health safety in times of crises.

“The health care system must be resilient and stable, supported by solid pillars: financial guarantees, stable human resources, digitization, prevention and building medicine autonomy.” – emphasized the guest Minister of Health, Dr. n. ekon. Adam Niedzielski.

As pointed out by Malgorzata Bogusz, President of the Institute Social Policy Development, President of the Kulski Foundation, Member of the European Economic and Social Committee, the health care system has to cope with challenges that cannot be prepared for. “Fortunately, many individuals and companies have become involved in helping Ukraine, following the Scottish proverb quoted by Winston Churchill <<defend one house and you will defend them all>>. We urgently need to find answers on how to change, among other things: the medicine market, prevention, diagnostics” she said.

They also discussed the issue of the influx of huge numbers of refugees to Poland from Ukraine, mainly women and children. “It is crucial to provide them with access to medical services. In addition, we must prepare to provide psychological support, especially for children. This huge challenge requires the support of the European community” appealed Radoslaw Sierpinski, MD, President of the Medical Research Agency, Plenipotentiary of the Prime Minister for the Development of the Biotechnology Sector and Poland’s Independence in Blood Products.

Minister Adam Niedzielski noted that we are talking about helping people, not just technocratic solutions. “We are helping Ukrainians like families, welcoming them into homes, not refugee camps. The idea of helping has the face of a child who suffers the consequences of the war on different levels. Since the beginning of the aggression, there have been many declarations of assistance for example from the European Commission, but words do not translate into the financial sphere. The entire burden is being carried by Poland” he said.

The first panel, moderated by Dr. Jakub Gierczynski, MBA, health system expert and Member of the Expert Council at the Patient Rights Ombudsman, dealt with Poland’s security in terms of access to medicines and medical devices in the current crises.  “We need to be self-sufficient when it comes to the supply of medicines. Essential preparations, which are used by several million Poles, are important. We need to be independent, including from supply chains that may be broken. This is what the two billion zlotys which are to be spent in the coming years on drug security are to serve,” informed Radoslaw Sierpinski, MD

Krzysztof Kopeć, President of the Polish Association of Employers of the Pharmaceutical Industry, argued that “drug security is as important as energy or physical security.” “We are now seeing the consequences of decisions made for the last 30 years about the massive supply of active substances from China. We need to think about how to change this and start taking into account whether the drug will arrive in the event of a crisis.” – he postulated

Maarten Van Baelen, Executive Director of the Plasma Protein Therapeutics Association (PPTA), argued that in difficult times it is essential to store and ensure an uninterrupted supply of blood and increased plasma collection. “We have an increasing need for blood and plasma-based medicines both in Poland and Europe”  – he assured.

Maarten Van Baelen, Executive Director of the Plasma Protein Therapeutics Association (PPTA), argued that in difficult times it is essential to store and ensure an uninterrupted supply of blood and increased plasma collection. “We have an increasing need for blood and plasma-based medicines both in Poland and Europe”  – he assured.

It is also important to ensure the continued availability of medical devices. “It is necessary to fight for them, to ensure availability. Unfortunately, the market for medical devices is unregulated, just as the market for medicines was a dozen years ago. It is worth considering the establishment of a system and procedures.”- argued Arkadiusz Grądkowski, President of the All-Poland Chamber of Commerce of Medical Devices POLMED.

In times of crisis, stocks and ways of distributing them play an important role. Michał Kuczmierowski, President of the Government Agency for Strategic Reserves, argued that “active pharmaceutical substances are often produced abroad, and will become unavailable during a crisis. Therefore, it is necessary to secure stocks and production lines”. “The government’s strategic reserve program takes medicines into account. It does not secure the entire needs, but it allows you to catch your breath for a while, without dealing with this issue in case of an emergency” he added.

Katarzyna Rumiancew, Chief Analyst at the Warsaw Enterprise Institute, pointed out the underestimated role of pharmacists. “The skills of pharmacists should be effectively used to relieve the burden on POZ during the first contact with patients. Pharmacists are not just drug sellers, they have specific medical knowledge, which is often sufficient in the first contact. For example, in measuring blood pressure or renewing a prescription there is no need to involve the doctors of the POZ”, she argued.

Lt. Col. Emil Lisiak of the Department of Military Health Services at the Ministry of Defense pointed out that military and civilian medicine are two closely interconnected  systems, and it is important to unify procedures and develop common standards for action in emergency situations.

The second panel was titled “Health security in terms of accessibility to services – how to meet the health needs of patients?”. The pandemic has halted the growth of life expectancy rates. Prevention and public education have become most important.

“Government programs are being established, and we will soon see the first effects in schools, in grades 1-6. A new medical profession – preventive medicine – has also been established,” informed Dr. Grzegorz Juszczyk, Director of the National Institute of Public Health PZH – State Research Institute.

Also for Grzegorz Błażewicz, Deputy Patient Ombudsman, education is paramount. The future shape and efficiency of the health system depends on it.

“The most important aspect is Poles taking care of their health, in addition to external factors such as a pandemic. There needs to be consistency in data collection so that it is clear what we are dealing with. We try to know the risk factors and address them, because then the hospital treatment may not happen,” argued Dr. Roman Topór-Mądry, President of the Agency for Health Technology Assessment and Tarification.

Maciej Karaszewski, Deputy Director of the Department of Health Care Services of the National Health Fund, pointed out the financial issues. “We have raised valuations, hospitals will get a cash injection”, he argued.

Because of the pandemic and war debt that has been incurred, the importance of child and adolescent psychiatry will increase. The reform currently being implemented is expected to change a lot.

We are launching a specialization in child and teenage psychotherapy, which is also available to psychologists, not just doctors. We are introducing a new profession – community therapist for children and teenagers. There will be about a thousand specialists in the system,” said Prof. Dr. Małgorzata Janas-Kozik, Head of the Department of Clinical Psychiatry and Psychotherapy of the Developmental Age of the Slaski Medical University in Katowice, the Health Minister’s plenipotentiary for the reform of child and adolescent psychiatry

Pharmacists can play an important role in meeting patients’ health needs. “Ukrainians turn to pharmacists for medicines, such as tranquilizers, which are on prescription in our country, but not in theirs. Often it is the pharmacist who has to explain how our system works, explain the steps of the procedure” noted Dr. n. pharm. Anna Kowalczuk, Director of the National Institute of Medicine.

The third panel was devoted to health security in civilization diseases.

“The main problem is cardiovascular, cardiac and vascular diseases. They are the main cause of disability. We have managed to solve the problem of reimbursement for more groups of drugs used in heart failure. Great changes have taken place in the treatment of diabetes. We dream of shared data on the course of treatment of patients, which would improve the treatment process” Maciej Miłkowski, Undersecretary of State at the Ministry of Health, enumerated in his introductory speech.

The environment has prepared a National Cardiovascular Disease Program planned for 10 years, somewhat along the lines of the oncology strategy. Its value is up to 3 billion PLN

“Prevention, lifestyle changes, innovations in pharmacotherapy, modern procedures are becoming the most important. The program will shorten the patient pathway, from the family doctor to the specialist, it should take no more than 30 days. The program will change the image of cardiology and the patients’ chances” – assures Prof. Tomasz Hryniewiecki, MD, Chairman of the National Council for Cardiology, National Consultant in Cardiology.

Cardiologists and diabetologists often share patients. Whether and how can the growing trend be stopped? Prof. Leszek Czupryniak, MD, Head of the Department of Diabetology and Internal Medicine at UCK WUM, believes that it is necessary to change the lifestyle not only of the patient, but of the family and the entire environment. Of course, innovative drugs are also helpful.

The situation is similar with kidney diseases. “Diagnosis is important, without it we can’t cope with civilization diseases. We need drugs to be administered as early as possible, thus a great role is played by the detection of the disease” – said Professor Tomasz Stompór, MD, Head of the Department of Nephrology-Hypertension and Internal Medicine and the Department of Internal Medicine at the Faculty of Medical Sciences of the University of Warmia and Mazury in Olsztyn.

Prof. Dr. Brygida Kwiatkowska, National Consultant in Rheumatology, Head of the Early Arthritis Clinic, Deputy Director for Clinical Affairs at the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, confirmed that “it is necessary to treat patients at an early stage, so disease detection is very important”.

The second part of the conference “Resilient and stable health care system – health security in times of crises” opened with a speech by Piotr Mazurek, Secretary of State in the Chancellery of the Prime Minister, Deputy Chairman of the Committee for Public Benefit, Government Plenipotentiary for Youth Policy. He pointed to the huge role of civil society in overcoming successive crises that Poland has had to face in recent years – the coronavirus pandemic, Russia’s aggression against Ukraine, and the influx of millions of war refugees.

“In the face of all these challenges, our state continually passes the test, but it would be impossible to provide such effective aid – both during the pandemic and now – without an active, well-organized civil society.” – Minister Piotr Mazurek highlighted.

As an example of successful cooperation between the third sector and public authorities, he cited the Solidarity Senior Support Corps, in which several hundred social actors were involved in providing coordinated assistance to those most in need during the first months of the pandemic.

“It is similar today – we have a real army of volunteers, social activists, NGOs or scouts, which immediately went into action to support people coming to Poland from Ukraine. From the very beginning, they could count on the help of state institutions, whose role was to coordinate grassroots initiatives – in all 16 provinces governors’ plenipotentiaries were appointed, who at the local level became responsible for constant dialogue and exchange of information between social organizations and the government” – Minister Piotr Mazurek said.

The minister pointed out that the Government’s support for the broader third sector also has a financial character.

“Never in the history of Poland has so much public money as now flowed to NGOs. Before the 2017 reform of Deputy Prime Minister Prof. Piotr Gliński, we had only one program, the Civic Initiatives Fund, dedicated to NGOs, with a budget of PLN 60 million a year. This year, due to the Prime Minister’s decision, it will already count 90 million PLN. Additionally, a whole network of new proposals for the third sector has been created,” Minister Piotr Mazurek noted. “The state is open to citizen activity, and citizens – ready to act, effective, efficient and committed. This allows me to believe that together we are capable of overcoming any possible crisis” he added.

The next two, closing the conference, rounds of debates were dedicated to the condition of Polish health care in the context of oncology, hematology and the treatment of patients with rare diseases. Both areas are currently facing fundamental changes related to the construction of the National Cancer Network and the National Plan for Rare Diseases.

“Hematooncology does not stand still, and progress in the area of treatment of all types of cancer is being made almost on a daily basis. It is very important that we constantly keep up with these changes to be able to offer patients access to ever newer and more effective drugs and forms of therapy” – said Agnieszka Wierzbowska, MD, Head of the Department of Hematology at the Medical University of Lodz.

“To improve the situation of oncology patients, the focus should not be solely on expanding the list of reimbursed drugs and including modern preparations in it. There is a need to involve both the medical community and public authorities in the development of modern immunotherapy in Poland. Therapies must also become increasingly targeted and personalized” added Prof. Jan Zaucha, MD, Head of the Department of Hematology and Transplantation from the Medical University of Gdansk. 

As Maciej Miłkowski, Undersecretary of State at the Ministry of Health, declared, a new drug program will be implemented in its entirety from May 1, which will significantly improve the availability of drugs for a wide range of oncology patients. He also pointed to the coordination of the ministry’s activities with the Europe’s Beating Cancer Plan – which, among other things, aims to achieve a 90% vaccination rate by 2030, which will enable the complete elimination of cancers dependent on the human papillomavirus.

On the other hand, the panel dedicated to patients suffering from rare diseases highlighted that the number of people waiting for their situation to improve ranges from 2.5 to as many as 3 million in Poland.

“Patients with rare diseases are still treated as second-class people. They flit from one specialist to another, spending huge amounts of money from their own pockets on tests that have no effect. Because they suffer from rare diseases, their demands are often ignored” said Prof. Anna Latos-Bieleńska, MD, National Consultant in Clinical Genetics, Head of the Department of Medical Genetics at the Medical University of Poznan.

Grzegorz Błażewicz, Deputy Patient Ombudsman, pointed to the National Plan for Rare Diseases as an example of the growing interest in the plight of people suffering from rare diseases. The document, which details support (financial, organizational, institutional) for this branch of medicine, went into effect last year.

“The plan provides for significant improvements in the care of people with rare diseases, such as the creation of expert centers, access to drugs and special dietary measures for rare diseases, or the creation of a Rare Disease Registry. In addition, a passport will be developed for patients with rare diseases, which often require complex treatment and interdisciplinary care” explained Grzegorz Błażewicz.

Another solution that offers hope for funding expensive innovative therapies is the Medical Fund Law. The implementation of both the National Plan for Rare Diseases and the Medical Fund Act could significantly improve the situation of people suffering from rare diseases. This is because gene diagnosis in Poland, unlike in most EU countries, is still not reimbursed by the state, and patients still have to cover its costs out of their own pockets. It is the identification of the specific mutation causing a given disease that enables the selection of appropriate, targeted therapy.

The Polish health care system urgently needs to find answers to the challenges of ensuring health security. Especially in a situation where we are struggling with the war and pandemics. At the same time, treatment and prevention of civilization diseases cannot be neglected, and a stable diagnostic and treatment pathway for patients must be guaranteed. The lives and health of nearly 40 million people currently living in Poland, both Polish citizens and more than 2 million refugees from Ukraine, depend on solving these problems.

The conference “Resilient and stable health care system – health security in times of crises” was organized by: Institute for the Social Policy Development, The Kulski Foundation. The Agency for Medical Research was an institutional partner.

The conference was held under the honorary patronage of the Minister of Health, the Ministry of Development and Technology, Deputy Prime Minister Piotr Gliński, the National Institute of Public Health, the Government Plenipotentiary for Youth Policy, the Council for Dialogue with the Young Generation, the Committee for Public Benefit, the Union of Entrepreneurs and Employers, the Warsaw Enterprise Institute and the Institute for Eastern Studies.

The conference was funded by the National Liberty Institute – Center for Civil Society Development as part of the Government Program for the Development of Civic Organizations 2018-2030.

A webcast of the event is available at the following link: https://www.facebook.com/events/1322430168245220/?active_tab=discussion.

Source: PAP and own information