Healthcare Forum. Zygmunt Berdychowski, Chairman of the Economic Forum Programme Council

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2 Debate What Are the Aims of the Polish Policy for Seniors? Healthy Ageing - A Challenge for the Polish Economy (2013), Bartosz Arlukowicz, Ministry of Health, Lech Walesa, Nobel Peace Prize Laureate, President of Poland , Lech Walesa Institute, Wojciech Dziworski, Director of the Section for Innovation and Healthy Ageing Directorate General for Health and Consumers (DG SANCO), European Commission, Barbara Bien, Head of the Geriatrics Clinic, Deputy President on Medical Affairs in Polish Geriatric Association, Medical University of Bialystok Zygmunt Berdychowski, Chairman of the Economic Forum Programme Council The need for continuous and open healthcare system debate has accompanied us for many years and it still seems that the debate has not yet exhausted topics and issues requiring each time new solutions and modifications. Continuously growing demand for healthcare services that results from demographic and civilizational changes, coupled with increasing costs, calls for discussion and cooperation in order to improve both quality and quantity of health care services. Health care is financed from such sources as: contributions for health, disability and sickness insurance, local self-government budgets, the state budget and private funds. Besides of the Ministry of Health, health care issues are dealt with by many other institutions, including Ministry of Labour and Social Policy, Ministry of Economy and Ministry of Finance, and that is why they need to be approached comprehensively. The Healthcare Forum has facilitated comprehensive health care review both in nationwide and local scale already for 5 years, searching for both general and specific solutions related to concrete specializations or organizational units. It has been attended by experts, physicians, business people, representatives of governments and international institutions dealing with health care. Their contribution has improved the efficiency of health care system and the health condition of the entire society. 2

3 European Health Policy (2011), Adam Fronczak, former Undersecretary of State, Ministry of Health, Poland, Stavros Malas, Minister, Ministry of Health, Cyprus, Ewa Kopacz, Prime Minister, Poland; John Dalli, Commissioner for Health and Consumer Policy ( ), European Commission, Belgium Healthcare Forum The Healthcare Forum is the most important meeting of broadly understood representatives of the Health Care sector. The conference is attended by representatives of the European Commission, governments, the biggest pharmaceutical corporations, hospitals and experts. The debates focus on the most significant problems and challenges faced by the entire sector. Hence, last year s discussions were especially devoted to the upcoming health care reform, the effects of the Refund Act and Cancer Plan. Due to increasing interest in the Healthcare Forum, the Forum agenda has been broadened each year. Last year, the forum involved a few dozen events - discussion panels, programme blocks and special events attended by more than 100 influential leaders responsible for various functions in the health care system. According to the guests, the Forum has been one of few places hosting serious and topical discussion about the Polish strategy for development of the health care sector. The Role of Private Health Care System in Cooperation with Local Authorities in Terms of Building a System of Integrated Territorial Investments. (ITI), Adam Rozwadowski, Vice-President of the Board, Polish Association of Private Hospitals, Poland, Andrzej Sokołowski, President of the Board, Polish Association of Private Hospitals, Poland, Jerzy Stępień, Judge, former Chairman Constitutional Tribunal, Lazarski University, Poland, Marcin Szulwiński, President of the Board, Grupa Nowy Szpital scp. z o.o., Poland, Piotr Gerber, Chairman of the Supervisory Board, EMC Medical Institute, Poland 3

4 Access to Medical Services vs. Social Delineation What Has Changed over the Past 25 Years?, Maciej Piróg, Advisor to the President of the Republic of Poland, Chancellery of the Polish President, Poland, Nicole Bedlington, Executive Director, European Patients Forum, Belgium, Peter Goldblatt, Advisor, Institute of Health Equity, University College London, United Kingdom, Janusz Michalak, Editor in Chief, Termedia Publishing House, Poland 6th Healthcare Forum Krynica-Zdroj, September 8-10, 2015 Main topics: Financing health care system Public Health Legal framwork of health care E-health - the future of health care Innovative methods of treatment Summary oncology package The Healthcare Forum is attended each year by representatives of public administration, presidents of medical universities, representatives of medical institutions, national consultants, directors of public and private hospitals, experts and management of pharmaceutical corporations. 4

5 Healing the Economy with Health Care (2012), Vladimir Makatsaria, former President Johnson & Johnson Medical Emerging Markets, EMEA, Johnson & Johnson, United Kingdom, Richard Bergström, Director General, The European Federation of Pharmaceutical Industries and Associations (EFPIA), Belgium, Johan Hjertqvist, President, Health Consumer Powerhouse, Sweden 5

6 Slawomir Neumann Deputy Minister of Health The 5 th Healthcare Forum was another substantive meeting devoted to the Polish health care system. As usually, the representatives of the majority of the system s stakeholders discussed openly not only about current, but also strategic issues. Tadeusz Jedrzejczyk President of National Health Fund Last year s Healthcare Forum enjoyed good attendance. The discussed topics were discussed succinctly, as we expected also thanks to a number of interesting reports prepared for this meeting. Jaroslaw Lange Director, Philips Healthcare Poland In my opinion, the Healthcare Forum has become more and more popular and increasing number of people have noticed its value. (.. ) It is possible for two reasons, firstly: quality of debates and panels has been improving attracting a growing number of listeners. Erik Plas Managing Director of MSD in Poland The discussion opening the Health Care Forum in Krynica was extremely interesting. We could see the possibility of ensuring optimal health care with the necessity of balancing budget from the point of view of physicians, the National Health Fund and the legislator. 6

7 Lukasz Zalicki Partner EY The presence of health care topics during the Forum in Krynica should be regarded as a valuable initiative. Every initiative that discusses issues connected with so socially sensitive sector is important, and its importance is even greater considering the scale of this event. Marek Balicki Minister of Health (2003 and ) The participants in the Healthcare Forum in Krynica stressed that by increasing the number of specialized medical services, without increasing the number and role of general practitioners in parallel, it would not be possible to stop the progressing crisis of health care in Poland, noticing in the same time that the situation was likely to deteriorate due to ageing of the society. Ewa Grenda President of the Board of INFARMA, Director General of Roche Poland It is extremely important to bring discussion about changes in the health care system outside of the ministerial offices. ( ) The initiative of the Forum is extremely valuable especially in view of its support for the dialogue concerning the government s health care policy and trust-building role between the patients, physicians, administration and business. Mariusz Gujski Editor-in-Chief of Słuzba Zdrowia Krynica is a very important place, where we can discuss about much wider dimension of health care and influence of the health care system on the state and health of Poles. We should bear in mind that health care means also more than one million workplaces, a considerable influence on the GDP, but it is also a great responsibility of politicians. Responsibility they have tried to evade for 20 years. 7

8 Oncology Will Coordinated Patient Path Change Polish Oncology?, Miroslaw Stachowicz, President, Think-Tank Oncology 2025, Poland, Lukasz Zalicki, Partner, EY, Poland, Krzysztof Tuczapski, Vice President, National Health Fund, Poland, Beata Malecka-Libera, Secretary of State, Ministry of Health, Poland, Jacek Jassem, Head of Department and the Oncology and Radiotherapy Clinic, Medical University of Gdansk, Poland, Anna Rulkiewicz, CEO, LUX MED Group, Poland, Slawomir Neumann, Secretary of State, Ministry of Health, Poland 5 th Healthcare Forum The Quality of the Regulatory Environment and Investment Attractiveness of Poland, Marcin Jedrzejuk, Vice President & CFO Europe, Valeant Pharmaceuticals International, Inc., Poland, Erik Plas, Managing Director, MSD Polska Sp. z o.o., Poland, Nicole Bedlington, Executive Director, European Patients Forum, Belgium Health of Poles. Health of the Europeans Challenges faced by the health care system, upcoming reform of the industry, the effects of the Refund Act, oncology, indirect costs in health care, and also senioral policy were the key topics the last Forum. According to the industry media and conference guests, the Forum is an important place for debate about the future of the Polish health care system. It is a place of meeting and discussion for experts, politicians of various options, officials, heads of medical centres, local self-government activists, representatives of private sector. Health care industry and economy It is hard to discuss about the future of the state its economy and finances without consideration to the health care area that generates 10% of GDP, offering employment for many millions of citizens. It is also not possible to create the country s future without considering health condition of the society, its importance and influence on all areas of life. Another edition of the Healthcare Forum offered a perfect opportunity to reflect how far health care industry was treated as a separate branch of industry and, what follows, how this industry could be supported within the scope of the economic policy of the state. Health care is a strategic issue of the state 8

9 Public Heath in the Social and Economic Aspect, Mariusz Gujski, Editor-in-Chief, Służba zdrowia medical journal, Poland, Krzysztof Chlebus, Lecturer, Medical University of Gdansk, Poland requiring involvement of all socio-economic sectors convinced the conference participants. Deputy Minister of Health, Sławomir Neumann, stressed that development of companies, connected with the Polish medical industry, was consistent with the interest of the state as well as allocation of as much funds as possible for research and development and production of new, cheaper medicines. President of the Board of INFARMA, Director General of Roche Poland, Ewa Grenda, pointed in turn to exceptional link between the pharmaceutical industry and development of modern technologies. She mentioned a public-private initiative of the European Union and innovative pharmaceutical industry IMI (Innovative Medicine Initiative), which gives the opportunity to leverage considerable funds (this year more than 3 billion Euros) for research projects in the area of biomedicine. Dorota Hryniewiecka-Firlej, President of the Board of Pfizer Polska, said that State s Medicines Policy Evaluation of the Act on Reimbursement of Medicines after Two Years in Effect, Tomasz Latos, Member, Chairman of the Health Committee, Parliament, Poland, Wojciech Matusewicz, President, The Agency for Health Technology Assessment and Tariff System (AOTMiT), Poland State s Medicines Policy Evaluation of the Act on Reimbursement of Medicines after Two Years in Effect, Jacek Zakowski, Journalist, Commentator, Polityka weekly, Poland, Stefan Boguslawski, Managing Partner, Sequence HC Partners Ltd, Poland 9

10 Health vs. Economic Development (2013), Richard Wilkinson, Honorary Professor of Epidemiology and Public Health, University College London, United Kingdom Let s Grow Old with Awarenes- Polish Social and Health Care Policy Facing the Challenge of Ageing Society (2012) 10

11 Pfizer was looking for a partner in Poland in order to share and apply investment funding and technologies in Polish research centres and laboratories. About the state s drug policy The debates devoted to the state s drug policy involved discussion about the effects of two years of functioning of the Refund Act. During the discussion, Stefan Boguslawski, a partner of Sequence HC Partners, presented the first results of the analyzes aimed at evaluation of health care system s functioning in the new refunding realities. The expert stressed that the law eliminated huge problems of the systems connected with too high refund spending of the Ministry of Health and the National Health Fund. On the other hand, a side effect of the refund law is increase of patients spending on prescribed medicines he emphasized. According to Undersecretary of State, Igor Radziewicz-Winnicki, the level of subsidy to refunded medicines in the pharmacies has been one of the highest in the EU, reaching 33 percent. This is something not altered by the Refund Act. On the other hand, the law caused that refunded medicines have become one of the cheapest in Europe he admitted. Another participant in the debate, Jakub Szulc, f. Deputy Health Minister and co-author of the Refund Act admitted that although the law improved the level of state s subsidy, the state should continue to work on its content. The Economic Committee negotiating the refund conditions should have more sophisticated tools than simply discounts emphasized the expert. Pawel Sztwiertnia, Director General of the Association of the Employers of Innovative Pharmaceutical Companies INFARMA, indicated that the law should be evaluated beyond the scope of legislative issues. The implementation of the Refund Act in practice should meet its objectives more completely and precisely and reduce unfavourable side effects of the refund regulations for the involved entities. Financial Resources and Human Capital in the Health Care System in Poland, Lukasz Zalicki, Partner, EY, Poland, Tadeusz Jędrzejczyk, President, National Health Fund, Poland, Andrzej Matyja, Chairman, The Regional Chamber of Physicians and Dentists in Cracow, Poland 11

12 Diseases of Affluence. System and Social Challenges in the Treatment of Aging Population, Jacek Sieradzki, former Chairman of Board Polskie Towarzystwo Diabetologiczne, University Hospital in Krakow, Poland, Krystyna Lewkowicz, Founder and President, Foundation Ogolnopolskie Porozumienie Uniwersytetow Trzeciego Wieku, Poland, Ian Banks, President of the EMHF, Chair of the EFAB, European Men s Health Forum (EMHF), European Forum Against Blindness (EFAB), Belgium, Jakub Gierczyński, Expert, The Healthy Ageing Foundation, Poland Economy - Health. Pharmaceutical Industry, Maciej Bogucki, Expert, Lazarski University, Poland, Maciej Adamkiewicz, President, Adamed Group, Poland, Bartosz Bednarz, Country President, AstraZeneca Pharma Poland Ltd, Poland, Dorota Hryniewiecka-Firlej, Country Manager, Pfizer Polska Sp. z o.o., Poland, Ewa Grenda, President of the Management Board, The Employers Union of Innovative Pharmaceutical Companies INFARMA, Poland, Slawomir Neumann, Secretary of State, Ministry of Health, Poland, Grażyna Henclewska, Undersecretary of State, Ministry of the Economy, Poland Time for senioral policy Polish society is ageing rapidly. According to the data presented during the conference, in 2035 one fourth of the population will be older than 65, and in 2060 half of the population will be over 50. Participants in the debates related to senioral policy first of all attempted to outline the definition of the senior. Who can be regarded as a senior? Is he someone who feels adult? Demographers define this group as: people over 65. The statistics of the National Health Fund confirm this borderline. The Fund has spent already now more than 35 percent of its budget for treatment of the seniors. This situation, as it seems, has been noticed by politicians emphasized Professor Boleslaw Samolinski, the founder of the Coalition for Healthier Ageing. We are the only country in Europe to establish a parliamentary Committee on Senioral Policy. From the medical point of view, the problem of the seniors is an unusual challenge. Specialists stress that in order to tackle this issue, one should first of all define the place of the elderly in the health care system. Hospitals are not prepared to respond to their needs, there is no training for doctors in the area of geriatrics, while the number of geriatrists is dramatically low, and, as a matter of fact, the seniors constitute nearly 40 percent of patients in hospitals today. Professor Ian Banks, Chairman of European Men s Health Forum (EMHF) and European Forum Against Blindness (EFAB) admitted that 12

13 Financial Resources and Human Capital in the Health Care System in Poland, Jakub Szulc, Health Sector EY, Poland, Igor Radziewicz-Winnicki, Undersecretary of State, Ministry of Health, Poland, Marek Krawczyk, Rector, Medical University of Warsaw (WUM), Poland, Tadeusz Jedrzejczyk, President, National Health Fund, Poland, Beata Malecka-Libera, Secretary of State, Ministry of Health, Poland the European health care systems were short of politicians, who would not look at the seniors through the prism of problems and expen-ses. Oncology in the centre of attention Oncology was considered as a multidisciplinary issue during the Forum - posing a challenge for the entire system. The solutions, adopted in the Cancer Plan, have appeared in the Polish health care system for the first time, although they are known to be successfully applied in other countries. The guests taking part in the conference tried to respond to the question whether the coordinated patient s treatment track would change Polish oncology? In their opinion, the factor deciding about the success or failure of the plan will be the definition of standards applied during diagnostics and treatment. The experts convinced that organization of health care translated directly into effects of treatment in oncology to a degree not encountered in other areas. Much attention was also directed towards the issue of monitoring implementation of the package. They convinced about the importance of implementation based on transparent rules, and control and coordination functions in the hands of an independent team of experts. Professor Sergiusz Nawrocki, the head of the Department of Oncology and Radiotherapy of the Medical University of Silesia, pointed that the waiting time for diagnostics and oncological treatment was the key for success of the therapy. He emphasized that there was not time for mistakes in medicine. Professor Jacek Jassem, the head of the of Oncology and Radiotherapy of Gdansk University of Medicine, admitted that the limits in oncology were a drama. In his view, today s challenge is to remove the limits, especially for oncological diagnostics. Marek Krawczyk, President of Medical University of Warsaw: There are currently 11 medical universities in Poland. The number of newly enrolled students does not depend on their presidents. From the point of view of the university, it is not a problem to increase the number of students. Beata Malecka Libera, Secretary of State, Ministry of Health: The ageing society in Poland is a huge problem. Consequently, we should train nurses or personnel for elderly care. The main point of attention should be education of General Practitioners. Slawomir Neumann, Deputy Minister of Health: There were ideas to introduce a rating. So that a higher amount of compensation would be paid for death. Yet, we are unable to estimate the value of life, death, sickness and a medical mistake. 13

14 Media In the coming decades the number of people over 65 is expected to increase considerably. Ageing society is a challenge for health policy in the coming years. Until 2060 there will be only 1.4 person in the productive age (20-64) per one person in the age of 65+ and still 3 years ago that ratio was 1:5. Situation of Poland as compared to other European Union countries is exceptionally unfavourable. In the perspective of a few decades, we could be the oldest nation in the continent. The above mentioned issues were discussed extensively by a group of experts invited to the 3rd Healthcare Forum of the Economic Forum in Krynica. We do not intend to introduce medical services co-financed by the patients. None of the countries managed to shorten the queues by introducing paid services. Co-financing has been withdrawn by such countries as: Hungary, the Czech Republic and Slovakia. It turned out that co-financing was most troublesome for the poorest part of the society. Such persons did not go to see the doctor and later they were admitted to hospitals in serious conditions - emphasized Ewa Kopacz, Minister of Health ( ) during the 21st Economic Forum in Krynica. We should organize a system in Poland to allow competition among payers as soon as possible. It would be based on competition between the public payer its private counterparts. The revolution would make the health care s patient a client, who is taken care of and respected. The above mentioned system would also be beneficial for public finances, since competition forces greater rationality in financial administration - convinced Grzegorz Pradzynski, President of the Polish Chamber of Insurance, during the Forum. During panel discussions of the Healthcare Forum of the 22nd Economic Forum in Krynica, arguments were articulated a number of times that health care should be seen in the categories of capital that does not only need, but also deserves investment. This opinion was shared by Polish and foreign experts as well as representatives of the Ministry of Health: Deputy Minister Slawomir Neumann and Igor Radziewicz-Winnicki as well as Minister of Labour and Social Policy, Wladyslaw Kosiniak-Kamysz. 14

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16 Our activities The Eastern Institute (full name: Foundation Institute for Eastern Studies) is an independent non-governmental organization committed to improving cooperation between the countries of Central and Eastern Europe. In 2014 approximately 3000 delegates from 60 countries were our guests. The institute organizes a range of high profile conferences: The major project of the Institute is Economic Forum in Krynica. Through the 90-s the Institute developed impartial and trustful platform for debate on the whole scope of political, economic and social issues. The Economic Forum in Krynica has become one of the largest and most comprehensive conferences in Central and Eastern Europe. o o o o o o o o Regions Forum Innovations Forum Investment Forum Energy Forum Europe-Ukraine Forum Europe-Russia Forum Europe-USA Forum Academy of Economic Forum Eastern Institute, ul. Solec 85, Warsaw, Poland tel.: , fax: , foz@isw.org.pl,