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Physician executive finds Poland's health care system shares many of the same problems as the U.S. system.

In July, the newly formed European Society of Medical Directors (ESMD) held its inaugural conference in Warsaw, Poland.

A few blocks away from the meeting site, doctors and nurses were holding a public demonstration and threatening a strike over working conditions, salaries and patient care. But the government budget for health care services is fixed so no amount of political pressure would change the reality of the situation.

Inside the meeting at the Leon Kozminski School of Business and Management, about 200 attendees were listening to Poland's health minister. Poland provides universal coverage for its citizens at a fixed rate that's six percent of the gross domestic product. The health minister acknowledged that the system faces many challenges.

Other speakers representing the Polish Association of Private Healthcare Employers, and the Polish Union of Clinical Hospitals talked about the growing market for supplemental insurance and the clinical imperative for safety, efficiency and cost management.

The nation's leading health economist lectured about the organization and financing of health services. Except for the language differences, the issues discussed and debated in Warsaw were familiar.

The meeting

The meeting was organized by Dr. J.J. Fedorowski, a dynamic young Polish physician with experience working in several countries--including the U.S.--who sees a need for physician leaders to address the system challenges of efficiency, safety, cost and working with hospital management.

Fedorowski invited the American Medical Directors Association and the American College of Physician Executives to make presentations to the audience on several topics:

* Traditional roles and responsibilities of medical directors

* Public and private financing of U.S. health services

* Challenges of medical management in the U.S.

* How physicians can collaborate with hospital CEOs

Fedorowski is a clinical associate professor of medicine at the University of Vermont College of Medicine. He was joined on the scientific committee that organized the conference by the professor and director of the Department of Public Health at the Leon Kozminski School of Business and Management, the medical director of the Vilnius University Hospital in Lithuania, and the director of the Department of Health Insurance, Signal-Iduna, Poland.

The goal of the ESMD was to exchange ideas concerning medical management in health care, establish a certification program for medical directors and represent European medical directors on national and international levels.

Clinical and professional issues seemed remarkably similar to the U.S.including:

* Primary care-specialist tensions over patient responsibility

* Emergency departments overburdened with patients who couldn't get appointments with primary care physicians

Our Polish colleagues seemed particularly intrigued by the U.S. health care system's ability to break down costs for physician services and hospital services separately. Apparently, the government-run system includes hospital and physician expense in the same budget category.

The country

Other observations about health and disease in Poland came from strolls on the streets of Warsaw, train rides through small towns and the countryside, and relaxed dinner conversations with our gracious hosts.

My wife, who was a college exchange student in Poland during the Communist era, provided basic Polish language help and a commentary on how the country has changed since capitalism arrived 15 years ago.

Both of us were impressed by the fit and healthy looking population--men and women, young and old. Compared to the U.S. obesity was unusual.

The once dull, dirty buildings of the Communist era are still there, but they are colorful and clean. It is amazing what sand blasting can do for the appearance of an old stone building.

In downtown Warsaw, it's possible to see iconic buildings from several different periods all in the same view. The Old City dates back several hundred years, while Stalin's Palace of Culture is an odd looking structure not far from an ultra modern shopping mall with a graceful sweeping glass roof that makes it stand out from its neighboring buildings.


What we learned

Like physicians we met in China and Tibet in 2005, and Russia in 2006, physicians in the European Society of Medical Directors recognized their important and changing roles from clinician to leader. They were curious about the skills and knowledge needed to be effective, and how the ACPE prepared physicians for these vital roles. What did we learn from the visit?

* Health care spending is fixed at six percent of GDP in Poland.

* The population in Poland is statistically healthier than the U.S. Obesity and overweight are not major stresses on the health budget.

* Overutilization of health care services didn't seem common. In one interesting anecdote, my wife was comparing her treatment of a metacarpal fracture with a Lithuanian physician, who had a similar fracture. The outcome: excellent in both cases. The difference: one X-ray for the Lithuanian doctor vs. 18 in the U.S. for my wife, and two visits to the doctor Lithuania vs. three in the U.S.. Satisfaction with experience was higher in Lithuanian patient.

* The emergency rooms of Polish hospitals experience overcrowding, like the U.S. According to one ER physician, this occurs primarily because family doctors don't have the time to see all the patients who need help.

* Regardless of a nation's choice regarding health care payment schemes, the delivery system must deal with significant stresses and strains of providing services efficiently, effectively, safely and in a timely manner.

* Physician leaders consistently have their patients' well-being foremost in their minds when dealing with complex management issues.

The members of ACPE who have traveled to China, Tibet and Russia in the past couple of years, and those who will travel to South Africa this year, see first hand the common bonds we share as physicians and physician executives working in our respective countries.

The College has been pleased to share our experience in creating leadership and management networking opportunities with several countries that are creating similar organizations. Most rewarding of all has been learning from our hosts about their challenges, successes and perspectives.

Barry R. Silbaugh, MD, MS, FACPE is senior health care partner with Creative Management Group and former president of ACPE. He can be reached at

By Barry Silbaugh, MD, MS, FACPE
COPYRIGHT 2007 American College of Physician Executives
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Author:Silbaugh, Barry
Publication:Physician Executive
Date:Sep 1, 2007
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