Mapping health needs and healthcare system performance assessment...

MAPPING HEALTH NEEDS AND HEALTHCARE SYSTEM PERFORMANCE ASSESSMENT, BASED ON THE EXAMPLE OF THE HEALTH PERFORMANCE INDEX FOR LODZKIE PROVINCE Mapowanie potrzeb zdrowotnych a ocena sprawnoÊci regionalnego systemu ochrony zdrowia – na przyk∏adzie indeksu sprawnoÊci ochrony zdrowia dla województwa ∏ódzkiego Adam Kozierkiewicz, Jakub Gierczyƒski, Miros∏aw J. Wysocki, Ma∏gorzata Ga∏àzka-Sobotka

STRESZCZENIE W artykule przedstawiono plany dotyczàce wdra˝ania wojewódzkich map oceny potrzeb zdrowotnych. Stwierdzono, ˝e tworzenie map zabezpieczenia zdrowotnego jest fundamentalne dla sprawnego i skutecznego funkcjonowania systemu ochrony zdrowia w Polsce. Zabezpieczeniem w∏aÊciwego funkcjonowania tego projektu b´dzie stosowanie wiarygodnych i aktualnych danych, w∏aÊciwa metodologia oraz cykliczna ocena jakoÊci wyników. Omówiono najwa˝niejsze polskie zasoby danych, które mogà byç wykorzystanie do tworzenia analiz i opracowaƒ dla potrzeb map. W tym kontekÊcie przedstawiono inicjatyw´ pt. „Indeks sprawnoÊci ochrony zdrowia” dotyczàcà oceny sprawnoÊci dzia∏ania regionalnych systemów ochrony zdrowia. Indeks oparty zosta∏ na mi´dzynarodowych doÊwiadczeniach, w szczególnoÊci doÊwiadczeniach Âwiatowej Organizacji Zdrowia. Zgodnie z planami autorów Indeksu, zestaw wskaêników b´dzie si´ poszerza∏, przy zachowaniu podstawowego zestawu wskaêników, które majà pozwoliç na obserwacj´ zmian w czasie. Wyniki Indeksu sprawnoÊci ochrony zdrowia 2014 pokazujà prób´ oceny stanu funkcjonowania systemu ochrony zdrowia w poszczególnych województwach. W sumarycznym zestawienia wskaêników najlepszy wynik osiàgn´∏o województwo warmiƒsko-mazurskie (33 pkt.), drugie miejsce zaj´∏o województwo zachodniopomorskie (324 pkt.), a trzecià lokat´ województwo wielkopolskie (321 pkt.). W zestawieniu tym pozycja województwa ∏ódzkiego by∏a niestety niekorzystna i znalaz∏o si´ ono z tylko 223 punktami na ostatnim miejscu poÊród wszystkich województw. Wynik dla województwa ∏ódzkiego powinien sk∏oniç do refleksji i dok∏adnej analizy wszystkich interesariuszy odpowiedzialnych za planowanie, funkcjonowanie i dzia∏ania naprawcze w ramach systemu ochrony zdrowia w tym regionie Polski. S∏owa kluczowe: mapowanie potrzeb zdrowotnych, wskaêniki zdrowia, mapowanie potrzeb zdrowotnych na poziomie lokalnym Keywords: health system performance measures, health indicators, ranking, provincial health needs assessment maps

INTRODUCTION According to the Ministry of Health there are long-term significant territorial differences in health in the population of in Poland [http://zachodniopomorskie.sld.org.pl/ aktualnosci/4788ministerstwo_zdrowia_proj ekt_zalozen_.html]. These differences are visible both in regions and districts and in city/

town quarters. Results of analyses made on this issue were presented in a number of studies, like: Social health inequalities in Poland [Ch∏oƒ-Domiƒczak, Marek, Rabczenko, Stokwiszewski, Wojtyniak, Spo∏eczne nierównoÊci w zdrowiu w Polsce], Analysis of health and socio-economic characteristics of district level populations in Poland, Atlas on mortality in Poland for 2008–2010, [Wojtyniak, Rabczenko, Pokarowski, Poznaƒska,

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Stokwiszewski, Atlas umieralnoÊci ludnoÊci Polski 2008-2010] and Health situation and its conditions in the Polish population [Wojtyniak, Goryƒski, Moskalewicz, 2012]. The received results indicate that there is a need to initiate activities which will aim at reducing health inequalities. These initiatives should include searching for methods of more effective identification of health needs as well as making periodical assessment of the effectiveness of activities aiming at improving of health of the population. To some extend the new legislative initiative of the Government addresses the issue. One of the most important objectives of the draft of the Act on General Insurance in the National Health Fund of 23 January 2013 is a new model of the health care system planning. The procedure of contracting health services by regional payers will be performed after making a thorough analysis of health needs in a particular province by the governor of the province and a group of experts on this issue. They will identify current and forecasted demographic and health situation of the population as well as available resources: personnel and infrastructure of health care. This will result in identification of issues which the central government or local authorities will have to deal with. The proposed act will introduce new legal instruments on creating provincial maps of health needs assessment and issuing opinions on a necessity of opening new medical units or organizations in a particular area. Provincial maps of health needs assessment will be an important instrument of health policy of the state. They are supposed to objectively reflect problems and health needs of the population in a particular province. However, differences visible in districts should be taken into account. The maps will be made out on the base of the most reliable and updated epidemiological data. The provincial maps will be mostly used in contracting health services by regional branches of the National Health Fund. The fund offices will have to take the maps into consideration before planning a purchase of health services for a coming year. The procedure of contracting services with the use of data included in the maps

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will allow for proper distribution of medical services which will be rendered according to the needs of local communities. In order to create the maps properly and to make the document important and sound, the task was assigned to provincial governors who will be advised by the Provincial Council for Health Needs Assessment. The council will be staffed by experts on public health. They will be appointed by provincial governors and will represent different institutions active in the system like: the provincial governor, the National Health Fund, the National Institute of Public Health and others. The Minister of Health will issue guidelines on the content and methodology of preparing the maps. As a consequence of the maps, there is a certificate of need, which will be required before opening a new medical unit or organization in a particular area. The expected role of the document is to control supply side of the health market, since every new health infrastructure competes for the same resources with the ones which already exist. Moreover, because of the supplydriving-demand in health care, controlling the supply, allows for controlling demand, too. s. The opinion will be issued by a particular provincial governor, after consulting with the council. The provincial map of health needs assessment and data gathered from the register of health care units will be grounds for issuing the opinion. According to the proposed ideas, provincial governors will be responsible for the preparation of the regional maps. The governors will use data gathered by the National Institute of Public Health – the National Institute of Hygiene and in their work they will be helped by Provincial Councils for Health Needs Assessment. The provincial maps will be drafted every three years. However, provincial governors and the National Institute of Public Health – the National Institute of Hygiene will be obliged to update the enclosed information. This will allow to monitor the effects of initiated activities and verify if they are performed in compliance with prognoses and planned procedures.

Mapping health needs and healthcare system performance assessment...

DATA AND THEIR POTENTIAL APPLICATION IN THE PROCEDURE OF DRAFTING HEALTH MAPS The National Institute of Public Health – the National Institute of Hygiene regularly gathers data on health situation in the country. The tasks of the institute include monitoring of biological, chemical and physical risk factors in food, water and air as well as monitoring of communicable diseases and infections [http://www.pzh. gov.pl/page/]. Currently the institute deals with the issue of prevention of communicable diseases (epidemiological reports, oncologic registers, hospitalization) and noncommunicable diseases which are socially important, monitoring of health situation, improvement of sanitary and hygiene conditions, safety of the natural environment. The institute cooperates with many similar organizations, both Polish and international (WHO, DG Sanco, ECDC). The institute also prepares expert opinions on all aspects of public health for governmental and local administration institutions. It helps with creating important programmes on public health in Poland (e.g. The National Health Programme for 2007-2015 and monitoring it). On Statistical Portal the Social Insurance Institution presents data on social insurance. There we can find statistical data on payers of contributions, the insured, health services recipients as well as information on medical

case-law and medical rehabilitation [Statistical Portal of the Social Insurance Institution, http://www.psz.zus.pl/]. The National Health Fund presents on its portal information on using health services, contracts for health services as given by providers of the services, refund scheme of medicaments [The National Health Fund, http://www.nfz.gov.pl/new/index.php]. The Central Statistical Office presents state and private expenditures on health protection, infrastructure of health care, employment, remuneration for medical personnel, number of hospital beds, counselling, number of days of hospitalization [The Central Statistical Office, http://www.stat.gov.pl/ obszary-tematyczne /zdrowie-opieka-spoleczna]. The Centre for Health Care Information Systems presents the structure and medical profile of medical subjects [The Centre for Health Care Information Systems, http://www.csioz.gov.pl/ statystyka.php]. It also puts cross-sectional information on the health care system in statistical bulletins. The Ministry of Health publishes information on hospital debts and the Chief Sanitary Inspector – data on safety of food, water, working conditions and sanitary situation in Poland [The Ministry of Health, http://www.mz. gov.pl/system-ochronyzdrowia/organizacja-ochrony-zdrowia/ zadluzenie-spzoz, The Chief Sanitary Inspector, http://www.gis.gov.pl]. Table 1 shows selected sources of information needed for preparing regional health indicators.

Table 1. Selected sources of information needed for preparing regional health indicators in Poland Institution

Kind of data (selected items)

The National Institute of Public Health Health behaviours, hospital morbidity, incidence – the National Institute of Hygiene of communicable diseases, data on pollution. www.pzh.gov.pl The Social Insurance Institution www.psz.zus.pl

Contribution payers, the insured, health services recipients, medical case-law, medical rehabilitation, disease-related absenteeism, disability benefits.

The National Health Fund www.nfz.gov.pl

Using health services, JPG data, refund scheme of medicaments, information on contracts for health services given by health services providers.

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The Central Statistical Office www.stat.gov.pl

State and private expenditures on health protection, infrastructure of health care, employment, remuneration for medical personnel, number of hospital beds, counselling, treatment procedures and number of days of stay in hospital wards.

The Centre for Health Care Information Systems www.csioz.gov.pl

Structure and medical profile of medical subjects.

The Ministry of Health www.mz.gov.pl

Hospital debts.

The Chief Sanitary Inspector www.gis.gov.pl

Safety of food, water, working conditions and sanitary situation in the country.

Source: The authors’ own study

USING DATA IN THE ASSESSMENT OF PERFORMANCE OF REGIONAL HEALTH SYSTEMS; HEALTH SYSTEM PERFORMANCE INDEX 2014 In 2014 the Health System Performance Index of was prepared and published [Krajowy Indeks SprawnoÊci Ochrony Zdrowia, 2013]. The index evaluates the performance of health care system in particular provinces [Kozierkiewicz, Boguszewska, Gajda, Gilewski, Ignatowicz, Kaoka, Laskowska, ¸aszewska, Natkaniec, WaÊko, 2014]. The authors used their own and the international experience in preparing Health System Performance Measures (HSPM) in order to make an assessment of the Polish health care system. While preparing the index the authors bore in mind the fact that managing a complex system involves systematic identification and communication of objectives of the system and then monitoring how many of them have been achieved. For more than a decade researchers who deal with health care systems have been using so called Health System Performance Measures (HSPM) (Smith, P.C., Mossialos, E., et al. (ed.), 2009). The measures make up a specific set of statistical indicators which facilitate the evaluation of health policy. Such measures have been used in many countries but they are particularly applied in Anglo-Saxon and Scandinavian countries as well as in international organizations, such as the World Health Organization 26

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(WHO) or the Organization for Economic Cooperation and Development (OECD). Particular sets of indicators are different because of different preferences of their authors. The measures can be applied for evaluating health care centres, country regions and also the whole territory of a country. In most cases the measures are used as benchmarks to compare results obtained by similar subjects. They can be either compared with targets assumed beforehand or to values which are considered referential. According to researchers from Health Policy Analysis Program, conducted at Washington University, there are seven reasons for the application of the Health System Performance Measures in management. They include: 1. Identification and communication of system objectives 2. Reflexion on possibilities of the system 3. Starting cooperation between interested subjects/entities 4. Delegating responsibilities 5. Constant quality improvement 6. Progress monitoring 7. Communication and promotion The system measures are finally used to inform particular subjects on the current situation and progress made while realizing the adopted objectives. The most important subjects include: the government and its departments, occupational environment and the society of the country or particular regions.

Mapping health needs and healthcare system performance assessment...

By using their international experience and the potential of the information system, the authors of the study presented the first issue of the Polish version of the Health System Performance Index. The main objectives of the Index include: 1. An assessment of values required in the system – the index consists of indicators representing and assessing certain values and characteristics required in a system. 2. An assessment of a particular province. The Index has a comparative value; it serves as a benchmark for results obtained in particular provinces. Its measures bear information on the effectiveness of the health care system in particular provinces. 3. An assessment of a phenomenon, not an organization. Most of the presented indicators depend on many factors, not on a single organization or person. Thus, the Index evaluates phenomena, not particular organizations or institutions. 4. The indicators are selective but representative. The Index is composed of dozens of indicators and it was created to describe a very complex system. Thus, the indicators are highly selective but they should also be representative for the described aspect of the system. 5. The indicators are adjusted to different points of view. It is assumed that they are representative for the subjects which are most involved in the system,

i.e. citizen/patient, government/payer, medical personnel. 6. The indicators are thematically arranged. They were divided into axes and aspects, which are identified with certain values and characteristics of the health care system.

INTERPRETATION OF INDICATORS OF HEALTH SYSTEM PERFORMANCE INDEX The indicators selected for the assessment of the system described and presented in such a way so that they could be interpreted individually, as particular indicators of a particular phenomenon and together, as synthetic indicators, assessing a particular component. The authors of the Index intended to measure the intensiveness of characteristics regarded as required in a health care system. Thus, the authors had to answer some questions: What is the purpose of a health care system? In what way is the system useful? Which elements should be favoured and which ones eliminated? This part of work on the Index involved creating and interpreting the indicators. The authors had to decide if the particular phenomenon described by the Index is required from the point of view of the system. The Index 2014 contains 44 detailed indicators. As a consequence, they created a scheme (Table 2) consisting of three assessment axes

Table 2. Axes and aspects of the assessment in the Health System Performance Index Improvement of health of the population

Effective financial economy

Consumer quality of the health care

Disease prevention

Allocative efficiency

Financial protection of patients

Disability prevention

Economic effectiveness of a therapy

Waiting time for health services

Exacerbation prevention

Finances of health units

Territorial availability

Death prevention

Infrastructure management

Patient satisfaction Quality system

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identified with three main objectives, which, according to the authors of the Index, a health care system should follow. The axes contained thirteen aspects grouping the indicators in categories which a good system should have. In this way the authors followed the idea used by Christopher Murray’s team in The Health Report 2000, issued by the World Health Organization. [WHO, 2000] In that document objectives and required characteristics of a system were publicly discussed and the authors adopted a bottom-up approach towards the problem. The Polish version of the Index contains objectives and characteristics which should be favoured in the health care system. 1. Improvement of health of the population Improvement of health is undoubtedly the main goal of a health care system. One should define whose health must be improved and in what aspects it should be improved. For the purposes of the Index it was assumed that the health improvement should refer to inhabitants of Poland and particular provinces, and not to insured people or citizens. Differences of values in these three categories are not so huge but in terms of the concept the values differ. Moreover, adopting of such an approach simplifies methodical issues on indicators because a common denominator for some of them, no matter what citizens they are or if they are insured. With regards to the aspects of health improvement, the following categories of indicators were adopted: 1.1. Disease prevention aspect 1.2. Disability prevention aspect 1.3. Exacerbation prevention aspect 1.4. Death prevention aspect 2. Effective economy Health is an extremely important value, both for an individual person and for the whole society. However, also a health care system is limited to some extent. Alternative costs of health care are always incurred. The core economic principle, which refers to limited resources, is “painfully” implemented in health care. In a discussion on that issue, held for more than 20 years, the problem of the amount of resources appears to be a dominant element. 28

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When citizens are to make a choice (either political or economic) they do not want financial reserves to be transferred from other public sectors to health care. They are not really willing to incur higher expenses on health (public contributions, contributions for individual, private insurance policies or any other financial burdens). Thus, management of financial resources of the health care system appears to be an important criterion of its assessment. With regards to the economy, the following aspects were addressed: 2.1. Allocative efficiency 2.2. Economic effectiveness of a therapy 2.3. Finances of healthcare units 2.4. Infrastructure management 3. Consumer quality of the health care It is widely known and obvious that a public health care system is created in order to protect and improve people’s health (public health) or that a public interest has an advantage over an interest of an individual and the patient applying for health services should be provided what is necessary for him but not what he wishes to be provided. Such a point of view of the health care system is quite common in the world, and it is even recommended and supported in countries which are poor and relatively poor. It is believed that health is a more important objective of the system than well-being and comfort of an individual patient. When we have to make a choice, consumer quality does not really matter that much. When the society becomes more and more affluent the role and importance of consumer quality increases, so do patients’ rights and the standard of health services as well as the quality of the way the service is provided. Thus, consumer quality of the health care is the third axis of the assessment: 3.1. Financial protection of patients 3.2. Waiting time for health services 3.3. Territorial availability 3.4. Patient satisfaction 3.5. Quality system

Mapping health needs and healthcare system performance assessment...

Weighs of the axes and indicators of the Health System Performance Index The three selected axes referring to: improvement of health of the population, economy and consumer quality are not equally important from the point of view of the health care system objectives . Since the axis referring to improvement of health seems to be the most important, the total weight of the indicators of this axis should be proportionally higher than indicators of the other axes. With regards to the remaining two axes it was assumed that their role in the system is equal so the weights should be the same (Chart 1). If one assumes that the total number of points a province can get in the

Index is 100, the distribution of the points is the following: 50 – health, 25 – financial economy, 25 – consumer quality. In the Health System Performance Index 2013 weights of particular assessment axes are only discussed but they are practically useless in the procedure of calculating indicators, either detailed or synthetic ones. In future issues of the Index its authors plan to apply axes weights in the structure of the synthetic indicator for the whole Index. The Health System Performance Index 2014 consists of 44 indicators in particular aspects. Significant differences between them are reflected in the weights – vide Table 3.

Chart 1. Axes of the Health System Performance Index and their weights

Source: The authors’ own study

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Table 3. Weights of the indicators of the Health System Performance Index 2014 by assessment axes ASSESSMENT AXIS 1. IMPROVEMENT OF HEALTH OF THE POPULATION Item no.

Indicator

Weight

Aspect

1

Participation in mammography screening programme

3.03

disease prevention

2

Participation in cytological screening programme

3.03

disease prevention

3

BCG vaccination for children

0.76

disease prevention

4

Vaccination against measles, mumps and rubella for children

0.76

disease prevention

5

Incidence of tuberculosis

1.52

disease prevention

6

Bacterial food poisoning

1.52

disease prevention

7

Ratio of people with certified work disability

2.27

disability prevention

8

Ratio of patients – hospitalized and dead due to cardiac insufficiency

4.55

exacerbation prevention

9

Hospital admission rate in diabetic patients

3.79

exacerbation prevention

10 11 12 13 14 15 16 17

Hospital admission rate in patients with 3.03 chronic diseases of the upper respiratory tract Hospital admission rate in outpatients treated 3.03 due to cardiac insufficiency (150) Ratio of psychiatric patients – hospitalized 3.03 and treated in outpatient clinics Infant mortality rate per 1,000 live births Percentage of survivors within a minimum period of 5 years following the diagnosis of breast cancer Percentage of survivors within a minimum period of 5 years following the diagnosis of colorectal cancer Deaths caused by chronic obstructive pulmonary disease to be avoided Number of organs taken from the deceased to be transplanted TOTAL

exacerbation prevention exacerbation prevention exacerbation prevention

4.55

death prevention

4.55

death prevention

3.79

death prevention

3.79

death prevention

3.03

death prevention

50

death prevention

ASSESSMENT AXIS 2. EFFECTIVE ECONOMY 1 2

30

Ratio of expenses incurred on treatment in hospital and outsider hospital Ratio of expenses incurred on one-day treatment and hospital treatment

2.78

allocational effectiveness

2.78

allocational effectiveness

3

Expenses incurred on long-term care

2.08

allocational effectiveness

4

Ratio of expenses incurred on treatment of rectal cancer vs. survival

2.08

economic effectiveness of a therapy

5

Ratio of expenses incurred on treatment of breast cancer vs. survival

2.78

economic effectiveness of a therapy

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Mapping health needs and healthcare system performance assessment...

Item no. 6 7 8

Indicator General liabilities of independent public health care facilities vs. expenses incurred on general health services EBITDA of locally managed public health care facilities in particular provinces Profitability of gross sale in locally managed public health care facilities in particular provinces

Weight

Aspect

3.47

finances of health centres

2.78 2.78

9

Number of hospital beds per 10,000 people

1.39

10

Bed occupancy rate

2.08

TOTAL

25

finances of health centres finances of health centres infrastructure management infrastructure management

ASSESSMENT AXIS 3. CONSUMER QUALITY OF THE HEALTH CARE 1 2 3

Share of health expenditures in household 2.68 income Percentage of households forced to refrain 1.79 from buying medication due to financial reasons Percentage of households forced to refrain 1.79 from buying health services due to financial reasons

financial protection of patients financial protection of patients financial protection of patients waiting time for health services

4

Number of people on waiting lists

2.23

5

Migration of patients between wards

1.79

territorial availability

6

Accreditation of Quality Monitoring Centre

1.34

quality systems

7

Satisfaction with public health care system

2.68

patient satisfaction

8

Information availability

0.45

patient satisfaction

9

Availability of specialist physicians

1.79

patient satisfaction

10

Availability of night and weekend health care

0.89

patient satisfaction

11

Accessibility to diagnostic tests

1.34

patient satisfaction

12

Registering system, quality of administration service

0.45

patient satisfaction

13

Time spent for obtaining a medical service

1.79

patient satisfaction

0.89

patient satisfaction

1.34

patient satisfaction

14 15

Quality of medical infrastructure, equipment of medical centres Professionalism and competences of medical personnel

16

Approach of a medical professional towards a patient

1.34

patient satisfaction

17

Treatment results

0.45

patient satisfaction

TOTAL

25

Source: The authors’ own study

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RESULTS OF ASSESSMENT OF PROVINCES WITH THE APPLICATION OF THE HEALTH SYSTEM PERFORMANCE INDEX 1. Improvement of health Findings of indicators in the Improvement of health axis indicate that the best results were observed in the following provinces: the West Pomerania (185 PTS), the Pomerania (182 PTS) and the Masovia (175 PTS). Another four provinces: the Warmia-Masuria, the Lubusz, the Greater Poland and the Podlaskie closely follow the three leaders. At the end of the list are: the Kuyavia-Pomerania (109 PTS) and the Lodzkie province (112 PTS).

Chart 2. Synthetic indicator in the Improvement of health axis of the Health System Performance Index 2014 West Pomerania Pomerania Masovia Warmia-Masuria Lubusz Greater Poland Podlaskie Lower Silesia Lesser Poland Opolskie Silesia Lublin Swietokrzyskie Subcarpathia Lodzkie Kuyavia-Pomerania

Source: The authors’ own study

2. Effective economy In the Effective economy axis two provinces hold top positions. They are: the Lower Silesia province (94 PTS) and the Greater Poland province (86 PTS). The Lesser Poland province and the Pomerania province received 83 PTS each. The Lodzkie province with its 71 PTS is ranked as the eight. The worst positions are occupied by the following provinces: the West Pomerania (44 PTS), the Podlaskie and the Lublin (49 PTS each). See: the chart below. 32

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Mapping health needs and healthcare system performance assessment...

Chart 3. Synthetic indicator in the Effective economy axis of the Health System Performance Index 2014 Lower Silesia Greater Poland Pomerania Lesser Poland Lubusz Warmia-Masuria Silesia Lodzkie Kuyavia-Pomerania Masovia Swietokrzyskie Subcarpathia Opolskie Podlaskie Lublin West Pomerania

Source: The authors’ own study

3. Consumer quality of the health care In the Consumer quality of the health care axis there are the following provinces: the Opolskie province (88 PTS), the Podlaskie province (79 PTS) and the Subcarpathia province (76 PTS). What is interesting, these are the same provinces which are ranked the worst in the Effective economy axis. With regards to the Consumer quality of the health care axis the the Lower Silesia, the Pomerania and the Lodzkie provinces took the worst ranks (27, 30, 32 PTS respectively).

Chart 4. Synthetic indicator in the Consumer quality of the health care axis of the Health System Performance Index 2014 Opolskie Podlaskie West Pomerania Subcarpathia Lublin Warmia-Masuria Greater Poland Lesser Poland Kuyavia-Pomerania Masovia Lubusz Silesia Lower Silesia Swietokrzyskie Pomerania Lodzkie

Source: The authors’ own study Journal of Health Policy, Insurance and Management – Polityka Zdrowotna

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4. Indicators of the Health System Performance Index 2014 – in total After adding up indicators of the three axes the authors obtained a general value which results from the application of weights to particular axes. The Warmia-Masuria province appeared to hold the top position (330 PTS), next is the West Pomerania province (324 PTS) and the third position is occupied by the Greater Poland province (321 PTS). Unluckily, the Lodzkie province obtained only 223 PTS and took the last position of all other provinces.

W ar m ia W es Ma t P su om ria G er re an at er ia Po Le ss la nd er Po Po lan d m er an i O po a ls ki e Lo Lub w us er z Si le si a M as ov Po i dl a as ki e Si le si a Lu S Ku ub bl ca ya in rp vi aa Po th i Sw me a ra ie ni to a kr zy sk Lo ie dz ki e

Chart 5. Synthetic indicator for all the three axes of the Health System Performance Index 2014

Source: The authors’ own study

CONCLUSIONS 1. Mapping health needs is invaluable for effective functioning of the health care system. The project will appear to be effective if we provide reliable and updated information, use adequate methodology and perform a periodical assessment of the quality of findings. 2. There are a lot of data on the Polish health care system. However, making a proper qualitative and quantitative analysis is the greatest challenge.

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3. The current Health System Performance Index 2014 is the first attempt to make a synthetic evaluation of the health care system in Poland from the performance perspective. The index was based on international experience, especially the experience of the WHO. The authors of the Index are going to gradually introduce more indicators and at the same time, keep the number of the most important, already existing, ones. The old indicators will allow observing changes happening in the course of time.

Mapping health needs and healthcare system performance assessment...

4. Results of the index show how the Polish health care system works in particular provinces. The results which the Lodzkie province obtained should provoke an extensive analysis and make all people who are involved in the issue of public health and responsible for making plans and improvements, take right steps in order to change negative trends in this region of Poland.

10. Gierczyƒsk J, Wp∏yw kosztów chorób cywilizacyjnych na polityk´ zdrowotnà w krajach Unii Europejskiej i w Polsce. Journal of Health Policy, Insurance and Management, No X, Warszawa 2012. 11. Health Indicators 2013. www.cihi.ca: Canadian Institute of Health Information, 2013. 12. Healy J., McKee M., The role and functions of hospitals. In: M. McKee and J. Healy, eds., Hospitals in a Changing Europe, Buckingham, UK: Open University Press, 2013.

LITERATURE 1. AIHW, National Health Performance Framework. Pobrano z lokalizacji Australian Institute of Health and Welfare, 2014. http:// meteor.aihw.gov.au/content/index.phtml/ itemId/392569 .

13. Holly R., Regionalization of health care in Poland and other European countries – who and what really benefits from it?, Journal of Health Policy, Insurance and Management, No XIII/III, Warszawa 2013.

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