Indirect and Direct 65+ Patient Reporting of Non-Steroidal Anti-Inflammatory Drug-Induced Adverse Drug Reactions as a Source of Information on Polypharmacy and Polypharmacy-Related Risk

Background and Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs), which have anti-inflammatory and analgesic properties, are commonly used in the treatment of various, particularly frequent, as well as chronic, conditions in older patients. Due to common polypragmasia in these patients and a high risk of adverse drug reactions (ADRs) and drug interactions, pain management poses a therapeutic challenge. This study describes the importance of ADR reports in the identification of polypharmacy and the ensuing interactions. Materials and Methods: Both healthcare professionals (HPs) and non-healthcare professionals (non-HPs) reports collected in the EudraVigilance database of NSAIDs, including most commonly co-reported medications and reported reactions, were analysed and differences between HPs and non-HPs reports were identified. Results: In the analysed period and group, non-HPs reported more reactions but indicated fewer drugs as suspect or concomitant. The outcomes of our analysis indicate more HP engagement and more detailed reports of serious ADRs when compared to non-serious individual case safety reports (ICSRs) by non-HPs, which appeared more detailed. Such reactions as kidney failure and increased risk of bleeding are known adverse reactions to NSAIDs and common symptoms of their interactions, which were described in the available literature. They were much more frequently reported by HPs than by non-HPs. Non-HPs more frequently reported reactions that may have been considered less significant by HPs. Conclusions: The differences between healthcare professionals' (HPs) and non-healthcare professionals' (non-HPs) reports may result from the fact that the reports from patients and their caregivers require a professional medical diagnosis based on symptoms described by the patient or additional diagnostic tests. This means that when appropriately classified, medically verified, and statistically analysed, the data may provide new evidence for the risks of medication use or drug interactions.

[Directions of organizational and economic changes in occupational health services as a response to the COVID-19 pandemic - challenges to the health crises]

The COVID-19 pandemic caused not only short-term organizational and economic changes in the functioning of occupational health services, but also enforced to include them in the formulation of a strategic systemic approach to this link of the health care system. The aim of the article is to identify and describe the organizational and economic changes in occupational health services during the pandemic. On this basis, the directions of further research on the improvement of the activities of health care entities of working people in response to future health crises have been formulated. The review covered legal acts relating to organizational and economic changes, Polish and foreign expert publications, full-text Polish and English-language scientific articles included in the PubMed database, publications beyond the specified period, consistent and useful in explaining the concepts of organization, management and economics. The changes in occupational health services presented in the literature during the pandemic consisted of: introducing additional organizational forms of providing health care to employees including occupational medicine leaders, strengthening supervision over working conditions, interdisciplinary cooperation for managing the health of working people, participation in pro-vaccination campaigns, activities in the field of rehabilitation after COVID-19 and new-quality cooperation with public and private health stakeholders. As the result of the review, problems were formulated for future research, which included ensuring the security of occupational medicine entities in terms of resource availability, adjusting the allocation of resources to new financial needs during and after a pandemic, evaluation of organizational and economic changes introduced during the pandemic and the legitimacy of their maintenance in subsequent periods, the development of economic and organizational instruments for the time of crisis, the scope and principles of cooperation with health care stakeholders and the introduction of medical technologies based on a medical and economic assessment according to Health Technology Assessment. Med Pr. 2022;73(6):471-83.

[Organizational and financial changes in the work of primary health care workers during the COVID-19 pandemic inPoland]

Following the outbreak of the COVID-19 pandemic, the objectives of the health care system had to be adapted to the changing circumstances, in order to meet the health needs of patients, but also the expectations of medical workers related to ensuring safe working conditions in the crisis situation. The activities of medical staff are greatly affected by organizational and financial changes in health care systems, which affect both the health care systems all over the world and the functioning of all forms of health care. The article examines the organizational and financial changes resulting from the introduction of regulations affecting the conditions of primary health care (PHC) workers in Poland from the beginning of the COVID-19 pandemic to May 8, 2021. The findings regarding measures taken to ensure the stability of PHC functioning during the pandemic highlight that the public health emergency exposed a significant need to introduce organizational and financial changes in PHC. The changes arising from legislation and good practices of medical, organizational and financial character resulted in health care system modernizations in Poland. It is worth stressing, however, that there is a great need to maintain coherence when implementing organizational and financial changes affecting the fluidity and effectiveness of the actions taken by PHC personnel, and thus their working conditions, when implementing future responses to public health emergencies. Such changes should be based on an analysis of the solutions introduced since the beginning of the pandemic in Poland: these include organizational changes such as housing conditions, organization of work and workplaces, flow of information and way of supplying the patient, and financial changes involving mobilization of additional financial resources. The article presents a list of future research questions that merit consideration when setting problems and priorities: these can be used to guide the introduction of permanent modifications to the functioning of PHC in Poland and to facilitate possible future adaptation in times of emergency. Med Pr. 2021;72(5):591-604.

Informal Dementia Caregivers: Current Technology Use and Acceptance of Technology in Care

(1) Background: Given the increased social isolation caused by the COVID-19 pandemic, the challenges faced by informal dementia caregivers have increased. An increasing use of technology, both in care and dementia clinical trials, depends upon caregivers' abilities as a user. Accordingly, the aim of our study was to verify the current technology (smartphone and computer) use and acceptance in care, regarding socio-demographic variables; (2) Methods: Questionnaires were distributed to 102 dementia caregivers, mostly of patients with moderate dementia; (3) Results: The majority of participants were women (63%), and large number of them used technological devices such as a smartphone (91%) or computer (81%). Results revealed differences between age, gender, and education level on technology acceptance. Interestingly, smartphone use and acceptance seemed to be feasible, regardless of age, whereas computer use was negatively correlated with age. Technology was perceived by respondents as most useful for patients' activities including locomotion, toileting, and meals; (4) Conclusions: The future of technology use in dementia care should indicate solutions tailored to individual characteristics such as new technology solutions (GPS trackers, smartphone apps, dietary intervention, and meal planning apps).

Priority Setting in the Polish Health Care System According to Patients' Perspective

Identification of health priorities is concerned with equitable distribution of resources and is an important part of strategic planning in the health care system. The aim of this article is to describe health priorities in the Polish health care system from the patients’ perspective. The study included 533 patients hospitalized in the Lodz region. The average age of the respondents was 48.5 years and one third (36.6%) had university education. Most of the respondents (64.9%) negatively assessed the functioning of the health care system in Poland. Most of them claimed the following aspects require improvements: financing health services (85.8%), determining priorities in health care (80.3%), the role of health insurance (80.3%), and medical education (70.8%). Over 70% of the respondents agreed the role of politicians in designing and implementing health system reforms should be limited. The fact that the respondents so negatively assessed the Polish health care system implies there is a need for full discussion on redefining health priorities.

[Occupational health services as the insurance product and insurance economic instruments]

BACKGROUND

One of the most controversial issues in restructuring the Polish health insurance system is the implementation of private voluntary insurance and creation within it a new insurance product known as occupational health services (OHS). In this article some opportunities and dilemmas likely to be faced by providers and employers/employees, when contracting with insurance institutions, are considered as a contribution to the discussion on private insurance in Poland. The basic question is how private insurance institutions could influence the promotion of different preventive activities at the company level by motivating both OHS providers and employers.

MATERIAL AND METHODS

The descriptive qualitative method has been applied in the analysis of legal acts, scientific publications selected according to keywords (Pubmed), documents and expert evaluations and research project results.

RESULTS

Taking into account the experiences of European countries, described in publications, international experts' opinions and results of research projects the solution proposed in Poland could be possible under the following several prerequisites: inclusion of a full scope of occupational health services into the insurance product, constant supervision of occupational medicine professionals, monitoring of the health care quality and the relations between private insurers and OHS provider and implementation of the economic incentives scheme to ensure an adequate position of OHS providers on the market.

CONCLUSIONS

The proposed reconstruction of the health insurance system, comprising undoubtedly positive elements, may entail some threats in the area of health, organization and economy. Private voluntary health insurance implementation requires precisely defined solutions concerning the scope of insurance product, motivation scheme and information system.

[Occupational health service management--the concept and application of lean management]

One of the most effective management systems is the so-called lean management (LM) aimed at loss minimization of institutions' activities while maximizing value and satisfaction to the clients. The system implementation comprises not only typical business areas but also health care sectors. The aim of the article is to present the concept and opportunity of improving the management of occupational health units. Due to its multi-profile nature of tasks and diverse relations with the environment occupational health could be a good institutional example of LM implementation. Operational perspective consists of five guidelines: describing values expected by final clients, setting value flow eliminating needless elements, creating the integrated, coherent and smooth sequence of valuable activities, offering the values to clients, and aiming at continuing improvement. LM could be implemented in occupational health units in the following areas: timing and tasks coordination, leaning some tasks and expanding others in order to maximize clients' value, cost rationalizing, improving the quality of services by eliminating mistakes, avoiding repetition of activities.

[Occupational health protection in business economics--business plan for health intervention]

INTRODUCTION

One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics.

MATERIALS AND METHODS

The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity.

RESULTS

The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company.

CONCLUSIONS

Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees' health.

[Return on investment for occupational health: review of methods and recommendations]

The impact of the population health on the national economy, occupational risk factors and economic consequences of workers' behaviors in the workplace are the subject of health economics studies. Conditions and behaviors at work are recognized as one of the major economic factors. These relations are analyzed and evaluated with use of methods that combine economic consequences of working conditions, management and enterprise finances. The methods of assessing this impact are well known but the ability to implement them in practice is still limited. There are two main types of methods: methods for measuring economic relations between the work environment and enterprise management and methods for the economic analysis of investments in the work environment and occupational health. Methods for assessing economic effectiveness of working conditions limited to measurements of costs of absenteeism at work are also used. One of the methodological options in this regard is return on investment (ROI) for occupational health. ROI has been applied in many firms all over the world. Depending on the analytical assumptions and the scope of research, the ROI value ranged between more than 1 and 13. This means that the increase in return on investment for occupational health has been observed. There are examples that the return on invested resources cannot be always obtained. ROI accounting gives employers an opportunity of increasing effectiveness. Evidence of the real value of health investment enables to provide the platform of discussion among managers and other persons responsible for occupational health management. The results of the studies cannot be overestimated as an element of economic incentives system. Based on the review of the methods and results of their implementation some recommendations can be formulated.

[Motivating instruments behind occupational health activities and their efficiency in expert judgment]

BACKGROUND

The aim of the study was to analyze and compare economic incentives practices in occupational safety and health (OSH) in the chosen EU countries and the USA, based on expert judgment.

MATERIAL AND METHOD

The information for the analysis was collected by using a questionnaire filled by experts from international organizations. It was supplemented by direct consultations with experts and experts' reports.

RESULTS

Economic incentives in OSH do exist in each country under study. The institutions engaged in providing economic incentives are as follows: social insurance, disability pension private insurance, state institutions supervising occupational health, health insurance, state institutions providing regulations, accident insurance. Experts evaluated the influence of state and insurance institutions on economic incentives promotion, as medium, and that of employers' organizations and trade unions as weak. They also confirmed a particular role of cost/benefit analysis.

CONCLUSIONS

Economic incentives are considered as a managerial instrument enabling individual and flexible health protection management at different levels in enterprises as opposed to the legislation that only provides for the observation of minimum standards. Economic incentives can be used faster and more effectively. Legal regulation is a slow process and proves to be a less effective tool.

[Cost-benefit analysis of the program on early detection of pulmonary diseases]

BACKGROUND

Economic evaluation of costs and effectiveness of the program aimed at early detection of lung diseases was the subject of the study. The scope of the study is related to the European tendency of creating information resources for public resources management.

MATERIAL AND METHODS

The study covered more than 14 000 people divided into three age groups, living in 11 localities in the Lódź region. The program aimed at lung diseases detection was conducted in three steps: first specialist examinations, X-ray examinations, second specialist examinations. Costs and effectiveness of the program were compared by cost/effectiveness and incremental ratios.

RESULTS

The results of the study were formulated in the following areas: costs of the program by age groups and groups with suspected diseases, effects of the program, costs per one detected case and incremental ratios.

DISCUSSION AND CONCLUSIONS

The results of the study show that economic evaluation conducted from ex post perspective could be useful in building decision scenarios. Sensitivity analysis allows for investigating how different assumptions of variables influence the study results. Variables useful for the scenarios of early lung diseases detection programs were identified for further studies.

[Financial incentives in workers' health management]

In the countries of the European Union, several million workers meet with an accident every year. In the national economy, the costs of accidents at work and occupational diseases are born by different institutions in different proportions, and they are estimated at several percent of the gross domestic product of each of these countries. The issue concerning economic consequences of occupational diseases and accidents at work has been emphasized in the section on health and safety at work of the Community Strategy for 2007-2012. Bearing this in mind, the need have arose to strengthen the efficiency of legal instruments and economic stimuli to motivate actions aimed at improving work conditions. Economic stimuli and legal instruments complement each other in the process of motivating various institutions. The following kinds of economic stimuli have been distinguished: subsidies, grants and financial assistance of the state and stimuli incorporated into tax and insurance systems. Economic evaluation at the information, allocation and educational levels, being an economic tool, may support policymakers who can use this tool to asses economic efficiency of decisions made in the area of health and safety of workers as well as to asses economic consequences of the functioning of legal instruments. The aim of the project, implemented under the Seventh Framework Program by the Nofer Institute of Occupational Medicine, is to promote the system of economic stimuli understood as an incentive to undertake actions for the improvement of work conditions. Owing to this project the discussion forum, addressed to relevant and interested social partners, will be established, and experts in the field will assist in determining directions of further actions aimed at advancing motivation systems.

[Models of workers' health and safety insurance in the selected European Union member states: certain economic problems]

BACKGROUND

The project entitled "An analysis of insurance models in the selected European Union (EU) member States" has recently been accomplished in the Nofer Institute of Occupational Medicine in the section concerning the health and safety of the working population. One of the aims of the project was to identify differences between EU and Polish models, which may provide the basis for a possible involvement of insurance providers (existing and/or created on purpose) in the implementation of tasks in the area of the workers' health protection in Poland.

MATERIAL AND METHODS

Documents and publications issued in Poland and elaborated by international organizations were used in the analysis. Of the existing models, those which differ in the solutions concerning the limitation of growing costs of insurance systems, the level of centralization of insurance system management, and the range of cooperation between public and private insurance providers were selected for the analysis.

RESULTS

The results of the analysis show that the functioning of insurance systems in the countries under study has been the subject of constant modifications and improvements. Their major aims are to limit the growth of costs of social insurance systems, to shape new qualitative relations between private and public insurance institutions, and to take account of new forms of work regarded as a factor contributing to changes in insurance systems.

DISCUSSION AND CONCLUSIONS

The conclusions arising from the analysis of European insurance systems in the area of workplace accidents and occupational diseases, as well as a possible direction of insurance system transformation in Poland address the following issues: the scope of centralization of insurance system management and the role of the state, the degree of independence of insurance institutions and their priority actions for prevention, motivation mechanisms targeted at employers, participation of employers in the consequences of occupational diseases and workplace accidents, as well as the role of additional voluntary workers' health insurance.

[Costs of intensive care of premature infants]

It is often pointed that hospitalizations of premature infants generate high costs. It is particularly bothering with reference to neonatal intensive care units (NICU).

OBJECTIVE

Since there is lack of desirable data in Poland, a study was launched in the city of Lódź in order to estimate exact costs of intensive care of premature infants.

METHODS

The study consisted in collecting data cocerning all resources (drugs, materials, medical equipment etc.) used during the hospitalizations of the neonates. It was constructed in a retrospective way, which means that data was collected from the first day of each patient's hospitalization till his or her discharge. The study lasted from 03.10.2004 to 06.04.2005. The study population were neonates borned before 37 week of gestation, who were treated in the Intensive Care Unit of Paediatric University Hospital, Medical University of Lodz. The population consisted of 30 patients borned between 23-36 week of gestation and birthweight between 600g and 3300g.

RESULTS

The structure of costs shows that the most expensive was medical care which constituted 51% of total costs. 90% of neonates costed no more than 30,000 zł and the average cost was 17,633,76 PLN.

CONCLUSIONS

Total cost of hospitalization depends mainly on the length of stay. Among recovered patients hospitalizations lasted from 6 to 125 days. The longest stay costed 90,780 PLN. Detailed analysis is needed to consider if there is feasible possibility to limit time of hospitalizations in order to decrease costs.

[Calculation of workers' health care costs]

In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials.

[Costs of occupational diseases and accidents at work in Poland]

BACKGROUND

The costs of occupational diseases and accidents at work in the state members of the European Union keep at a level of several percent of their gross national product (GNP). Employees, employers and the society as a whole have to incur this financial burden. Therefore, all social partners should be involved in the improvement of health and safety in the work environment through their concerted efforts. It should be pointed out that information in the field of economy is an inherent instrument of all activities. It allows to estimate economic consequences of occupational diseases and accidents at work as well as to formulate future strategies. The aim of this study was to estimate and assess the range of the expenditure of money on occupational diseases and accidents at work in Poland in 2004.

MATERIAL AND METHODS

The algorithm for estimating economic consequences of occupational diseases and accidents at work was developed, taking into account, e.g., the selected components of the costs, the estimation of economic consequences for the national economy, and the costs incurred by employers and social insurance institutions. In addition, the model for estimating economic consequences and defining the range of expenditure of money on occupational diseases and accidents at work relative to indicators of socioeconomic situation of the country was constructed. Economic consequences are understood as costs incurred by the health care and social insurance systems in Poland, institutions, companies, and individual employees.

RESULTS

The following cost components were estimated: the average-annual costs of lost production, sickness benefits, social insurance benefits and those incurred by enterprises related with accidents at work and occupational diseases.

CONCLUSIONS

Due to the lack of complete, reliable information essential for estimating economic consequences, a number of assumptions and study limitations were accepted. The range of identified and estimated costs of occupational diseases and accidents at work was set relative to GNP and to the value added in the national economy. Bearing in mind that the costs of occupational diseases and accidents at work are underestimated, it can be concluded that their share in values characteristic of the national economy do not depart from average values recorded in European countries.

[Calculating costs of premature infants' intensive care in the United States of America, Canada and Australia]

Although advanced neonatal care technology has contributed to significant decline in mortality of premature infants, it has also resulted in rising costs of hospitalization. Premature infants constitute 4% to 6% of all newborns treated annually in Neonatal Intensive Care Units (NICUs) and that is why the cost of prematurity determines considerable financial burden on health care in each country. In Poland research concerning costs of neonatal intensive care have not been conducted so far. The object of this paper is to review world-wide literature on that subject, particularly taking into consideration methods of estimating costs and economic analysis, such as cost-benefit analysis, cost-effect analysis and cost-utility analysis. The results of studies undertaken in the United States of America, Canada and Australia have been presented. Results of review indicate the strong relationship between high costs and small gestational age or low birth-weight of newborns. As no research in this area has been conducted in Poland so far, it seems to be crucial to estimate costs of neonatal intensive care of premature infants in Poland. Precise analysis of main factors determining high costs may be helpful in searching for significant savings. It would be a useful decision-making tool both for the NICU and the hospital managers.

[Models of economic evaluation of health and safety interventions at workplace]

Economic analyses and evaluation of the effect of workers' health on the national economy have begun to play a significant role in decision-making processes in terms of relations between health and safety in the work environment and the financial policy of enterprises. The economic dimension of consequences of occupational diseases and accidents at work is more frequently associated with the financial policy of enterprises understood as an element of costs involved. This gains particular significance when enterprises must maintain and improve economic effectiveness especially in the case of limited resources and permanent competition on the market. Therefore, the evaluation of economic interventions in the area of health and safety at workplace and its results are so important in the enterprise decision-making process. Several models of economic evaluation are used in assessing effectiveness of actions aimed at improving health and safety at workplace against a background of the overall economic situation of enterprises. The author presents the principles of six models, which have been used in the evaluation process. These models are based on information about costs of interventions/programs designed to reduce harmful effects of working conditions on workers' health and information concerning the results of individual ventures. They also take account of the influence of changes in working conditions on reduced sick absence, increased effectiveness of enterprises, production costs, and changes in productivity. The relationship between costs of intervention and its effects in financial terms based on cost-benefit analysis is the measure of effectiveness of health investments. The models presented show in practice a number of limitations, resulting mostly from the way the data are recorded in individual enterprises. Therefore, it is recommended that evaluation should be preceded by a precise definition of its aims, the range of the intervention and effects to be attained, which should provide the basis for defining the means and resources necessary for its implementation. This mainly applies to availability of data on costs and effects as well as to calculation methods, which can be used in view of collected numerical data.

[How to measure efficiency of health investments in enterprises: selected issues]

BACKGROUND

World trends and international organization recommendations point out the necessity of OHS economic appraisal methods improvement in order to ensure effective resources management in companies.

MATERIALS AND METHODS

Published world literature on economic appraisal results, recommendations of international organizations, results of the own studies on economic appraisal in the field of health and safety at work in the companies in Poland were the background of the economic appraisal model for Polish companies. Several project assumptions have been adopted. The model of the return of the investment, model based on the company participation and some elements of the net costs formula are recommended for Polish companies in order to appraise efficiency of the health investment. The basic ratio in economic evaluation should be cost/benefit ratio. The project of the economic evaluation algorithm has been elaborated.

RESULTS AND CONCLUSIONS

The economic analysis of the health protection and safety at work should include clear division between the internal and external costs. The proposed model could be used for the companies management needs in two directions: to microeconomic efficiency appraisal of investment in programs/intervensions in health and safety at workplace and to analyze the influence of the costs of accidents and occupational diseases and costs of preventive programs on finance management on the company level.

[Cost analysis of task implementation at the regional occupational medicine centers]

In this paper, the considerations on setting the costs of the tasks to be implemented by provincial occupational medicine centers (POMCs) are continued (Med Pr 2001; 3: 197-201). Under the research project carried out by the Nofer Institute of Occupational Medicine, the method of setting costs has been elaborated and implemented in selected POMCs. At the implementation stage, a set of forms to collect and process data on costs involved was prepared. These forms together with the instruction were distributed among the selected centers. The data collected were analyzed, and the conclusions concerning the factors responsible for shaping relevant costs in POMCs, as well as the barriers hindering the implementation of this new method were formulated. The introduction of new principles of isolating so called "cost phases" was necessary only for setting full costs of health promotion and postgraduate education programs. The method of setting values for the remaining POMC costs has been implemented without its modification. The collected data on costs show that the wages of physicians and medium-level personnel affects mostly the costs of tasks in a given center, however, indirect costs also have a substantial share in unit costs. In addition, the range of specialistic consultations and diagnostic tests performed in or outside POMCs also exert some effect on the differentiation of unit costs.

[Economic evaluation as a component in the evaluation of a prevention program]

BACKGROUND

A growing gap between the required and available funds forces relevant bodies to use more effectively available financial means without decreasing the health care efficiency. Health policy makers have to take decisions on the kind, timing, and standard of medical care as well as on the mode and place of health service delivery. Moreover, they have to decide who should be provided with medical care under the National Health Fund. The economic evaluation techniques, primarily cost-benefit and cost-effect analyses, are essential tools supporting decision-making processes.

MATERIALS AND METHODS

Under the LEONARDO DA VINCI (2000-2003) EUROPHAMILI project, an economic evaluation method has been developed and used to evaluate the antismoking program. In developing the method, the guidelines of the World Health Organization (WHO) were applied. Actual data on the cost of the program carried out in Lódź were used, and the benefits attained due to its implementation were estimated adopting the study assumptions based on actual data on the program efficiency and the literature data.

RESULTS

In view of the expanded calculation model, only some examples of synthesized calculations are given. The results of the analysis show that the program financial profits exceed the costs incurred even if the assumed calculation parameters are changed. The performed calculations indicate that the shorter period of the prevention program implementation, the more advantageous cost-benefit relation.

CONCLUSIONS

The performed economic evaluation helped to formulate prerequisites, which have to be met to facilitate the economic assessment of efficiency of the selected prevention programs.

[Financing of regional occupational health service centers: structure and financial criteria in years 2000-2001]

The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.

[Efficiency assessment of investment in workers' health--economic issues]

The economic analysis of efficiency of investment in health care and health at large by means of cost-benefit or cost-effectiveness techniques is the subject of implementation work in a number of countries. Poland's integration with the countries of the European Union justifies the need to understand and to use economic analyses. Unfortunately, these activities encounter many methodological and executive barriers. The investments in workers' health are not only investments in health care and the improvement of working conditions, but also in compensations, including financial ones, resulting from adverse effects of factors influencing the health of working population. The financial reporting system that exists in Poland does not ensure the possibility of full presentation of the aggregated data on the financing of activities for workers' health and diminishing of the adverse effects of factors present in the work environment. The information on the outcome of the investments in workers' health come from different sources, which means that it applies to different groups subjected to the analysis. The problem lies not only in the assessment of profitability of health investments but also in the social problem of the division of the resultant costs and benefits among various branches of the national economy. Therefore, the analyses involving mutual relations between individual sectors that invest in workers' health and those that bear consequences is essential in the terms of economic analyses. The authors present the determinants of economic evaluation in regard to health of working population in Poland.

Health and safety economics: limitations of economic appraisal of occupational health services activities in Poland

Methods of economic appraisal developed for evaluating activities in health care system may as well be successfully used for evaluating occupational health service activities. This involves the problem of resources management and cost containment not only at the company level, but also at different managerial and institutional levels. The decision makers have to know what resources are spent on occupational health, what is the effectiveness and efficiency of investing in employees health. The key issue of good understanding of the theory and practice of economic appraisal is a precise definition of costs, effectiveness and benefits. Another important area is the identification of information sources and barriers of economic appraisal. The results of the project carried out by the Nofer Institute of Occupational Medicine have provided evidence that defining costs, effectiveness and benefits of preventive activities need to be developed. It becomes even more clear after an analysis of existing limitations of economic appraisal in Polish enterprises.

Financing occupational health services in Poland

OBJECTIVES

Financing occupational health services (OHS) at the regional and basic level is an important issue in view of the transformation process going on in OHS in Poland. The Occupational Health Services Act from 1997, The Public Finance Act from 1999 and The Labour Code Act with amendment have been regulated by the new principles of financing. The organizational structures and the financial system have been changed since 1 January 1998. The process is still being continued. The gaps between information systems of past and present financial data enforced the examination of the current situation in regard to the structure of financing and internal allocation of financial means.

MATERIAL AND METHOD

The studies of OHS funding were carried out by the Nofer Institute of Occupational Medicine in Lodz. The data were collected and analysed for the period 1998-2000. They included full accessible statistics on OHS funding in Poland. The information on the financing system was collected by a questionnaire mailed to directors of OHS centres, and was supplemented by direct contact with directors.

RESULTS AND CONCLUSIONS

Sources of OHS financing in Poland are as follows: local government, state budget, companies, social health insurance institutions (since 1 January 1999 a social health insurance system has been implemented), OHS providers (as primary units), other sources. Analyses of their structures in a given period were conducted. The role of companies and social health insurance institutions in financing Regional Occupational Health Services Centres (ROHSCs) was considered in relation to the existing law regulation.

[Problems in setting costs of tasks carried out by regional occupational health centers]

An analysis of costs incurred in tasks carried out by regional occupational health centers and sources of finance, completed by the Nofer Institute of Occupational Medicine, allowed for defining obstacles in the efficient functioning of the finance management in these centers. Unsatisfactory system of financial information including. The information on costs is one of such obstacles. Therefore, a project has been initiated with the aim to develop the methodology of the cost that could provide necessary information for the current finance management and supervision as well as for the accomplishment of the defined aims. The author presents the objectives and major stages of setting unit costs involved in the task implementation including the standards for consumption of resources.

[Performance and costs of services provided by physicians in selected regional occupational health care centers]

Collecting accurate data on performance and costs of services is recognized as the most difficult managerial problem because of limited application of medical standards and procedures as well as the different methods for costs calculation. The report presents the implementation of standardized medical procedures for referral examination, diagnosing occupational disease; and consultation in Regional Occupational Health Care Centers (ROHCC). Data on procedures were related to those on costs in cost centers and to cost structure--the time required for each task. Direct normative costs were analyzed in 6 ROHCC for managerial goals and selling the products as well. The results revealed important differences among different physicians' paid worktime spent on the same types of services. At 2 ROHCC time measurements and estimation of time gave similar results, in contrast to the rest ROHCC where those times were more prolonged. In contrast to commonly accepted opinions, the cost of physicians' work time amounted just several percent of total cost of the service. Such differences were noted not only among different ROHCC but even inside the same single ROHCC. The highest costs of production and of selling referral examinations and diagnosing occupational diseases resulted from the high percentage of indirect costs and overhead costs. The possible reasons of differentiated data on .rapid" and "slow" ROHCC were discussed. The need of right use of medical, organizational and financial data in evaluation of occupational health care efficiency is stressed.

[Analysis of costs involved in activities of regional occupational health centers]

In this paper the authors continue considering the financial economy in the selected Regional Occupational Health Centres (ROHC). The paper contains an analysis of costs involved in the implementation of the ROHC activities, which constitute one of the components of the financial economy of health care institutions. Due to analyses carried out thus far it was possible to infer conclusions regarding the level and structure of the ROHC financing. The cost analysis supplements the considerations on the financial sources, and illustrates at the same time how the financial means have been used by these facilities. The ROHC expenditures were analysed in two dimensions: in the kind dimension and the subject-object dimension. Single costs were also the subject of the analysis. The comparison of the results obtained allowed for formulating conclusions on the financial economy of the selected ROHC. However, these conclusions cannot be generalised in terms of all facilities as the relationship between the structure and level of the costs, and the structure and level of financing was not common. The relationship between the highest share of salaries in the ROHC expenditures and a high level of financial support provided by regional Governors in 1998 was most frequently observed. A number of considerable limitations in the analysis performed were discussed in the final section of the paper.

[Sources of finance for provincial occupational health services. Theory and practice]

The financing of occupational health services (OHS) at the provincial level is an important issue in view of the transformation process going on not only in OHS but also in the overall health care system in Poland. New principles of financing must be now based on the cost and effects analyses. Thus, the question arises on how to provide financial means adequate to needs of health care institutions resulting from their tasks and responsibilities. The gaps existing in the information system have encouraged us to examine the situation in regard to the structure of financing and internal allocation of financial means. The objectives were formulated as follows: to characterise the sources of financial means received by provincial OHS centres; to analyse the structure of financial means derived from various sources, taking into account forms of financial administration, using the data provided by selected centres; to define the relation between the financial means being at the disposal of OHS centres and the scope of their activities; The information on the financing system was collected using a questionnaire mailed to directors of selected OHS centres. The information collected proved to be a valuable source of knowledge on the above mentioned issues as well as on how far the new system of financing associated with a new form of financial administration--an independent public health institution--has already been implemented. The studies indicated that at the present stage of the OHS system transformation it is very difficult to formulate conclusions on the financing administration in provincial OHS centres.

[Cost-benefit analysis--occupational health and safety]

Cost-benefit analysis (CBA) as an economic tool for evaluating activities undertaken in different branches of the national economy may be also used in the field of occupational health and safety at workplaces. A growing economic approach to all actions concerning the work performance and the work environment increases the interest in this kind of analysis, what is reflected by numerous international conferences and seminars. A supporting role of CBA in the decision-making processes compels the development of methodology and empirical verification of its assumptions. International studies aimed at elaborating uniform guidelines for cost-benefit analyses apply mostly to interventions for prevention of accidents at work, health promotion, rehabilitation of workers and occupational disease prevention.

[Costs and benefits of medical prevention in small enterprises]

The current transformation of Polish economy towards free market compels a rational management of resources and more effective instruments for the cost-benefit control in small enterprises. One of the most important areas of activities in small enterprises is the promotion of medical prevention at the workplace. Employers are committed to ensure that all workers have access and benefit from medical prevention, as well as to bear all costs involved in prevention programmes, periodical prophylactic examinations, and actions aimed at promoting workers' health and improving working conditions. Planning these improvements, health certificates and recommendations resulting from the evaluation of working conditions should be taken into consideration. New legal regulations create the ground for employers to choose the most effective and appropriate measures for providing preventive care. The aim of the study was to elaborate and implement the cost-benefit analysis of medical prevention activities in enterprises, thought as one of decision-making tools to be used by employers. The principles of the cost-benefit analysis in enterprises algorithm of proceedings and the instructions how the analysis should be implemented, were elaborated. In addition, a supportive computer system was developed. The cost-benefit analysis was already implemented as a pilot project in several enterprises what helped to modify the method and collect numerical data necessary to perform the analysis and to define the scope of its application.

Occupational accidents in a selected chemical enterprise in Poland and an attempt to evaluate their economic effects

An analysis was made of occupational accidents leading to temporary absence from work occurring in a selected chemical plant in the years 1988-1989. The authors also studied the possibilities of evaluating costs and financial losses for the enterprise due to occupational accidents. However, the results of the evaluation, in the Polish situation and based on records existing in the enterprise, were not very useful.