The Polish healthcare system has been grappling with challenges for years, including unequal access to medical services, inefficient spending of public funds, and a lack of a coherent investment strategy. In response to these problems, a number of interventions have been undertaken, including instruments such as the National Transformation Plan (KPT) and Voivodeship Transformation Plans (WPT), which are intended to increase the system’s efficiency and better address social needs, particularly in the context of EU funds for 2021–2027. The key question is: do these adopted plans meet citizens’ expectations, ensuring equitable allocation of resources, or do they remain merely formally required documents whose implementation encounters systemic and political barriers?
Responding to social needs and fairness in resource allocation
A 2019 European Commission report indicated that many healthcare investments from EU funds in the 2007–2013 and subsequent years failed to deliver the expected benefits due to a lack of coherent planning. Projects were often implemented with local interests in mind, rather than social priorities, leading to fragmentation of the system and suboptimal use of resources.
Moore’s concept of public value assumes that public institutions should generate the common good by responding to real needs and ensuring equitable distribution of resources. In healthcare, this means investing in areas with the greatest impact on society’s health, including marginalized groups, such as residents of regions remote from major medical centers or selected social groups. The National and Regional Public Health Plans (KPT) and the Regional Public Health Plans (WPT), introduced under the 2004 amendment to the Healthcare Services Act, are intended, according to the recommendations of the aforementioned report, to address these challenges. However, their effectiveness depends on translating general assumptions into concrete actions, precise monitoring, and resistance to political pressure and lobbying. A lack of coordination between the national and regional levels and between individual regions can limit their ability to ensure equitable allocation of resources.
A Strategic Approach to Health System Transformation
The KPT and WPT are based on the principles of strategic public management and are based on a health needs map, which provides data on the availability of services and identifies areas requiring intervention. This document serves as the foundation for strategies such as “Healthy Future. Strategic Framework for the Development of the Healthcare System for 2021–2027, with a 2030 Outlook” and operational programs such as the National Recovery Plan (KPO) and the Cohesion Policy 2021–2027.
The KPT encompasses the modernization of medical infrastructure, human resources development, long-term care, and service coordination. It emphasizes the need to strengthen the role of outpatient specialists in the diagnostic and treatment process, in order to reduce the burden on hospital care.
The WPT, developed by regional health needs councils, is intended to take into account local conditions in its assumptions, allowing for tailored actions to the specific needs of the regions. The process of creating these plans involved consultations with stakeholders, including the Ministry of Health, the National Health Fund (NFZ), local governments, patient organizations, and employers, which should foster transparency and consensus building. These plans are intended to direct public funds where they will yield the greatest health benefits, supporting the concept of public value. However, their success depends on the proper interpretation of the National Transformation Plan when creating the Provincial Transformation Plans, as well as the correct identification of local needs, taking into account actual social needs. This also requires effective implementation and monitoring, as well as the ability to counteract political influence.
The WTP should therefore be aligned with the KTP and respond to local needs. The scope of these activities is broad, and the choice is not obvious. Among the competing priorities, the investments listed in the WTP should include infrastructure and equipment in outpatient clinics, allowing, in particular, for the shift of imaging tests from hospitals to outpatient clinics where clinically justified. The concept of an inverted pyramid of services, promoting a broader base of outpatient clinics, also suggests the need for greater access to outpatient tests, especially for marginalized groups.
Updates to Provincial Transformation Plans in the Context of Imaging Diagnostics
An analysis of the Provincial Transformation Plans (PTPs) formulated in 2021 and amended in 2024, focusing on magnetic resonance imaging and the inverted pyramid concept, reveals a trend toward greater detail and adaptation to health challenges such as an aging population, increased demand for diagnostics (e.g., in oncology, neurology, cardiology), and experiences from the COVID-19 pandemic. The updates are based on data from the System Analysis and Implementation Database (BASiW), introducing metrics such as wait times (up to 200 days), diagnostic equipment utilization (over 3,750 tests per year), and demand forecasts. However, progress is uneven across the country – in some regions, updates are limited or no changes have been implemented.
In the author’s opinion, the advantages of the PTP updates over the original plans include:
- More precise data: The introduction of metrics such as wait times and equipment utilization allows for better resource allocation. Examples include the Kuyavian-Pomeranian and Masovian Voivodeships, which addressed queues and justified new investments.
- Integration with other areas: WPTs in the Lubusz and Lesser Poland Voivodeships combine diagnostic imaging with oncology, cardiology, and neurology, shortening treatment processes.
- Expansion of activities: The Kuyavian-Pomeranian Voivodeship increased the number of new MRI scanners to 10 in selected counties, reducing the distance to examinations (to 40 km).
- The Silesian and West Pomeranian Voivodeships have implemented recommendations for monitoring and optimization.
- The author also notes the following shortcomings of the WPT update:
- Uneven progress: In the Opole, Podkarpackie, and Greater Poland Voivodeships, the lack of data updates suggests stagnation.
- Marginalization of the inverted pyramid: This concept, crucial for reducing hospital workload, is omitted from the WPT or treated vaguely.
- Lack of a Systemic Approach: Focusing on equipment investments at the expense of organizational and staffing reforms limits the comprehensiveness of the plans.
- Implementation of the National Medical Research Programme (KPT) in the Updated Medical Research Programmes (WPT)
An analysis of the WPT and KPT shows that most voivodeships are implementing the KPT goals through investments in diagnostic equipment, the creation of MRI laboratories, and infrastructure modernization, which improves access to tests. However, the consistency between regional and national plans varies. The initial WPT from 2021 was too general and opaque, allowing for biased interpretations that allowed for the pursuit of vested interests. However, the 2024 updates introduce more data and focus on improving diagnostic imaging. Key advantages include detailed metrics and integration with other areas of the healthcare system, although the lack of uniform data remains a challenge, hindering plan comparison and system evaluation at the national level.
In light of the above observations, the author proposes the following proposals for standardizing the WPT:
- Standard indicators: Number of MRI scanners, equipment age, waiting times, workload at the laboratory, distances or travel times to facilities.
- Uniform structure: Standardization of diagnostic sections in each WTP.
- Integration with the MPZ: Incorporation of data from the BASiW into all plans.
- Monitoring the inverted pyramid: Introducing metrics for the number of tests in primary care and outpatient clinics compared to hospitals.
Conclusions
The KPT and WPT have the potential to respond to social expectations, ensuring equitable allocation of resources. The 2024 updates indicate progress in their creation in the form of precise data and investments. At the same time, they do not fully meet the hopes of the legislator legitimizing the transformation plans and their original assumptions formulated in R. Mołdach’s report for the European Commission. Data standardization, integration with the MPZ, and a greater emphasis on systemic reforms are crucial to creating a coherent and effective healthcare system that fully realizes the concept of public value.