Hospital reform. Deputy Minister of Health: Around September, we will propose financial tools for hospitals.

• Senators debated the government's hospital reform, which assumes, among other things, voluntary participation, a greater role for local governments, and the possibility of flexible transformation of departments and merging hospitals.
• The amendment introduces recovery programs for indebted public healthcare facilities, which will be analyzed by AOTMiT in terms of efficiency, finances and quality of management.
• The reform also provides for simplifications for patients, including the lack of referrals to optometrists, psychologists and sports medicine doctors, as well as new services at district health centers.
• Senators' opinions are divided: some point to the lack of financing sources and the transfer of responsibility to local governments, while others emphasize decentralization and adaptation of hospitals to local needs.

Senators debated the hospital reform, which includes amendments to the Act on Publicly Financed Healthcare Services and the Act on Medical Activity. No new legislative proposals were submitted during the discussion. Previously, the Senate's Health, Local Government, and State Administration Committees had requested the amendment be adopted without amendments.

The Deputy Minister of Health said that the first hospital recovery plans will be ready in spring next year.

- Around September, we will propose financial tools for hospitals - he added.

Szafranowicz noted that the financial mechanisms are being developed by the Ministry of Health, the Ministry of Finance and the National Economy Bank (BGK) as part of a team.

He noted that the current mechanism for debt relief for hospitals has failed. "We didn't require any rationalizations from directors," Szafranowicz said. He emphasized that the new debt relief mechanism involves financial assistance and rationalizing hospital expenses through the preparation of a recovery plan.

Senator Waldemar Kraska (PiS) said the amendment will be ineffective because it doesn't specify where the funding for district hospitals will come from. He noted that the mayor of a well-managed hospital would not consent to its merger with a hospital in debt. According to Kraska, the amendment shifts responsibility for hospital restructuring and consolidation to local governments. "The voivode should have a greater role here," he said.

Senator Agnieszka Gorgoń-Komor (KO), rapporteur of the committee's work, said that the prepared reform is voluntary, decentralizing and strengthening the role of local governments.

According to Beata Małecka-Libera (KO), chairwoman of the Senate Health Committee, the amendment introduces a small tool to help put the healthcare system back on track. She noted that district hospital directors are currently tied because they fail to adapt their hospital offerings to current needs, owing to the loss of their lump sum payments.

The government's hospital reform introduces the flexibility of local governments to reorganize departments and merge hospitals. Hospital services are to be adapted to local needs, including demographic changes: declining birth rates and an aging population. Medical staff, equipment, and infrastructure are to be utilized more efficiently.

The amendment assumes that a hospital in the so-called network will be able, with the consent of the President of the National Health Fund, within a given profile, to replace full hospitalization with planned or one-day treatment or to provide long-term inpatient care services.

Another solution envisages that associations of local government units (LGUs) will be able to establish and operate independent public healthcare facilities (SP ZOZs), as well as healthcare entities operating as joint-stock companies and budgetary entities. The bill envisages the possibility of merging hospitals by LGUs.

The reform envisages the introduction of regulations for the development and approval of recovery programs for public healthcare facilities (SPZOZ) that have experienced a net loss. The development of the program would be preceded by an analysis of the effectiveness of the hospital and its individual units.

The Agency for Health Technology Assessment and Tariff System (AOTMiT), commissioned by the Minister of Health, will analyze recovery programs and their implementation, including the economic and financial situation of healthcare providers and the quality of management. Furthermore, when shaping tariffs, AOTMiT will analyze the share of services in inpatient and outpatient care.

The amendment introduces a new guaranteed service provided at the district health center. It also eliminates the need for referrals to see a sports medicine physician, optometrist, or psychologist. Optometrists will be able to issue referrals to ophthalmologists.

The hospital reform is a milestone in the National Reconstruction Plan (KPO), meaning the disbursement of funds from the KPO depends on its implementation.

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