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In modern laboratory diagnostics, the flow of information in electronic form is common, more and more extensive, and complicated. For the flow of this information to be efficient and complete, it should include medical diagnostic laboratories and their complete environment, including nationwide healthcare information systems. Optimizing the electronic flow of information requires standardization of terminology and coding of laboratory procedures and the creation of IT infrastructure, which, with institutional support, will ensure adequate access to laboratory diagnostic data in the healthcare system. In this article, we present a system proposal prepared by the Section for Standardization of Information in Laboratory Medicine of the PSLD in cooperation with experts from other bodies, the purpose of which would be to systematize, improve the quality and certainty of processing information on laboratory diagnostics. The proposed System of Standardization of Information in Laboratory Diagnostics (SSILD) should ultimately allow for the unambiguity of the names and codes of procedures using the LOINC® terminology, certainty as to the key features of the procedures, certainty as to the reference intervals/decision values, access to information necessary for the interpretation of the result and clarity as to whether the procedures are covered by the regulation of the guaranteed benefits basket.

Introduction. The aim of our study was to analyze the number and structure of patients diagnosed and treated due to cancers of lips, mouth and throat in Poland between 2008 and 2015. Material and methods. Secondary statistical analysis of data obtained from the Polish National Cancer Registry (KRN) and Polish National Health Fund (NFZ), concerning patients diagnosed for the first time between 2008 and 2015. Results. Based on the available data, in total there were 30 800 new cases of cancers in population of Poland, and 29 800 people starting their treatment financed from the National Health Fund. Discussion. Cancers of the discussed locations, considered individually, are often rare diseases, with the incidence counted in hundreds of people per year in the entire Polish population. Due to the etiology and course, however, they should be analyzed together, which means that they become a significant group. Conclusions. In recent years, the annual incidence of these tumours was about 4000 cases, 70% of them were men. There is an approximately 10% difference in the number of registered cases of these cancers in NFZ databases. The creation of a medical register, including administrative, epidemiological and clinical data, would significantly improve the observation of the population of patients with these tumours.

AIMS To assess the number of people with diabetes in Poland using combined national sources and to evaluate the usefulness of data from an insurance system for epidemiological purposes. METHODS The data were collected from four sources: 1) 2013 all-billing records of the national insurance system comprising people of all age groups undergoing procedures or receiving services in primary healthcare, specialist practices and hospitals and also those receiving drugs; 2) an epidemiological study, NATPOL, that involved the assessment of people with undiagnosed diabetes; 3) the RECEPTOmetr Sequence study on prescriptions; and 4) regional child diabetes registries. RESULTS In 2013, 1.76 million people (0.98 million women and 0.79 million men) had medical consultations (coded E10-E14) and 2.13 million people (1.19 million women and 0.94 million men) purchased drugs or strip tests for diabetes. A total of 0.04 million people who used medical services did not buy drugs. In total, the number of people with diabetes in the insurance system was 2.16 million (1.21 million women and 0.95 million men), which corresponds to 6.1% (95% CI 6.11-6.14) of women and 5.1% (95% CI 5.12-5.14) of men. Including undiagnosed cases, the total number of people with diabetes in Poland was 2.68 million in 2013. CONCLUSION The estimated prevalence of diabetes (diagnosed and undiagnosed cases) in Poland is 6.97%. Data from the national insurance system with full coverage of the population can be treated as a reliable source of information on diseases with well-defined diagnosis and treatment methods, combined with an assessment of the number of undiagnosed individuals.

Ovarian cancer (OC) affects over 3 000 women in Poland annually. The efficacy of the therapy remains relatively low due to challenges of systematic improvement in the early detection OC rates. International comparisons indicate a positive correlation between health expenditures and 5-year survival rates of cancer patients. To the best of our knowledge, our study has been the first to present a correlation between the 5-year survival rates (SRs) and the cost of ovarian cancer therapy in particular regions of Poland. Material and methods: The study was based on the National Health Fund (NHF) data, available in the Disease Treatment Registry. The analysis included approximately 13 000 OC patients who started their treatment between 2005 and 2008 to allow for the evaluation of long-term therapy results. The 5-year survival rates were analyzed in relation to average NHF expenditures in various regions of Poland, distinguishing the population of patients aged 45-64 years. Results: The 5-year survival rate in the cohorts diagnosed in 2005 and 2008 changed marginally, from 42% to 43%, maintaining relatively large differences between the regions (from 35% to 53% in patients diagnosed in 2008). The NHF expenditures in particular regions differed significantly: mean cost for the entire treatment cycle ranged from 31.600 PLN do 58.000 PLN per person among patients diagnosed in 2008. No significant correlation between the survival and the cost was found. Conclusions: SRs of OC patients in particular regions of Poland are not correlated with average treatment cost. Thus, the differences in SRs between various regions of Poland have their source in other factors, e.g. clinical stage at diagnosis, or prevailing treatment patterns in the given region. Further studies may decrease regional discrepancies in patient care and SRs in OC subjects.

Heart failure has becoming an increasing medical, economic, and social problem globally. The prevalence of this syndrome is rising, and despite unequivocal positive effects of modern therapy, reduction of mortality has been achieved at the cost of more frequent hospitalisations. Unlike in many European countries, in Poland heart failure is usually recognised later, at a more advanced stage of the disease, leaving less time for ambulatory treatment and resulting in a high number of hospitalisations. The current paper presents the most important data regarding morbidity and mortality due to heart failure in Poland. The experts in the field focus on the key source of high costs of therapy and highlight several critical organisational deficits present in the Polish health care system. This background information builds a basis for a concept of coordinated care for patients with heart failure. The paper discusses the fundamental elements of the system of coordinated care for patients with heart failure necessary to enhance the diagnosis, improve therapeutic effects, and reduce medical, economic, and social costs.

Poland has one of the lowest patient satisfaction ant it is manifestated in many international surveys, where Poland is one of the last countries in the rankings and where responsiveness assessment is the lowest. It is mainly due to high fragmentation of services, long waiting lists and low level of implementation of comprehensive prevention programs. In 2013 Ministry of Health (MoH), the National Health Fund (NFZ) and The World Bank (WB) launched an integrated care discussion. The Project dedicated to the development of the 3 models of the population based integrations has been developed. The envisaged integrated delivery models will focus on two key areas: (i) reform on contractual arrangements between National Health Fund (Narodowy Fundusz Zdrowia- NFZ) and service providears to encourage service integration and coordination, (ii) The reform on provider contractual arrangements is coupled with reform on service organization solutions and structures to explore integrated care options. The objective will be to present the process leading to integrated care population model for Poland, in the context of the lessons learned from Polish and international integrated care examples. The new model of care will be composed of the regular primary health care services provided by the PHC/family doctors and nurses, with new in scope and volume of prevention and education activities, additional services for chronic patient’s, diagnostic tests and rehabilitation delivered in a coordinated, well managed and monitored way. The new tasks will be provided by the health teams and supported with the modern IT systems to facilitate the flow of information about the patients in real time. Within the new system, a set of monitoring and evaluation activities will be implemented reinforced with the capacity building systems for patient’s provides and health stakeholders. Population targeted is 250 000- 500 000 people, who will be enrolled in the study starting January 2017. Planned integrated care model in Poland is being perceived as a strategy towards patient’s centric health care system with the shift from hospital’s service delivery to the greater importance and wider implementation of prevention tools to meet the modern health challenges. This will be done in the long term, strategic approach towards the change of the health care system. As a result, it is expected that there will be: integration of care on primary and ambulatory level for the chronic patients, organizational integration of services tailored to patient’s needs with their active participation as well as integration of clinical pathways and higher patient satisfaction. Based on the results of the pilot, further models of integrated care on different levels will be developed. After the four years of the implementation of the pilots, based on evaluation, a scaling up the integration of care is being planned for Poland. Due to the similarities in the epidemiological issues and health systems organization in Central Europe and historical approach towards the health care, it is very likely, that the models, after some adjustments could be transferable cross borders.

Wstep. Choroby nowotworowe stanowią powazny problem ze wzgledu na ciągle wzrastającą liczbe zachorowan oraz wysokie koszty rozpoznawania i leczenia. Zwiekszenie odsetka osob w starszym wieku w polączeniu z wiekszym narazeniem na dzialanie szkodliwych czynnikow środowiskowych, jak rowniez rozwoj metod diagnostycznych powodują wzrost liczby wykrywanych nowotworow. Celem pracy bylo określenie populacji chorych z rozpoznaniem nowotworow w Polsce, oszacowanie wydatkow platnika publicznego związanych z leczeniem przeciwnowotworowym oraz oszacowanie kosztow wprowadzenia nowoczesnych metod leczenia chorych na nowotwory.Material i metody. W celu wykonywania analiz informacji sprawozdawczych w bazach danych NFZ zostal wykonany modul analityczny o nazwie „Rejestr Leczenia Chorob” (RLC), ktory umozliwia pobieranie informacji z bazy danych oraz prezentacje danych w czasie rzeczywistym. W analizie przyjeto metode oszacowania kosztu wprowadzenia innowacji. Przyjeto zalozenie, ze kosztem innowacji staje sie wartośc środkow wydatkowanych przez platnika publicznego w danym roku, jakie pozostają po ekstrapolowaniu kosztow terapii z roku poprzedniego na liczbe chorych w danym roku. W analizie nie zostaly wziete pod uwage wartości wskaźnika inflacji. Niepowtarzalnym identyfikatorem danego chorego zostal uznany numer PESEL. W analizie danych zostal wykorzystany arkusz kalkulacyjny Excel. Analize dokonano z wykorzystaniem wszystkich istniejących w bazie pozycji, nie roznicując stopnia wiarygodności potwierdzenia rozpoznania. Wyniki. Liczba wszystkich wykazywanych chorych z rozpoznaniami nowotworowymi w latach 2002–2012 rosla corocznie i osiągnela w roku 2011 ponad 1 milion osob leczonych z powodu nowotworow. Dynamika średnioroczna liczby pacjentow wzgledem roku poprzedniego wyniosla ok. +11%. Rozpoznania, ktorych koszty na przestrzeni calego badanego okresu przekroczyly 10% budzetu na rozpoznania onkologiczne, obejmują: nowotwor zlośliwy sutka (C50) — 14,41% budzetu i przekroczenie średniorocznego kosztu dla rozpoznan onkologicznych o blisko 1400% oraz nowotwor zlośliwy oskrzeli i pluca (C34) — 10,5% budzetu i przekroczenie średniorocznego kosztu dla rozpoznan onkologicznych o 1018%. Rozpoznaniami o najwyzszych kosztach średniorocznych w analizowanym okresie byly nowotwor zlośliwy sutka (C50) — 566 944 649 PLN oraz nowotwor zlośliwy oskrzeli i pluca (C34) — 412 877 994 PLN. Wyzej wymienione nowotwory stanowily rowniez rozpoznania o najwiekszej liczbie zrealizowanych świadczen na przestrzeni lat 2002–2011. Wnioski. Przeprowadzone analizy wykazaly, ze spośrod ponad 100 grup rozpoznan nowotworow istnieje okolo 35, ktore są istotne z punktu widzenia epidemiologii spolecznej. Świadczy to o tym, ze Narodowy Program Zwalczania Nowotworow wlaśnie te choroby powinien potraktowac priorytetowo i dla nich powinna byc opracowana szczegolowa strategia postepowania. Istnieje okolo 20 grup rozpoznan, w ktorych obliczony koszt innowacji przekroczyl na przestrzeni trzech lat 50 milionow zlotych (nowotwory, w leczeniu ktorych wprowadzono nowe leki). Istnieje duza i utrzymująca sie w badanym okresie rozbieznośc (okolo 50%) miedzy wykazywanymi rozpoznaniami i rozpoznaniami potwierdzonymi lub chorymi leczonymi, co wymaga przeprowadzenia odrebnych i bardziej szczegolowych analiz.

Wstep . Rak odbytnicy jest w Polsce jednym z najczestszych nowotworow, z rosnącą zachorowalnością. Porownania miedzynarodowe wskazują na zaleznośc pomiedzy wydatkami na ochrone zdrowia a wskaźnikami 5-letniego przezycia chorych na nowotwory. W niniejszej pracy, po raz pierwszy w Polsce, przedstawiono analize związku pomiedzy wskaźnikami 5-letniego przezycia wśrod chorych na raka odbytnicy w poszczegolnych wojewodztwach a ponoszonymi tam wydatkami na ich leczenie. Material i metody . W pracy wykorzystano dane NFZ dostepne w systemie pn. „Rejestr Leczenia Chorob”. Analizie poddano okolo 25 tysiecy chorych na raka odbytnicy, ktorzy rozpoczeli leczenie w latach 2005–2008. Wykonano analize porownawczą wskaźnikow 5-letniego przezycia wśrod tych osob oraz wydatkow ponoszonych w calym cyklu ich leczenia z podzialem na poszczegolne wojewodztwa. Wyniki . Wskaźniki 5-letniego przezycia chorych na raka odbytnicy w Polsce w latach 2005–2008 utrzymywaly sie na podobnym poziomie (okolo 41% u mezczyzn i okolo 45% u kobiet), przy wzglednie duzej roznicy w poszczegolnych latach na poziomie wojewodztw (w granicach od 36% do 45% u mezczyzn i od 39% do 49% u kobiet). Stwierdzono takze znaczne roznice pomiedzy wojewodztwami w wysokości wydatkow na leczenie; wśrod mezczyzn wynosily one za caly cykl leczenia od 32,3 do 41,0 tys. PLN na osobe, a u kobiet od 27,0 do 33,3 tys. W wiekszości porownan nie wykazano związku pomiedzy średnią wysokością wydatkow na leczenie a wskaźnikami 5-letnich przezyc. Wnioski. Przedstawiona analiza wskazuje na brak zalezności pomiedzy średnimi wydatkami i wynikami leczenia chorych na raka odbytnicy w Polsce. Przyczyny roznic w wynikach leczenia mogą byc zatem zalezne od innych czynnikow, np. stadium klinicznego nowotworu w chwili rozpoczecia leczenia lub odmiennych sposobow leczenia. Poglebienie tej analizy z uwzglednieniem przyczyn moze sie przyczynic do zmniejszenia regionalnych roznic w opiece zdrowotnej i nierowności w uzyskanych wynikach leczenia raka odbytnicy w Polsce.

Polski system opieki onkologicznej wymaga opracowania kompleksowej strategii. W niniejszym opracowaniu przedstawiono przegląd strategicznych dokumentow dotyczących zwalczania nowotworow, ktore powstaly w ostatniej dekadzie w innych krajach europejskich. Z analizy tych dokumentow wynika w szczegolności, ze 1) defi niowanie strategii wymaga dobrego rozpoznania i diagnozy sytuacji, wraz z przyczynami niedomagan obecnego stanu, 2) nalezy dobrze zdefi niowac cele strategiczne i rozroznic je od planowanych dzialan, 3) konieczny jest jasny podzial rol w realizacji strategii, 4) przydatne jest wskazanie zasobow, w tym fi nansowych, niezbednych do realizacji strategii. National strategies for cancer control: the experiences, structure, good practice Polish system of oncological care necessitates the development of comprehensive strategy. This article reviews strategic cancer control documents, which were developed in the past decade in other European countries. Observation and analysis of the documents lead to following conclusions: 1) defi ning a strategy requires good assessment and diagnosis of the present situation, including detection of main causes of shortcomings, 2) the goals and objectives should be well defi ned and logically distinguished from actions, 3) there is a need for clear distribution of roles of diff erent actors in the strategy execution, 4) it is useful to indicate resources, including fi nancial resources, which are necessary in the strategy execution.

Wstep. Rak piersi jest jednym z najwazniejszych problemow onkologicznych, a jednocześnie jest chorobą coraz cześciej uleczalną. System zwalczania raka piersi powinien posiadac odpowiednią infrastrukture oraz zapewniac skuteczne klinicznie i uzasadnione ekonomicznie metody leczenia. W tej sytuacji istotna jest wiedza na temat wydatkow (z punktu widzenia platnika), a takze kosztow (z punktu widzenia wykonawcy uslug) leczenia, tak aby decyzje o nakladach na leczenie raka piersi byly obarczone najmniejszym mozliwym ryzykiem. O ile w prowadzeniu leczenia zaleca sie stosowanie metod opartych na dowodach o charakterze klinicznym (evidence based medicine), tak zarządzanie powinno byc oparte na dowodach o charakterze ekonomicznym (evidence based management). Niniejsza analiza jest przyczynkiem do dyskusji na temat wlaściwego zarządzania fi nansami w leczeniu chorych na raka piersi. Material i metody. W pracy wykorzystano dane NFZ dostepne w systemie pod nazwą: Rejestr Leczenia Chorob. Analizie poddano dane dotyczące okolo 104 tys. chorych leczonych w Polsce z powodu raka piersi w latach 2004–2010, to jest wszystkich chorych zidentyfi kowanych jako potwierdzone przypadki raka piersi fi nansowane w tym okresie przez NFZ. Wykonano analize wydatkow na leczenie poszczegolnych chorych, obejmującą wydatki ponoszone od rozpoznania do wyleczenia (lub zgonu). Analiza obejmuje wydatki NFZ, zatem jest analizą kosztow bezpośrednich, nie uwzgledniającą wydatkow ponoszonych przez chorych. Wyniki. Wydatki związane z leczeniem chorych na raka piersi rosly w latach 2004–2010 w tempie przekraczającym tempo infl acji konsumenckiej i w roku 2010 osiągnely ok. 500 mln PLN. Wydatki na osobe w tym roku wynosily średnio 32 tys. PLN, przy znaczących roznicach pomiedzy poszczegolnymi wojewodztwami. Wydatki na osobe zdecydowanie obnizaly sie z wiekiem — z ok. 67 tys. PLN u chorych 30-letnich do ok. 20 tys. u osob ponad 80-letnich. Wydatki na osoby, ktore przebyly badanie przesiewowe w kierunku raka piersi, byly o okolo 8–15% nizsze niz u pozostalych chorych. Wnioski. Przedstawione dane obrazują skale obciązenia fi nansowego wynikającego z leczenia raka piersi w Polsce. Dzieki danym gromadzonym w NFZ mozliwe jest wyliczenie calkowitych wydatkow oraz wykazanie roznic w wydatkach pomiedzy roznymi grupami chorych rozniących sie miejscem zamieszkania, wiekiem, datą rozpoczecia leczenia czy uczestnictwem w badaniach przesiewowych. Powyzsze dane pozwalają na bardziej świadome i bezpieczne projektowanie zmian i modyfi kacji w systemie zwalczania raka piersi.

Governments across Europe are required to make decisions about how best to allocate scarce health care resources. There are legitimate arguments for eliciting societal vales in relation to health care resource allocation given the roles of the general public as payers and potential patients. However, relatively little is known about the views of the general public on general principles which could guide these decisions. In this paper we present five societal viewpoints on principles for health care resources allocation and develop a new approach, Q2S, designed to investigate the extent to which these views are held across a range of European countries. An online survey was developed, based on a previously completed study Q methodology, and delivered between November 2009 and February 2010 across nine countries to 33,515 respondents. The largest proportion of our respondents (44%), were found to most associate themselves with an egalitarian perspective. Differences in views were more strongly associated with countries than with socio-demographic characteristics. These results provide information which could be useful for decision makers in understanding the pluralistic context in which they are making health care resource allocation decisions and how different groups in society may respond to such decisions.

Background and aim. A significant bias of national AMI registries have been described recently. Therefore, to assess a comprehensive picture of AMI in Poland, we performed a study on nationwide data of all Polish AMI patients in 2009-2012 to assess incidence, quality of care, and cardiovascular events up to 3 years following AMI. Methods. The database of the only, public, obligatory, health insurer in Poland (NHF)together with the data from Ministry of the Interior, and Central Statistical Office were used (AMI-PL nationwide registry). The AMI cases were selected based on primary diagnosis coded in ICD-10 as I21 or I22. For years 2009-2012 all hospitalisations (N=311,813) in a given year and death records were analysed. Additionally, for 2009, data on hospitalisations, procedures, and deaths in a 3-year follow-up were obtained. Results. The age-standardized incidence of AMI in Poland in 2009 was 196 cases per 100,000 population (176 per 100,000 were hospitalized) with decreasing trend over time (80-90 thousands AMI patients each year per 38 mln of population). The incidence was 2.5 times higher in men than in women. Proportion of STEMI declined over time from 55% to 47% in 2012. The percentage of patients treated with invasive strategy raised from 72% to 81%. Decrease of in-hospital case fatality was observed, from 9.1% to 8.0% in 2012. Age-standardized fatality was essentially equal in women and men. Data for index hospitalization in 2009 and cardiovascular events up to 3 years following discharge are presented in the table. Total costs of index AMI hospitalizations for NHF insurer in 2009 were 203 mln EUR, and during 3 years following discharge additionally 162 mln EUR. Conclusions. In Poland standards of care and early outcomes in AMI are similar to Western countries. However high incidence of AMI in Polish population, approximately 35 to 50% higher when compared to reported in Denmark or England, indicates a need for intensifying primary prevention programmes.

Ovarian cancer (OC) affects over 3 000 women in Poland annually The efficacy of the therapy remains relatively low due to challenges of systematic improvement in the early detection OC rates. International comparisons indicate a positive correlation between health expenditures and 5-year survival rates of cancer patients. To the best of our knowledge, our study has been the first to present a correlation between the 5-year survival rates (SRs) and the cost of ovarian cancer therapy in particular regions of Poland.The study was based on the National Health Fund (NHF) data, available in the Disease Treatment Registry The analysis included approximately 13,000 OC patients who started their treatment between 2005 and 2008 to allow for the evaluation of long-term therapy results. The 5-year survival rates were analyzed in relation to average NHF expenditures in various regions of Poland, distinguishing the population of patients aged 45-64 years.The 5-year survival rate in the cohorts diagnosed in 2005 and 2008 changed marginally from 42% to 43%, maintaining relatively large differences between the regions (from 35% to 53% in patients diagnosed in 2008). The NHF expenditures in particular regions differed significantly: mean cost for the entire treatment cycle ranged from 31.600 PLN do 58.000 PLNperperson among patients diagnosed in 2008. No significant correlation between the survival and the cost was found.SRs of OC patients in particular regions of Poland are not correlated with average treatment cost. Thus, the differences in SRs between various regions of Poland have their source in other factors, e.g., clinical stage at diagnosis, or prevailing treatment patterns in the given region. Further studies may decrease regional discrepancies in patient care and SRs in OC subjects.

For several decades we have observed the development of data transmission technology on an unprecedented scale. With the development of such technology there has also appeared concepts on the use of these solutions in health care systems. Over the last decade telemedicine has been joined by the concept of mHealth, which is based on mobile devices mainly to monitor selected biomedical parameters. On 10 October 2014, during the conference Baltic Electrocardiology Autumn — Telemedicine and Arrhythmia (BEATA), a debate was held with the participation of physicians, politicians, businessmen, and representatives of the Government (Ministry of Health, National Health Fund, Social Insurance Institution) concerning the use of telecardiology services in daily practice. During the meeting issues were discussed such as: telemedicine solutions available throughout the world, analysis of their effectiveness based on clinical trials, funding opportunities, their legal status, and the development perspectives of telecardiology in Poland. The result of the meeting was a document called the “Baltic Declaration”. The declaration is a call for proven and profitable technologies to be introduced into clinical practice. The declaration also indicates that the variety of available technological solutions are merely tools, and the utility of such tools stems not only from their modernity, but also primarily from matching their functionality to the features of the health interventions that are to be improved.

The subject of “health benefit basket” has been hotly debated for years among the Polish public, but until recently the debate has tended to be largely theoretical and abstract and therefore has lacked an effect on public policy. The situation changed in 2004, for two reasons: first the verdict of the Constitutional Tribunal invalidating the existing health insurance law and, second, Poland’s accession to the European Union. The first problem was solved in part by defining a list of specific exclusions in the law and a promise to establish an institution for health technology assessment. The second issue remains open, although to some extend it is being dealt with legally by regulations issued from the Ministry of Health on acceptable waiting times for health services.

Background and aim: Nationwide data on acute myocardial infarction (AMI) are available for some Western but not for Central and Eastern European countries. We performed a study on nationwide data of all Polish AMI patients in 2009–2012 to assess incidence, quality of care, and cardiovascular events during 1 year following AMI. Methods: The database of the only public, obligatory health insurer in Poland (National Health Fund) together with data from the Central Statistical Office were used. AMI cases were selected based on primary diagnosis ICD-10 codes I21-I22. For years 2009–2012, index hospitalisations (n = 311,813) in a given year and death records were analysed. Additionally, data on hospitalisations, procedures and deaths during 1 year follow-up were obtained for 2009. Results: Age-adjusted incidence of AMI in Poland in 2009 was 196 cases per 100,000 population (176 per 100,000 were hospitalised), with a decreasing trend over time. The incidence was 2.5 times higher in men than in women. The median age was 63 years in men and 74 years in women. The proportion of ST elevation myocardial infarction (STEMI) decreased from 59% to 48% in 2012, and the proportion of patients receiving invasive treatment increased from 72% to 81%. Age-adjusted case fatality rate was equal in women and men. In 2009, the number of patients with AMI was 75,054 (61% men, 39% women) and 83% of them were treated in cardiology units. Invasive strategy was used in 77% of patients with STEMI and 66% of those with non-STEMI, thrombolysis in 1% and coronary artery bypass grafting in 1.9% of patients. Invasive treatment was used less frequently in women and the elderly patients. When all hospitals where a patient was treated until the final discharge were taken into account, in-hospital mortality was 10.5%. The lowest in-hospital mortality was noted among patients treated invasively (6.3%). The total number of readmissions within 1 year following AMI was 84,718, of which 61.9% were due to cardiovascular causes. The most common causes were stable coronary artery disease (27%), heart failure (7.9%), recurrent infarction (7.0%), and unstable angina (6.8%). Within 1 year after AMI, only 22% of patients participated in a cardiac rehabilitation programme. Total 1-year mortality was 19.4% (invasive treatment 12.3%, non-invasive treatment 38.0%). Conclusions: Standards of care and early outcomes in AMI in Poland are similar to Western countries. The major cause of higher mortality due to AMI in the Polish population is a high incidence of AMI, indicating a need for intensification of primary prevention programmes. Secondary prevention is also underused, especially in the field of cardiac rehabilitation.

The health reform of 1999 in Poland introduced market-like relations in the health care sector. The oligopsonic and the current monopsomic position of the payer makes prices for health care products purchased in this quasi-market low and does not usually take into account the costs of production. Despite a long history of cost calculation in the system, a systematic and reliable assessment of costs is still lacking which would help in setting up fair financing. At the same time providers complain about the dictatorship of the National Health Fund (NHF) yet they rarely resign from contracts with the NHF when they have the chance to conclude one.

This study, perhaps the first of its kind in this region, is based on a study that explores the practice of casual sex among truck drivers, and commercial sex workers in the border areas of the Baltic region at a point of time, and, uses this evidence to extrapolate the potential impact on the spread of HIV/AIDS in these countries. While the threat of an HIV/AIDS epidemic cannot be taken lightly in any country of the Europe and Central Asia region, four countries - Poland, Latvia, Lithuania, and Estonia - stand out as being particularly vulnerable. First, the prevalence of HIV/AIDS is relatively high, and is rapidly increasing in locations neighboring these countries to the east, like Ukraine, Kaliningrad, Belarus, and Moldova, where public health conditions are also rapidly deteriorating. Second, because of their geographical location, those four countries stand at the crossroads of the main east-west, and north-south transport corridors, and represent the link between countries of the former Soviet Union and western Europe. The open borders, and rapid transit threatens to broaden the sweep of the HIV epidemic, as drug injectors and sex workers come into contact with other population groups. After the Introduction which provides background, Section 2 reviews similar studies carried out elsewhere in the world. Section 3 describes the methodology employed in this study, followed by a brief description of the data in Section 4. Finally, Section 5 contains a discussion of the results, and policy implications.