World Bank2014-07-282014-07-282014-04https://hdl.handle.net/10986/19033Over the past twenty years, the Polish health system has undergone several deep systemic changes. Poland spends more of its healthcare budget on inpatient hospital care than comparable countries, signaling an area of inefficiency that requires reform ahead of demographic trends. Ownership of public hospital facilities is fragmented between different levels of government, leading to multiple stakeholders and a lack of accountability. Poland has made significant progress in rationalizing its hospital system and reducing the number of beds, but the reform agenda remains unfinished as evidenced by the continuing debt issue. This note outlines a path to improving the financial sustainability of the hospital sector in Poland. The anatomy of the debt problem is examined and major obstacles to financial health are systematically reviewed. The root causes of barriers are analyzed from a managerial as well as a health system perspective, including the role of regulatory and financing constraints. In making the case for change, the report also discusses how secular trends, for instance in population health and service delivery, need to be taken into account as plans to reshape the hospital system are being formulated. Preliminary recommendations are made distinguishing: (i) system-level changes which will require national-level policy interventions, and (ii) options for Voivodships and facility managers to work better within the existing system and enhance the chances of selecting no regret move investments.en-USCC BY 3.0 IGOACCESS TO FINANCINGACCUMULATION OF DEBTADDICTIONADDICTION THERAPYAGEDAGINGANESTHESIAARREARSBANKRUPTCYBIDSCAPITAL INVESTMENTCAPITAL INVESTMENTSCERTIFICATIONCITIESCITIZENSCLINICSCOMMERCIAL CODECOMMERCIAL LAWCOMMERCIAL TERMSCONTINGENT LIABILITIESCONTRACTUAL RELATIONSHIPCREDIBILITYCREDITORSDEBTDEBT BURDENDEBT CRISISDEBT FORGIVENESSDEBT ISSUEDEBT ISSUESDEBT LEVELSDEBT RATIODEBT RELIEFDEBT RESTRUCTURINGDEBT SERVICINGDEBT STOCKDEBTSDECENTRALIZATIONDEFICITSDEMOGRAPHIC TRENDSDEPENDENCY RATIODESCRIPTIONDEVELOPMENTAL OPPORTUNITIESDIABETESDISEASESDISSEMINATIONDISTRICTSECONOMIC EFFICIENCYECONOMIC GROWTHEMERGENCY MEDICAL SERVICESEMPLOYMENTEXPENDITUREFERTILITYFERTILITY RATEFINANCESFINANCIAL CONSTRAINTSFINANCIAL HEALTHFINANCIAL MANAGEMENTFINANCIAL SUSTAINABILITYFUTURE POPULATIONGOVERNMENT BUDGETSGROSS DOMESTIC PRODUCTGYNECOLOGYHEALTH CAREHEALTH CARE PROVIDERSHEALTH CARE SYSTEMHEALTH EXPENDITURESHEALTH FACILITIESHEALTH OUTCOMESHEALTH PROBLEMSHEALTH REFORMSHEALTH SECTORHEALTH SERVICEHEALTH SERVICE PROVIDERSHEALTH SERVICESHEALTH SPECIALISTHEALTH SYSTEMHEALTH SYSTEMSHEALTH-CARE SYSTEMHOSPITAL ADMISSIONHOSPITAL BEDSHOSPITAL BUILDINGSHOSPITAL CAREHOSPITAL MANAGEMENTHOSPITAL SERVICESHOSPITALSHUMAN RESOURCESIMPROVEMENTS IN MANAGEMENTINCOMEINFLATIONINITIAL DEBTINPATIENT CAREINTEREST GROUPSINTERMEDIARIESINTERNATIONAL BANKINTERNATIONAL DEVELOPMENTINTERNATIONAL FINANCIAL CRISISINTERNATIONAL STANDARDSINTERVENTIONSINVESTMENT DECISIONSINVESTMENT STRATEGYISOLATIONLACK OF INFORMATIONLAWSLEASINGLEGAL FRAMEWORKLEGAL STATUSLEVEL OF DEBTLEVEL OF DEBTSLIABILITYLIFE EXPECTANCYLIQUIDATIONLIQUIDATIONSLIQUIDITYLIQUIDITY CONSTRAINTSLOANLOCAL GOVERNMENTLOCAL GOVERNMENTSLOCAL POPULATIONMARKET SHARESMEDIA ATTENTIONMEDIA COVERAGEMEDICAL CAREMEDICAL EQUIPMENTMEDICAL SERVICESMEDICAL SPECIALTIESMIDWIFEMINISTRY OF HEALTHMODERNIZATIONMORBIDITYMORTALITYNATIONAL HEALTH INSURANCENATIONAL LEVELNATIONAL STRATEGYNEEDS ASSESSMENTNUMBER OF BIRTHSNURSENURSESNURSINGNURSING CAREOBSTETRIC SERVICESOCCUPANCYOLD-AGEOUTPATIENT CAREPATIENTPATIENTSPAYMENT SYSTEMPEDIATRICSPHYSICIANSPOLICY DIALOGUEPOLITICAL SUPPORTPOPULATION TRENDSPRIMARY CAREPROGRESSPSYCHIATRIC HOSPITALPSYCHIATRIC HOSPITALSPUBLIC DEBTPUBLIC FINANCESPUBLIC FUNDSPUBLIC HEALTHPUBLIC HEALTH CAREPUBLIC HOSPITALSPUBLIC INFORMATIONQUALITY ASSURANCEQUALITY OF CAREQUALITY OF SERVICESQUALITY SERVICESREGIONAL HOSPITALREGIONAL NETWORKSREGIONAL POPULATIONREGULATORY FRAMEWORKREHABILITATIONREPAYMENTRESOURCE ALLOCATIONRETURNRURAL AREASSAFETYSERVICE DELIVERYSERVICE PROVISIONSERVICE QUALITYSOCIAL SECTORSOCIAL SERVICESSURGERYTAXTOTAL DEBTTOTAL DEBTSTRAINING OPPORTUNITIESTRANSITION ECONOMIESTRAUMAUNIONSWARWELLNESS10.1596/19033