Older People in the Maze of the Health Care System ‐ Polish Experiences Dr Katarzyna Miaskowska-Daszkiewicz John Paul II Catholic University of Lublin, Lublin, Poland The Bureau of Research of the Chancellery of the Sejm, Warsaw, Poland

Changes of the size of population aged 65 years and more; 2013-2050 (in thous.) – Central Statistical Office 2013-2014 2014-2015 2015-2020 2020-2025 2025-2030 2030-2035 2035-2040 2040-2045 2045-2050 192,5 205,5 1123,0 995,3 457,5 270,4 512,6 772,0 896,0512,6

Share of population aged 65 years and more (in %) in 2013, 2020, 2035, 2050 14,7% 18,9% 24,5% 32,7%

Population aged 65 years and more per 1000 aged 0-14 2013 2020 2035 2050 983 1271 1966 2693

selected issues lack of geriatric care system lack of increased reimbursement for medicinal products for seniors long waits for health services ageizm violations of patients' rights

lack of geriatric care system too few geriatricians, specialist outpatient clinics and hospital departments – Poland has 343 physicians specializing in the field of geriatrics (332 actively practices the profession; geriatrics does not occur as a compulsory subject of education in medical schools) the lack of a universal, comprehensive and standardized procedures dedicated to elderly people: „normal track” – basic care physician – specialist (s) – treatment in narrow scope, often without paying attention to other, previously prescribed treatment The key barrier is the method of settling medical services by NHF which assumes financing one disease, although elderly people usually suffer from several ailments at the same time.

Availability of medicinal products the co-existence of many diseases is the need to buy multiple medicinal products the minimum pension in Poland in 2015. it is 880,45 PLN net (about 200 Euro) … older patients often resign from part of the prescription or divided medicinal product into smaller portions (!) to have enough for a long time the solution could be increased refund or programs of pharmaceutical care for elderly patients

Examples of terms of expectations for health services – public system knee endoprosthesis implantation 1 year - urgent case to 15 years - stable case excision of varicose veins – to 3 years implantation of hip replacement – to 15 years cataract surgery – 2-3 years

Ageizm - study

Violations of patients' rights

the Commissioner for Patients' Rights since October 2009 a central body of governmental administration and is subordinated directly to Prime Minister main aim is to guard and protect patients' rights conducts investigation procedure regarding violation of patients' rights

Activity in year 2012 Commissioner opened 217 investigations in cases on persons over 60 years, of which a violation of patients' rights was found in 24 cases Additionally, in 421 cases the employees of the Bureau benefited from the opportunities referral queries and clarify the situation directly with service providers. As a result of these actions in 381 cases among healthcare providers, they changed in favor of elderly patients the approach to provide a faster services.

Common examples recorded by the Commissioner barriers in communication between doctor and patient or his guardian -brevity of the message, information incomprehensible for the patient - this results in misunderstandings between doctor and the patient or the patient causes a feeling of insecurity; denial of the right of the patient to the presence of a relative during health services; implementing a medical procedure in the presence of unauthorized persons; disrespectful attitude of medical staff to the elderly

Thank you for your attention! dr Katarzyna Miaskowska-Daszkiewicz kamias@kul.pl