1. The consequences of the National Health Account for Occupational Health Services evaluation in Poland ICOH, Amsterdam 2002 Izabela Rydlewska – Liszkowska Nofer Institute of Occupational Medicine Lodz, Poland

2. The consequences of the NHA for OHS evaluation... What does NHA mean for OHS? What does NHA mean for OHS? What are the observations and conclusions after NHA preliminary implementation to Polish OHS? What are the observations and conclusions after NHA preliminary implementation to Polish OHS? What are the consequences for OHS? What are the consequences for OHS?

3. The consequences of the NHA for OHS evaluation... What does NHA mean for OHS? What does NHA mean for OHS?  More complete data for : international comparisons, system description (monitoring, planning, evaluation)  Distinguishing core OHS functions from other functions  Identifying financing flows  Providing framework for reporting on OHS over time  Monitoring economic consequences of OHS policy

4. The consequences of the NHA for OHS evaluation... What does mean NHA for OHS? What does mean NHA for OHS?  Answers the questions: What kind of services are performed? Where does the money come from (funding sources)? Where does the money go to (providers)?  Expenditures according to: functions, providers, funding sources

5. The consequences of the NHA for OHS evaluation... What are the observations and conclusions after NHA preliminary implementation in Poland? What are the observations and conclusions after NHA preliminary implementation in Poland?  present state of OHS financing (sources of funding – legal regulation vs practice) Occupational Health Services Act from 1997 Public Finance Act from 1999 Labour Code Act with the amendments from 1991 Health Care Organisations Act from 1991 Social Health Insurance Act from 1997

6. The consequences of the NHA for OHS evaluation... What are the observations and conclusions ? What are the observations and conclusions ? The structure of funding sources in Regional OHS Centres in 1998 (%) - Regional budgets:41,1- 99,8 - Employers:5,1 – 48,4 - Individuals:0,01 – 3,1 - Primary OHS units:0,9 – 2,17 - Other: 0,42 – 5,54

7. The consequences of the NHA for OHS evaluation... What are the observations and conclusions? What are the observations and conclusions? The structure of funding sources in Regional OHS Centres in 2001 (%) - Central government:14,0 – 45,5 - Local self-governments:7,4 – 97,0 - Employers:3,0 – 56,0 - Health insurance institutions:8,0 – 52,0 - Other:0,4 – 18,0

8. The consequences of the NHA for OHS evaluation... What are the observations... What are the observations...  Two levels of financing and provision: regional (public OHS centres) and primary level (public and private OHS primary units); aggregated or unavailable data in financial reports (not possible to identify employers means on the basis of individual financial reports in private OHS units)  Relations between the funding sources and OHS functions (lack of information on cost sharing according functions in ROHSC)

9. The consequences of the NHA for OHS evaluation... What are the observations... What are the observations...  OHS market - relations between public and private sectors of providers; first analysis in Poland in 2001: public OHS units – 26% (including ROHSC – 5%) private OHS units – 74% (private practice – 35%)  The scope of unavailable data - necessity of some financial data estimation (employers)

10. The consequences of the NHA for OHS evaluation... What are the observations... What are the observations...  Companies play significant role in financing ROHSCs which should act as supervising bodies in system  Social health insurance participate in OHS units financing; OHS units having legally independent status combine the statutory OHS functions with other activities going beyond

11. The consequences of the NHA for OHS evaluation... What are the consequences for OHS evaluation? What are the consequences for OHS evaluation?  How to manage the OHS finance in order to assure the relevant using of resources and quality of care  Creation the information system on OHS as the component of NHA according to standards  Implementation of the economic appraisal of OHS activities as the element of integrated management for health

12. The consequences of the NHA for OHS evaluation... What are the consequences... What are the consequences... NHA provides basis for further debate on OHS financial system in relation to functions

13. The consequences of the NHA for OHS evaluation... What are the consequences... What are the consequences... NHA implementation allowed to collect and supplement financial information on OHS (some of them had to be estimated) at macro level

14. The consequences of the NHA for OHS evaluation...  What is the contribution of the funding institutions?  What is the resources allocation?  Does it reflect the priorities given? (efficiency, equity)

15. The consequences of the NHA for OHS evaluation... Sources: 1.A System of Health Accounts. Version OECD 2000 2. Polish System of Health Accounts. Version 1.0. Warsaw 2002 3. Research projects on economic apects of OHS in Poland – Nofer Institute of Occupational Medicine in Lodz, Poland

16. The consequences of the NHA for OHS evaluation... Thank you for your attention