1. SPECIFIC FIELDS AT PUBLIC HEALTH IN MAZOVIA VOIVODESHIP Krzysztof Romanowski M.D. Deputy Director Department of Health Office of the Marshal of the Mazovia Voivodeship 1 • Warszawa 27 kwietnia 2011 r.

2. General characteristics of the Mazovia voivodship: Overall 5.12 million residents including 2.46 million of men and 2.66 million of women 42 districts, including five cities in the district rights (Warszawa, Ostroleka, Płock, Radom, Siedlce) 314 municipalitiesincluding 35 municipalities,50 of urban - rural229 rural municipalities 9135 villages 7309 auxiliary units of municipalities (village councils) total area of ​​35.6 thousand km2 2 • Warszawa 27 kwietnia 2011

3. Income per capita in subregions in the Mazovia Voivodeship as % of medium income in EU countries • Mazowieckie voivodship • total - 88%including: • Warsaw - 167% • subregion around Warszawa - 53% • subregion ciechanowsko - płocki 57% • subregion radomski -39% • subregion ostrołęcko - siedlecki - 41% 3 • Warszawa 27 kwietnia 2011

4. Demographic prognosis • The average number of years of life expectancy at birth is 71 years for of men and 79 years for women. • The coefficient of aging is about 16% - regressive type of population • Demographic forecasts predict that in 2020 the population of post working age will be 20% 4 • Warszawa 27 kwietnia 2011

5. Foreigners(except for citizens of European Union countries)There are no accurate data on persons illegally residing Poland, but it is believed that the biggest concentration of foreigners is in Warsaw and Mazovia voivodship. In 2010, the voivodship was issued almost 20 thousand work permits. A much larger group of illegall, are working without any permission. The largest group of foreigners are nationals of the countries from the eastern border. Such persons in an emergency to their health and lives are guided to health care institutions, which have the obligation give them with adequate aid and cary out the treatment. At the same time health units do not have a guarantee reimbursement of medical expenses of such patients nor from patients themselves, nor from people inviting them, nor from the embassies of countries from which they come. 5 • Warszawa 27 kwietnia 2011

6. 20% respiratory disease 42% cardiovascular disease 6% accidents and injuries 7% cancers 25% The main health issues: causes of death other 6 • Warszawa 27 kwietnia 2011

7. The number of Health Care System – Masovia voivodeship 2359 Health care units in total, including: 332 public and 2027 private. Date on 29 April 2011 Total Hospitals in masovia voivodeship Total hospitals – 180 including: pulbic - 87 private - 93 7 • Warszawa 27 kwietnia 2011

8. Hospitalsinvoivodeshipaccording to foundingbodies. 8 • Warszawa 27 kwietnia 2011

9. Self – government ‘s resources of Masovia voivodaship in health care – health care units subordinated to Mazovia voivodaship self – government . Division according to legal form: • Masovia voivodaship self – government is a founding body for 30 independent health care units, (includuing 5 due to be liquidated). • 6 companies operate as a commercial law company • Division according to form of activity: • 15 speciality hospitals • 7 psychiatric hospitals Other units: • 3 specialistic out-patient clinics (dispensaries) • 4 units of medical emergency and sanitary transport 9 • Warszawa 27 kwietnia 2011

10. Objectives of the restructuring programme for health care companies in Masovia voivodeship. Since 1999 restructuring has been acheived through: • combining health care units, • liquidating health care units, • transfering activities between units, • changing internal structure (creating new wards, clinics, liquidating useless ones) 1927 beds have been restructured so far. • Main objectives of restructurization • consolidation of units and establishing stronger entities offering more complex medical services – more competing, more opportunities of contracts for services • better usage of the possesed potential – e.g. staff, equipment, medical equipment. • better usage of the facilities. • concentration of invest funds and directing them to modernisation processes, adaptation and refurbishment processes as well as rebuilt in health care units with significance to health care system. • decreasing costs of chief-executives employment and both administrative employees with service staff • eventually better economic results . 10 • Warszawa 27 kwietnia 2011

11. Restructuring– SWOT analysis • Strengths • - changing internal structure aiming at improving of effectivness and its progress • - expansing markets of medical services, gaining new patients • - aternation of medical services assortment, develpment of new services, withdrawing from some services • - improving accessibility and quality of medical services, improvement of clinic’s image (equipment, the card of patient’s rights) • - improving forms of influencing of market (promotions) • - undertaking the other business (hospitality industry, parking fees, etc.) • - the number of posts based on detailful analysis • - implementation of other forms of employing new employees instead of full contract, e.g. commision contracts, temporary contracts, teleworking • - changing organization and legal form - e.g. commercialization • privatisation of clinic or its part, finding strategic investor / or finance investors • privatization Health Care Units or its a part, finding strategic investor • changing ownership structure 11 • Warszawa 27 kwietnia 2011

12. Weakness - restructuring is one of the most difficult projects in management, because it affects finances and prestige of different group of staff - causing resistance and is an outlet to negative energy - many restructuring projects end up with failure and its only result is management restructurisation - hiding real objectives and plans of restructurisation, enable opposition to spread false information what makes difficulty to present it right in the future - no trust, no faith in effectiveness of restructuring - reduction in the number of posts - costly project 12 • Warszawa 27 kwietnia 2011

13. Chances • - economize unproductive property, ground rent, buildings and equiment and tools • - purchase of new diagnostic and treatment equipment • - providing with better usage of possesed diagnostic and treatment equipment • - implementation of new posts e.g. promotion • outsourcing - excluding some activity from the clinic’s structure • - improving organisation of exsisting cells . • - restructuring of financial commitments, factoring (selling out of financial claims). 13 • Warszawa 27 kwietnia 2011

14. Threats - full repayment of restructuring debts without possibility of remission from a bank - return of medical equipment, obtained through donation, unless donor does not allow to transfer these equipment to a newly opened structure - the risk of return of public aid 14 • Warszawa 27 kwietnia 2011

15. Medical staff employed in Masovia Voivodeship 15 • Warszawa 27 kwietnia 2011

16. Thank you for your attention 16 • Warszawa 27 kwietnia 2011