The deadline for submitting bids in the competition announced by the Health Ministry, i.e. November 6, 2024, is inexorably approaching, and from the questions asked by hospitals all the time, it seems that both the founding bodies and the hospitals themselves are still considering whether to apply in the competition.
Long-term beds - is it worth reaching for KPO money?
Published Oct. 15, 2024 10:58
In Poland, there is currently one hospital per 1.5 counties (statistically). In 2022. Eurostat published "Statistics on health care resources - hospital beds"[1].
An analysis of the number of hospital beds in relation to the population shows that in 2018 there were an average of 538 hospital beds per 100,000 population across the EU-27 (Total number of hospital beds = inpatient (acute) care beds + rehabilitation care beds + long-term care beds + other hospital beds).
Poland is above average, i.e. provides 653 beds per 100,000 residents.
Among EU member states, Germany recorded not only the highest number of hospital beds (661,000; 2017 data), but also the highest number relative to population, with 800 hospital beds per 100,000 residents (with this being due to the high proportion of private non-profit and for-profit hospital entities). Bulgaria, Austria and Hungary also recorded more than 700 hospital beds per 100,000 residents, with Romania's rate slightly below that.
Ireland (excluding psychiatric beds, excluding beds in the private healthcare sector), Spain, Denmark and Sweden recorded the lowest number of hospital beds relative to population size in 2018, all below 300 per 100,000 population. At the same time, this did not affect the quality of health services, as qualitative studies show (more on this later).
Poland is above the average, i.e. 653 beds per 100,000 inhabitants, which means that we have more than 2 times as many hospital beds as Ireland, Spain, Denmark, Sweden. One could justify this if the referenced countries were self-sayers in terms of health care quality ratings. However, this is not the case.
Long-term care beds accounted for less than 15% of the total number of hospital beds in 2018 in most EU member states (no data for Portugal and Sweden), with only Hungary (17.4%), Croatia (17.4%), Finland (19.0%), Estonia (19.5%) and the Czech Republic (29.6%) recording a higher percentage.
In turn, contrary to demographic trends and the recommendations contained in the documents: the announcements of the Minister of Health of August 27, 2021 on the map of health needs and the announcements of individual governors on transition plans, the share of long-term beds in the number of all hospital beds in Poland is extremely small - it is the smallest in Europe[2].
Therefore, the answer to the question of whether it is worth it or not to reach for KPO money can only be one. We have no other choice, for the demographics are inexorable.
In 2022, a continuation of the aging of Poland's population was observed. At the end of 2022, the number of people aged 60 and over reached 9.8 million, increasing by 0.7% compared to the previous year. The share of the elderly in Poland's population reached 25.9%, an increase of 0.2 percentage points compared to the previous year[3].
The elderly dependency ratio rose to 29.9 from 28.9 the previous year[4].
The ratio of the post-working age population per 100 working-age people stood at 39.0, compared to 38.1 a year earlier[5].
According to the demographic forecast, the senior population is expected to grow steadily through 2060. In 2060, 11.9 million senior citizens are expected to live in Poland, 21.0% more than in 2022, accounting for 38.3% of the total population.
In 2022, the largest group of seniors were those aged 65-69. Their share in the total number of senior citizens was 25.7%. In previous years, their youngest group, those aged 60-64, dominated. Still the smallest group were those aged 80-84 and 85 and over. In both cases, their share stood at 8.2%.
Applying in the competition could be an opportunity for hospitals granting at the first and second reference levels.
According to the Regulations, the definition of "district hospital" has been defined.
A county hospital is a therapeutic entity that performs therapeutic activities in the type of hospital services in a therapeutic facility, Article 2 (1) (9) of the Law on Therapeutic Activity, qualified to level I or II of the system of basic hospital provision of health care services, providing health care services from public funds.
According to Paragraph 5(1) of the Regulations, the applicant must be a therapeutic entity performing therapeutic activity in the type of hospital services in a therapeutic institution within the meaning of Article 2(1)(9) of the Act of April 15, 2011 on therapeutic activity (Journal of Laws of 2024, item 799).
In addition, according to § 5(1) of the Regulations, the applicant must be qualified for Level I or II of the basic hospital health care system, providing health care services with public funds.
The applicant must meet the following criteria: a) have a contract with the National Health Fund in the type of nursing and care services in long-term care or in the type of hospital treatment, b) present the scope of the project, which will include activities relating to the creation of new long-term care or geriatric care places as part of the hospital bed conversion processes, c) have the right to dispose of the real estate for construction purposes, as referred to in Art. 3(11) of the Construction Law, d) have an opinion on the advisability of the investment issued by the Governor or the Minister of Health consistent with the scope of the application - in accordance with Article 95d(1)(2) of the Law on health care services financed by public funds only in cases specified in the law. The Opinion on the advisability of the investment may be attached within 30 days from the date of the end of the call, or no later than at the request of the IOI; e) if the applicant submits more than one positive Opinion on the advisability of the investment, or if the opinion was issued for a broader investment scope than that described in the Application (§ 5 paragraph 4 of the Regulations).
According to the Regulations, the subject of the call is the selection of proposals, in the implementation of at least one of the following areas:
1) modernization of building infrastructure of county hospitals involving the following construction works such as reconstruction, expansion, superstructure, renovation, and other works that do not constitute construction works within the meaning of the Construction Law leading to modernization of building facilities, or
2) construction of new infrastructure of medical entities in justified cases related to the impossibility of effective investment of funds in the reconstruction or expansion of old, worn-out buildings that do not meet the requirements that should be met by the premises and facilities of the medical entity in accordance with applicable laws, and retrofitting with modern equipment and medical devices or necessary equipment.
[3] Situation of the elderly in Poland in 2022. https://stat.gov.pl/obszary-tematyczne/osoby-starsze/osoby-starsze/sytuacja-osob-starszych-w-polsce-w-2022-roku,2,5.html (accessed October 3, 2024).
[4] Ibid
[5] Ibid
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Michał Modro
