Unhealthy competition. Current comment

Due to this competition - in the minister's opinion - hospitals cannot have a sufficiently large number of patients (because some will always be taken over by the competition), and thus a sufficiently large amount of funds (because the National Health Fund has to pay for both ). Competition for doctors causes them to raise their salaries to an exorbitant level, which results in additional impoverishment of hospitals. In such a situation - instead of developing - they fall into debt. If this competition was eliminated, the money that goes to 2-3 centers today would go to one, which would increase the effectiveness of the facility (the same fixed costs, higher revenues) and doctors could be paid much less, because they would have nowhere to run away, which would have resulted in further savings. Hospitals would grow in (financially) strength and be able to develop. At first glance, the above concept seems correct and consistent. There is, however, an element that completely destroys it.
On the same occasion, the minister of health, who criticized the competition of hospitals for patients, for funds from the National Health Fund and for medical staff, stated that "obviously hospitals should compete with each other in the quality of services". Here a thinking person has to ask the question: With whom and for whom (for what) a hospital should compete with the quality of its services, which will not compete for patients, for resources that follow "the patient", or for the medical staff? What will motivate hospitals to “compete with quality”, if the number of patients and funds from the National Health Fund will be ensured without it? And will it be possible at all? After all, we know that in such specific services as health services, the skills of individual people have the greatest impact on their quality, especially in countries where good equipment is not difficult to find. Can better quality services be provided without being able to 'attract' better professionals?
The minister did not answer such questions directly. However, you can find them. The minister announced, on another occasion, that hospitals that would provide better-quality services would be better remunerated by the National Health Fund than other hospitals, i.e. they would receive more money for the same service. Thus, the mystery of "for whom (for what)" was solved by hospitals in terms of the quality of their services. They are to compete for the favors of the National Health Fund, and because the National Health Fund is represented by specific people, it means: for the favors of these people.
I remembered the conversation with the director of my hospital, which took place in the mid-90s of the last century, when the "commune" had already collapsed, but not everywhere. In public health, it was in full swing. The director showed me a list: how much money for each individual hospital in our voivodeship received money for their activities per one resident covered by the care (these were annual budgets, hospitals did not compete with each other and there was treatment regionalization). The differences were significant and our hospital was at the tail end. I asked what it resulted from. "You know," said the director, "I will be performing my function soon, and there are those who have been on managerial stools for many, many years. They know the provincial doctor personally (he distributed the funds to hospitals), drink vodka with him, go hunting and other events ... ".
And here you have to agree with the Minister of Health that competition can be unhealthy. However, it is not competition for the patient and his money, but for the favors of the clerk who - instead of the patient - is to decide where the money will go. In this competition, it is easier to find "non-substantive" considerations. And while competition for a patient may lead to the collapse of a hospital that was unnecessary, badly responded to the patients' expectations or had bad management, competition for the favors of an official, such a hospital may not only protect against collapse, but even reward it with additional funds.

Krzysztof Bukiel - February 5, 2022.