Waste in health care. Where is the money going missing?

There is such a paradoxical situation that there is more money in the health care system and still not enough. How can this be explained?

This would seem to be an economic paradox, but it is not. In theory, the category of needs is unlimited. It's not that at some point we say STOP, it's just that the more we have, the more we want. In the case of health care, there are two such factors: not only that we want more. Let's put it bluntly: the patient is very demanding and we assume that everyone gets everything, and there are no such systems anywhere in the world! But the patient is not to blame for the health care situation. One factor is demographics, that is, we are getting older, sicker and need medical help more. And the other factor is that health care is getting more costly - the needs are higher.

This is one side, but also a lot of money is wasted. Now we are talking about so-called adherence, or adherence to medical recommendations, and it turns out that patients either don't buy the drugs or don't follow the recommendations, they worsen their condition, and a vicious cycle begins. How much of this money is wasted? Is there any way to improve it?

We certainly waste some amount of money. In any even well-organized enterprise, there are some losses. And systems of thought, namely LEAN and KAIZEN, say that you have to eliminate these inefficiencies, see where they are. In the health care system, such inefficiency is when, for example, one waits for the printer to print the doctor's recommendations. The doctor then sits, the patient sits and nothing happens. We waste quite a lot of this money in health care, unfortunately, because it is not optimized enough. We waste them, for example, when a patient is prescribed drugs and he doesn't buy them and doesn't recover, and his disease progresses. This money is wasted when a patient picks up free drugs, puts them in a cabinet and never uses them. They are wasted when the patient smokes cigarettes and lives a very unhealthy life, does everything to be sick, and then is surprised that he is sick. And so much for the patient. But they are also wasted in situations of inefficient use of doctors' time, that is, that this work is poorly organized simply.

But also because there are not enough doctors.

Yes, we don't have enough doctors because we organize their work badly. Because we don't have a team, where everyone knows what someone is doing between the medical professions, it's just that we have something that overlaps and we have blanks and the pushback starts: I won't do it, it's yours, it's not my responsibility. This is also where it goes to waste, right down to large parts of the system, as we say we don't have enough space in hospitals. It's that we have hospitals that shine with emptiness when there is a full staff on duty in surgery, and no patients. Not to mention obstetrics, there are fewer of these births, and the hospitals are like those of the 1950s and 1960s, when births were plentiful. Pure waste. And the last waste will probably await us from November, when hospitals will bear all fixed costs. That is, they will be paying for energy, for garbage collection, for security, for the nurse, who is on a labor contract, that is also a fixed cost, not a variable cost. This variable cost is medicines, equipment wear and tear and the doctor if he is on contract. Starting in November, we will probably pay for all of these elements, but we won't serve scheduled patients, because hospitals will say, OK, I'll have to subsidize anyway, but I won't want to add so much for so long. So if we look at it, there are really some elements like this where you could optimize health care.

I very much like your comparison that the medical industry is like the court of Louis: We debate, we bestow awards, and the patient continues to stand in line, and indeed, even in recent times, awards chase awards, debates chase meetings, panels are a dime a dozen, and nothing comes of it for the patient, who continues to stand in that line.

Nothing comes of it, it's even getting worse, that is, we talk to ourselves, only it doesn't penetrate further at all. When there is conflict in an organization, talking in the kitchen or over coffee about how bad it is hasn't changed anything yet. We need to listen, implement, give solutions and break the stereotype that change will do everyone good. It just doesn't. It is precisely the change that violates everyone's comfort zone. Because everyone has to move a little. For things to get better, they first have to get worse. It's like making order in the closet. When we have a mess in the closet, we have to take everything out of it, throw it on the floor, and then it's a total mess to put it back together from scratch. And this Ludwig court of ours is trying very hard to make sure that there is a change, but in fact, as in Lampedusa's "Leopard": let's do everything to change nothing and to do nothing, because I may have to move from my safe point and position. This is not the case, such miracles do not happen even in behavioral economics.

The heated discussion on the reduction of health premiums for entrepreneurs is behind us. What consequences will this have on the system?

Always if we lower something, we will have less. Only we have to look at another thing, which is part of economics, which is the Laffer curve, which says that if we have too high taxes, too great a burden on some tributes (not just taxes, a contribution is theoretically not a tax, although it performs its function in the broad sense of the word), if someone has to give too much to the state, then at some point he will be discouraged and state revenues will be less. So I don't know if this curve will work here, because it doesn't have any guidelines. You have to observe the market, while one thing is certain: we have to create such conditions for entrepreneurs that they want to develop these enterprises. Because the higher their volume of revenues, turnover and profits, the state will be de facto richer thanks to this. The health premium on entrepreneurs is a thing that works both ways. We must also say out loud a very unpopular thing, that the health premium should apply to everyone equally. That is, it can't be that someone pays less, or someone doesn't pay at all. If we say that there is social solidarity in health, then we must be solidary and not run away, not try to make us pay less. Populist theories that say we'll give everyone 4,000 each and let them have their own health fund are untrue, because suddenly someone gets cancer that costs hundreds of thousands of zlotys. And then what? Are we left with four thousand? Unfortunately. Everyone should know that this is a solidarity thing and be happy if they can give this money away and not use it themselves.

The 100 billion NFZ loophole is already a threat to the health of Poles?

We keep talking about this money and pointing out 100 billion, 200 billion zlotys. These amounts fall in such a strange way. Undoubtedly, a lot of activities have been shifted to the NFZ, which builds up more liabilities. From the health premium we collect too little. Now the geopolitical situation is quite dramatic, because we have nothing to siphon off for health. As for more state debt, we are already at the limit. We are even trying to take some elements of the budget out of the budget so that we don't get into these dangerous excessive deficit procedures. 100 billion zlotys should be an alarm bell for everyone that something has to be done about it. We assume that the state will not collapse, yes? But assuming precisely that the state will not collapse and pulling in the maximum amount of money leads to the fact that this state will become impoverished and everyone will be bad off. This is the moment when you need to clearly count and see what it looks like. Maybe the valuations of all benefits need to be changed? We know that the valuations we have are also ruining health care by making chimneys. Hospital directors have already learned that they have to have some very expensive procedures to cover those procedures that are undervalued. Is that the way it should be? No, we should have fair valuations. Or should we go into a negotiation mode, that if a hospital has the capacity and performs a procedure well in terms of quality, it should get a bigger contract? A bit like wholesale shopping it should work. There are very many ways just have to sit down, tell everyone that their comfort zone has to be violated, tell the patient that his comfort zone also has to be violated, because he has to take care of his health. And drive forward, because this is such a moment in business cycles, in geopolitics, in the social situation, to get along, not argue.