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Addressing post-pandemic challenges facing the healthcare system

Anna Rulkiewicz, CEO of Lux Med, talks to the BPCC’s Michael Dembinski about the pressing need for cooperation between the private healthcare sector and the state if Poland is to meet the healthcare needs of its population
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From the macroeconomic perspective, we have seen how the percentage of GDP countries spend on healthcare has increased because of the pandemic. Poland’s share rose from 6.5% in 2019 to 7.2% in 2020, whilst the UK increased its share from 10.2% to 12.8%. The disparity between the UK and other OECD countries and Poland shows that there’s still a big gap to be filled. [Of EU member states in the OECD, only Hungary spends less.] Which measures should the Polish government take to improve the access to and quality of its healthcare system in the long term?

I am afraid that there’s no one clear answer for that. The healthcare system in Poland is a difficult sector as it needs to address several challenges such as demographics, growing demand, staff shortages and financial constraints. The first step is of course to focus more on preventive medicine in order to promote health across the large group of society that will benefit most in the long-term perspective. But when we look from the systemic point of view, the key requirement is to ensure the stability and predictability of the economic and regulatory environment. For healthcare, this means we need to continue to develop space for new forms of financing, which will secure the quality and continuity of patients’ health path. I think we could look at best practices in other developed markets – but having in mind of course that those needs to be adapted to domestic specifics. I think such changes could help to formulate a good definition of a role of the private sector in the Polish healthcare system, and its cooperative relation with public providers. We need to ensure that both sectors support and complement each other, so that the system as a whole can provide comprehensive and coordinated care. Private funding can be a significant support for the Polish healthcare system and attract further investment.

How has Lux Med fared through the pandemic, as a healthcare service provider, as an employer, and as a business? What have been your greatest challenges over the past year and half?

The beginning of the pandemic was marked primarily by fear, not just for patients but for medical staff. It was a time when as an organisation we had to make a great effort to prepare our medical centres to operate in such an unpredictable environment. The pandemic forced us to remodel our business. Previously, like everyone else, we relied on traditional consultations, and telemedicine was only a small form of support across the entire treatment process. That changed overnight, when the threat appeared and people stopped leaving their homes. We have invested a lot of resources, financial and human, to ensure the continuity of our healthcare services. It is a fact that many medical procedures had to be postponed due to the regulator's decision, and this applies to both public and private sectors. However, despite the strict sanitary regime, we have decided not to limit certain services - this is, for example, our oncology or pathways for pregnant women. In next step, we have intensified our activities aimed at fighting Covid-19. This led us to join the national vaccination programme or reorganise our entire St. Elizabeth hospital for the purpose of treating and saving the lives of patients affected by coronavirus.
How much of Lux Med’s focus and resources were switched to dealing with Covid-19, and how much of your core business could you still maintain at pre-pandemic levels?

The war with the pandemic temporarily suspended all the rules we knew in terms of running a company. We had a situation where practically overnight it was necessary to radically change the current operational model. We had to ensure the continuity of healthcare services, and that was the priority. Absolutely the entire company was involved. While we had to adhere strictly to the state regulations, we offered our patients three different forms of consultation: telemedicine advice, online consultation or a visit to a medical facility. It shouldn’t be a surprise that the big winner of the pandemic is the telemedicine. At its peak, 75% of consultations took place this way. Telemedicine will stay with us, of course, to a lesser extent. The same is with all things that can go digital. When it comes to our offer, I would say that pandemic helped us to truly realise how the mental-health area is important. Generally speaking, people are now more health-aware. For the first time in the history of this country, health has become the people’s and the government's priority. I believe that this reflection will lead us into decisions that will guarantee citizens access to appropriate quality medical care. I am convinced that this is not possible today without the participation of private healthcare providers.

Please tell me about public-private cooperation – contracting healthcare services for the Polish state, sharing the burden, helping out with peaks and troughs – how does this look in practice?

Today, cooperation between the public and private sector is quite weak. We can’t find many good examples of such win-win cooperation.  At the same time, we are a large country and with public financing alone we are not able to guarantee healthcare at a sufficiently high level for all citizens. In my opinion it is necessary to talk about alternative financing, including additional health insurance, cooperation under public-private partnership, outsourcing of medical services or subcontracting. I think the future role of the private sector in hospital provision should also be discussed. We have companies that have invested in hospitals in Poland, that want to develop them, and yet their future in the structure is unpredictable. If there are areas in which there are specific health needs, the state could use the resources that already exist in private sector. The key is the long-term perspective, that would encourage business leaders to make specific investments.
It is estimated that half of the patients who were hospitalised with Covid-19 will go on to develop long-term health issues related to the virus (‘long Covid’). How will this affect the health insurance industry?

The healthcare market in Poland in the near future is a market of gaps that have never been this big. On one hand, it’s about financial resources, but it’s also about the physical possibilities of providing services. It looks like the system will be even more inefficient than it currently is. We will have to deal with the so-called health debt, the massive number of medical procedures, that have been postponed due to epidemic restrictions. In addition, there is a problem of a lack of doctors, which is particularly big in Poland. Will the system cope with this challenge? If we continue to divide patients into private and public and not start looking at the healthcare system as a whole, my answer will be ‘no’. And certainly not at the level that a citizen of a large European country deserves.  
A positive side-effect of the pandemic has been a marked acceleration in medical R&D and in clinical-trials procedures, with the potential of improving future healthcare outcomes. How do you see technologies such as gene therapy, personalised medicine, moving in to the medical mainstream?

Introducing innovative solutions to healthcare market is not enough, because those also need to be effectively incorporated into a patient's pathway. Here we must talk, among other things, about a legal environment that can keep up with the development of technology. The role of the state is crucial here. We need open regulations that will, at least, not block innovations. This is already changing in Poland; the only question is whether it isn’t too slow. Today we are certainly much closer to the moment when truly personalised medicine becomes widely used. However, it still will be rather a long run than a revolution.

A healthy lifestyle seems to be part of the answer as to why some people avoided the worst effects of Covid-19. Prevention being better than cure – and cheaper than cure – what is Lux Med doing to encourage its customers to adopt a healthier way of living?

We want to help people live longer, healthier and happier life. We believe that it is not possible without prophylaxis and undertaking physical activity. That is why our comprehensive offer also includes extensive preventive programmes. We educate and build health awareness in the communities where we operate. Our sustainable development strategy puts in front the idea of healthier way of living. And that also means taking care of environment. I want to mention here our recent initiative, Healthy Cities, in which we combined two elements: physical activity, which consists in participating in a competition for as many steps as possible, counted by a smartphone application, and care for nature. We have made a declaration to plant 300,000 trees, but at the same time we also managed to strengthen the awareness among participants, that it is difficult to talk about staying healthy without thinking about the quality of the air we all breathe.

We also lead an example of responsible business and undertake initiatives to reduce our direct CO2 emissions impact. Knowing our carbon footprint, for several years we have been purchasing energy from renewable sources. We also replace our fleet with hybrid cars and run educational campaigns among our employees.

For years, our group has been involved in spreading the spirit of sport and Olympic values. Lux Med is the Main Medical Partner of the Polish Olympic Committee and the Polish Paralympic Committee. Our offer also includes special programmes that guarantees professional medical support to anyone who wants to practice sport in a healthy and safe way.

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