Introduction
The good health of nations is a key to human development and economic growth and it is important to analyze health systems’ performance and to share what we knew with governments and the international community (Brundtland G.H., 2001).
According to the World Health Organization, WHO, a good health system has three primary goals: (1) good health which is making the health status of the entire population as good as possible across the whole life cycle; (2) responsiveness which is responding to people’s expectation of respectful treatment and client orientation by health care providers; and (3) fairness in financing which is ensuring financial protection for everyone, with costs distributed according to one’s ability to pay (WHO, 2000). All these three make up an ideal health system.
Based on this metrics set by WHO, many countries are developing initiatives to measure performance and improve its health system. Generally measurement and improvement are linked as indicated by phrases such as ‘evidence-based medicine’ and ‘evidence-based policy’ (Zeynep, 2002). Initiatives are also being developed due to some issues raised on the policy agenda in most countries.
These issues include: raising clinical effectiveness which is ensuring that clinical decisions are based on the best current practice; improving safety or reducing medical errors which involves developing health care organizations that are capable of detecting medical errors or adverse events to patients, and which are then able to effectively act on them to avoid future occurrences; raising responsiveness of the system or providing timely services centered on patients with respect to individuals’ culture, needs and values; improving efficiency/containing costs which involves provision of the right incentives to providers, those who support funds, and consumers to get better value for money; and ensuring equity of quality of health care provided to all regardless of gender, race, and socioeconomic status, reducing health inequity (Blazevska, Vladikiene, Xinxo, 2004).
Other related issues on the health care policy of most countries are: unsafe health systems; unequal access to health care services; dissatisfaction on the part of users and the public; unacceptable levels of variations in performance, practice and outcome; overuse or under-use of technologies for health care; inefficient delivery; unaffordable waste from poor quality and unaffordable or additional costs to society (Shaw, 2002).
The health system of different countries varies significantly due to many reasons. One primary reason is the wealth of a certain nation and the budget it can allocate for its health system. Another reason is how the government gives importance to the health care system. Healthcare system is also dependent on how a country allocates resources for its health care advantages. Distribution and allocation determines if individuals have the opportunity to access or use of health care services that provide for those needs. Distribution will be dependent on the policy used by decision-makers and on the methods of distribution. Healthcare authorities prioritized resources and its distribution, and further study what resources are best needed by the people in their country.
In relation to these issues, this paper discusses about the healthcare system of two countries, the UK (England), and Poland. The health policies of these countries are compared and contrast in connection to the issues on each country’s ambulance services. Included in the study are how each country determines the needs of the people, how they meet these needs, and how each country allocates its resources to be able to meet the needs.
Health Care System in Poland
Because of its being a communist country before, the current health care system of Poland has a comprehensive program of health care benefits, offering universal coverage. The Polish health care system provides services through three tiers which are the central level, the regional level, and the local level with autonomous health care administration units (Imai et al, 2000). Each tier or level works autonomously from each other making the Polish health system poorly coordinated nationally resulting to redundancy of facilities and excess capacity.
The Ministry of Health (MH) is at the central level, and is responsible for national health services including hospitals associated with medical academies, medical research institutes, and education and training of medical staff. Hospitals and outpatient health centers comprise the regional level while at the local level, there are health administration units which provide basic health care through outpatient clinics, diagnostic and phisiotheraphy departments, and emergency services.
The legislation of the republic of Poland makes it sure that all people will be given fee access for medical services. In addition, the government ensures that over 99% of its population will be covered by the state health insurance system. Part of the medical service or assistance provided by the health care system of Poland is the delivery of ambulatory health services. The ambulatory health services of Poland are a part of the provision of national health care system in the country. Poland’s ambulance service hotline is 999. Like any other ambulance service, the country health care policy has been able to set guidelines for the ambulance service delivery system.
In Poland, the ambulance service is based in a hospital. In this manner, the ambulance service has an immediate doctor who will provide personal; assistance to the patient. In this manner, doctors are being trained to become experts in emergency response activities.
Health Policy in the United Kingdom
Health care systems across the world are set up and managed in a variety of ways. In UK health care was under the National Health Services (NHS). The NHS is a government agency set up on July 5, 1948. It is recognised as one of the best health services in the world by the World Health Organisation. NHS organisations like Strategic Health Authorities, Primary Care Trusts, Care Trusts, Mental Health Trusts and Hospital Trusts help deliver health care services to a locality.
In 1974, Community Health Councils were setup as local independent bodies to represent the interestsof the public in the National Health Service. They are statutorybodies and have rights to information, to be consulted, andto meet with Health Authorities and National Health ServiceTrusts. Public health is also integrated into the mainstream of the NHS through the national health inequalities targets. The NHS, acting in partnership with the organisations across the community, aims to improve public health and reduce inequalities.
The NHS is also composed of agencies that focus on research. These include the Public Health Research Unit, and the Public Health Genetics Unit, which keeps the public informed on the developments in molecular and clinical genetics and their implications on social and public health. The NHS also set up Special Health Authorities like the National Institute for Clinical Excellence (NICE), which providespatients, health professionals, and the public with authoritative,robust and reliable guidance on current “best practice” on both individual health technologies including medicines,medical devices, diagnostic techniques, and procedures, andthe clinical management of specific conditions.; the NHS Litigation Authority (NHSLA) which handles claims and cover NHS bodies in respect of both clinical negligence and non-clinical risks; and the National Patient Safety Agency (NPSA).
The NHS also supports primary health care. With the establishment of the National Primary Care Research and Development Centre, which support service and policy development in the NHS by producing and disseminating high quality research, primary health care is improved. The NHS continually monitors its services to try to improve its service. The proposed NHS Plan (2001), which aims to secure the modern, high-quality and convenient health service required by both patients and primary care professionals, will enhance the role of primary care and put in place the policies and investment to expand and improve services and standards.
In UK there is 31 ambulance service covering England and provide single services in Northern Ireland, Wales and Scotland. This ambulatory health services provide emergency access to health care. It is a national service which is a part of the health care system of UK to give assistance to people who are in life threatening situations and serious medical emergencies. The ambulance health care services are provided from NHS trusts. The hotline for this service is 999. As part of the National Health Service Trust, these ambulatory services are obliged to respond emergency cases, high dependency and urgent inter-hospital transfers, doctor’s urgent inter-hospital transfers and other major incident. The people of this service are also responsible for giving patient transport back and forth in hospitals for treatment.
Herein, the personnel or the telephone operator will evaluate the seriousness of the emergency and is responsible for design is most suitable for such case. In all cases, an ambulance is being sent with enough crews, either with Emergency Medical Technician or a paramedic or sometimes both. The ambulance has been designed to give a mobile clinical workplace which has different emergency care resources. One of the responsibilities of the ambulance health care service is to react quickly or respond quickly to emergency situations. The Department of Health in UK has provided guidelines which should be followed by the ambulances regarding the time that the ambulance services should consume in giving the service.
The service being offered depends on the seriousness or severity of the situation and whether the service operates in the city, town or countryside. When someone called in the hotline, the calls are being prioritised into three categories: Category A, B and C. Category A are those calls that are most prioritised because of the life threatening situation and in this category, the ambulance service should respond within eight minutes regardless of location. On the other hand, Category B and C emergencies are serious but not immediately life threatening. In these categories the ambulance should respond within 14 minutes in urban locations and 19 minutes for rural.
Furthermore, ambulance services in UK are also responsible for undertaking complex admissions, discharges and transfers. Such ambulance service is carried out by the Patient Transport Service (PTS). The PTS gives transport assistance for geriatric day care and disabled patients along with all other patients who need to attend a hospital for out-patient appointments or treatment. UK has a different policy compared to Poland, especially in terms of managing the operations of their ambulance services.
Conclusion
Today we know where the most urgent problems lie and what they are; where health care delivery is inadequate; what consumers want; and where fragmentation and, therefore lack of continuity of care occurs. The time is right for us to demand a system that is truly about the health of society, not only its illness. This requires hard decisions about reconfiguring our narrow illness-focused health care system to one that is inclusive of all the population, understanding the contexts in which they live and get sick, and acknowledging their differences and their priorities. It will also demand a shifting of resources, human and fiscal. It does not necessarily mean building more hospitals, but rather planning appropriate models of health care better tailored to the needs of specific groups and contexts.
The most successful health systems are those that have learned to get their strategy right. Planning, implementing and monitoring must be a never-ending process if it is to support growth and achieve satisfactory changes. Staffs who work in the health service—doctors, nurses and other health professionals—are a key resource. There must be an appropriate level of investment in education and training to help people to do their jobs effectively and due recognition of excellence. The product of research development and a sense of critical evaluation of implementation must be integrated into all activities. Continual attention must be paid to attitudes and practice as well as access to data, information and intelligence with a focus on results and outcomes.
It shows that both health care system of UK and Poland has been able to have a standard and effective policies that can be used in improving the health of the people living there. However, in terms of providing ambulatory services, the two health care systems have differences. One of which is the management style in responding to the patients who are in needs of immediate health care service. In UK, the calls are categories into three distinctions and the ambulance service are being sent with a crew, either an EMT or a paramedic, or (both), this varied on the category of the call. However, in Poland, the ambulance service is based in Hospitals and the doctor always goes with the ambulance service.
The differences of the health care system imposed by these two countries, only means that Poland and UK are two independent countries which follows different but effective health care system to ensure quality services provided with their patients.
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