Rapid Responses to:

LETTERS: Aleksandar Dzakula Health care based on priorities is lost in decentralisation BMJ 2005; 331: 235 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Health care, decentralization and priorites: different experience in different countries

Ivan Kocić   (27 July 2005)

Health care, decentralization and priorites: different experience in different countries 27 July 2005
Ivan Kocić, Consultant in Department of Pharmacoeconomics, National Health Fund-Gdansk Department, Poland Department of Pharmacology, Dębowa 23, 80-204 Gdansk, Poland Send response to journal: Re: Health care, decentralization and priorites: different experience in different countries	In last decade we have in Poland two big reorganisations of the health system: regional, based on local administration and decisions (1999 -2002), and national, centralized with a 16 regional districts but without posibility to make significant decisions, directed by central Department in Warsaw, (2002-ongoing). Taking into account preliminary analisys of morbidity and mortality rates in the particular districts (Vojvodaships)it seems, that decentralisation with regions able to decide about financial metters according to own requriments is more effective and better for health outcomes. It seems resonable, as such a big country as Poland has different priorites in different regions, e.g., in Pomerania Vojvodaship neoplastic diseases are the top priority, but in others-cardiovascular diseases dominate. Therefore, we have special project to clarify significantly higher incidence of neoplastic diseases in our region and have to pay more attention to this metter. In my opinion, the crucial point for effective work of decentralization health system is a local network of professionals, mentioned in letter by Dr. Dzakula from Croatia. Development of this kind of organisation should be supported and granted by goverment, as it is in interest of all citizens. Competing interests: None declared