Managed care and a process of integration in health care sector: a case study from Poland

The aim of the paper is to explore a causal nexus between contract type (financing rules and scale of responsibilities) and tendency towards integration between Polish health care providers. For more than 40 years Polish health care sector structures were fully integrated. The law introduced in 1991 initiated development of a system of contracts between public payer and the independent medical services' providers. After a few years, new legislation enabled much faster movement from an integrated model of provision towards separating a public 'third party payer' from health services providers. After reforms in 1999, in the context of poor enforcement mechanisms, unit financing rules proved to be one of the weaknesses of the Polish health care system. By enhancing a structure-disintegrating process, cost-per-case contracts destroyed those of organizational and professional networks (both formal and informal ones) which could guarantee coordinated, continuous and high quality health care for people. On the other hand, in 2002, 2 of the 17 Sickness Funds implemented contractual arrangements typical for the managed care system. The primary care providers who realized pilot experiment, took on responsibility for coordinating treatment of the enrolled patients and for management of financial resources assigned for the health care packages broader than usual in Poland. Capitation payment was the major technique of financing those providers. Using a case study descriptive analysis, it is argued here that capitation prospective payment for wide packages of health care may encourage spontaneous (bottom-up) integration between primary and secondary care providers.