Internal Conflicts Vs. Integrity within Medical Profession Under Managerial Encroachment

Poland, like other European post-communistic countries inherited the inefficient health care system. The first major reform was implemented in 1999, ten years after the fall of communism. The reform changed hospital financing from fixed budget to payment for performance and granted private medical organizations access to public money.

After the Cold War, Poland inherited too many hospitals, as in the days of communism additional hospitals were created for the military purposes, internal security forces, and even for large professional groups, such as railway workers. Thus, after the reform public hospitals have been forced to compete for financial resources and a limited number of medical professionals, not only among themselves but also with rapidly growing private sector.

In the communistic system, costs control were made through a lack of access to expensive medical technologies, which absolved both physicians and managers of moral responsibility for cost containment and thus limited the conflict between managers and doctors. However, nowadays managers bear the primary responsibility for balancing the hospitals budget, and the task can be realized only through exerting pressure on doctors to reduce costs. This situation exacerbated the conflict between these roles.

This paper presents the study on Polish hospitals concerning the identification of methods used by managers to take control over the clinical practice, the response of medical profession to managers actions, internal conflicts within the profession and defense of its autonomy. In western countries the pressure to reduce costs was increasing gradually over many decades, but in the post-communist states these phenomena occurred rapidly. Most doctors currently working in Polish hospitals entered the profession in the communist times and now not only they have to adapt themselves to new reality, but also help to socialize younger colleagues entering the medical profession.