Supreme Medical Chamber on Barczyk’s hospital and MEDASK: “It’s a slippery subject”

The istotne.pl editorial team asked the Supreme Medical Chamber about ethical standards in a situation where people professionally associated with a public hospital participate financially or organizationally in a private company providing services to that same facility.

The questions concerned Szpital św. Łukasza in Bolesławiec and MEDASK sp. z o.o. The editorial team established that the hospital had entered into an agreement with the company to provide outpatient specialist services. Settlement is to be based on the number of services provided and the rates resulting from the offer submitted in the tender.

At the same time, registry documents show that people professionally associated with the hospital are or have been involved in MEDASK. These include doctors, people associated with the facility’s organizational units, administration and legal services. In the past, a person from the hospital director’s immediate circle was also a shareholder and member of the management board.

The hospital refused to disclose detailed financial data concerning its cooperation with MEDASK, citing business confidentiality. The editorial team asked, among other things, how much public money had gone to the private company, how many services had been provided and what the detailed settlement rules were.

Supreme Medical Chamber spokesperson: it is legal, but may be disadvantageous for the hospital

Jakub Kosikowski, spokesperson for the Supreme Medical Chamber, noted in a response sent to the editorial team that the issue is difficult because current regulations allow such arrangements.

– It is a slippery subject because under the regulations currently in force, it is legal – wrote Jakub Kosikowski, the Supreme Medical Chamber spokesperson.

At the same time, he pointed out that from the perspective of a public hospital, such a model may be financially disadvantageous.

– The Code of Medical Ethics is the Code of Medical Ethics, but usually this is simply financially disadvantageous for the hospital. It is directly disadvantageous management of public assets, because external entities usually lease only those departments and perform only those procedures that are profitable – Jakub Kosikowski assessed.

The Supreme Medical Chamber spokesperson also explained the mechanism that may raise concerns. In his view, a public hospital should carry out profitable procedures itself and use the resulting margin to cover losses in deficit areas.

– It is in the hospital’s interest to keep this in its own budget, generate that margin itself and use it to cover the losses of deficit departments – he pointed out.

It is about transparency and patients’ trust

The Supreme Medical Chamber does not directly assess specific people from the hospital and MEDASK. However, its spokesperson addressed the general problem of doctors and people associated with the public healthcare system having dual roles.

– In our opinion, it would definitely be healthier, both for transparency and for how the medical profession is perceived by society, if such dual employment did not occur – wrote Jakub Kosikowski.

In his view, such an arrangement may raise questions about whether medical and organizational decisions are made solely with the patient in mind.

– It may raise doubts as to whether, in therapeutic and diagnostic decisions, the doctor is truly guided by the patient’s welfare rather than the company’s financial results – the Supreme Medical Chamber spokesperson added.

This is important in the context of public money and public facilities. A patient arriving at a hospital should be certain that the way they are treated, diagnosed and scheduled for services is determined solely by medical indications, not by the economic interests of an external entity.

“It is circumvented through external companies”

The Supreme Medical Chamber spokesperson also drew attention to a broader organizational problem. As he pointed out, Polish law does not allow two forms of employment within one entity, but in practice this prohibition is circumvented by using external entities.

– As a rule, Polish law does not permit two forms of employment within one entity, but this is precisely circumvented through external companies – wrote Jakub Kosikowski.

In the Supreme Medical Chamber spokesperson’s view, it is difficult to expect rapid systemic changes. As he noted, the Ministry of Health has so far failed to take effective action even against other controversial practices, such as referring patients from private practices more quickly to queues funded by the National Health Fund.

– I am convinced, almost to the point of certainty, that nothing will change here either – the Supreme Medical Chamber spokesperson assessed.