The influence of investment in medical equipment within the Regional Operational Programme for the Śląskie Voivodeship (ROP ŚV) on the enhanced quality and greater availability of health
services in the Śląskie Voivodeship
Summary
The main objective of the research was the evaluation, that is to say the assessment, of the influence of the purchase of medical equipment within the projects implemented on the greater availability and enhanced quality of medical services in the Śląskie Voivodeship.
The main objective has been accomplished through the realisation of the following specific objective: The analysis of the form of currently functioning co-financing the purchase of medical equipment within the ROP ŚV .
The context of the evaluation research is on one hand determined by the documents of strategic character. According to the Development Strategy for the Śląskie Voivodeship "Śląskie 2020", providing the residents with access to public health services of high quality constitutes one of indispensable elements in the region development policy. On the other hand, there are the objectives of Priority IX Health and recreation of the Regional Operational Programme for the Śląskie Voivodeship for the years 2007-2013, that is the enhancement of the health of the region's residents through the increased availability and enhanced quality of medical services. Among the activities aimed at the objective implementation was the opportunity to finance the purchase of medical equipment and the replacement of waste medical equipment. On the basis of the above assumptions, the following research areas were included in the assessment:
I The state of medical equipment in healthcare units in the Śląskie Voivodeship before the implementation of ROP ŚV.
In this area, the healthcare units in the Śląskie Voivodeship were characterised before the implementation of the Regional Operational Programme, that is at the end of 2007. Next, medical equipment distribution was presented according to the locations of healthcare units, in particular in the scope of units possessing equipment of various kinds, inter alia: ultrasonography equipment, X-ray equipment, computed tomography scanners, magnetic resonance, gamma cameras, linear particle accelerators, and lithotripters. At the next stage, the extent to which the medical equipment available in healthcare units was used was assessed, as well as the waiting time of patients for the realisation of a particular medical procedure. The research in the last part includes the analysis of the
demand for medical services, which constitutes a significant reference point for further comparisons of this evaluation.
II The financial support mechanism for the health protection sector within ROP ŚV
This research area comprises of, to a large extent, the analysis of the programme documentation that enabled the identification of areas of support provided within the ROP ŚV and the types of project implementation and recipients of activities dedicated to medical equipment investments. Additionally, the analysis of the allocation opportunities of Measure 9.1 and Measure 9.2 has been carried out in the context of the number of investments implemented, as well as of the purchased and modernised medical equipment. The location of investments involving medical equipment in terms of quantity and value has also been included in the assessment. The investments which contributed most to achieving the goals defined in Priority IX of ROP ŚV in the scope of enhancement of the quality of treatment standards and the increase in the availability of medical services are concerned have also been identified.
III The effects of the implementation of the projects
The above research area constitutes the most significant part of the research, since it indicates the actual and potential effects of the projects analysed. At the same time, the results obtained in the course of the analysis allow the assessment of the logic of intervention and the effects of the activities undertaken. That is why the following issues were included in the analysis within the research area:
– the extent of accomplishing the objectives of Priority IX (Measures 9.1 and 9.2),
– output and result indicators in the context of the programme assumptions,
– the extent of using of the equipment purchased,
– the waiting time of the patients for the delivery of medical services using the purchased
and/or modernised medical equipment,
– factors influencing the process of investment realisation and implementation,
the financial sustainability of investment (after financial and in-kind settlement of the investment),
– the cohesion of the Voivodeship Development Strategy within the scope of investments
covered by the study.
IV The co-financing of the purchase of medical equipment in the programming period to come The research area includes the analysis of the justness of supporting the healthcare sector within ROP ŚV in the field of purchasing medical equipment in the programming period to come. In this
research area, proposals have been presented which provide an opportunity ensure the efficiency the projects for the future, understood as the influence on the quality and availability of medical services. The applications presented in this field are the basis for the formulation of recommendations, in particular from the angle of the next financial perspective. The team recommended a limitation on the subsidies for the current activities and the appropriate growth in financing investments in medical equipment in the voivodeship or subregional orbit of influence.
The analysis of the above areas led to the following conclusions from this research, which were the foundation for the recommendations indicated in Chapter 5:
1. Objective: The enhancement of the availability of medical services indicated in the ROP ŚV Programme has been achieved to various extents (although beneficiaries declared that due to the investment realisation using co-financing, the quality, as well as the availability of medical services, have improved). First of all, it is connected with the nature of the equipment purchased, which was relatively inexpensive and simple. At the same time, it indicates dispersion of financing with a view to satisfying the basic, as well as the current, needs of the beneficiaries. That is why it is a good idea to introduce financial restrictions on the minimum value of individual equipment purchase and subject restrictions concerning the purchase of spare parts.
2. However, the beneficiaries claim that the vast majority of investments has been made in accordance with the co-financing applications, which proved their thorough preparation. Beneficiaries also cited the quality enhancement and availability of health services attained due to the co-financing of the projects.
3. The distribution of equipment in the area of the voivodeship did not fall within regional programmes or planning works, and was solely dependent on the financial possibilities of owner authorities (most frequently of Local Governments) and their financing potential. This situation results from the lack of hospital networks at the national and regional levels and from the well-advanced decentralisation of the function of the management of healthcare institutions. In analysing project assessment criteria it should be stated that too many of the criteria were in descriptive form. Therefore it seems reasonable to introduce an increased number of criteria that would award bonuses depending on the results of given investments and stimulate the use of equipment purchased on a supra-local scale. An direct influence of the project implementation on improving and/or raising the quality of health services should be placed, e.g., in the context of healthcare programmes implemented by a given unit.
4. Output and result indicators for Measures 9.1 and 9.2 were too general and imprecise, especially as far as capitalised purchases made are concerned. They did not allow the ultimate
verification of the degree of raising the quality of medical services provided, nor the scope of extending the access of patients to these services. It is therefore worthwhile to work out a catalogue of indicators for output, result and influence of the investment that, on the one hand, will be an obligatory catalogue and, on the other, will allow the beneficiary to propose his/her own indicators. Indicators should be adjusted to the type of equipment and they should characterise the extent of equipment usage (including the number of medical procedures, the number of patients attended, the number of hours when the appliance is in use), and the availability of equipment (measured by the number of patients waiting and their waiting time) 5. The beneficiaries of the project treated the ROP ŚV Programme means as, above all, the source of investment financing aimed at maintenance of the already-existing infrastructure. This resulted in a situation when a minority of healthcare centres supported not only developed the previous activities, but also extended the catalogue. This is why it is worthwhile that the beneficiaries justify their purchase of medical equipment based on an analysis of the saturation of medical services market with medical devices, and on that basis to indicate the scope for extending the catalogue of medical services offered by a unit.
6. The influence of the majority of projects implemented has been assessed as local or subregional. The beneficiaries of the projects were members of communal or district communities. This is why the projects met, most of all, the demand of the immediate environment. Projects implemented from structural funds should exercise an influence on a larger scale and that is why in the next programming period it is worthwhile to award more points to projects with a larger scale of influence that will bring added value in the form of new medical technologies and for which there is demand on a subregional scale.
5. The analysis of the matrix of compatibility between objectives and directions defined in the 2010 Strategy for the Śląskie Voivodeship confirms that all the projects implemented within Measures 9.1 and 9.2 ROP ŚV are entirely a part of the “Health and Safety for Voivodeship Residents” strategy, and are particularly consistent with the designated directions of support which may show that the programme objectives are too generally defined compared to too-specific health needs in the voivodeship. This is why it is worthwhile to analyse needs on the basis of studies and data collected from healthcare institutions and the National Health Fund, it is also worthwhile to systematically monitor the relationships between equipment resources and the investment plans of the key healthcare institutions of the voivodeship (especially of the crucial hospitals).
During the preparation of the project, numerous research methods were put into use. These included, but were not limited to, desk research, individual depth interviews (IDI), Computer Assisted Telephone Interviews (CATI), a panel of experts, a compatibility matrix and analytical methods.
