![]() ![]() ![]() This situation exacerbated the conflict between these roles. 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. 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. 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. 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. The reform changed hospital financing from fixed budget to payment for performance and granted private medical organizations access to public money. The first major reform was implemented in 1999, ten years after the fall of communism. (Oral presentation in Yokohama) Poland, like other European post-communistic countries inherited the inefficient health care system.
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