CATCHING GAPS WITH HEALTHCARE MAPS A Map of Healthcare Needs for Mazovian Voivodeship – Paediatric Diseases THE PROJECT CO-FINANCED BY THE EUROPEAN UNION FROM THE EUROPEAN SOCIAL FUND UNDER THE OPERATIONAL PROGRAMME KNOWLEDGE EDUCATION DEVELOPMENT 1 www.mpz.mz.gov.pl Table of Contents Demographic and Epidemiological Aspects ......................................................................3 1.1 Demographics of the Voivodeship and its Counties ......................................................4 1.2 Hospital morbidity in general pediatrics and primary health care ...................................4 Status and Use of Resources: the Analysis .......................................................................7 2.1 Inpatient Healthcare ......................................................................................................8 2.1.1 General Paediatrics .............................................................................................. 28 2.1.2 Neonatology ......................................................................................................... 64 2.1.3 Specialized paediatrics ......................................................................................... 64 2.2 Specialist Outpatient Care .......................................................................................... 64 2.3 Primary Care ............................................................................................................... 64 2.3.1 Primary Care in Poland......................................................................................... 64 2.3.2 Primary Care Services .......................................................................................... 74 2.3.3 Active Patient Lists ............................................................................................... 88 2.4 Emergency Medical Care Utilisation ............................................................................ 93 2.5 Medical Staff ............................................................................................................. 106 2.6 Equipment Resources ............................................................................................... 106 Forecast ............................................................................................................................ 107 3.1 Population Status and Breakdown Forecast .............................................................. 108 3.2 Number of Beds Forecast ......................................................................................... 108 3.3 Services and Healthcare Providers Forecast ............................................................ 108 2 CATCHING GAPS WITH HEALTHCARE MAPS Part I Demographic and Epidemiological Aspects 3 1.1 Demographics of the Voivodeship and its Counties The demographic status in the analysed period was discussed in the hospital maps of healthcare needs published on 30 April 2016. Due to the size of this document, content already published before will not be repeated here. For more details, see the respective elements of hospitalmaps. 1.2 Hospital morbidity in general pediatrics and primary health care Hospital morbidity The hospital morbidity rate is expressed by the number of people hospitalised by place of residence due to the group of diagnoses analysed in this document per year per 100,000 children and1. In Mazowieckie Vovodeship, morbidity rate was 6704.3 patients per 100,000 children. It was the 7th lowest result in the country. Figure 1.1: Empirical hospital morbidity rate according to the patient's voivodeship of residence (2014) Number of patients per 100,000Number people per patients of Higher values in the Lower values in the voivodeship voivodeship Source: DAiS study base on GUS and NFZ data. In Mazowieckie Voivodeship, the highest values for hospital morbidity were reported in Łosice County and Lipsko County. The rate values for those two counties were 12,985.7 and 11,688.1, respectively. 1In some patient entries in the National Health Fund’s database, an incorrect TERYT code was provided, preventing unambiguous identification of the administrative unit in which the patient lived. In such cases, it was assumed that the inpatient's place of residence was the same as the place of treatment. Despite incomplete data, this method represents as accurately as possible the actual use of public healthcare services by the local population. 4 Map 1.1: Empirical consultation rate for primary care clinics according to the patient's county of residence (2014) Rate values Source: compiled by DAiS based on data provided by the Central Statistical Office and the NFZ. Consultation Rates in Primary Care Consultation rates for primary care represents the number of patients who used primary healthcare services (i.e. those of a general practitioner, primary care nurse or primary care obstetrician) at least once, according to their place of residence, during one year, per 100,000 local residents2. In Mazowieckie Vovodeship, the consultation rate was 86,536.5 patients per 100,000 children. This was the lowest result in the country. 2In some patient entries in the National Health Fund’s database, an incorrect TERYT code was provided, preventing unambiguous identification of the administrative unit in which the patient lived. In such cases, it was assumed that the inpatient's place of residence was the same as the place of treatment. Despite incomplete data, this method represents as accurately as possible the actual use of public healthcare services by the local population. 5 Figure 1.2: Empirical consultation rate in primary care according to the patient's voivodeship of residence (2014) Number of patients per 100,000 people Higher values in Lower values in the the voivodeship voivodeship Source: DAiS study base on GUS and NFZ data. In Mazowieckie Voivodeship, the highest consultation rate values for primary healthcare were reported in Siedlce City County and Ostrołęka County. The rate values for those two counties were 104,651.3 and 100,705.7, respectively. Map 1.2: Empirical consultation rate in primary care according to the patient’s county of residence (2014) Rate values Source: compiled by DAiS based on data provided by the Central Statistical Office and the NFZ. 6 CATCHING GAPS WITH HEALTHCARE MAPS Part II Status and Use of Resources: the Analysis 7 2.1 Inpatient Healthcare This document was elaborated based on microdata provided by the National Health Fund (hereinafter: NFZ), relating to hospital services reported3for 2014. Such services are defined as products listed in catalogues 1a and 1b, completed by the end of 2014 (those parts of hospitalisations that went beyond 2014 were also included for the purposes of the respective analyses). Services provided under an agreement with the payer, e.g. therapeutic rehabilitation are in separate study - tables, summaries and figures related to such services were clearly marked. It is noted that in some tables, the data is presented in thousands rounded two decimal points (i.e. the values are rounded to hundredths). Hence, the value 0.00 indicates that the analysed variable have a value close to zero (not exceeding 5). In general information, all under 18 year of age patient information is included regardless of the cause, ward or scope. In further subchapters divided analysis was divided into general paediatrics, specialized paediatrics and neonatology separated using the ICD-10 classification, regardless of the ward were hospitalisation was performed. In 2014, 226.3 thousand hospitalisations due to the diagnoses analysed here were reported in Mazowieckie Voivodeship,28.6 thousand of which were day treatments (inc. 9.02% hospitalisations from outside voivodeship) (hereinafter: the Group). It accounted for 16.48% of all hospitalisations in the voivodeship. The number of hospitalisations per 100,000 inhabitants was 22,907.23, which was the 1st value among all voivodeships. In the analisys several age groups were identified: • in the 0-5 age group, number of hospitalisation per 100 thousand population was 41,153.97 (2nd highest value among all voivodeships) • in the 6-10 age group, number of hospitalisation per 100 thousand population was 12,818.25 (3rd highest value among all voivodeships) • in the 11-17 age group, number of hospitalisation per 100 thousand population was 12,663.02 (3rd highest value among all voivodeships) Figure 2.1: Hospitalisation breakdown in Mazowieckie Voivodeship according to main cause Other Causes Paediatric Diseases 3I.e. all services reported to the payer by healthcare providers. 8 Source: Compiled by DAiS based on data provided by the NFZ. Map 2.1- 2.4 show the data in the form of maps for each voivodeship. The size of each pie chart corresponds to the number of hospitalisations due to diagnoses analysed here per voivodeship. The structure of each pie chart reflects the structure of the place of residence of the patients (light colours represent patients from Mazowieckie Voivodeship, dark colours – those from other regions). The shade filling the contour of each voivodeship corresponds to the number of hospitalisations per 100,000 inhabitants of that voivodeship, according to the place of service. Map 2.1: Number of hospitalisations per 100,000 people and hospitalisation structure according to the patient's place of residence (children) Percentage of patients from other voivodeships _ From this voivodeship _ From other voivodeships Number of hospitalisations per 100 thousand people Source: Compiled by