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(en) Poland, ozzip: A sad portrait of Polish laboratory diagnostics [machine translation]

Date Thu, 24 Jun 2021 09:31:23 +0300

Manifestation under the Ministry of Health in 2019.the author's archive
There is no need to convince anyone that things are not going well in Polish health care. Less than 5% of GDP allocated to health, compared to the European average of around 7%. Overcrowded, underfunded hospitals, queues to see doctors, lack of access to modern and reimbursed therapies, collections for treatment provided by patients on crowdfunding portals. One of the components of this sad puzzle is also - equally underfunded, and certainly less known to the average reader - Polish laboratory diagnostics. ---- Despite the fact that approximately 60-70% of medical diagnoses are based on the results of laboratory tests (and, in the opinion of experts, laboratory tests are the most reliable, fastest and cheapest way to gain knowledge about the patient's health and - in most cases - the basis for determining the treatment method), the improvement of the condition of Polish laboratory diagnostics was not a priority for the previous governments, nor is it for the current government.

NIK auditors sounded the alarm in 2017, announcing the "Report on the availability and financing of laboratory diagnostics". According to the data derived from it, " in Poland, laboratory diagnostics is underestimated, and the expenditure on the supply of laboratory diagnostic products compared to EU countries is small - only EUR 8.5 per person (...), while, for example, in Slovenia it is EUR 23 (...) and in Belgium EUR 33.5 ". What is worse, "in Poland, too few laboratory tests are performed as part of primary healthcare services. So far, there are no valuations of laboratory tests in Poland, it is not known exactly how many of them are performed in the country. There is also no registry of laboratory tests. There is still no universal, binding laboratory licensing system related to the assessment of the quality of research ".

Considering the fact that the system dramatically lacks money for laboratory diagnostics, doctors order patients to have too little preventive examinations. As a result, many diseases are detected too late or at a stage that significantly hinders or increases the cost of their treatment. Hence, a large proportion of patients pay out of their own pocket for tests that are not cheap, especially when they are specialized tests or you have to perform a lot of them at once. A system that prioritises restorative medicine rather than preventive medicine, however, is turned upside down: it is ineffective, ineffective and more expensive to maintain. In the opinion of the Supreme Audit Office, failure to use laboratory tests in prophylaxis may result in "Dynamic increase in drug reimbursement costs", increasing with the severity of the disease,

Could it be worse? Maybe. NIK also writes that Polish laboratories, apart from adequate funding, are also deprived of appropriate supervision and control, as costs are often outsourced outside hospitals, and the Ministry of Health does nothing to change it. The activities of the Ministry of Health are described in the report as inaction which may "threaten the proper quality and availability of the performed laboratory diagnostics services".

Although more than three years have passed since the publication of the NIK report, the situation has not changed for the better, and the COVID-19 pandemic has highlighted even more the shortcomings of the Polish health care system and the lack of adequate financing of laboratory diagnostics.

What does a diagnostician do

Until now, hardly anyone knew who performed and who was responsible for laboratory tests. On the order given by the doctor, "the results were obtained": someone took our blood, someone else took it behind the glass door of the laboratory, and after a few hours, a printout with mysterious numbers was attached to our documentation, or - if we paid for the test ourselves - we downloaded this printout from the website web lab. The COVID-19 pandemic, however, made Polish women and Poles heard about the profession of a laboratory diagnostician, and in fact laboratory diagnostics, because almost 90% of people working in Polish laboratories are women.

There are about 16,000 laboratory diagnosticians, mostly graduates of five-year MA studies in the field of medical analyst, conducted exclusively by medical universities. For comparison - we have 150,000 doctors in Poland, and nurses - almost 20 times more than diagnosticians.

A separate group of laboratory employees are medical analysts who support diagnosticians in their work - but from year to year there are less and less of them, and post-secondary schools do not educate subsequent years. Currently, there are about 3,000 of them still working.

Laboratory diagnosticians not only confirm SARS-CoV-2 infection, they also examine all other parameters, ranging from routine morphology, through the determination of glucose levels, hormones, ESR, and liver tests. Laboratory diagnosticians also perform microbiological and genetic tests, mark the histocompatibility antigens before organ or bone marrow transplantation, select blood for transfusion, mark the types of hemato-oncological diseases or test the response of cancer cells to treatment. And this is just the beginning of the several thousand items long list of laboratory tests that can be performed.

As partners doctor that diagnosticians involved in the whole process of diagnosis and treatment, further studies suggest that in the case of a patient would be worth more to do. In addition, they learn all their lives - they acquire specializations in several areas of laboratory medicine and scientific titles, participate in conferences and industry conferences, and at medical universities they educate next generations of laboratory workers.

In total - less than 20,000 people with specialization education throughout Poland are involved in laboratory research for the remaining 38 million citizens and provide staffing in over 2,500 laboratories. The statistics seem to contradict this possibility, because assuming that there are 0.318 laboratory diagnosticians per 1,000 Polish patients, we are much below the European average, lower than Finland (1.24), Iceland (0.830), and even than Serbia (0.796). Cuba (0.536) and India (0.370). Behind us there are only Brazil, Qatar, Egypt, Bangladesh and Mongolia on the axis.


It would seem , that such a small group of professional (to pay such a large amount of work, well-educated, essential health care system and public obliged to lifelong learning and specialize your own money )should be adequately remunerated for their work. Unfortunately - for years we have been working excessively in underfunded laboratories, for money that is disproportionately small compared to our responsibility. The salary of a laboratory diagnostician without specialization is currently around PLN 3,000-3500 gross, the salary of specialists usually oscillates around PLN 4,200 gross, while medical analysts are usually sentenced to the lowest national salary, enriched only with a long-term employment allowance. To make it funnier, and certainly more interesting, for any mistakes at work, which can often cost even human life, laboratory diagnosticians are responsible with all their assets. Taking into account the amount of their salaries, the legislator evaluates the health of patients very low. For this - as one of the 15 professions of public trust,

In order to make ends meet, fill the staff shortage in the health care system and make money on the cost of compulsory continuing and specialization education[sic!], Diagnosticians and technicians work overtime and several jobs. It is not uncommon when, during an interview in a new job, fresh graduates of medical analytics hear from the management of the institution whether they have a rich husband or another person who will be able to support them financially, because their salary will be programmatically low. Having no alternative, they take up a job for a low salary, thus cultivating a pathology that has been growing over the years, and looking for it - they leave the profession, because it is impossible to build an adult life for such low salaries. Taking into account the decreasing number of analytical technicians every year, there are no more people to work in laboratories.

Paradoxically, Polish health care functions only thanks to the dedication and poverty of its employees and the self-preservation instinct of patients. If employees were not empathetic and willing to help, and patients were not forced to co-finance theoretically free health care, everything would have long since fallen to pieces.

Agnieszka Gierszon

Secretary of the National Trade Union of Employees

Medical Diagnostic Laboratories

The article originally appeared in the journal "A-Tak" No. 15/2021

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