Risk Management and Financial Stability in the Polish Public Hospitals: The Moderating Effect of the Stakeholders’ Engagement in the Decision-Making
Abstract
:1. Introduction
2. Legal and Economic Determinants of Hospital Functioning
3. Risk and Stakeholders in the Decision-Making Processes in Public Hospitals
4. Research Methods and Way of Data Collection
5. Research Results
6. Discussion
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Stakeholder | Interest | Impact | Relevance | Identified Risks |
---|---|---|---|---|
Founding body | High level of medical security in a given area; secured provision of health care services; stable financial condition; achievement of statutory objectives; improved image of the organization. | Grants subsidies for provision of services, approves a plan for development of the entity reporting to it. | Attempts are made to take into consideration the expectations and suggestions of a social supervisory board. | Lack of acceptance for actions taken by managers in the hospital and, as a consequence, reduction in financial support and/or boardroom changes in the hospital. |
Patients | High quality and availability of medical services; well-developed and modern hospital infrastructure; a comprehensive range of medical services; competent and friendly staff; a variety of medical services on offer. | Their positive feedback is an incentive for and an indicator of future development and a way to attract new patients; patients’ preferences determine the performance of the contract; claims may affect the entity’s financial condition. | Decisions which are made do not always take into account the expectations of patients’ families. | Change of a service and, consequently, a risk that the contract with the NHF may not be completed. Negative feedback, once spread, may damage the organization’s positive image. |
Ministries (e.g., Ministry of Health, Ministry of Labor and Social Policy) | Tasks performed in compliance with legal requirements (acts and ordinances); adherence to legal standards in the area of public obligations; provision of top quality services, in line with valid regulations and standards; ensured and secured medical services in a given area; an increase in one’s own political capital. | Indirect impact through legal regulations, decide about some funds allocated to health care units. | It is important to meet their requirements and perform a contract in compliance with accepted documents, without the need to incur additional costs of service provision. | Withdrawal of funds allocated for operations. Refusal to finance activities planned for the future. |
The National Health Fund (NHF) | Correct performance of contractual provisions; a wider range of services; maintaining the right cash flow from provision of services; timely accounting for service provision; furnishing of complete and up-to-date information. | Decides about awarding contracts for provision of services. If a contract is not signed the entity is not able to continue its operations. | The adopted strategy must take into account the legal regulations. | Inability to sign a contract for provision of medical services. |
Local government | Availability and high quality of services for the local community; fulfilment of statutory obligations; ensuring highly specialized medical care for inhabitants; pursuing the political interest (health care tends to be one of the main points on the political agenda). | Through a decision-making process related to financial support they approve a specific strategy of the health care unit. | Maintenance of good relationships by meeting the contractual provisions. | Making a decision on replacement of managerial staff. Refusal to grant funds. |
Expenditure Structure on Healthcare in 2017 | Structure |
---|---|
Government schemes | 10.4% |
Compulsory contributory health insurance schemes | 59.1% |
Voluntary health insurance schemes | 5.7% |
NPISH financing schemes | 0.8% |
Enterprise financing schemes | 1.2% |
Household out-of-pocket payment | 22.8% |
1991 | Healthcare Units Act from 30 August 1991 [Ustawa z dnia 30 sierpnia 1991 r. o zakładach opieki zdrowotnej], Polish Journal of Laws 1991 No. 91, act: 408. |
| |
1997 | Common Health Insurance Act from 6 February 1997 [Ustawa z dnia 6 lutego 1997 r. o powszechnym ubezpieczeniu zdrowotnym], Polish Journal of Laws 1997, No. 28, act: 153. |
| |
2003 | Common Health Insurance in National Health Fund Act from 23 January 2003 [Ustawa z dnia 23 stycznia 2003 r. o powszechnym ubezpieczeniu zdrowotnym w Narodowym Funduszu Zdrowia], Polish Journal of Laws 2003, No. 45, act: 391. |
| |
2004 | Publicly Funded Healthcare Services Act from 27 August 2004 [Ustawa z dnia 27 sierpnia 2004 r. o świadczeniach opieki zdrowotnej finansowanych ze środków publicznych], Polish Journal of Laws 2004, No. 210, act: 2135. |
| |
2010 | Healing Activities Act from 15 April 2011 [Ustawa z dnia 15 kwietnia 2011 r. o działalności leczniczej], Polish Journal of Laws 2011, No. 112, act: 654. |
| |
2017 | The change of the Publicly Funded Healthcare Services Act from 23 March 2017 [Ustawa z dnia 23 marca 2017 r. o zmianie ustawy o świadczeniach opieki zdrowotnej finansowanych ze środków publicznych], Polish Journal of Laws 2017, act: 844. |
|
Voivodeship | Sampling Frame—Number of the First-Level Hospitals in Voivodeships | Number of Received Questionnaires | Number of Discarded Questionnaires | Number of Questionnaires Included in Analyses | |
---|---|---|---|---|---|
1 | Lower Silesia Province | 20 | 15 | 7 | 8 |
2 | Kuyavian-Pomeranian Province | 16 | 8 | 5 | 3 |
3 | Lublin Province | 18 | 7 | 5 | 2 |
4 | Lubuskie Province | 10 | 5 | 4 | 1 |
5 | Łódź Province | 15 | 15 | 0 | 15 |
6 | Lesser Poland Province | 11 | 9 | 5 | 5 |
7 | Masovian Province | 37 | 17 | 4 | 13 |
8 | Holy Cross Province | 8 | 6 | 2 | 4 |
9 | Pomeranian Province | 11 | 8 | 3 | 5 |
10 | Podkarpackie Provnice | 12 | 9 | 2 | 7 |
11 | Podlasie Province | 14 | 8 | 4 | 5 |
12 | Opole Province | 12 | 4 | 2 | 2 |
13 | West Pomeranian Province | 15 | 8 | 3 | 5 |
14 | Greater Poland Province | 24 | 12 | 3 | 9 |
15 | Warmia-Masuria Province | 19 | 8 | 1 | 7 |
16 | Silesia Province | 32 | 16 | 2 | 12 |
Together | 274 | 155 | 52 | 103 |
Constructs | Financial Stability | Risk Management Practices | Stakeholders’ Engagement |
---|---|---|---|
Mean | 3.6893 | 5.6951 | 5.2994 |
Std. Deviation | 1.47474 | 0.97612 | 0.94695 |
Model | Model 1 | Model 2 | Model 3 |
---|---|---|---|
The Effect of Risk Management Practices on Financial Stability | The Effect of Risk Management Practices and Stakeholders’ Engagement on Financial Stability | The Effect of Risk Management Practices on Financial Stability Moderated by Stakeholders’ Engagement | |
MODEL FIT STATISTICS | |||
RMSEA | 0.074 | 0.092 | - |
CFI (Compound Fit Index) | 0.980 | 0.913 | - |
TLI (Tucker–Lewis Index) | 0.968 | 0.889 | - |
Akaike Information Criterion (AIC) | 2304.632 | 3838.519 | 3834.898 |
r2 | 0.060 | 0.110 | 0.121 |
MODEL ESTIMATION RESULTS | |||
Independent variables (IV) | Estimate β (S.E. σ) | Estimate β (S.E. σ) | Estimate β (S.E. σ) |
Risk management practices | 0.572 (0.269) * | 1.003 (0.465) | 0.265 (0.253) |
Stakeholders’ engagement | - | −0.623 (0.619) | −0.221 (0.224) |
Risk management practices × stakeholders’ engagement (the interaction) | - | - | −0.207 (0.088) |
Constant | 2.230 (0.440) | 2.106 (0.431) | 0.904 (0.061) |
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Frączkiewicz-Wronka, A.; Ingram, T.; Szymaniec-Mlicka, K.; Tworek, P. Risk Management and Financial Stability in the Polish Public Hospitals: The Moderating Effect of the Stakeholders’ Engagement in the Decision-Making. Risks 2021, 9, 87. https://doi.org/10.3390/risks9050087
Frączkiewicz-Wronka A, Ingram T, Szymaniec-Mlicka K, Tworek P. Risk Management and Financial Stability in the Polish Public Hospitals: The Moderating Effect of the Stakeholders’ Engagement in the Decision-Making. Risks. 2021; 9(5):87. https://doi.org/10.3390/risks9050087
Chicago/Turabian StyleFrączkiewicz-Wronka, Aldona, Tomasz Ingram, Karolina Szymaniec-Mlicka, and Piotr Tworek. 2021. "Risk Management and Financial Stability in the Polish Public Hospitals: The Moderating Effect of the Stakeholders’ Engagement in the Decision-Making" Risks 9, no. 5: 87. https://doi.org/10.3390/risks9050087