1. Prof. dr hab. Irena Ponikowska Katedra i Klinika Balneologii i Chorób Przemiany Materii Akademii Medycznej w Bydgoszczy Polish Health Resorts during political changes in Central Europe

2. Head: Prof. dr hab. Irena Ponikowska Leśna 3 87-720 Ciechocinek tel. +48 54 283 3945 tel/fax +48 54 283 3915 e-mail: info@balneoklinika.com www.balneoklinika.com Clinic of Balneology and Metabolic Diseases Medical University in Bydgoszcz, Poland

3. The principal activities of Clinic of Balneology Didactics Research activity Health service

4. Clinic of Balneology and Metabolic Diseases Activities in Balneology and Physical Medicine in Poland Clinic is a head office of Polish Balneological Consulting and Control Program Clinic is a head office of Polish Balneological Consulting and Control Program Seat of Polish Association of Balneology and Physical Medicine Seat of Polish Association of Balneology and Physical Medicine It is a place where postgraduate education is curried on for the doctors from whole country It is a place where postgraduate education is curried on for the doctors from whole country Clinic is an organization center of balneological congreses Clinic is an organization center of balneological congreses Textbooks and Polish Balneology journal is published in Clinic Textbooks and Polish Balneology journal is published in Clinic Clinic acts as an expert of projects of spa law, indications, recommendations Clinic acts as an expert of projects of spa law, indications, recommendations We work up the medical standard in balneology We work up the medical standard in balneology

5. Polish institutions working on health resorts problems Polish Balneological Consulting and Control Program Polish Balneological Consulting and Control Program (Head- prof. I.Ponikowska) Polish Association of Balneology and Physical Medicine Polish Association of Balneology and Physical Medicine Union of Polish Spas Union of Polish Spas Polish Spas Chamber of Commerce Polish Spas Chamber of Commerce Spa Communes Association Spa Communes Association

6. POLISH SPAS

7. Types of Medical Departmants in Polish Spas Kamień Pomorski Health Resorts HospitalHealth Resorts Hospital Health Resorts SanatoriumHealth Resorts Sanatorium Health Resorts polyclinicHealth Resorts polyclinic Department of natural treatmentDepartment of natural treatment

8. Referring the patients to the medical health resorts treatment Preparing case history Preparing case history and sending to the National Health Fund Remove of refers from waiting queue Doctor-specialist in balneology and physical medicine Health Insurance Doctor (F.D.) National Health Fund PATIENT mailing of refers to the patient, or signing him to the waiting queue mailing of refers to the patient, or signing him to the waiting queue review, check and confirmation of documents review, check and confirmation of documents determination of date and type of treatment (hospital, sanatorium) determination of date and type of treatment (hospital, sanatorium)

9. Finances of Health Resorts Treatment in Poland National Health Fund- about 70% National Health Fund- about 70% Insurance Company –about 10% Insurance Company –about 10% Centers of Family Support- 5% Centers of Family Support- 5% Agriculture Insurance Company – 5% Agriculture Insurance Company – 5% Private patients- about 10% Private patients- about 10%

10. Condition of polish Health Resorts Medicine (1)-substantial resources Natural resources: mineral water, healing gas, peloides 43 Health Resorts statutes 350 Health Resorts Medical Departments Health Resorts devices (salt graduation tower, walking taraces etc.) Climate, landscape

11. Condition of Polish Health Resorts (2 ) non material resources Medical, managers and other professional staff Own medical specialization- Balneology and Physical Medicine Polish Association of Balneology and Physical Medicine, and the other spa associations Research attainments Balneological methods and programs existing in health resorts Publishing the own Polish Journal of Balneology Working up medical standards in Health Resorts

12. The principal activities carried out in Polish Health Resorts 1.Treatment of chronic diseases in Health Resorts (hospital, sanatorium, polyclinic) 2.Health Resorts prevention 3.Balneorehabilitation 4.Health promotion 5.Spa tourism

13. Health Resorts privatization in Poland (1) In my OPINION (Prof. I. Ponikowska ) Health Resorts privatization almost every time decreases the quality of medical service !

14. Privatization in Polish Health Resorts (2) Present status Only one health resort was privatized in Poland Only one health resort was privatized in Poland There are some private hotels in Health Resorts with minimal medical service There are some private hotels in Health Resorts with minimal medical service Private Spa-Nałęczów Zdrój Private spa-hotel in Ciechocinek

15. Our problem: How to preserve spa medicine in Health Resorts in Poland Preservation of traditional Health Resorts medicine Improvement of financing by National Health Fund Improvement of quality medical service Improvement of quality medical service Preservation of conventional methods in Health Resorts medicine Preservation of conventional methods in Health Resorts medicine

16. Research centers in Balneology Clinic of Balneology Polish Association of Balneology and Physical Medicine Some physical medicine departments in Medical Universities

17. Current activities in balneological science present state and requirements Research works and doctors thesis are curried out Articles in polish journals are being published International research works in EU structures should be curried out to work out EBM based treatment programs Improving quality of research works done and publish them more frequently in IF journals Present status Future requirements

18. Research activities - Congresses International congresses of balneology should be hold International congresses of balneology should be hold in Poland in Poland Members of the Association should be taking part more often in other international congresses Members of the Association should be taking part more often in other international congresses Congress of Balneology is hold every 2 years by Balneological Association Congress of Balneology is hold every 2 years by Balneological Association Members of the Association taking part in others medical congress Members of the Association taking part in others medical congress Present status Future requirements

19. Education Activities specialization in Balneology and Physical Medicine There is a separates pecialization for doctors- balneology and physical medicine There is a separates pecialization for doctors- balneology and physical medicine Postgraduate education takes 2 years and can be done by those who finished basic clinical specialization Postgraduate education takes 2 years and can be done by those who finished basic clinical specialization There are 450 specialists in Balneology and Physical Medicine in Poland There are 450 specialists in Balneology and Physical Medicine in Poland Doctors in-training

20. Association of Polish Balneology and Physical Medicine Members of Association- 650 Members of Association- 650 Main activities of Association is to held congresses, publish Polish Balneology Journal (Balneologia Polska), taking part in education in balneology Main activities of Association is to held congresses, publish Polish Balneology Journal (Balneologia Polska), taking part in education in balneology http://www.balneologia.maxi.pl Leśna 3 87-720 Ciechocinek tel.:+48-54-283-3945fax:+48-54-283-3915

21. What goes wrong in polish balneology nowdays (1) Attempt to reduce medical services in Health Resorts, and to change them in recreation centers Attempt to reduce medical services in Health Resorts, and to change them in recreation centers Increasing amount and prosperity of nonconventional therapeutic methods Increasing amount and prosperity of nonconventional therapeutic methods Low level of accommodation service Low level of accommodation service Lack of modern health resorts law Lack of modern health resorts law

22. Too low financial support of the medical service from National Health Fund Too low financial support of the medical service from National Health Fund Lack of specific research and didactic center working for polish health resorts Lack of specific research and didactic center working for polish health resorts Too few specialists in Balneology Too few specialists in Balneology What goes wrong in polish balneology nowdays (2)

23. 1.These problems which polish balneology has to cope with, I think are general for all spas in EUROPE so we should work to solve them together 2.Most difficult part is to find a BEST way to solve them

24. Thank You!