The 2017 reform of the hospital sector in Poland - The challenge of consistent design.

Beginning in October 2017 a system of basic hospital service provision, popularly called the 'hospitals network' was implemented in Poland. It covered 594 hospitals out of a total number of approx. 920 operating in 2017. The regulation's official objectives were to: "(1) improve the organization of services delivered by hospitals; (2) improve access to hospital care; (3) optimize the number of specialist wards; (4) improve coordination of in- and out-patient care; (5) facilitate hospital management". The aim of this paper is to describe the background of the reform planning and its formal objectives, content and implementation process, as well as to assess the preliminary results and discuss the possible limitations and implications. Although the official term 'hospitals network' is used to describe the reform, in practice it does not involve an element of cooperation between hospitals. The regulation's main feature was changing the financing methods for a pre-defined scope of services (from per-case to global budget).The reform was planned and implemented on a rather ad-hoc basis while its major controversy is the lack of quality of care, health outcome and population health need measures in the network inclusion criteria. The assessment of the reform's impact on service provision requires long-term analysis and access to detailed quantitative data.