Civil-law contracts as the solution to the poor accessibility to specialists?

Original Article, Zdr Publ 2012;122(2): 111-113


1 Independent Public Health Care in Krasnik

2 Medical University of Lublin, II Faculty of Medicine with the English Division, Department of Public Health

3 Institute of Journalism and Social Communication, Department of Media Workshop and Axiology, The John Paul II Catholic University of Lublin


Introduction. The functioning of specialist outpatient clinics is closely related with the value of the contract for the provision of health services, e.g. specialized outpatient care, concluded with the National Health Fund. Waiting time for advice of a specialist, i.e. the access to a specialist clinic indirectly depends on that contract.

Aim. The research aimed at proving the relationship between the form of employment of medical personnel and the number of performed medical services in specialist clinics in the Independent Public Health Care Unit in Kraśnik.

Material and methods. The study included five types of outpatient specialist clinics: surgical, endocrine, neurological, orthopedic and rheumatologic. The execution of the contract with the NHF in 2006, 2009, 2010 and the value of the contract in 2011 as well as the financial performance of these specialist outpatient clinics, were compared with each other.

Results. The amounts of services rendered in 2006 by the medical staff having employment contracts, defined by settlement points with the National Health Fund, were considerably lower than the values of 2009 and 2010. The agreement concluded for 2011 at discussed specialist clinics was also on average about the 85.08% higher than the completed one in 2006. Each of the clinics improved its financial result, with endocrinology and orthopedic clinics reducing the losses, the rheumatologic clinic changing the loss for the profit, and surgical and neurological clinics improving the income. In case of the reimbursement by the National Health Fund for over-the-limit services - this result would be further improved, and every of the discussed clinics would accomplish the year with the profit.

Conclusions. It has been showed that the change of the employment status from the employment contract to the civil-law agreement significantly increases the number of services rendered at specialist outpatient clinics and thus improves the accessibility to consultants. Moreover, the change of the employment status from the contract of employment to the civil-law agreement radically and positively changes the financial result at the analyzed specialist clinics.

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outpatient specialist healthcare, civil-law contract, medical specialist, financing the health care, models of the healthcare systems


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