Table 4.

The assessment of health system governance in Denmark, Greece, and Poland

	Denmark	Greece	Poland
1. Transparency
1.1. Is the population entitled to services under the statutory health system clearly defined in legislation, and is it clearly communicated to the public?	Y	Y	Y
1.2. Is the list of services, to which patients are/are not entitled under the statutory health system, clearly defined in legislation, and clearly communicated to the public?	S	Y	Y
1.3. Are quality and waiting time guarantees under the statutory health system clearly specified in legislation, and clearly communicated to the public?	Y	N	N
1.4. Is the information on performances (quality, waiting time) of health care legal entities (e.g., hospitals, clinics, individual practices) collected and publicly available?	Y	N	S
1.5. Is obligatory patient cost-sharing under the statutory health system clearly specified in legislation, and clearly communicated to the public?	Y	Y	Y
1.6. Are patient payments under the statutory health system, other than obligatory cost-sharing (e.g., gratitude payments, payments to foundations, balance/extra billing), clearly regulated, and clearly communicated to the public?	S	S	S
2. Accountability
2.1. Are there any laws or regulations, and are they enforced in practice, to penalize individual health professionals for demanding or accepting informal patient payments?	Y	S	S
2.2. Are there any laws or regulations, and are they enforced in practice, to penalize health care legal entities (e.g., hospitals, clinics, individual practices) for demanding or accepting informal patient payments or for their employees demanding or accepting informal patient payments?	Y	N	S
2.3. Are there any laws and regulations, and are they enforced in practice, to penalize patients (or individuals acting on their behalf) for giving informal payments?	Y	S	S
2.4. Are there any mechanisms within the health system (e.g., internal whistleblowing, complaint mechanisms) to enable people to report cases of informal patient payments and be protected against reprisal?	Y	Y	S
2.5. Are there any watchdogs (e.g., committees, Ombudsman) at the national, regional, local or individual level, which are responsible specifically for protecting patients’ rights.	Y	Y	Y
2.6. Are there established and effectively implemented mechanisms to hold health care legal entities accountable for providing adequate quality and access to care (e.g., accreditation, monitoring of errors and compliance with quality standards, quality-based payment mechanisms, etc.)?	Y	N	N
2.7. Are there established and effectively implemented mechanisms to ensure adequate financing of the benefit package by public payer/s (e.g., cost-based price setting, population needs assessment, etc.)?	Y	N	S
3. Participation
3.1. Is there a rule and practice of involving relevant stakeholders (including patients) in health care decision making at the local, regional, or national levels?	Y	S	S
3.2. Are there any monitoring and evaluation mechanisms in place that enable citizens to provide feedback on the quality of care?	Y	N	N
3.3. Are there any mechanisms and policy initiatives to foster patient involvement in decisions regarding their health (allowing the choice of providers, promoting shared decision-making, patient empowerment, and person-cantered care)?	Y	S	S
3.4. Has the participatory and consensus-based approach been applied to policy on obligatory patient cost-sharing in the statutory health system?	Y	N	S
4. Integrity
4.1. Are there any specific missions, strategies, codes of conduct to fight/prevent informal patient payments, which authorities and institutions are committed to?	S	S	S
4.2. Are the public sector and private sector well separated, i.e., are health care legal entities allowed to provide both public and private services, and are medical professionals allowed to work in both the public and private sectors?	S	S	S
4.3. Are there any regulations and mechanisms to take into account the performances of health professionals when hiring, promoting, and remunerating them?	N	N	N
5. Capacity
5.1. Are there any specific institutions that provide evidence and support health policymaking, including policy on patient payments (e.g., HTA agency, research institutes)?	Y	Y	Y
5.2. Is there a mechanism and practice of relying on evidence in health policymaking?	S	N	N
5.3. Are reliable data (e.g., from national household surveys) on informal patient payments systematically collected and available for policymakers?	N	N	N

Note: Y – yes, S – somewhat, N – no