EN
The article has formulated the concept of a health care system (HCS) with its components, structure, goals, functions and tasks. It also relates to a construction of mission and “good practice” in health care. Then it shows that the notion of evidence based medicine is for axiological reasons significantly opposed to a construction which uses the assumption of “good practice”. When constructing theoretical bases and appropriate modelling techniquest widely interpreted logistics may prove useful, e.g. enabling the increase in the number of transplants performed in Poland. The following task was formulated: to lay out, where possible, a direction which rationalises evidence based health care without the need for resolution of moral dilemmas, concerning e.g.: queues, transplants, refusal of services. This can be realised through the use of system diagnostics along with health measurement. The implementation of risk management methods in HCS should also form an important complement to this direction. Active methods of risk management in health care were presented, such as: modification of VaR which enables the assessment of medical, economical and logical effectiveness (MEL effectiveness) and leads to rationalisation of choices on limiting the availability of medical services, a model of modification of risk factors which enables the creation of a post-operative care system on general surgery wards, a method of black spots in hospital care, ETA and FTA methods. The practice of using system diagnostics and health measurement on the basis of ICF platform was then referred to. It was stated, that without axiologically appropriate assessment technologies which are MEL effective may not be selected and as a result a credible basic health benefits basket, nor additional baskets may not be created. At the end the conditions and practice of HCS in Poland were referred to, showing the existing, uncontrollable conflicts. It was established that to conduct rational health care policy and effective MEL risk management in health care the following are necessary: a holistic approach, and e.g. basis of utilitarianism as a theoretical foundation, creation of system assessment tools – aggregates, scales, multidimensional qualitative and quantitative models, data analysis methods (cluster analysis, clustering, data analysis methods).