Poland

Background

After 1990, Poland split its national health service into several provincial health services. It was only in 1999 that funding and provision were separated by establishing one health fund for each province. All residents of a province were automatically enrolled with their respective funds.

Recent years

In 2001, people were given the option to switch to funds outside their area of residence, which may eventually have resulted in a quasi-multiple insurance system. However, there was a perception that this system aggravated the already pronounced geographical variations in the quality and availability of healthcare. In 2003, influenced by a new Minister of Health, all health funds were merged into a single national insurance fund. The constant shuffling within the Health Ministry (including the six ministers appointed between 2001 and 2006) has plagued Polish health reforms, making it impossible to fully carry out a specific reform programme during these years.

The national insurance fund is financed from wage-related contributions paid by each worker, with no formal split between employee and employer contributions. It negotiates wages and prices with all providers collectively. Patients do not have a free choice of specialists; a referral from a GP is required.

The provider side is very concentrated and possibly over-integrated. Almost 80% of all doctors are specialists, and hence, costlier than GPs. The government has pursued a strategy to strengthen the role of “family doctors” by granting them capital cost subsidies. Hospitals are generally run by local authorities, and their budgets are determined by historical formulas.

Current situation

Waiting lists and shortages continue to be a problem, which is why informal payments still exist. According to one estimate, practitioners received about 15% of their income through “gratitude payments”. In 2008, six health reform bills were presented by the Civic Platform (the party of Prime Minister Donald Tusk), including one which would transform health institutions into commercial enterprises. However, President Lech Kaczynski, who is part of the opposing Law and Justice Party, has vetoed three of the bills, eliminating the possibility of reforms in this sector.

Despite the informal move towards the private sector, reliance on private care is growing. About 10% of patients are now being treated in private hospitals and private doctors provide around half of the several types of specialist treatment.

Poland has also made progress in overcoming common threats to public health. With regards to HIV, tests are soon to be free of charge for all pregnant women. In addition, smoking has been banned on Gdansk beaches as of June 1 2009. Measures to ban smoking nationwide are expected to be implemented by the end of 2009. 

Poland statistics

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Total Population in 2006: 38,140,000

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