In 2016, we spent as much as PLN 56.6 million on private he alth insurance. No wonder, public he alth care is insufficient for many of us. However, it is worth knowing if we spend this money well and if we will receive the services we expect for it. Read how to choose the best he alth policy and what are the pros and cons of such a solution.

Zprivate he alth insurancewas used by 54 percent of Polish households in 2015, according to the report "Social Diagnosis". Meanwhile, only 12 years ago, only 27 percent of respondents were treated in private facilities.

In turn, according to CBOS research, the increase in interest inin he alth policiesis primarily influenced by: shorter waiting times for an appointment, no need to refer to a specialist, greater involvement of doctors and more convenient admission hours.

What is private he alth insurance?

The private he alth insurance market has developed a lot in recent years. Private policies are a paid supplement to he alth insurance guaranteed by the National He alth Fund. It is not worth risking a high invoice for treatment later, because you did not pay the obligatory contributions.

However, it is worth ensuring greater comfort of treatment and access to specialist doctors. This is the motivation of most Europeans - not only our public he alth service needs to be supplemented with private insurance.

Private he alth insurance cannot replace that guaranteed by the National He alth Fund - in emergency, when you need to save your life, you will end up in a public hospital.

Experts: the he alth insurance premium should be increased

Medical care requires systemic changes, more financial resources are needed for this, and this means an increase in the he alth insurance premium - experts said during the conference "Priorities in he alth care", which took place on January 10, 2022 in Warsaw.

Head of the Department of Surgery and Urology for Children and Youth at the Medical University of Gdańsk prof. Piotr Czauderna said that the main changes should be to ensure better interaction between primary he alth care and specialist outpatient careand hospitals at various levels. "At the same time, it is necessary to increase the financing of medical care in our country so that we can meet the increasing he alth challenges related to, inter alia, with the aging of the society "- emphasized the specialist.

A serious challenge in our country is the shortage of medical staff. According to the data presented by Dr. Gałązka-Sobotka, Poland ranks 27th in Europe in terms of the number of doctors and 28th in terms of nurses per population.

Source: Esculap.com, https://diabetologia.esculap.com/news/154804/naley-podwyszy-skadk-zdrowotn?link_id=203601

You have two basic solutions for this:

  • subscription to a private medical center,
  • he alth insurance in the insurance company.

The main difference between them is that you can buy a subscription directly in a specific facility, although it also has the form of a he alth policy. As part of the insurance in the company, you have the option of using the network of facilities, even where there is no clinic. The costs of treatment will then be reimbursed by the insurer.

Advantages of a private he alth policy

1. Variety of choice

He alth policies belong to the group of voluntary insurance, and thus the offers available on the market are quite diverse. For example, hospital insurance enables hospitalization in a higher-standard facility, medical cost insurance (KL) reimburses treatment-related costs, and medical insurance guarantees outpatient treatment.

There are also packages on the market that provide comprehensive insurance protection. It is the variety of offers that is one of the main advantages of private he alth insurance. Both policies covering only specific conditions are available, as well as packages that guarantee care in a broader scope. This makes it easier to adjust the insurance to your financial capabilities.2. Access to specialist doctorsAnother advantage of private he alth insurance is the much greater availability of specialist doctors. In this case, you do not need to have a referral from your GP.

You just need to arrange a date convenient for you. Importantly, the waiting time for such an appointment is a maximum of several days, while patients using the state he alth service have to wait several or even several dozen months.

3. Possibility to take out insurance in the workplaceOffersprivate policies in the form of packages are also often directed to companies. In such a situation, employers cover all or part of the cost of insurance.

Both solutions are very beneficial for employees. Moreover, as a person covered by such a policy, you can extend it to your loved ones, e.g. your partner. In the case of state insurance, this option applies only to family members.

Disadvantages of private he alth insurance

1. Private insurance does not replace the benefits guaranteed by the National He alth Fund

The services included in such policies have a narrower scope. Situations such as:

  • committing or attempting to commit suicide or self-harm by the insured person;
  • hostilities, riots, as well as acts of terror or strikes;
  • infertility treatment and diagnosis;
  • intoxication with alcohol, intoxicants and drugs used contrary to medical recommendations

and the resulting he alth problems are not covered by private insurance.Grace period, exclusions and rehabilitation visitsWhen signing the contract with the insurer, you should also check the issue of possible grace periods. This is the period during which you cannot take advantage of the insurance, despite the premium paid.

Most often they concern the most expensive services, e.g. rehabilitation. For example, if the grace period for this service is 60 days, you will be able to use it under the policy only two months after signing the contract.

Private he alth insurance usually does not cover the cost of ambulance travel, but only medical transport of a specific, private facility.

Poles spend PLN 40 billion on private treatment every year

Long lines to see doctors and low-rated quality of the public he alth service mean that Poles spend an average of PLN 40 billion a year on treatment out of their own pocket. According to last year's CBOS survey, most Poles are dissatisfied with the functioning of the National He alth Fund, and over 50% receive private treatment.

Some insurers also use the so-called sanitation visits. If it concerns, for example, dental treatment, then a visit to the dentist is necessary to determine the condition of the dentition. All detected cavities must be treated for a fee. Only then will each subsequent visit to the dentist be covered by the insurance and the limits for visits or specific examinations are also applied. As in the case of grace periods, they apply to the most expensive services, e.g. magnetic resonance imaging or computed tomography. Any information about the limits of such tests is always written in the contract or in the general terms and conditionsinsurance (GTC).

Private and state insurance - the best model?

You already know that you cannot resign from the NHF completely. But if you visit a private doctor several or a dozen times a year, it is worth revising these expenses and paying for a policy tailored to your needs, e.g. if you have a preschool child, you visit a doctor even several times a month. You often do additional research.

As a parent, you most likely avoid long lines in waiting rooms, because with a sick and whining toddler it is an unnecessary burden. In this case, the policy allows you to arrange an appointment quickly and also do tests as part of the subscription. To make the best use of it, choose it exactly to your needs, analyze your and your family's he alth, recent expenses, availability of doctors, facilities, and tests. Compare different offers, you can do it without any problems using the services of an insurance comparison website, and a conversation with a consultant will also make your task easier.

Such services are provided by e.g. mfind.pl. Only then make a decision. So far, no system has been invented that would work flawlessly in this respect and would be sufficient if you wanted to base your treatment only on it.

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