Polish he alth care is a topic that arouses a lot of emotions among patients. Is it efficient and how does it compare with other European countries? We asked Rafał Janiszewski, the owner of the Advisory Office providing services in the field of he althcare organization for he althcare entities and patients' rights, with these questions.
Anna Tłustochowicz: Can we start our conversation with the definition of the he alth care system?
Rafał Janiszewski:Please. Many people think that this is all that is a public service, and that is not true.The he alth care system should be treated as the entirety of services, all he alth servicesboth provided by institutions and private institutions. The system is created by those who are financed by the National He alth Fund and those for whom we pay out of our own pocket. There are several models of the he althcare system. The first one that would need to be replaced is the insurance system.
Our?
No.We are not such a system at all!The insurance system is based on the fact that citizens pay contributions to specific he alth insurance funds. For insurance funds, which are not always - or even not at all - part of the state administration. They are often autonomous when it comes to finances. The funds determine the scope of he alth services that are financed by the insured and differentiate the premiums! Soinsurance system, it is a system in which - to put it bluntly - I pay the premium to a given insurer , and depending on the amount of the premium, he or she sets a basket of benefits for me. So it determines which he alth services it will pay for. Taking into account e.g. the risk of …
Yes. It's clear. The next model of he althcare is what?
National He alth Service.
And this is our system?
Not either. The National He alth Service is e.g.in Great Britain, Italy, Sweden.Access to it is for all citizens. Regardless of the we alth of the wallet. There are some additional benefits, privileges, special opportunities for certain groups of citizens. In general, these are groups that are particularly important from the point of view of the state's he alth policy.
So?
For example, if the he alth policy isfocused on cardiovascular diseases, people with heart disease will have additional powers. Pregnant women are a particularly eligible group.
And what does the financing of he alth services look like?
They are paid from the state budget.
There is no he alth insurance fee?
This isa tax system.Taxes are structured differently, of course, organized differently, but generally speaking, he althcare services are financed from the state budget.
And provided by public he alth institutions?
Mostly yes. All public he alth is subject to quite strict state control. Again: it is logical that since the state finances benefits from the budget, it also exercises supervision over the institutions that provide them. The state simply controls what it pays for. It can be said that this isa very pro-social system.Another system is also called the national he alth service, but in the Soviet version. So it is the so-called siemaszka.
Still practiced in Russia?
Yes. This is free access to he althcare for every citizen.
This system is completely centralized, completely nationalized, the clinics do not have any autonomy, they are managed from above. The state knows better what citizens need.
How is this different from what is eg in Great Britain?
The fact that the so-called he alth policy. He alth problems emerge, he analyzes the phenomena. And the medical entity, which is from the public sector, is largely independent and ensures compliance with standards, takes care of improving quality, etc.The facilities are financed from the state budget, but no one manages them on behalf of the state. However, in the Soviet version it is all equally, managed from above.
For a citizen, where is it better: in Russia or England?
Of course in England! We have privileged groups there, we have benefit baskets, while in Russia there is a legalization of rights and that's it.
Another model?
Voluntary He alth Insurance. One such country is the United States, whereis not required to have he alth insurance.Citizens can contract with an insurance company of their choice, but do not have to.
And Hollywood productions are made about the drama of the uninsured, where it suddenly turns out that, for example, a child will not have an urgent heart surgery.
This systemin fact, it didn't quite work out and that's where Obama Care came from. Basic he alth care was provided to those who did not take out this he alth insurance.This program was aimed at the poorwho were told: "We will give you money to buy this basic he alth insurance." But let's go back to Europe.
In Europe, in most countries, we have mixed systems that combine the Bismarck insurance model with the possibility of voluntary, additional insurance, and there are also elements of the national he alth service there.
Of course, the question arises …
Which system is the best!
Of course (laughs). The answer will depend on who is judging. However, we also have the option of a fairly objective assessment, where various measurable indicators and elements that affect the final assessment are taken into account.The World He alth Organization has created a ranking of he alth care systems , which took into account, inter alia, the effectiveness of the system in ensuring the protection of citizens' he alth and their satisfaction with the services provided.
Where is the best?
France always comes first in the rankings. But let's be honest, open and honest: which system is the best depends mainly on how much citizens spend on contributions or he alth taxes. And we, Poles, spend very little.Hence, the Polish he alth care system is one of the worst in Europe.I want to emphasize clearly that this "worst" is not due to the fact that we have bad medics, bad hospitals. It results from the fact that our Polish system wants to create the largest possible range of access to services with a small premium.
This can't be successful? There are no miracles?
Sure there isn't. Hence, at the moment,in Europe, many hybrid systems are being created,combining state expenditure on he alth care, citizens' contributions and subsidies to certain benefits. Note that we also pay extra in Poland …
To the dentist.
Yes, but also mainly for drugs. The state also contributes to the he alth care system, e.g. through various types of programs. After all, we have the National Program for Combating Cancer Diseases, where the state finances the equipment of medical facilities providing services in this area. To sum up: there are many models of he alth care in the modern world, these are models that combine various elements.
Each of them has one most important common feature: more and moreresponsibility is placed on the citizen.
How?
Simple: if you do not want to pay a higher premium, you will have to pay more for higher standard benefits, for example. Or simply: if it pays a lower premium, you will wait in a long line to see a specialist. And if you go privately, you will not wait at all and you will have your appointment right away, but you will pay for it out of your own pocket.And this private visit - let me remind you - is also an element of the Polish he alth care system.
And what kind of he alth care system do we have today?
First of all, we no longer have the insurance premium! In fact, in Poland today we have a kind of he alth tax, which citizens pay and from which - in a joint and several manner - he alth services are financed. Please see: in an insurance system, the availability of benefits depends on the type of insurance you have. In Poland, no.
In Poland, all insured persons have the same right to the same scope of benefits. We have one centralized payer that is accountable to the state.
Therefore, we have a peculiar mix of different solutions. After all, in the Polish system we also have private insurers. We can additionally insure ourselves in a private medical center, but these are not alternative insurance!
Although I will buy a package in a private medical center, I still have to pay the he alth insurance premium.
This is because it is a kind of solidarity among citizens. Finally, it must be said that if we still, as citizens, do not have confidence in the National He alth Fund and we do not want to pay a higher premium, then we will definitely have to pay extra for our he alth care: either buy individual medical services or additional insurance.
Expert
Rafał Janiszewski, owner of the Advisory Office providing services in the field of he althcare organization to he althcare entities
Speaker, organizer of many trainings and conferences on he alth protection and patient rights. In the years 1998-1999 an employee of the Office of the Government Plenipotentiary for the Implementation of the General He alth Insurance. Author of over 20 books on he althcare organization and he alth care financing standards. In 2005-2007, he was an expert of the Presidium of the Parliamentary He alth Committee, as an advisor on he alth services. Co-author of the general study as part of the Pharmaceutical Pricing and Reimbursement project for the European He alth Commission.
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