What’s next for healthcare in Poland?
The 156th mBank-CASE seminar was devoted to Poland’s healthcare system. After almost a decade, we decided to return to this important subject, because the problems we pointed out 10 years ago (at the 97th BRE-CASE Seminar on June 12 2008) are unfortunately still current.
The experts invited to the May mBank-CASE seminar on healthcare economics initiated another discussion on the situation of the healthcare system, and their theses and recommendations are based on the results of comparative analysis of the results of European research projects they participated in over the past decade.
The introductory presentation was delivered by Professor Stanisława Golinowska, vice chairwoman of the CASE Supervisory Council, a professor of economic sciences who specializes in healthcare economics, social and healthcare policy and public health at the Jagiellonian University’s Collegium Medicum and the Institute of Labor and Social Affairs. She started her presentation with a discussion of the difficulties in diagnosing the situation in Polish healthcare, whose causes include problems of definition. She stressed that diagnosing and assessing the situation requires adequate approaches and support in research, analysis and forecasts. Also necessary are regular reports on the situation in the healthcare sector. The problem is that in Poland there is no institution that performs such analyses. Although much research is conducted, often it is not considered at all by politicians, Golinowska noted.
In her conclusions, Golinowska stated that it is high time for Poland to conduct a comprehensive and honest diagnosis of the healthcare system and to develop a reform program; however, this shouldn’t be a revolution that takes place by destroying what has already been created. She also pointed to the need for an honest information campaign on healthcare, and stressed the importance of health education, as well as the need to build confidence in the healthcare sector’s institutions and workers.
The second speaker was Dr. Hab. Christoph Sowada, director of the Public Health Institute in the UJ’s Collegium Medicum, who presented the system and level of financing for healthcare in Poland.
At the outset, he stressed that although spending on the health service is increasing in Poland (in 2015, PLN 114 billion was spent, taking into account both public and private spending, and in 2016, more than PLN 120 billion), but it still remains much lower than in developed countries. But Sowada stressed that the problem in Poland isn’t just insufficient public funds for healthcare, but also the way the funds are spent. Healthcare in our country is fragmentary, and marked by fragmented budgets, as a result of which we have an uncoordinated, “hospital-centric” allocation of funds, while allocation should be coordinated and “patient-centric.” A great deal of money is designated e.g. for inpatient care (Poland is among the leaders in the OECD on this measure), while other countries try to shift spending and treatment to basic care, Sowada noted.
He also presented how spending on healthcare can be increased. In the case of public spending this can happen by measures including growth of social insurance contributions or broadening the earnings base on which they are calculated, or by requiring the same contributions from everyone (the question of the KRUS farmers’ social insurance system). Other methods include an increase of budget subsidies, greater engagement by local governments and/or dedicated excise taxes on cigarettes or alcohol. A separate question is private health insurance, or the introduction of copayments by patients for medical services.
The questions of patient payments for medical services in Poland and selected EU countries was discussed by the next speaker, Dr. Marzena Tambor of the Jagiellonian University’s Collegium Medicum.
International research indicates that mandatory patient payments for health services are decidedly more widespread in Western Europe and take various forms, of which copayments (fixed payments) are most common. The conclusions of Dr. Tambor’s research on the experiences of countries that have introduced payments indicate primarily that this changes the usage of medical services, and the most exposed are vulnerable groups, meaning the poor and chronically ill. In turn, net revenues from this type of payment are relatively low. In the countries of Eastern Europe that have introduced forms of copayments, they sparked great social opposition, and succeeding governments eliminated copayments, which for the healthcare system meant a lack of stability.
Dr. Tambor listed the arguments for introducing copayments in Poland; the main one is the low financial resources designated for the health service (6.3% of GDP in 2015), and, which follows, the need to spend them very efficiently. The second important reason is the fact that Poles already frequently use services offered by the private sector, paying out of their own pockets, and polls indicate that consumers are willing to pay for benefits with higher quality and accessibility (often young people, with higher incomes and better health).
Dr. Tambor also pointed out the barriers to the introduction of fees in Poland. The most important are the already high share of households in total healthcare financing (23%) and high public opposition to the introduction of this type of payment, combined with a lack of faith that additional financing will improve the quality and accessibility of services. As the speaker stressed, the social consensus on the question of patient payments is exceptionally important, because politicians will use the issue in election campaigns, and it is highly likely that the next government will cancel the payments.
Dr. Alicja Domagała, director of the Healthcare Policy and Management Department at the UJ Collegium Medicum, discussed one of the effects of insufficient financing of the health service: staff shortages.
OECD data indicate, for example, that during the past 15 years in Poland there has been practically no change in the number of doctors per 1,000 residents. Domagała pointed out that Poland is not the only country affected by shortages of medical staff. According to EU estimates, shortages throughout the bloc in 2020 will total more than 1 million workers. But in Poland, in contrast to many other European countries, there is still a lack of formal structures for planning and forecasting the staff of the healthcare system, as well as systematic strategies and forecasts.
Domagała also presented solutions to the staffing crisis, including: introduction of thorough analysis in the planning of education and forecasting employment of medical employees; putting compensation policy in order; defining migration policy for medical workers and monitoring the scale of migration; and introducing non-medical staff professions (e.g. medical assistant, public health specialist, health coordinator, organizer and promoter) to lighten the burden on medical staff and make their work more efficient.
The final speaker was Dr. n. med. Krzysztof Kuszewski, a deputy health minister in the 1990s and co-creator of the National Health Programs (NPZ), who focused on the concept of public health.
He began by stating that health spending should be treated not as a cost, but as an investment in people (this is also the position of the World Health Organization), which the state and society receive back in the form of various social and economic benefits in many sectors. Here arises the need for national healthcare programs; Poland had the last such program in 2007-2015. He described the general targets (including improved health and reducing health inequality) and designated 18 operational goals that are measurable – which is a fundamentally important characteristic. Kuszewski stressed that attention to public health isn’t an alternative to therapeutic medicine (both are essential), and presented how public health should be redefined. He mentioned components of public health including eliminating inequalities in the health of various social groups; targeting operations at people who need help and support; and the need to decentralize programs as part of the National Health Programs and adjusting them to local needs and decisions.
The speakers’ presentations bore fruit in a substantive discussion that engaged the seminar participants. Audience members brought up questions including the reasons for failure to fully use medical staff (limits on patient admissions), the influence of new technologies on healthcare and the development of telemedicine and robotization in the healthcare system.