The Polish Health Care System: in historical prospective and today
The evolution of the health care system
in Poland ( 1918-1989)
During the period of Polish independence between 1918 and 1939, health services were expanded, and some extra finances were tapped through a limited Bismarckian social health Insurance system which covered about 7% of the population. Under communist rule after the second World War, a Ministry of Health was created in 1945 and health care was declared a public responsibility. Administration of the health care system was strongly centralized as was the administration of the economy in general. Poland developed an extensive health care system over the next few decades which, however, resisted some aspects of the Soviet model. For example, private practice was never formally abolished and private medical cooperatives and dental services remained, although much diminished, under communism. There have been three major sets of health sector reforms before 1989. The first set of reforms aimed to develop free and universal public health care. Health care services were offered to all state employees, and in the 1950s occupational health clinics were set up at workplaces. Only limited free health care was available in rural areas, but this improved after 1972 when coverage was extended to include agricultural workers.
The second set of reforms aimed to bring together comprehensive health and social services in each district. In 1960, the Ministry of Health became the Ministry of Health and Social Welfare. In 1972, the integrated health care management units, the ZOZ (Zespół Opieki Zdrowotnej) were established, which managed hospitals, outpatient clinics, specialist and primary health care, as well as some social services.
The third set of reforms aimed to decentralize the public administration. Health sector reforms in the 1980s were linked to effort to decentralize the administrative structure of the country by strengthening the position of voivodships and later the gmina. In 1983, the powers of the Ministry of Health and Social Welfare were reduced and the voivodships and the ZOZ were given greater policy.
Mayor reforms in the Polish
health care system (since 1989)
The ongoing reforms of the health care system, initiated in 1989, were parallel with reforms of the national economy. Life expectancy was extended by four years at the low birth rate and the costs of pharmaceuticals and high medical technology continued to grow.
Positive effects of the reforms were manifested e.g. by shorter hospitalizations, improvement of primary health care, or restructuring of hospitals, including a decrease in the number of hospital beds. Following the system transformation in Poland, a number of solutions which were introduced over 1991-1998, focused on establishing a regulated market of services in the public health care system.
Numerous attempts to modify and improve the health care system failed to eliminate the negative phenomena which was the reason why – in the public opinion – the public health service was assessed negatively. In the late nineties, the need to enforce new reforms was recognised as a priority by the Government of the Republic of Poland.
As a result the 1997 general health insurance act enforced on January 1st 1999 created a new insurance-budgetary model of health care funding. The state budget was no longer responsible for funding health services. The separation of functions of the payer for health services from those of the health services organiser and provider became a crucial matter.
Health Insurance Organisation System
The HIO were autonomous, non-profit bodies provided with legal personality, established to ensure that the insured persons received services to preserve, save, restore and improve health. The services were provided in case of sickness, injury, pregnancy, child-birth and confinement, as well as in prevention of diseases and health promotion For the purpose of those tasks the HIO collected funds from premiums paid by persons assigned to the given HIO. Further on, the HIO managed the funds and contracted providers to render health services, both for prophylaxis and therapy.
Operation of the Health Insurance Organisations was supervised by the Health Insurance Supervision Office; its major responsibility was to protect the interests of insured persons.
The current state: National Health Fund
The solutions adopted in the general health insurance law proved insufficient. Considerable differentiation of the number and quality of services in individual regions (different service contracting principles in each health insurance organisation, different prices for the same service, etc.) and other deficiencies of the health care system called for adoption of different solutions.
The law on general insurance in the National Health Fund, was enforced on April 1, 2003. Under this law the Health Insurance Organisations ceased to exist. They have been replaced by the National Health Fund (Head Office with Branch Offices geographically corresponding with the regional HIO). The task of providing health services to insured persons within the framework of the Trade HIO was taken over by the NHF branches.
The next step towards clarifying the health protection system made by the NHF consisted in developing principles of health service contracting and cap prices for each health service, which would be uniform for all providers. These principles were intended to unify the pricing of individual health services across the NHF regional branches and attenuation of unjustified differences.
In spite of several new solutions, the law on universal insurance in the National Health Fund met with the criticism of opposition. In January 2004 it was legally qualified as not standing in accordance with the Constitution.
As a result of works of the Sejm Commission of Health, the Sejm of the Republic of Poland passed on 30 July 2004 the law on health benefits financed from public means. The law defines in a uniform way the responsibilities of individual and public bodies cooperating with the State in the area of citizens health care.
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