Polish Health Services 2005-06-15 In Poland every employee must be insured. Their health contributions reach the state insurer, who in turn guarantees financing for medical care. In theory, patients should not pay for treatment in a state-run health center, but in reality this is not always the case. In Poland, those covered by universal health insurance (obligatorily or optionally) can use free health services. Its rules are defined by a law of Jan. 23, 2003 on universal insurance in the National Health Fund (NFZ). Insured individuals and members of their families are eligible for free medical services if they use the services of doctors and medical centers which have signed contracts with the NFZ. The NFZ finances health services and ensures drug refunding for patients. It has a central office in Warsaw and 16 provincial branches. Public and private service providers who have signed contracts with provincial NFZ branches must provide health services. Service providers include health insurance doctors (physicians and dentists), public and private healthcare centers (hospitals, ambulance services, health centers and clinics), and individual, specialist and group medical practices. In Poland, funds for healthcare come from both public and private sources. Most funds are sent to the NFZ, which collects health insurance contributions. For 2005, the NFZ has a total of zl.32 billion at its disposal. Another source of public support for the healthcare sector is the national budget-in 2005 a total of zl.3.4 billion. A third source is money provided by local governments, which generate their income from local taxes. Private funds for the health service include households, employers, private health insurance and charity organizations. As a result of a healthcare system reform conducted in 1999, the main burden for healthcare financing and subsidies for the insured was assumed by health funds-subsequently replaced by the NFZ. Earlier the national budget was responsible for financing healthcare. On the basis of contracts with hospitals and clinics, the NFZ finances medical services (including hospital and ambulatory treatment and diagnostic examinations) and prevention as well as subsidies to medicines, which will consume 20 percent of its total receipts this year. Usually, local governments pay for the operation of medical centers as well as their utility bills and repairs. Local governments also finance some prevention programs. The national budget finances some highly specialist medical procedures such as bone marrow treatments, operations involving congenital heart defects in infants or cardiosurgical procedures in children under 18. The national budget also finances clinical hospitals, medical emergency services, blood banks and sanitary inspections as well as health policy programs. However, state outpatient clinics increasingly charge for their services-from zl.10 to zl.100-for a doctor visit without waiting. The reason is obvious: the number of patients wanting to consult individual specialists is larger than the number of medical services contracted with each outpatient clinic by the NFZ. The fund condemns such practices as illegal, yet they are currently a widespread practice. The situation could change with the emergence of private health funds, which were planned by the architects of the system reform of 1999. Today it is argued that private health funds would take contributions from high-income earners, leading to a gradual deterioration in the standards of services provided by the NFZ, which would lose many clients and eventually become a fund for the poor. This is because the health insurance fee is proportional to a patient's salary. Pessimists warn that the current system could collapse if this occurred. However, many critics of the current healthcare system insist that the creation of private health funds is being blocked for political reasons. The NFZ budget means a lot of money to distribute and many positions to fill. On the other hand, many private companies prosper by offering various prepaid medical packages, which are favorable to patients, because fixed monthly charges guarantee better treatment conditions than those provided by traditional public health facilities. Many families may actually pay less for such plans than the average health insurance contribution to the NFZ. Perhaps some of the contributions could consequently be directed to private funds if these proved capable of financing treatment of more serious ailments. Andrzej Komorowski, a doctor at the Hilaritas Family Psychomedical Center, says that an institution such as the NFZ should only be intended for the poorest citizens. Every employee could be insured, but only up to a specific amount, for example zl.1,000 quarterly. "In addition to the National Health Fund, a Private National Health Fund should be established, bringing together private specialists entering the market with guarantees from their bank," said Komorowski. In his opinion, there must be both private medical centers and private health funds so that Western partners could enter the market in greater numbers. Watching the tempestuous development of the Polish medical services market-and the frustration of those who pay obligatory contributions, but pay out of pocket for private doctor visits anyway-it might seem that the emergence of private health funds is only a matter of time. Private institutions usually precisely calculate their costs-unlike many of state-run health service centers inherited from communism. Employers increasingly finance prevention-treatment, prepaid healthcare packages for their employees. This is quasi-insurance for employees. A December 2004 report by the Ministry of Health, Financing Healthcare in Poland, states that in 2002 (according to the most recent data), employers bought about 300,000 prepaid packages for large companies and a similar number for small businesses. By now, this figure has probably exceeded 1 million. Generally, medical care for a fixed monthly charge is offered by employers (including most foreign companies which have invested in Poland), even though it is also possible to pay on one's own. This is usually done by well-to-do people who do not want to wait in line to see a doctor in the public system and also expect higher service standards. Over the past decade, more than 10 companies have appeared on the market to offer medical treatment for a fixed payment. These include Medicover, Centrum Medyczne Damiana, Centrum Medyczne Enel-Med, Medycyna Rodzinna and Falck Medycyna Sp. z o.o. "Foreign patients will ultimately account for about 20 percent of the services offered by private healthcare providers," says Dr. Marek P³oszczyñski, president and owner of Centrum Medyczne Damiana. Renowned medical companies have their own websites with information about their services. Their staff is generally fluent in foreign languages. Centrum Medyczne Damiana, which has its own modern hospital and clinics, has experienced doctors fluent in English and German. Payments from patients in cash account for 60 percent of the center's revenue; contracts with companies which ensure medical care for their employees provide a further 35 percent; and cooperation with Western insurance companies accounts for the remaining 5 percent. The center can make cash-free settlements for services to patients with insurance from international companies such as BUPA, AXA, PPP Healthcare and Allianz. The prices of procedures are about 50 percent lower than in Western Europe. Medicover, which operates not only in Poland, but also in the Czech Republic, Hungary and Estonia, has more than 5,000 corporate clients in the region. It is oriented toward both treatment and prevention. In Poland, Medicover has 19 medical centers and cooperates with nearly 300 facilities. More than 100,000 clients carry its prepaid healthcare cards. Falck Medycyna Sp. z o.o., which offers prepaid packages for companies and individuals, maintains a personnel that is fluent in English and operates clinics adapted for disabled patients. Falck has clinics in Warsaw, Cracow, Katowice, Gdañsk, Szczecin, £ód¼ and Poznañ, and cooperates with partner clinics in 200 cities. Enel-Med Medical Center has its own general practice hospital and specialist clinics. Payments can be made at each individual visit or with a prepaid package. Similar to state hospitals, the center provides emergency standby duty for laryngology, orthopedics and internal medicine. It also offers prevention programs for individual age groups and separately-cancer and heart disease prevention. The more expensive the package, the more extensive the range of medical services offered. The cheapest monthly package, covering basic medical assistance, costs less than zl.100. Packages guaranteeing hospital treatment are more expensive. Cheap packages are becoming increasingly affordable even for lower-income earners. In April, the average monthly salary in Poland in the corporate sector was zl.2,425, according to the Central Statistical Office (GUS). Prepaid cards are also available from some hospitals. One example is the renowned Central Clinical Hospital of the Ministry of Internal Affairs and Administration in Warsaw. Once accessible only to uniformed services, it is now also open to ordinary patients. The cheapest card provides access to basic medical specialties and tests, while the most expensive card guarantee access to all services available in the hospital, with the exception of complicated operations and transplants. These operations are performed as part of health insurance. In the hospital, insured patients can also make an appointment with a doctor, because the hospital has signed a contract with the NFZ, which finances these services. In addition, private medical treatment financed exclusively by patients, not by companies in the form of prepaid healthcare packages, is developing in Poland. Patients consult with doctors at their private office, where the service usually costs upwards of zl.100 or in private or cooperative clinics, which affiliate doctors of the same or different specialties. Consultation prices in such facilities start at zl.50-60. Reproduced with permission from Click on the logo for current issue of Poland's English language weekly