The picture of Polish health service

The picture of Polish health service.

Polish health care system deserves a mediocre note. Abnormally low compared to its potential. In addition, you can leave it on the basis of not just one but many indicators. The quality of medical services offered by the NHF, the same doctors and facilities where these services are implemented, you can write epics. Examples is really a lot, not to mention the fact that the waiting time for an appointment with a specialist ranges on average from a month up to half a year, of course, if we are lucky.

Facility itself has a tradition dating back the nineteenth century, and in my humble opinion, time has stopped just at that time. For example - horror of horrors - they included the so. mixed units, or male-female, where - according to the name - on one branch and are hospitalized men and women. It is true, is there are only two or perhaps even two, however, although it seems to me that in civilized conditions, and even more in the XXI century is a rather embarrassing for the representatives of both sexes residing there, and for many, even unacceptable.

As regards the social conditions - living in these units, they are standard - there is a dining room, kitchen, where meals are issued, there are also two bathrooms with toilets koedukacyjnymi - both women's and men's and showers, opened by a nurse at the request of the patient, or usually at the whim of the staff, ie, at specified times and for a short time, so that it is impossible to use the showers if you do not have a corresponding reflex. However, what many przyprawiłoby the chills, it's not uncommon that patients sleep when you arrive at the cot in the hallway, because it has no place in the halls, which left without comment.


Theoretically, our average life expectancy reaching 75 years, ranked the world's relatively high rate. In the end - in Angola, the newborn boy has a chance of surviving 38 years in Congo - 42 But what of that, since we live longer than people as much as 33 countries. And not just rich (Japan, Norway, Canada), but poorer countries (Costa Rica and Cuba - after 77 years). This is what you can - divide by two

Success in business medical Gerber began in 2000 when he built in Wroclaw EuroMediCare specialist private hospital beds by 55. It turned out soon that the market does not need so many new outlets, such as healing agents. From this observation led to the idea of establishing contacts with local EMC, which corresponded to their area of work inefficient and indebted hospitals. First transform the district hospital in a private self-made jointly in 2004 Ozimek. Following a deep reorganization, the balance began to spinać after four months. This encouraged the EMC board to seek partners to further the transformation of hospitals.

Today, EMC creates a network of five hospitals and nine clinics. In some institutions is a major shareholder, in other rents equipment and conducts operations as a completely new entity. The EMC network doctors use appropriate incentive schemes. Broke with the traditional model in which the heads are independent ordynatorzy, for the structure known from a single company. The company finances investments with current revenues, and a major injection of funds has brought its public issue of shares in July 2005 and entering the Warsaw Stock Exchange.

Worse we have several indicators that are strictly medical: the number of deaths from non-operational reasons, a high infant mortality, the level of dissatisfaction with hospital services. Well, poor quality of medical services, issuing directly from a socialist economy. Confirm this, anyone who for two months waiting for diagnostic tests using the apparatus, three months to meet with a specialist, and some operations half a year (and most often, patients complain to the Ombudsman). At one point ranked among the best - the number of doctors and nurses per 1000 inhabitants. So what, when and so massively emigrate in search of bread.

It's easy to defend the thesis that the main cause of misery Polish health service is too small pot of money left to her disposal. In terms of per capita spending on health care, the level of 354 dollars. in 2003 (comparable data WHO currently about $ 500. like its appreciation of the zloty), deal with one of the last quarter of the seats in ten countries providing such information. Issue for this purpose 8 - 10 times less than those of the old European Union (although the level of GDP per capita is lower in our "only" three - four times), and also two times less than the Hungarians and Czechs. In nearly 12 percent. money on health care from the state budget (4 billion zł) and budgets of local government (2.8 billion Polish Zloty (zł or PLN)), while the bulk (34 billion PLN, or 59 percent.) from the collection of universal health insurance, paid to ZUS and KRUS -u, whose patron is the National Health Fund (NHF). It is this element of the system is considered the most inefficient, poorly controlled and requires the top contractors for the syndrome of a short blanket. Contributions to universal health insurance depend on the number of employees (ie, are inversely proportional to the number of unemployed), the average wage and the same values. In the last five years, these contributions to ZUS-ie increased annually by 0.25 percent. And there was additional revenue of 700 - 900 million. At the beginning of next year's contribution will not increase, in line with an earlier contract with the Government, employers and trade unionists, in turn, in subsequent years will decrease the number of people of working age.


The other side are the increasing costs of health care. As we live longer, you need to spend more on it. On the one hand the money to the health system barely ciurkają, on the other hand pruje it at the seams. They are also stronger in the cells, such as dentistry and patient support, which are coping well with the privatization or private financing. The weakest link is the public hospital treatments. Only in the years 2000 - 2005 the number of hospitalized persons increased by 15 percent. But because the procedures have become more expensive treatment for many years now, public hospitals can not balance expenditures with revenues. Nearly 60 percent. of them have no liquidity. The average debt of public hospitals is as much as two years of their revenues from contracts NHF. Twenty most indebted institutions will not be able to go above the line for 20 - 25 years.


What therapy is therefore applicable department heads? Recently released the third in five years to restructure regulation of the debt and aid. As a result, not enough that we all pay extra for what they have previously public hospitals were unable to obtain "legally" from the NHF, in addition to the method used clinics exempt directors from liability for the economy. The healthcare system is not spinałby even more if we did not they put the him more and more of their own pockets, by the way - without the possibility of a partial copy of these expenses from personal income tax. Pay extra for this dental care, laboratory analysis and technical, but most to buy drugs.


At the same time, we have the largest economy in the gray zone of their own experts from the Ministry of Health estimated (on the occasion of the profitability of the introduction of cash registers in the private offices) for 1910-1914 zł billion a year, a fifth of the funds going to the health market. Successive ministers of trying to fight this phenomenon, as well as the various manifestations of corruption, the commands and prohibitions. To no avail.


This system is the pate juxtaposed with too many ingredients. Among them, for example, we have the contradiction between the constitutional principle of full citizen access to benefits in the event of threats to life and health and are limiting due to lack of funds. If you want to come to any positive changes, mainly in the reform of the health insurance system. The aim is to introduce some form of additional or commercial insurance, or trójfilarowego system, similar to pension reform, while respecting the principle of social solidarity, ie the shield for the poor. The market could thus rapidly acquire several billion dollars per year, with the possibility of increasing that amount in subsequent years. Urynkowiona medical care at the same time reduce the problem of availability of services, including those for "free" guaranteed. Such reform would have a different value.


- The system of private insurance is the most effective way of controlling health care spending and improve its efficiency - points prof. Romuald Holly, Director of the National Insurance Institute. You need good quality benefits from the insurer and the provider, paying only as much as we should. For relatively small premiums may be treated with medical benefits to which the terms of fee for service, or it could not afford or do not have to pay for the equivalent price of the car (if even more complex operations). - Private insurance also civilized process of care and enforce mechanisms to eliminate the irregularities charged out of it, from corruption to medical errors - says prof. Romuald Holly.


Why, then nothing is still happening? Because too much is people in the health sector and close to the environment that they enjoy doing nothing and mess. Change has not been until now and for political reasons. Defenders of the current order - from the levels of government after government - like a mantra invoke Article. Paragraph 68. 2 of the Constitution, which prohibits citizens differentiation in access to health care services financed from public funds. And it is still an obvious fiction, since the lack of resources limits the NHF benefits. The Constitution is therefore used by politicians instrumentally - as a fig leaf. They are afraid of the reaction of voters, which would have to say what, and so everyone knows that we are in a country of rich and poor Poles.


Indeed, in nine Zbigniew Religa reform agenda provides for amendments to the system of financing health care. Long to this overture is to be called the term. guaranteed services. However, it is to be the earliest in 2009, unless the reason or another there is no slip. It is significant that the recent attempt to introduce the Religa additional charges piętnastozłotowych improving the standard of hospital stay she met with immediate versus prime minister. The opposite of a state are a mess and the failure of private hospitals, with their constantly growing numbers. When asked why Swissmed in Gdansk offers benefits by 10 percent. cheaper than the best public hospitals in Pomerania, its president, Roman Walasiński replies that "provides full analysis of all processes, from purchasing materials and equipment, economies of utilization of beds, after staff costs." It turns out that the same can be managed in a recent public hospitals, transformed into commercial companies. As if by magic in them cut costs, particularly in the administration ("He managed 60 people, now I have three" - says the director of one of them), rents unnecessary surfaces, reaches for the outsourcing of services and ... staff salary increases.  Hospitals continue to derive income is mainly from the NHF contracts, offer medical services pełnoprofilowe (classic complaint of directors of public institutions: private hospitals choose the best tidbits, so that their expenditures and revenues are in balance). Changed legal form, since the local government had the courage to take over their debts and we pay every year to solve the problem. Notes include Tuczapski Christopher, President of Non-public Zamojskiego Hospital, which is still in December 2004 had a hump in the form of losses reaching 27 million zlotys. Throughout Poland, doctors began an indefinite strike. The question of whether politicians will want to see in it only to wage demands, or the tip of the iceberg and the problem to be solved? But one thing is already visible to all: so far the formula of the social health care facilities has just died. To failure.



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