Around 20,000 health workers, from around Poland, marched through Warsaw on Friday 5 October, demonstrating against their worsening conditions of work and the commercialisation of the health system.
Despite the fact that the Polish constitution includes a clause that health care should be provided by public funds to all citizens regardless of their material situation, the Polish health system is in a state of long-term decline. This has primarily been caused by a chronic lack of funding. Poland spends just 5% of its GDP on health care (and its GDP per capita is over two and a half times lower than the EU average), which is the third lowest in the European Union and far below the EU average of 7.5%.
While successive governments have underfunded the health service, they have also implemented a series of reforms that have sought its commercialisation. This began during the term of the right-wing coalition government at the end of the 1990s, which introduced elements of market competition into the system. This drive towards a commodification of the Polish health system was further intensified when the present PO government passed new legislation stating that hospitals with debts must be transformed into commercial companyies from 2014. In return local governments will take on part of the hospital’s debt, which will be paid off with the help of the government. These new commercial hospitals are then expected to be profitable and are not allowed to incur new debts.
This process of commercialisation is transferring the responsibility for the running of hospitals from the public to the private sector. This is opening the way towards the privatisation of at least parts of hospitals and even towards their closure. The drive to cut costs is being directed at health workers, through reducing the number of nurses and doctors; forcing them out of full-time employment and into self-employment; cutting salaries; increasing their range of duties and raising their retirement age.
Reducing the working conditions of health workers is also worsening the quality of care received by patients. Nurses, in particular, are extremely poorly paid in Poland and are expected to take up an ever greater range of responsibilities. Many are forced into taking on more than one job at a time in order to make ends meet, meaning that they often work long hours, in poor conditions and under extreme stress.
The commercialisation of the health service in Poland has brought no evident positive effects – quite the opposite. According to the most recent Euro Health Consumer Index report (that measures the state of health care in Europe) Poland has now fallen to 27th out of the 34 countries analysed. The report also shows that Poland is in last place when it comes to providing access to modern medicine, mortality due to cancer and the time that a patient has to wait to see a doctor or receive treatment in a hospital.
A report by the Polish Supreme Audit Office has also revealed that hospitals have not improved after being commercialised. The report states:
The commercialisation of the majority of hospitals has had not any noticeable effect. Waiting times have not reduced, the overall debts of the health system not declined and a section of the commercialised hospitals have fallen into yet more debt. Those facilities that had a positive financial situation before commercialisation have managed well. However commercialisation has not helped those which had already been generating losses.
The enduring underfunding, passing of responsibility for health care away from the government and commercialisation of the health system is creating a potential catastrophe in the Polish health system. One recent high-profile example has been the main childrens health centre in Warsaw (Centrum Zdrowia Dziecka) that is under intense pressure to cut its debts. The director of the hospital has announced that costs will be cut by 5% (t21m złoty) in order for it to receive a bank loan. This has already meant that the hospital has started to stop seeing some patients and cancelled a number of planned operations. The Minister of Health has commented that the health centre must ‘adapt to these new realities’.
The demonstrators on Friday combined demands for higher wages and better working conditions with those of improving the health service and ending its commercialsation. They demanded that the health service remains in public hands; that waiting times to see a specialist are reduced and that the cost of medicine is not raised.
Their slogan ‘we are all or will be patients’ captured the joint interests that health workers and patients have in preventing the further commercialisation of the public health service in Poland.