The Polish Health minister, Konstanty Radziwiłł, has revealled plans to reform the health care system, that if carried out could be the most important and progressive changes to have occured in Polish health care over the past two decades. The two proposed changes are:
- To significantly increase the level of public health care spending;
- To fund the health care system directly from the central government budget.
Poland has one of the lowest levels of public health care spending in the EU, with little more than 4% of GDP spent on health. The Health Minister has said that next year he hopes to inject billions of złoty into the health care system. The long term aim of the government is then to increase public health care spending to 6% of GDP.
Secondly, the government plans to move away from a Bismarkian style health insurance system to a Beveridge state funded one, similar to that which exists in Britain. The major damage to the health care system occured in 1999, when the then right-wing administration introduced a reform that both reduced public health care spending and created a number of local health care funds. This fragmented the system and opened it up to more market competition. It had an immediate negative effect on the health care system, with for example the number of public hospitals declining from 702 to 501 between 2000 and 2010. This reform was partly reversed by the Democratic Left Alliance (SLD) government in 2003, which introduced a new central health care fund (NFZ). However, not only has this not solved the issue of funding but around 2.5m citizens remain without health care insurance coverage. This includes both the most socially excluded (such as the homeless) and also many contractual workers or self-employed that miss health insurance payments.
The Polish constitution states that: Equal access to health care services, financed from public funds, shall be ensured by public authorities to citizens, irrespective of their material situation. As with many of the other social clauses in the constitution this has been broken by successive governments. In this case the government's proposals would actually be a case of meeting the obligations of the constitution rather than breaking them. Therefore, those in Poland defending the constitution should actually be supporting this proposal by the government and pressuring it to introduce it as quickly as possible.
The other major health care proposal by PiS made during the election campaign was to provide pensioners with medicines free of charge. The government has now announced that there will be a list of certain medicines that pensioners will be allowed to get for free. The health ministry has said that it is still compiling this list and that there is a chance this bill will be introduced in the next two or three months.
The government has not provided detailed plans for its proposed reforms and it is unclear both how they will be paid for and exactly when they will be introduced. However, they potentially tackle some of the largest deficiencies in the country's most important public service.