Wednesday, 23 February 2011

Health Reforms - Morally Wrong and Constitutionally Inconsistent

It's there in black and white and noone can dispute it. In Article 68 of the Polish constitution it is written that "equal access to health care services, financed from public funds, shall be ensured by public authorities to citizens, irrespective of their material situation."

The PO government is embarking on a series of health care reforms that directly conflict with the Polish constitution. These will open the way for the privatisation of hospitals and unequal access to health care. The PO government is continuing to run down the Polish health service and is putting forward a series of measures that will further starve it of funds .

Everyone who uses the Polish health care system will understand the state that it is in. Access is often difficult, hospitals run down and people regularly have to pay for private consultations and treatment. Research has found that 44% of society make additional payments out of their own pockets for their health care (only 7% rely entirely on private health care and 36% solely on public health care.) Yet despite these difficulties the inheritance of a comprehensive health system from Communism - with all its deficiencies - is a great social and human asset. It provides care and treatment for millions of people and without it the standard of living in Poland would be drastically reduced.

In comparison to other industrialised countries the Polish health care system fares badly. A recent report carried out by Health Consumer Powerhouse shows that Poland's health service occupied 7th from bottom place out of 26 countries under study. This is reflected in the very low level of financing for the public health system. Out of all the OECD countries Poland remains virtually at the bottom with regards public funding for health. Public spending on health equals only 7% of GDP in Poland, while the OECD average is 9%. This is not only far below the most advanced industrial countries in the world but also far behind neighbouring states such as Hungary and the Czech Republic. There are only 2.2 doctors per 1000 persons in Poland (OECD average 3.2) and 5.2 nurses (OECD average 9.0). The low pay and poor conditions for health workers in Poland acts as a disincentive for people to work for the public health system and has also enticed many health workers abroad .

The low level of public funding for health is set to get worse. Since 1999 local governments have spent a total of ZŁ15bn on investments in health care institutions - around two times the amount spent by central government. This allowed for many local hospitals and surgeries to be improved and buy new equipment. Increasingly central government has delegated fewer funds for investment into the health system's infrastructure. However, the slowdown in economic growth and decreasing tax revenues (due to lower rates of income tax and corporation tax) have meant that local governments have had less available money to fund these investments. Local government debt has accordingly risen - growing from around ZŁ21bn in 2005 to 55bn in 2010. The reality for local governments has been that it has received less funds from central government while more demands have been placed upon it. Also, much of the public investment projects - partly funded by the EU - have come through local governments. It is such investments that have in fact kept the Polish economy afloat in recent years.

The PO government is now seeking to limit the levels of local government debt, which will lead to a drastic slowdown in investments including in the health system. For example in the city of Łódż the local government invested ZŁ13.4bn in 2009 and ZŁ10bn in 2010 on buildings and property connected to the health service. In 2011 this will be further reduced to just ZŁ6bn, while the local government estimates that there is a need to invest around ZŁ162bn in health service institutions. The majority of these investments are needed to bring its institutions into line with the safety recommendations made by inspectors from the Health Department.

As the public health service is being run-down and underfunded the government is planning new legislation whose logic is towards privatisation. Now we should be careful here – after all Komorowski took Kaczyński to court, during the Presidential elections, when he dared suggest that PO wanted to privatise the health service. However, it is better to call things what they actually are:
- The government plans to transform indebted public hospitals into commercial companies. In exchange the government will pay part of these hospitals’ debts, after which the hospitals will have to remain profitable and therefore focused upon the pursuit of profits rather than serving patients. If these hospitals fail then they can go bankrupt. They also will be able to decide from which contractors they will buy services - which will further increase the influence of private companies in the health service and undermine the public health system.

- PO also wants to strengthen the role of commercial health insurance. It plans to allow private health insurance companies to compete with the public health service for the mandatory health contributions made by individuals.

- Finally the government is proposing to introduce an extra insurance payment that would allow those paying into it to have quicker access to doctors and operations.

The first proposal of PO to privati.. (sorry) commericalise hospitals was vetoed by Lech Kaczyński when he was President. Whatever the reasons for him doing so it can be stated that this was absolutely the correct decision and was in line with the Polish constitution. Now that PO have their own man as President they should not face such obstacles. However, perhaps the constitutional court should look at the proposals of the government. Firstly, by allowing people to transfer their payments away from the public health care system and into private insurance undermines the principle of a comprehensive universal health service into which all are obliged to contribute. Secondly, setting up an additional payment that allows privileged access to health services seems to contradict entirely the constitutionally defined right to have equal access to health care. People are of course free to buy their own private health insurance if they wish - but they should not be entitled to buy themselves privilleged access to public services nor transfer their obligatory payments away from the public health service.

Some actions have been taken against the government's health plans. However, these have tended to be isolated campaigns with no common focus. A broad national campaign to defend and build the public health system would be politically important, morally correct and constitutionally consistent.

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