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The Warsaw Voice » Politics » January 16, 2008
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A Stitch in Time?
January 16, 2008 By W.Ż.    
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As health service workers continue their latest protest, the government has produced a set of bills designed to resuscitate the country's failing health system.

Healthcare is a priority for the government and the national health service system should be based on "solidarity, justice and efficiency," Health Minister Ewa Kopacz told parliament's health committee last week as she unveiled the government's plans for the health service sector in the coming four years.

Kopacz said the government would make the first "resolute" moves to reform the health system in the first half of this year.

One of the first projects will be a bill on restructuring health centers, allowing them to be transformed into commercial-law companies with local governments as the main shareholders. Kopacz said these companies should have managers "who would not have to be doctors." She added that the main criterion in filling these positions should be "appropriate managerial skills," and the newly established companies would be "given equal treatment in access to public funds."

Another plan concerns extra insurance that patients would pay on a voluntary basis, in addition to their mandatory healthcare contributions. Kopacz told the health committee members that the additional insurance would "give the public health system access to funds that patients otherwise spend on private medical services." Such insurance could be used to finance services that are not included in what has been referred to as a "basket of guaranteed medical services." While introducing the new extra insurance, Kopacz said, the government has no plan to increase healthcare contributions or "make patients cover a part of the cost of certain medical services."

Kopacz also called for a tighter system of reimbursing patients for drugs and for more transparent rules in compiling lists of pharmaceuticals subject to reimbursement. She said the government would come up with a bill on patients' rights and a "basket of non-guaranteed medical services," along with measures to help junior doctors upgrade their professional qualifications and regulations to "deprive the National Health Fund of its monopoly."

The plan is to decentralize the National Health Fund and transform it into several independent funds, Kopacz said. The changes would become effective in 2010.

Jacek Paszkiewicz, head of the National Health Fund, says the institution is working to compile a new register of medical services. The fund "is in possession of zl.1.4 billion that will be assigned for medical services right away to complete the process of signing contracts for medical services," Paszkiewicz said.

Meanwhile, Kopacz's ideas have generated little enthusiasm among the medical community. Konstanty Radziwiłł, head of the General Physicians' Chamber, a doctors' self-regulation organization, said "the main priority is to increase spending on healthcare." Radziwiłł added he has "serious doubts as to how the bills are being drafted," because they have not been submitted as governmental bills but as legislation drafted by deputies, "and as such, they will not be subject to consultation with individual ministries and the public."

Prior to Kopacz's meeting with parliamentarians, Zbigniew Chlebowski, head of the PO parliamentary caucus, disclosed that there would be three proposed bills to reform the national health service system. The bills concern the protection of "patients' individual and collective rights," along with the appointment of a special commissioner for patients' rights; the launch of a private health insurance system to supplement the public system; and the operation of healthcare centers. Chlebowski said he would soon tell the public about a fourth bill that is expected to "regulate the basket of guaranteed medical services."

Prime Minister Donald Tusk said the PO's deputies "will propose an intense but possibly brief debate on the bills." He added that the government and the ruling coalition would also "try to diffuse tension over the salaries of doctors and other medical staff." According to Tusk, this tension is "the result of flaws in the healthcare system and the expectations of doctors, nurses and other medical personnel."

Addressing physicians who met at a convention in Warsaw Jan. 12, Kopacz made an effort to get her message across to her opponents. She called on doctors to take part in a "health summit" with government officials including Tusk. Kopacz said the healthcare reform should be carried out "rationally rather than at gunpoint," referring to "the constant threat of strikes, including medical personnel's threats that they would leave their patients unattended."

Kopacz said the government would send the draft healthcare bills to physicians as well as doctors' organizations to give them an opportunity to discuss this legislation. She promised that there would be pay raises for doctors and dentists at all levels of the professional ladder. She added that the government is considering a system of annual adjustment of salaries for junior doctors without specialist qualifications so as to prevent them from seeking employment abroad. According to doctors' organizations, several thousand specialist doctors have left Poland to take up jobs in Western Europe over the past two years. In some regions of Poland, medical staff shortages at hospitals were so serious-especially when doctors and nurses went on strike-that local government authorities were thinking of temporarily hiring doctors from the former Soviet Union.

Doctors gathered at the Warsaw convention said they were skeptical about Kopacz's reform agenda. They said the Polish healthcare system cannot be repaired without higher government spending. Doctors' organizations insist that in order to improve the condition of Poland's health system, the mandatory healthcare contribution needs to be increased to 13 percent of the gross monthly wage, from 9 percent at the moment. Moreover, patients "should pay for certain medical services," and the minimum salary of doctors should be no less than twice the national average monthly wage.

Dorota Gardias, chairwoman of the Nationwide Trade Union of Nurses and Midwives, said the health ministry's reform plan "lacks substance."

Meanwhile, Kopacz called for efforts to make sure that healthcare reform is not "derailed by political games," especially as the opposition is "bound to try and take advantage of the latest crisis in hospitals to gain public support," she said. The opposition Law and Justice (PiS) party has announced plans to come up with a rival set of health bills named "The Religa Package" after Zbigniew Religa, the previous minister of health and one of Poland's foremost heart surgeons.

Religa said that one of PiS's first bills that seeks to increase the healthcare contribution has already been submitted to parliament. Under the bill, the contribution would increase by 1 percentage point each year until it reached 13 percent of the gross monthly wage.

PiS deputy Bolesław Piecha, formerly a deputy health minister and now chairman of the parliamentary health committee, says the Religa Package also contains a bill that calls for moving some of the funds accumulated in the Labor Fund and the Guaranteed Employee Insurance Fund to the National Health Fund. According to Piecha, PiS also plans to amend a law on the national hospital system by dividing hospitals into those that should remain in public hands and those that can be sold to private owners along commercial lines. PiS is also preparing to submit a bill to define a range of medical services available to patients, Piecha said.

In response to the PO's plan to appoint a commissioner for patients' rights, PiS has come up with an amendment to a law on physicians' chambers. The bill, which has already reached the Sejm, seeks to give more rights to patients in the event of medical malpractice. Under the proposal, patients harmed by doctors would be able to appear before medical boards as claimants, and not as witnesses as is now the case. PiS is also seeking to introduce faster malpractice proceedings, setting the maximum duration of a review at six months.

President Lech Kaczyński has joined the debate on the healthcare crisis by proposing a "Round Table for all interested parties." He came up with the idea at a meeting with members of all political parties represented in parliament Jan. 10. Kaczyński said the health reform requires an "all-party agreement," and apart from the reform, the system needs stopgap measures to help hospital managers raise funds for pay raises for their personnel.

For the first time during his term as president, Kaczyński Jan. 14 called a Cabinet council, or a special meeting of the government that he presided over himself. The 40-minute meeting focused on the health service crisis, but led to no new conclusions. "We are worried because we wanted to hold substantial talks about the bills, while the president only asked three questions and did not have enough patience to hear the answers," said Tusk after the meeting. "No concrete proposal was made."
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