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The Warsaw Voice » Politics » May 28, 2008
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Hospital Reforms Under Fire
May 28, 2008 By W.¯.    
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The Polish government's latest proposal on how to reform the country's ailing health service has drawn criticism from the opposition and trade unions. Plans to transform state-owned hospitals into businesses controlled by local authorities have caused the most controversy.

The economically liberal Civic Platform (PO) party, which governs the country in coalition with the Polish People's Party (PSL), unveiled the reform plan in early May. Health Minister Ewa Kopacz, seconded by Zbigniew Chlebowski, chairman of the PO's parliamentary group, said that local governments would acquire 100-percent ownership of all hospitals in their areas. The announcement alarmed critics because earlier, in a bill sent to the parliamentary health committee, the government only planned 51-percent transfer of ownership.

The opposition conservative Law and Justice PiS) party, the Democratic Left Alliance (SLD), and some smaller parliamentary groupings immediately warned that these changes would in practice open the door to the "unfettered privatization" of hospitals. Various opposition politicians said the plans would adversely affect the quality and cost of hospital services and, in consequence, drastically worsen patient care, in particular for poorer patients.

PiS referred to a commercial that it ran during its parliamentary election campaign last year; in the commercial, a patient summoning an ambulance in an emergency is refused medical assistance because they do not have a credit card.

Kopacz said that a health-service reform based on "commercialization," or transforming hospitals into companies operating under market rules and 100-percent owned by local governments, was the best way to improve the work of the health service. "Let us not frighten people with the word 'privatization,'" Kopacz said. "What the PO is currently proposing is the transformation of ineffective hospitals, which have debts, are badly managed and troubled by bureaucracy, into efficient businesses that are well financed and managed under commercial law. Management does not necessarily have to be by doctors but by a firm or an individual appointed by a mayor or another regional authority to ensure that a given hospital does not fall into debt."

The reforms will be successful if hospitals are freed of debt first, Kopacz said, adding that the total debt of Poland's health service centers runs into some zl.10 billion.

The PO's Chlebowski said May 11 that a detailed proposal on how this debt load should be removed would be drafted within two or three weeks. The finance ministry is working on the proposal, Chlebowski said. "Maybe this will take the form of bonds or maybe the debt load will be canceled in part. Hospitals are mostly indebted to institutions such as the ZUS social insurance office," said Chlebowski when asked if the government knows how to finance the planned reduction of hospitals' debts.

Chlebowski said the debt cancellation process would happen at the same time as the transformation of hospitals into companies wholly owned by local governments. Debt cancellation will also be accompanied by a significant increase in government spending on the health service, he said. This year and next, the government will spend zl.5 billion on the health service annually, and in 2010 spending will grow to zl.10 billion, Chlebowski said.

In another project related to the health service, Kopacz May 14 unveiled a new proposed list of drugs to be subsidized by the National Health Service (NFZ). The list includes 23 new drugs, and the ministry says patients will pay less than they do now for 85 different drugs. The health ministry also unveiled a new prescription form designed to prevent forgeries. The new prescription form carries a watermark with the NFZ's logo and other security measures similar to those found on banknotes. Each prescription will have a special visible number to indicate which doctor has issued it. The Polish Security Printing Works (PWPW) designed the security measures. The new-style prescriptions could be in use from July 1, but the health ministry may introduce a trial period first, Kopacz said.

Kopacz also announced that an additional zl.200 million annually would be available for what she called long-term patient care. This amount will make it possible to ensure that older people get regular specialist treatment, she said. "Today, a patient lying in a care home can wait for months to see a cardiologist, surgeon or orthopedic doctor," Kopacz added.

The government plans to fully reimburse patients for the costs of treatment of three rare chronic diseases, and the same goes for patients undergoing treatment after removal of part of their pancreas. The amount earmarked from the national budget for these measures is zl.8 million, Kopacz said.

The government's plan to transform hospitals into companies has provoked strong criticism from leftist labor unions. The All-Poland Alliance of Trade Unions (OPZZ) issued a statement May 14 that read: "We are indignant at the change of stance by the governing coalition with regard to the transformation of health service centers." According to the OPZZ, the government's latest ideas for changing the ownership status of health service centers differ significantly from those discussed during talks that lasted several months-known as the "white summit"-between government officials, trade unions, doctors and other hospital workers. The government's latest proposal is also different from ideas included in some previous proposals drafted by PO parliamentarians, the OPZZ said.

The union went on to say: "Having actively participated in the 'white summit' in our role as the central voice of the trade unions, we feel cheated by the government, which took advantage of legislative procedures to introduce, via deputy-drafted bills, its own ideas that had not been discussed at either the summit or during any form of dialogue with the medical or worker communities." The OPZZ demanded "renewed social dialogue" on the health service, and it also called for the establishment of a trilateral committee to discuss plans on how to reform the health service. Consultations with trade unions and a "clear and cohesive idea" are needed to solve
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