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The Warsaw Voice » Politics » October 29, 2008
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Battle Over Health Reforms
October 29, 2008 By W.Ż.    
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Deputies have voted through a wide-ranging package of laws designed to reform Poland's ailing healthcare system. But President Lech Kaczyński has vowed to veto the plans proposed by the ruling coalition. And persuading the left-wing opposition to help overturn the veto may mean key parts of the reforms are ditched.

After a stormy debate, the lower house of parliament Oct. 21 adopted a packet of healthcare reform bills. The most important part is the draft on local healthcare boards (ZOZ). Under the draft, all boards would be turned into profit-earning companies operating under commercial principles and wholly owned by local governments. The local governments would then have the right to sell their stakes in the companies altogether or retain the whole of them or part of them.

Under the draft, ZOZ employees would be offered no employment security packages, a key demand by healthcare workers during negotiations with the government. The draft includes provisions saying that ZOZ workers would be employed in the companies to be established, but these do not specify employment conditions.

Under another draft, the companies to be established would hold ZOZ real estate in lease. The initial proposal was that the companies should become owners of the ZOZ real estate, but eventually the ruling coalition agreed to change this draft provision as demanded by the left-wing opposition.

The deputies also passed a draft law to regulate the working hours of people employed by local health-care boards. The draft sets the maximum working hours for medical interns at 52 hours a week. Under regulations in force since this year in line with EU law, physicians can work a maximum 48 hours a week. This, however, does not apply to interns or residents. The draft equalizes working hours for all ZOZ employees, which means extending the hours of some medical workers-for example radiologists, forensic pathologists and mortuary staff-who so far have worked five hours daily. A physician on duty would not be allowed to work longer than 24 hours at a time, after which he or she would have to be given a break of 11 hours.

Deputies also adopted a draft law on national and provincial healthcare consultants. Most of the draft provisions are already in force, however, in the form of ordinances rather than parliamentary legislation. The draft specifies the way in which such consultants should be appointed and dismissed. One of the changes to existing regulations is that a consultant can be dismissed if he or she has been sentenced to a penalty of imprisonment or restricted liberty or if their right to practice the medical profession has been suspended.

The last draft includes a provision on establishing the office of commissioner for patient's rights to be appointed for a five-year term by the prime minister. The draft also specifies the most important rights and duties of the patient. The patient would have the right to medical assistance in case of a medical emergency-life threatening condition or delivery. They would also have the right to latest-technology medical services or to "a reliable, medical criteria-based procedure" of drawing up a waiting list in case access to such services is limited.

Under the draft, patients would also have the right to demand that the physician providing medical services to them asks the opinion of another medical professional or holds a case management conference. However, the physician would have the right to refuse if he or she decided that the demand was groundless.

Prime Minister Donald Tusk said after the vote he did not understand the position of the left-wing opposition which voted against the draft law on local healthcare centers. He also said he would be trying to persuade the president not to veto the draft. "I know no alternative program to save Polish hospitals," he added.

The left-wing opposition said that if the president vetoed the draft it was ready to help the ruling coalition to vote the veto down. However, it set a number of conditions-that local governments should be guaranteed majority stakes in hospitals, that the transformation of hospitals into companies should be voluntary and that hospitals should operate as non-profit companies. "These demands are unacceptable," said Zbigniew Chlebowski, head of the parliamentary caucus of Civic Platform (PO), the senior coalition partner. "They completely overturn the government vision of healthcare reform."

Kaczyński said several weeks ago he would not sign the healthcare drafts into law. A three-fifths majority is needed to reject his veto, which means a majority of 276 if all 460 deputies take part in the vote. The ruling coalition does not have the required majority-they need 36 more votes.

"If the SLD [left-wing opposition] blocks the law in conjunction with the other opposition party, Law and Justice, we will carry out the reforms by means of extra-parliamentary measures," said Grzegorz Schetyna, deputy prime minister and interior minister. He did not specify what these measures would involve. "You cannot be dictated to by groups that do not care about reform," he added.
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