Warsaw Voice - A Matter of Health

By Wanda Jelonkiewicz
19 May 2004

"Medical tourism" plays an important role in England, France and Germany. Patients are sent by health funds abroad for specialist treatment. In England, waiting for a hip replacement may take several months, so the British prefer to go to Germany instead, where the waiting time is shorter. Will Poland begin to compete with Germany for Western European patients?

Poland already has a number of hospitals fully prepared to treat foreigners. The treatment results are the same as in the West. Surgery costs are lower, while hospital rooms are smaller and modestly furnished. Non-insured patients arrive, seeking help on their own. For example, Germans come to western Poland because the waiting time for treatment in the German system is long. In the future, insured patients are also expected to be interested in treatment in Poland.

"We have an observation ward with 25 beds that usually admits foreign patients with internal diseases," says Dr. Irena Walecka, director of marketing and administration at the Central Clinical Hospital of the Ministry of Internal Affairs and Administration in Warsaw. "Patients who require the services of, say, a surgeon, orthopedist or cardiologist, who pay for their treatment out of pocket, are located, whenever possible, in single rooms with all the conveniences, such as a telephone, TV set and bathroom."

In Poland, it is possible to successfully undergo a transplant, get a diagnostic examination, go to a sanitarium, fix one's teeth or undergo psychotherapy. For the time being, these medical services are cheaper than in Western Europe, which is important for people who pay upfront. However, due to a lack of private health funds, foreigners undergoing treatment in Poland for the time being may not count on easy access to the free health care. Some foreigners obtain a refund of treatment costs from their insurers, but that results from individual negotiations.

The rules of the game
The situation changed after Poland's European Union accession. Since Poland is covered by the rule of the free movement of persons, that means more Poles may use medial services outside their home country and more foreigners may come to Poland for treatment.

In Poland, all employees have to be insured. Their health care contributions go to the state insurer who finances the healthcare system. Patients in state medical facilities do not pay for services out of pocket. There are still no private health insurers but their emergence is only a matter of time.

The market for private healthcare is developing for those who have money to spend on treatment, do not want to wait in lines to see a doctor and require a higher standard of service. Individual visits in private or cooperative-owned clinics or for a monthly subscription fee are available. The more expensive, the wider the range of medical services offered. The cheapest package costs under zl.100 and the average monthly salary in Poland exceeds zl.2,200.

It is estimated that over 1 million Poles hold private medical packages. In most cases, these are offered by employers although it is also possible to pay independently. Over the past decade, several companies offering treatment for a regular fee have appeared on the market. These include Medicover, Centrum Medyczne LIM, Centrum Medyczne Damiana, Centrum Medyczne Enel-Med, Medycyna Rodzinna and Promedia. "Some 20 percent of services on the market for private medical services will go to foreign patients," says Dr. Marek Płoszczyński, president and owner of Centrum Medyczne Damiana.

A cure for your heart in Anin
"We perform all the procedures connected with cardiology and cardiosurgery, in line with international standards," says Dr. Jarosław Pinkas, medical director at the National Institute of Cardiology in Anin near Warsaw. "What is done in Europe is done here with the same methods and according to the same standards. We use the same treatments as abroad.

"The German and British are interested in our offer. Talks about cooperation with Arab countries are much advanced. This involves a systemic solution: since in Western Europe cardiology treatment is more expensive, they would like to send their clients to us," says Pinkas.

Tele-medical services are a complete novelty on a European scale. The Institute of Cardiology has completed work on a system that makes it possible to deliver cardiological and cardiosurgery consultations over long distances. "Hospitals may send a set of data to our server that publishes it in the form of a website accessible to our personnel. Our doctors may provide consultations," says Adam Koprowski, an expert. "This system is open enough to allow any hospital in Europe to start cooperation with us."

In order for a cardiological tele-consultation to be possible, the patient has to have a special apparatus that registers the heart functions. Signals from the apparatus, providing an EKG, are sent via mobile phone to the Center in the Institute of Cardiology. There, the data is compared with the results of previous examinations. On that basis a consultant cardiologist may decide whether the patient should be operated on or not.

Thanks to this system, foreigners staying in Poland may obtain advice from their doctor who may be in Western Europe or the United States. With access to the system, the doctor will evaluate the results of a patient's examination carried out in Poland. Moreover, consultations in Poland will certainly be cheaper than in Western European hospitals.

Transplants for foreigners?
In Poland, routine transplant operations include kidneys, the heart, liver and pancreas. Soon it will be possible to transplant isolated cells of the Isles of Langerhans, that is, pancreatic cells that produce insulin. As for the heart and liver, these organs are donated only by the deceased," says Wojciech A. Rowiński, professor of surgery at the Department of General and Transplantation Surgery, Transplantation Institute, the Medical Academy of Warsaw.

According to law, an organ taken from a deceased Polish national may only be provided to a Polish citizen. Maybe after Poland's EU accession these regulations will change. In theory, an Italian may get a transplant in the Netherlands if the Italian insurer accepts the Dutch conditions because surgery prices vary.

However, in Poland it is already possible to transplant organs from live donors. "If someone brings a live donor-a relative or someone close to them-then surgery in Poland is possible and the price is probably lower than abroad," says Rowiński.

"My hospital is prepared to work round the clock," says Rowiński. "Emergency surgeries are performed at any time of day or night, the laboratory and X-ray are open 24 hours a day." In the clinic, doctors speak foreign languages and several nurses speak English.

Needing improvement
There are no EU directives regulating the way healthcare is organized in EU member countries because local conditions, traditions and treatment standards vary. In January, Poland's Constitutional Tribunal ruled that the law on the National Health Fund-which was to replace the regional health funds introduced in 1999-was unconstitutional. The law must be rewritten. The government must complete this task by the end of the year. It is unknown how the new system of healthcare financing will look and it is not clear whether it will include a new mechanism for settling the costs of treatment of Poles staying abroad and taking advantage of treatment in other EU countries. The costs of medical services in Poland are 10 times lower than in other EU countries, so increased spending on treatment for Poles abroad may be a significant burden on the Polish system.

According to the principle of the free movement of services and persons and of coordination between insurance systems, EU citizens may seek treatment in Poland under the same rules as those enjoyed by persons insured in Poland. The costs of health care will be financed by insurance institutions from the country of the given patient's origin.

A citizen from an EU country may also apply for a permit to leave for treatment to another country where they will be treated at the cost of their own insurer, according to the rate of the target country. If a certain treatment is a service guaranteed by the law in the patient's country of origin, and cannot be carried out in the country within the time required by the patient's condition of health, the insurer may not refuse permission for treatment abroad. The permit means that the insurer will cover treatment costs.

Healthcare-a Polish specialty
In Poland, 63 medical facilities are fully accredited. It is not known exactly how many facilities have an ISO certificate. Experts believe that now that Poland is an EU member, an influx of investors may be expected, along with the arrival of patients from both the EU and beyond. "The number of large hospitals will increase. This will involve investment by private individuals or consortiums. Then medical tourism will develop. Actually, this trend can already be observed in border areas. Apart from that, the large Polish emigrant community is a chance for Poland," says Płoszczyński.

A significant amount of spending by EU insurers goes to prevention and patient rehabilitation, including treatment in sanitariums. That presents new opportunities for Polish spas, which are cheaper than those in other EU countries. There are some 1,100 in Europe, and Poland has 44 featuring some 40,000 beds. That potential, however, is not fully used due to a lack of money. In Poland it is possible to treat circulatory system and rheumatic ailments, motor system, gynecological, laryngological, eye, digestive tract, nervous system and skin diseases. Allergies can be treated in the underground chambers of the oldest salt mine in Europe in Wieliczka.

In the summer, many foreigners come to seaside spas and the Kotlina Kłodzka area. Some of them are regulars. They praise the high quality of treatment and relatively low prices. Spas on the Baltic coast are also visited by organized groups of retirees from the Scandinavian countries and Germany. The Enel-Med Medical Center attracts patients from Belarus and Ukraine whose treatment is financed by their home countries.

According to a report by McKinsey & Company entitled Poland-A Service Center for Europe?, health services may become one of several Polish specialties. Conducive factors include a high number of doctors and nurses and many sanitariums and spas with unused potential. Polish healthcare providers should focus on orthodontics, prosthetics, rehabilitation, organization of trips including medical services, analysis of results of lab tests and establishment of nursing homes, say McKinsey & Company experts. They expect that 100,000 jobs will be created in this market segment.