Traditional Chinese Medicine in Poland – country report 

Monika Rybicka, MD 

(Department of Internal Medicine, University Hospital, Kraków, Poland, 2017 IATC participant)

Introduction

Poland,  officially  the  Republic  of  Poland  (Polish: Rzeczpospolita  Polska)  is  a  parliamentary republic in Central Europe. Poland is a unitary state divided into 16 administrative subdivisions, covering an  area  of  312,679 square  kilometres  (120,726  sq  mi)  with  a  mostly temperate  climate.  With  a population of over 38.5 million people, Poland is the sixth most populous member state of the European Union. Poland's capital and largest city is Warsaw. Other cities include Kraków (the previuos capital of Poland), Wrocław, Poznań, Gdańsk and Szczecin. [1] 

Polish healthcare system

Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) – the sole payer in the system – is in charge of health care financing and contracts  with  public  and  non-public  health  care  providers.  The  Ministry  of  Health  is  the  key  policy-maker and regulator in the system and is supported by a number of advisory bodies. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. [1] In 2015, Poland spent 6.5% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. [2] The relatively high share of private expenditure is mostly represented by out-of-pocket payments, mainly in the form of co-payments and informal payments. Voluntary health insurance does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance  covers  98%  of  the  population  and  guarantees  access  to  a  broad  range  of  health  services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are  not  always  available.  Health  care  financing  is  overall  at  most  proportional:  while  financing  from health  care  contributions  is  proportional  and  budgetary  subsidies  to  system  funding  are  progressive, high  out-of-pocket  expenditures,  particularly  in  areas  such  as  pharmaceuticals,  are  highly  regressive. The health status of the Polish population has improved substantially, with average life expectancy at birth reaching 81.9 years for women and 73.9 years for men in 2016. However, there is still a vast gap in  life  expectancy  between  Poland  and  the western  European  Union  (EU) countries  and between life expectancy  overall  and  the  expected  number  of  years without  illness  or  disability.  Given  its  modest financial, human  and  material  health  care resources  and  the corresponding  outcomes,  the  overall financial  efficiency  of the  Polish  system  is  satisfactory.  Both  allocative  and technical  efficiency  leave room for improvement. Several measures, such as prioritizing primary care and adopting new payment mechanisms such as diagnosis-related groups (DRGs), have been introduced in recent years but need to be expanded  to  other  areas  and  intensified.  Additionally, numerous  initiatives  to  enhance  quality control and build the required expertise and evidence base for the system are also in place.  [1] Polish healthcare system is a multi-layered one and its respective segments are primary healthcare, outpatient specialty care, hospitals, diagnostics, long-term care, sanatorium services and rehabilitation. In Poland there are around 800 hospitals and around 220,000 hospital beds, which gives nearly 6 hospital beds per 1000 people. This is one of the highest results in Europe. At the hospitals patient’s stay costs range between PLN 300-500 per day, and at sanatoriums, spa hospitals and long-term care facilities, the costs of a patient’s stay start from PLN 100 per day. The healthcare infrastructure can be divided into two types: day-care (such as primary healthcare, outpatient specialty care, diagnostics and rehabilitation) and  inpatient  care  (such  as hospitals,  sanatoriums,  spa  hospitals  and  long-term  care facilities).  The funding of the public hospital networks is based on limited contracts with the National Health Fund. [3]

Underfunding has been and will remain problem number one of the healthcare sector, but the problems will not be solved simply by increasing the level of funding, contrary to what might be thought. What is required  is  more  effective management  of  the  funds  earmarked  for  healthcare,  the identification  of areas  requiring  investment/development  in the  mid-  and  long  term,  and  a  consensus  reached with respect to the need to balance the constantly growing expectations of patients (and the growing supply of increasingly advanced medical technology) with the payer/payers’ capacity. Health needs maps have been developed  relatively  recently  in  Poland.  The  operating costs  of  healthcare  providers  include, without limitation (based on sample entities from various segments): personnel costs (~52% of costs), costs of outsourced services, including patient meals (~24% of costs), costs of materials (~18% of costs), costs  of  infrastructure  depreciation  (~4%  of  costs), overhead  and administrative  costs  (~2%  of  costs) and other costs, not quantified at present, e.g. costs of debt servicing. Personnel costs especially, which is reasonable as salaries in Polish healthcare are definitely lower than in other countries. [3]