Traditional Chinese Medicine in Poland – country report
Monika Rybicka, MD
(Department of Internal Medicine, University Hospital, Kraków, Poland, 2017 IATC participant)
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. 
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.  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.  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.  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. 
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.