Devising an effective, fair, accessible and cost-conscious healthcare system is difficult for any country, let alone those in transition. Poland has been grappling with healthcare reform for over a decade and though progress has been slow and piecemeal, some important reforms were implemented over the past few years. Getting them to work implies a change in attitude and habits not only on the part of medical practitioners, but also the general public, and that takes time.
The healthcare system that Poland inherited in 1990 from the Soviet bloc era offered universal coverage with a comprehensive programme of healthcare benefits distributed through facilities owned and run by the state. But the system was over-centralised, over-specialised and costly. It was also poorly managed. Regional inequalities, rationing and misallocation of resources emerged, with growing unofficial payments to public healthcare providers. Increasingly, patients perceived the quality of care to be poor and the general public’s dissatisfaction has grown.
Some changes were introduced in the early 1990s, especially regarding the importance of primary care, and on 1 January 1999, a new general obligatory health insurance system entered into force. This latest reform, which operates through regional funds, splits purchaser and provider functions and emphasises the role of family physicians, should provide a strong impetus to the reform process, despite some initial financing problems. This marks a radical shift to a decentralised, insurance-based system. In addition, a comprehensive law on healthcare is currently under consideration that should resolve some of the problems of the new system, one of which is lack of clarity and transparency.
In Krakow and elsewhere in Poland, current “family doctor” experiments have proven to be largely successful in raising the profile of primary care physicians and encouraging patients to use them as gatekeepers to the overall system. However, reform efforts so far have been isolated to regional projects with limited overall effect. In order to attain the official target of 50% specialist and 50% primary care doctors, the family doctor network has to be extended. It will also mean making more training available to both practising and new doctors.
©OECD Observer No 220, April 2000