|
Poland The Health Care System
The constitution of 1952 guaranteed universal free
health
care. In the last two decades of the communist era,
however, such
care became progressively less dependable for those
without
informal support networks or enough money to buy health
care
outside the official system
(see
Social Relationships
, this
ch.). As
early as 1970, Polish governments recognized the need to
reform
the cumbersome, inefficient national health care system,
but
vested interests in the central planning system prevented
meaningful change. From the beginning, administration of
the
system was inefficient. The structure of the medical
profession
did not supply enough general practitioners, and medical
personnel such as dentists and nurses were in short supply
(see
table 9;
table 10, Appendix). Treatment facilities were
too few
and crowded, preventive medicine received little
attention, and
the quality of care was generally much poorer in rural
areas. As
in other communist countries, the finest medical
facilities were
reserved for the party elite.
In the postcommunist reform period, constriction of the
state
budget and fragmentary privatization of medical practices
made
the availability of health care unpredictable for many
Poles.
After inheriting a deteriorating health care system,
Polish
policy makers placed their near-term hopes on reducing
bureaucracy, encouraging self-government in the medical
profession, shifting resources to more efficient
departments, and
streamlining admissions and diagnosis procedures.
In 1992 Poland had fifty-seven hospital beds per 10,000
citizens, about half the ratio of beds available in France
and
Germany. The ratio had been declining since the 1960s; in
1991
alone, however, over 2,500 beds and nearly 100 clinics and
dispensaries were eliminated in the drive for
consolidation and
efficiency. Already in the mid-1980s, about 50 percent of
the
medicines officially available could not be obtained by
the
average Pole, and the average hospital had been in service
sixtyfive years. Because the reform budgets of the early 1990s
included gradual cuts in the funding of the Ministry of
Health
and Social Welfare, additional targeted cuts of 10 to 20
percent
were expected in clinics and hospital beds by 1994. The
long-term
goal of Polish health policy was a complete conversion of
state
budget-supported socialized medicine to a privately
administered
health system supported by a universal obligatory health
insurance fee. Under such a system, fees would be shared
equally
by workers and enterprises. Before introduction of that
system,
which was not expected until at least 1995, interim
funding was
to depend heavily on a patchwork of voluntary
contributions and
local and national health-care taxes. Even after 1995,
however,
planners projected that the state budget would continue
contributing to the national health care fund until the
insurance
system became self-sufficient. The state would now
contribute
directly, however, bypassing the old health care
bureaucracy.
Data as of October 1992
|
