OZZL – OGÓLNOPOLSKI ZWIĄZEK ZAWODOWY LEKARZY
ZARZĄD KRAJOWY
D.T.U.P. – DOCTORS’ TRADE UNION OF POLAND - NATIONAL BOARD
A member observer of F.E.M.S.
REPORT ON THE SITUATION OF HEALTH CARE SYSTEM IN POLAND
F.E.M.S. Meeting in Varna, OCTOBER 2005
During first ten years after transformation from communism into democracy and from socialism into capitalism in Poland, until 1999, health care system in Poland functioned on a traditional communist’s rules basis. All hospitals were government properties. In 1999 this system was completely changed. The ownership and management of hospitals were transmitted to local self-governments. Instead of governmental budget financing of health needs, money was taken from common taxes paid by all taxpayers (now it is amount of 8,75 % of tax). Sixteen special public regional health insurance funds („dispensaries”) was established for dividing those money between hospitals and other health care plants. At the same time denationalization and privatization of medical plants (especially – local clinics) started, and next deep changes were imposed, to introduce an idea of insurance and free-market system.
But four years ago the post-communist party came to the power, and changed health care system in Poland again, towards the centralized direction. Sixteen regional institutions was united into the one National Health Found (NHF), with a head in Warsaw. The process of introducing a free market into the system was stopped. Post-communists didn’t want to hear about joint-paying for public services directly by patients. Hospitals are drowning in debts, because real services costs are much higher than a poor NHF coverage. Patients have very difficult access to medical services now, and they are forced to wait in long lines.
Nowadays in our system is around 9 billion euros of public money per year, and it is the lowermost level of health care financing per capita (per head) from among all European Union countries. Converting it into GNP (Gross National Product), this is a short 4 %. In other countries GNP for health care brings up from 6,5 % even to 12 %.
After the last general election in Poland, which took place in September this year, our organization and many others, started to force a new, right-wing government coalition to come back to the previous conception. A deep reform of health care system in Poland is necessary, because it is dreadful, very poor, primitive, and its effectiveness is completely idle now. Our organization (OZZL) have its own, big and comprehensive project of reform, leading to establish a rational health care insurance system, working on a competition and a free-market basis. We back up introducing of free market into this system everywhere, where it’s possible. We demand to establish rational and competing health care system with an excess charge taking from some patients.
Generally, in Poland there are registered 120.000 doctors and dentists. Nearly 90.000 of them work in the medical profession. Almost all general practitioners (GPs) work as a private (non-public) doctors’ and dentists’ local clinics (surgeries). Many specialists also act on the same base. We have about 100 private, small hospitals too.
In near 800 public hospitals, there is a big group of physicians rendering services in hospitals as a private firms, hired under the contract, but most doctors there are salaried physicians under the administrative authority, working full-time and part-time.
The situation of salaried doctors in Poland is the worst. There are some reasons of it:
- drastically low doctors’ earnings, leading them into a low and poor standard of living,
- working overtime with no money,
- no leisure (free time) after overnight duties,
- necessity to take several additional jobs in a row,
- wrong working conditions forcing physicians to the continuous play with danger,
- overwork,
- a lack of employer’s appreciation,
- a lack of time and money for self-education,
- drastic reduction of family life, etc. etc.
It leads to tiredness, discouragement and frustration. An average domestic salary in Poland is about 400 euros net monthly. Net doctor’s basic salary in public hospitals and public outpatients’ departments is from 300 euros up to 500 euros a month, apart from the additional payment for overnight duties. For 6 overnight duties doctor can earn another 350 euros. So, since 15 years we demand to obtain threefold average domestic salary for doctors, but it is still and constantly ignored by rulers.
Easier is to act in cases of breaking labor law by employers in hospitals and other health care plants, where doctors (our members) are engaged. If necessary, we support legal, successful help for our members.
But introducing European Working Time Directive (ED 2003-88/EC) in Poland is a real problem. We appreciate all advantages of this solution, we realize (as says F.E.M.S. in its Motion) that extending of working time above the 48 hours weekly norm leads to the reduction in the level of protection of both patients and doctors, and jeopardizes the quality of healthcare, reduces patients’ safety, increases the risk of accidents at work and involves individual liability.
We support this Motion as well, but on the other hand, it is vitally important to cause a considerable rise of doctors’ wages in Poland and in other EU newcomers. If not, doctors from these countries will stand against the 48 hours weekly norm, because the only way for them to earn more money will still be taking as many overnight duties, as possible. The alternative for them is to emigrate to old EU countries, but in turn, this solution is not favorable to doctors working there now, because of danger of taking over their positions. About three thousand doctors from Poland found a job in old EU countries already, but next thousands are looking around to do the same, especially young ones.
All those problems are similar in EU newcomers, and some of them are present in old EU countries too, so we hope that F.E.M.S. is a good forum to discuss it.
Dr. Richard KIJAK
Vice President of OZZL (D.T.U.P.)
