Hidden injuries of Poland’s election

The article, by the University of Cambridge sociologist Dr. Peggy Watson, argues that the result of Sunday’s vote could represent the final nail in the coffin of public health services in Poland, where hundreds of thousands of people cannot afford private care.

Writing in the British Medical Journal, Dr. Watson argues that while the world’s attention has been focused on Barack Obama’s efforts to close the affordability gap for healthcare in the US, the reverse has been happening to Poland’s system, where the rich-poor divide is as wide as in America.

Its hospitals, described as the last bastion of a publicly-funded health service, have been the subject of a 10-year privatisation battle. In 2007, the last time the government attempted to launch a commercialisation programme, the bid was vetoed by the former President, Lech Kaczynski.

Since Mr. Kaczynski’s death in an air crash in April, however, the government has pledged to revisit its plans. Bronislaw Komorowski, the front-runner bidding to become his replacement, is in favour of commercialising the country’s hospitals.

The policy would essentially give Poland’s hospitals full market status – essentially, the same legal standing as any other company – and open the door to privatisation.

Dr. Watson’s article argues that doing so would hit hardest the people who need healthcare the most, in a country where many already struggle to afford basic services like dental treatment, or medicines.

“While discussions over Barack Obama’s health care changes have recently dominated the international media, the radical health reforms taking place in postcommunist Europe have met with silence,” Dr. Watson said.

“A system is emerging in Poland where better care is being offered to people who are better able to pay. Much has been said about the country’s growth, but levels of poverty are high. The hospitals are the last bastion of an even health service. There is a real danger that private companies would bring that to an end.”

The report in the BMJ stresses that any hospital commercialisation programme would exacerbate the dual effects of an existing shortfall in funding for healthcare in Poland and a widening poverty gap.

Poland replaced central state funding of healthcare with a social insurance system in 1999 but, Watson argues, this was insufficiently thought through.

Government contributions to healthcare were set deliberately low, in the expectation that it would lead people to seek more private care and that private health insurance would develop to fill the gap. Public spending on health therefore dropped to below 4% of gross domestic product, less than under state socialism.

As a consequence of these reforms, the number of people in Poland having to pay privately for previously free care has risen sharply, with out of pocket payments in health rising to among the highest in Europe. Most Polish people, however, are too poor to afford private health insurance. The biennial Polish social survey, Diagnoza Spoleczna, found in 2009 that only about 5% of respondents had health insurance.

The article argues that this pattern has worsened the effects of already severe income-inequalities, meaning that those most excluded from health care are also those with the greatest health needs.

According to the 2009 survey, just over 47% of people with no source of earned income, 26.4% of people on old age pensions and 43.4% of those on disability pensions were unable to afford the drugs they needed, compared with 7% of the self-employed. Over one half of disability pensioners and unemployed people were found to be unable to afford dental care.

Privatising hospitals, Watson says, would only make this situation worse still. A further survey by the country’s National Security Bureau this year found that the value of planned contracts for 2010 between Poland’s National Health Fund and its hospitals had already fallen compared with 2009 due to shortage of funds. For a number of years, many hospitals have had to limit their intake because of a funding shortfall.

Three quarters of the 506 hospital directors who responded to the survey believed that the functioning of their hospitals would come under threat this year. Watson suggests that this has raised optimism among private companies, many of them western firms, that this will encourage local authorities to privatise.

“The introduction of a system of competing private insurers in Poland is laced with contradictions,” she added. “Private insurance is significantly more expensive than a single public purchaser system, and Poland is one of the poorest countries in Europe.”

“What observers outside Poland forget is that there was full healthcare access for everybody not so long ago. Now an expensive system is being introduced to a country where people already have less to spend on healthcare than rich countries. Their fate, and the fate of that system, could in many ways hinge on Sunday’s election result.”