Health services as an economic factor-the example of Poland

By Brigitte Fehlau
24 July 1999

Poland has recently been showered with praise in the Western press. Of all Eastern Europe, Poland's transition from a planned economy to a market economy has been most successful, they say. Its economic data is exemplary, and the country is even a candidate for membership in the European Union (EU).

The government under Jerzy Buzek has conscientiously fulfilled all the conditions set for Poland to have a fast-track entry into the EU. This has led to the destruction of whole branches of industry, but above all agriculture. In the mining and metallurgical industries at least 120,000 jobs are threatened. Only a very small minority of the population has profited. The real picture of Poland is one where the broad majority lives in bitter poverty; unemployment in the countryside rises to 60 percent in some areas, and those who still have work receive low wages.

At the start of the year a “health reform” took effect which has caused indescribable chaos. Within weeks the already inadequate health service became a disaster for most of the population.

The collapse of rescue and emergency services has already led to numerous fatalities. Many just put up with their illnesses, partly because the hospitals refuse to accept them and partly out of uneasiness over the miserable service.

Whoever has the misfortune to suffer an accident is lucky if the ambulance comes late—sometimes it does not come at all. In the hospital, if the patient is accepted, only a bare minimum of care is provided, for reasons of cost. This has already had serious consequences.

A pensioner from Masuren died of flu last winter. The hospital simply refused treatment. In Lodz the hospital refused four times to accept a 36-year-old suffering with severe influenza. The patient's father only succeeded with the help of a priest in getting his son into an out-of-town hospital, where, unfortunately, he soon succumbed to his illness.

How the “health reform” saves money and costs lives is illustrated by the case of a director at a psychiatric hospital from Boleslawiec. The planned personnel reductions in this hospital drove him to such despair that he took his own life.

As far as the government is concerned, the "health reform" measures are about ridding the state of its responsibility for providing care. The health service is now supposed to function like other industries.

In the past the state was responsible for providing this service and for the employment of all medical personnel. Since the beginning of the year, it is no longer responsible. Furthermore, the government majority in parliament decided on the formation of 16 regional health insurance companies, to which each employee must contribute 7.5 percent of his gross income. These companies now negotiate with the independent hospital operators and agree on contracts for services and for the price of health care. The new hospital operators also employ the medical personnel. The regional and municipal authorities are responsible for the buildings and the medical equipment. The size of health insurance contributions is still laid down by the government.

Those who have come into some money in recent years and can afford to be treated privately will not have a problem with the results of these policies. But the large majority of the population cannot afford private care and their anger at conditions in the health service is growing.

Since the spring, protests and strikes against shortages and low wages have not let up. Physicians, anesthetists, nurses and emergency service workers have taken strike action again and again. Often, care has only been available for acute emergencies.

For almost 10 weeks nurses and midwives have been protesting. Last week a protest march clad entirely in black walked through Warsaw, in mourning over the low wages of 700 Zloty (US$194) that a nurse earns each month. The wages of a physician with 15 years seniority amounts to just 800 Zloty. Out of a total of 250,000 nurses, 30,000 are now on hunger strike. They are demanding that the government provide for a wage rise and increase its health insurance contribution.

The government reacted to their protest, to the extent that it wrote off the repayment of a credit that had been granted to the health insurance companies at the start of the “health reform”. Whether this will lead to an improvement in the position of the hospital personnel remains to be seen.

At the end of June, in the border region around Frankfurt-Oder and Slubice, three German-Polish conferences took place. One of them was held under the slogan: "The economic factor of the health service". The delegates discussed how German companies could "secure earnings" as a result of the reforms in Poland's health service. Whether this would lead to an improvement in health care or a rise in the living standards of those employed in the service was a moot point.

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