Around privatisation in health care : some issues

In recent years Polish health system underwent a lot of changes. One of their important dimensions was a balance between public and private. Before 1989 the system was almost completely public and the idea to boost private segment was raised many times. It was propagated mostly by a group of outstanding medical professional who hoped it to be beneficial for them as well as by a few economists believing in market efficiency, but their position was too weak to alter political decisions and privatisation has never explicitly been declared as a priority of national reform. Nevertheless privatisation appeared from time to time as a hidden goal of some health care reform initiatives and a substantial part of health care providers – mostly in out-patient care – has been privatised. Public convictions and beliefs make a psychological bedrock in which health system can be transformed. Many surveys reveal the Polish population is rather confused in their perception of private segment of health care provision. They approve private providers in verbal declarations which are believed to be more accessible, but are afraid of having to pay in privatised hospitals. The people are not ready to be charged with fees. In early stages of the reform an idea of setting up a structure to negotiate collectively terms of work was very popular. But launching the “Providers’ Alliance“ (Porozumienie Zielonogorskie ) in 2004 resulted rather from urgent need to negotiate contracts between PHC providers and the payer than from democratic concept. Physicians demanded many concessions from administration - working time, free Saturdays and Sundays – and they managed to get them. It was definitely against all promises given at first stages of health care reform. What more, all these concessions were approved by the authorities as binding in all country wide negotiations between the payer and providers. One of the most important component of proposals presented by the government referred to the law on health care institutions. The inherited arrangements ("independent public healthcare institutions" or SPZOZ) were seen to confine chances to make optimal decisions. Making them more flexible seemed to be a prerequisite to better management and better meeting health needs of population. According to proposals a health institution could be run in the form of a company (in terms of the Code of Trade). Such transformation was intended to increase the managerial possibilities for hospital management to operate in more efficient way.. Equally important was to implement a rule of a stronger accountability - mostly financial - for decision makers responsible for running hospitals. In early nineties the concept of patient right was hardly recognisable even if a list had been included in the law. One of areas where patients’ dignity was violated was obstetrician: conditions of delivery which were very poor. It was certainly the problem of scarce resources but also of attitudes shared and demonstrated to women. In 1994 the largest newspaper "Gazeta Wyborcza" proclaimed a campaign entitled "Childbirth with Dignity". At the time the reason to do so was to initiate a public discussion on the subject, which was a taboo for years, but actually it contributed to change the situation substantially.