CASE REPORT
Around privatisation in health care. Some issues
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Instytut Zdrowia Publicznego, Uniwersytet Jagielloński
Wydział Prawa i Administracji, Uniwersytet Łódzki
Publication date: 2020-06-03
Problemy Polityki Społecznej 2010;13-14:17-40
ABSTRACT
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.
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