Paulina Miskiewicz is the Co-ordinator of programmes for Poland at the World Health Organisation (WHO) Regional Office for Europe in Varsovia. She has dealings with the Polish Health Minister. She reveals the characteristics of public health in the previously Socialist countries, future members of the EU, and the type of health care system used in the CEEC.
Alongside her expert view, Marek Milewzki, a Polish law student from Cracovia, highlights certain practical problems within his country’s health system.
These two different perspectives present a broad view of Europe’s health problems in this period of enlargement.
café babel: Ms.Miskiewicz, as Liaison Officer of the WHO (1) in Poland, could you present the mains issues and difficulties of the healthcare system in the CEEC (2) and in Poland?
Paulina Miskiewicz: After the collapse of Communism, the issues concerning healthcare have to change; all sectors have to enter the market system, including healthcare. We have to find other financial possibilities for these areas. Before independence, we were all dealing with this famous Semachko system, which established free access to the health care system. The State budget was distributing sickness allocations, primary healthcare was provided by the polyclinique. Actually, health care was not a priority sector in the GDP, the mortality rate was high, and the Semachko system was very expensive for the State. After the fall of Communism, the CEEC had to ensure people had efficient health services.
The Bismarck system has been implemented in Poland. It is based on contributions by employees and employers to the health insurance fund. Then you can have free access to health care units.
What was the role of the WHO in reforming the health care system in Poland?
There is a strategic paper which indicates Poland's priorities and the WHO is trying to fulfil these needs. The WHO is carrying several programs concerning food safety, child health and pharmaceutical policies. Moreover, a “biennial collaborating agreement” was implemented between the Ministry of Health and the WHO in 2002. It deals with policy development (Alcohol Action Plan for example), infrastructures and systems development (capacities building for health information), and support for the implementation of legislation and management tools. The WHO provides the funds and in exchange the Government is providing the personnel, materials, equipment or supplement funding. The State decided to accept this in order to answer the population’s health needs but it is not obliged to.
Is the European model being implemented in Poland and in the CEEC?
Not exactly because every country has its own specific need and the WHO tries to tailor services corresponding to the need. But in some ways, the point of health care policies undertaken in the framework of the WHO is to harmonize and develop indicators and instruments in line with the accession process. Moreover, we have this “new public health programme” (2003-2008), following a link with the European Commission.
Do you think that Poland could be attracted by the liberal system since the World Bank (2) has some influence on Health care issues?
Poland is implementing Bismarck-type insurance even if it is not the pure one. Meanwhile, there is no perfect system. The World Bank is rather active, in the European observatory of Health Care or in the global partnership for Safety. We have a couple of joint activities because we are UN agencies, but the WHO is the only agency that has the mandate for health.
Marek, as a student what are your thoughts about the Polish health system since the fall of Communism?
Marek Milewzki: Generally speaking, doctors are well educated and competent. But the health system is facing certain difficulties. The principal problem that it is suffering from is bureaucratisation. This prevents equal access to health care and hinders quality. Moreover, since the left-wing government came to power, the system of a health insurance fund no longer exists. The right-wing government had created a system that was too centralised which sometimes paid too much attention to the remuneration of State employees. The left-wing government therefore cancelled health funds and installed another type of system that was a little less centralised but still badly organised. Health is not a priority for the government.
Corruption is also a problem. In general, if you want to have an operation done quickly you have to use the financial argument even though the system is theoretically free since people pay their taxes in order to have access to all aspects of health care. It is the same if you want to be looked after by a nurse when you are hospitalised. It is a vicious circle. The medical profession is one of the least well paid professions in Poland; personnel therefore go down the road of corruption so that they are paid a decent salary. Furthermore, doctors are very well known and strongly protected. Indeed, people sometimes talk about the doctors’ ‘Mafia’.
Of course, there are good, ethical doctors but there are some who have fallen by the wayside. As we prepare to join the EU, people must not disregard these serious problems. At the moment - to use an extreme example - doctors are being prosecuted for killing elderly patients. They were thereby providing supplementary clients to certain funeral companies who paid them a commission.
Today, the fact that patients are able to prosecute the hospital if a doctor has made a mistake is nevertheless a positive sign. Previously, the doctor being accused used to be protected by medical corporatism. There is, therefore, more transparency now but patients still need to know their rights. The Polish organisation Primum non nocere tells patients what these rights are. In this sense, progress is being made. But even if Poland is joining the EU in six months, European directives on the subject of health will not be applied. First of all mentalities need to be changed.
2. Central and Eastern European Countries