Competition is the best medicine

Andrzej Wróbel: Why is the health system ailing?

Marcin Halicki: The system is in a dire situation. It is malfunctioning and ineffective because of a lack of competition. One of the most crucial things is that there is too little money in the health system [and we need to] use the money in a more effective way. If there are no private funds managing the contributions paid by citizens or any insurance companies, the waste will continue.

So the industry needs one public institution and a number of private funds?

I am sure that when private funds are allowed, effectiveness will improve. Price and quality should be the only factors taken into account when contracting services. Now, because the National Health Fund (NFZ) is a public institution there are other factors to be considered: the social situation of employees, the rate of unemployment and lobbying.  Sometimes there are two or three hospitals that are artificially sustained in a small town although just one would perfectly satisfy the needs of the local patients. Funds could be used for one effectively managed hospital.

Unfortunately, such consolidation would mean an employment reduction.

What about the level of debt in public hospitals?

 

I haven't heard of any proposals related to public hospitals' debts. A debt that has been suppressed several times does not reappear without a reason. This happens because of the structure of the public-health system. On the other hand, it isn't true that all hospitals have debts; there are plenty of well-managed hospitals.

Does the Minister underestimate the problem of medical staff going to work abroad?

Employing new doctors and nurses in many bigger cities in Poland is becoming more and more difficult and it's not because of their salaries. The market is automatically reacting and wages that are much higher than two years ago are still increasing. Private companies will deal with this situation better because they don't have the same budget limits, because they are able to pass on part of the salary to the consumer - i.e. the patient. Perhaps we will have to employ people from abroad after special training.

What is needed for a real reform of the health service?

 

Reforming hospitals takes major investment and a lot of time. If private insurance firms appear, meaning that private institutions will have funds to cover capital expenditure, they will be able to build a hospital. But if we built a hospital today, it could turn out that the number of people willing to pay for their medical needs in a legal way would be too low. 

Corruption in the public sector is significant. There is no long-term contracting of medical services by the NFZ, which would make capital-intensive investments risky. Because of the high-investment risk and long-lasting investment cycle, these changes will take place very slowly and will be secondary to the financing changes. We need to activate and re-direct money that is now spent on bribes in the health service.

How can corruption be reduced?

The only solution is to introduce some element of competition. A private institution will be able to offer better quality services. Creating new medical-insurance firms will be followed by new private hospitals. Tax relief should encourage patients to spend money in a legal way. Today the patient has no motivation to ask for an invoice.

How should the government persuade patients to change their habits?

By educating people, and showing them the services they can get in exchange for their money. At the moment people would rather give a 'brown envelope' than have an operation performed in a private hospital.           

Interview by Andrzej Wróbel