Health reform opponents find a willing ear

Opponents of a centralized national health care system met with Prime Minister Leszek Miller late last week after being shut out of consultations with Miller's health minister. Miller postponed his cabinet's debate on the national program, drawn up by Health Minister Mariusz Łapiński, to listen to heads of the Śląska, Małopolska and Podkarpacka Patients Funds - three of the 17 independent regional health care operators - and representatives of the Supreme Council of Physicians (NRL). Grzegorz Rydlewski, head of Miller's advisers, said after the meeting that the health minister should be given time for reflection. Łapiński prompted the prime minister's meeting when he failed to invite critics to an April 15 assembly, planned as the finale of consultations on his new program. "It's no use to listen to the opinions of (those who weren't present at the Monday meeting)," Łapiński told a press conference last week. "They have their own program." As of January 2003, Łapiński plans to abolish the regional Patients Funds created under the 1999 health care reform and responsible for contracting medical services. Instead, he intends to establish a centralized national health fund with regional branches to gain direct control over the entire system.

The fund would contract medical services for the entire country according to a single price list. The health minister, who will appoint the fund's management and a supervisory council, would ultimately approve the fund's financial plans with the prime minister. Regional councils representing local governments would also be set up to work with the fund. Łapiński said his program would make the health care system efficient in a couple of years. "What we're doing should lead us to a rational distribution of funds," he said. Planned changes will cost zł. 10 million ($2.43 million) according to Łapiński, but staff reductions would yield zł. 90 million ($21.95 million) in savings. "There is a lot of politics in the current system and we're going to change that," he said. "It's not centralization that we're doing. It is cleaning up the mess in the current system." Specially selected guests praised his program during a conference last week but critics charged that the new reform would lead to central planning in health care. "The program's most serious weakness is its attempt to centralize the health care system," said Elżbieta Radziszewska, deputy of the Civic Platform (PO) and a member of the Sejm's Health Committee. "It's a threat to the interests of patients and small medical institutions in particular because you cannot see from Warsaw what every single place in Poland needs. We've already learned that lesson during 50 years of the old (communist) system."

Last week PO's deputies submitted a motion of no-confidence against the health minister. "Even if our motion is rejected we can't stop alerting the public that the minister is unable to introduce any kind of changes," Radziszewska said. "Everything he does causes scandals and offense and what we need is dialogue." Łapiński's party, the Democratic Left Alliance (SLD), and coalition partners hold a decisive majority in Parliament, making the success of a no-confidence vote unlikely. Radziszewska said that a group of lawyers, economists and doctors with no political affiliations is currently working on yet another program that could fix the health care system's weaknesses. "We support evolution kind of solutions, which means that we would keep everything that's good in the system and abolish only what's defective."