Legal Eye: Healthcare for all?

"Everyone has the right to healthcare."

Article 68, paragraph one of the Constitution of the Republic of Poland.

Healthcare systems in many a country are easy and popular targets for the soap-box.  As a lawyer, I try very hard to understand all sides. However, after hearing yet another story of the dilemma of whether to pay privately for healthcare at a Polish state hospital or to wait several months, you begin to wonder why you are paying the healthcare component of ZUS. And in light of yet another set of proposed changes to the healthcare system, you may be asking yourself: "What are my alternatives?"

The Polish Constitution contains a noble principle of guaranteeing universal healthcare. In addition to the affirmation that healthcare is a right, the Constitution also requires the State to provide citizens "equal access to publicly-funded healthcare." Furthermore, public authorities are charged with ensuring special care for children, pregnant women, disabled persons, and the elderly. 

But the devil is always in the details. And when it comes to the lofty ideals of public healthcare, the infernal detail is that the Constitution states that a separate law will specify the "conditions and scope" of healthcare services.

Anyone who has had the privilege of visiting a state clinic or hospital as of late probably has a good idea what "conditions and scope" means in practice. Healthcare institutions providing publicly-funded services receive, in accordance with the Law on Publicly-Funded Healthcare Services, a set amount of money from an annual budget. Thus, these institutions can only provide services to the extent of the money received, which does not necessarily cover all patients' needs. If you are going to get sick and want to use public health care, you should first check whether any money remains in the current fiscal year to cover your procedure.

The alternative to waiting and hoping in the publicly-funded system is private healthcare, whether through a private - healthcare provider or privately at - publicly funded healthcare institutions. But then this cost comes right out of your pocket. The government has done little legislatively to acknowledge and attempt to encourage alternatives to the stark choice of private versus publicly-funded healthcare. 

As an employer, I have considered providing some sort of health benefits to my employees.  My accountant, however, tells me that anything beyond employment-related examinations and prophylactic care would be considered as income to my employees, and they would have to pay personal income tax on the benefits. The Labor Code narrowly defines the medical care that an employer is required to provide. For many employees, the care an employer may offer is limited to initial and periodic medical check-ups.   

Not only are businesses limited in what they can provide for their employees, but current  VAT laws make corporate philanthropy costly and burdensome. A corporate entity providing charitable assistance must pay VAT on the value of the assistance. The recent story of the bakery required to pay VAT because it gave unsold bread to the needy rather than destroying it demonstrates the absurdity well.

Despite my declared intent to view matters objectively, I see that I already have one foot on the soap-box. That being so, I'll risk another, solely personal opinion. As public funding is insufficient to meet the healthcare needs of Poland, the government should consider granting incentives for business to provide additional healthcare for their employees. This could be as simple as allowing some healthcare expenses to be treated as a tax-deductible cost of doing business.

Judith Gliniecki is the managing partner of Rymar and Partners.