Lower Silesia takes step toward healthcare reform
The days when the government turned a blind eye to ailing public medical institutions could be coming to an end.
Four public hospitals in Lower Silesia will be shut down under a regional restructuring plan announced by the Health Ministry last week.
The initiative was one of 16 regional restructuring programs prepared by local governments for 2000. The restructuring, which is to be financed by the ministry, is aimed at reducing the number of hospital beds in areas where too many are empty and maximizing the allocation of funds.
"Like Warsaw, Lower Silesia has huge over employment (in healthcare). Unlike Warsaw, though, they're taking it seriously and decided on an extremely costly plan in social terms," said Jagoda Gregier, chairman of the Healthcare Solidarity trade union. "But when it's done, they will finally be able to start functioning properly."
The ministry will assign more than zl. 6.5 million ($1.4 million) toward the restructuring in Lower Silesia by 2001. "The fact that they (the Lower Silesian government) decided to close down those hospitals is why the plan was evaluated so highly," said Anna Huk, deputy director of the healthcare organization department at the Health Ministry.
Under the other regional plans, 43 public medical institutions will be privatized and 110 long-term medical care providers will be established. The government plans to spend zl. 355 million ($77.2 million) on the initiative by 2001.
The restructuring is part of broader healthcare reforms launched in January 1999, when the new healthcare insurance system was introduced. Under the old system, healthcare funds were distributed from the central budget. But under the new system, individual contributions are transferred to 17 Patients' Funds responsible for contracting and financing medical services in the public and private sectors.
However, the allocation of funds still remains a problem. A number of public medical institutions are badly managed with many beds lying empty. At the Lodz Polish Mother's Hospital, for instance, only 50% of beds are occupied and there are eight employees per bed. For their part, non-public medical institutions complain that their services are not being used because the government is protecting ailing public institutions from competition. Private healthcare providers accuse Patients' Funds of propping up public institutions that didn't restructure in 1999 and are unlikely to do so this year. While last year, Patients' Funds contracted 116 non-public hospitals, this year that number has been reduced to 110.
"Under the circumstances, it's good that such a wide restructuring plan has come into effect," said Piotr Blaszczynski, medical director of Medicover Development, a private healthcare organization. "It's the beginning of a long-term political and social process, but the reform needs to go this way."
The restructuring of the public healthcare sector is the domain of local government authorities, which under the law are responsible for providing medical care in their area. But according to Solidarity's Gregier, it was a mistake on behalf of the ministry to let local governments prepare the restructuring plans on their own. "It's too early. Local governments still don't feel that they are owners of public medical institutions," Gregier said. "In two or three years they will learn to care about people and the property."
The local governments prepared the restructuring plans with the support of consulting companies. Those plans were then evaluated by experts in restructuring healthcare institutions and the ministry, which finally distributed the funds.
"It is up to individual provinces how they will use this opportunity," Gregier said. "Unfortunately, some decided to take the money, do nothing and only postpone the real crisis."
According to the ministry's Huk, the plan prepared by the local government of the Mazowieckie province ignored the need to reduce specialized services and limit the number of short-term, in-patient beds. "Under the proposed plan, specialized healthcare is to be developed and the global number of hospital beds to be increased by 1,000," she said. As the ministry estimated, only 68% of beds are effectively used in the Mazowieckie province compared with a country average of 85%. "If the local government wishes to keep those deficit-generating beds that's up to it, if it has the money to pay for it," she said.
But according to many in the healthcare industry, some local authorities could hold back the restructuring for social and political reasons. Closing down loss-making institutions would drastically increase the number of people out of work in areas already hit by high levels of unemployment. Trade unions are also watching what they do. "Our philosophy is to defend jobs where possible," said Solidarity's Gregier. "I agree that sometimes layoffs are necessary, but let's do it where it's really needed."
However, the Health Ministry's Huk said the layoff statistics are not that black. "Last year, 40,000 healthcare staff were laid off, but only 14,000 registered as unemployed since most of them were re-hired by non-public medical institutions or even established private clinics," he said.
This year, the ministry estimated that almost 30,000 would be laid off. "I believe that many of the laid off might find new jobs in private healthcare," Medicover's Blaszczynski said. "Today, private healthcare services are available mostly in big cities but the market is ready to expand."
