No relief for private healthcare
Private medical centers are prospering as Poles look for an alternative to the ailing public healthcare service. But until the government creates laws that allow patients to use their state insurance contributions for private treatment, private hospital development will lag far behind the public sector.
Although Poland's economic downturn has meant cutbacks by patients and companies on their healthcare spending, private medical centers are nevertheless increasing their patient intake as dissatisfaction with public healthcare grows. The Centrum Medyczne medical center in the Marriott Hotel has signed up 64 companies this year, adding another 8,796 new patients to its swelling ranks. Meanwhile, the Luxmed chain of medical centers will soon open its 12th clinic in Warsaw.
But despite the growing popularity of private medical centers among patients and companies, healthcare managers are concerned the public funding of healthcare is inhibiting the progress of private medical services.
"As long as regional authorities set healthcare budgets and choose healthcare providers, they will negotiate in the name of the public hospitals and clinics in their area that are most in need of finance," said Iwona Łaszcz, chairman of Centrum Medyczne.
Healthcare funding is administered by Poland's 16 public Patients' Funds, established by the 1997 insurance and healthcare act, to administer compulsory healthcare contributions and contract out medical services through public and private facilities.
The act also contained provisions to create, by 2002, private Patients' Funds to allow patients to pay their monthly contribution of 7.5% of their income toward the cost of private treatment. The move would have channeled state funds into private clinics for the development of private medical services. But when the Sejm examined a bill to amend the healthcare and insurance act proposed by Prime Minister Jerzy Buzek's government in 2000, the introduction of private Patients' Funds was postponed indefinitely because the Sejm considered the bill underdeveloped.
Industry analysts said the main problem with public Patients' Funds, which are now the only bodies distributing healthcare funds, is that they are not a credible business partner for investors in private hospitals. This is because the directors of Patients' Funds are chosen by local authorities, which own the hospitals. They are therefore more concerned with preserving state hospitals than allocating funding to private facilities.
"This is one of the reasons why no hospitals have gone bankrupt in Warsaw since the previous reform," Łaszcz said.
Jerzy Nowak, chief medical consultant at German insurer Allianz, said Patients' Funds offer contracts for medical service providers for too-short periods to guarantee a private hospital a long-term flow of patients and funding, creating unacceptable investment risk.
"Patients' Funds organize tenders once a quarter or once every six months," Nowak said. "Imagine investing in a hospital with the knowledge that you are only guaranteed revenue for six months and not knowing how much the funds will want to pay next year. This is why we have seen no investors wanting to invest money in such dramatically risky conditions."
As a result, patients requiring complex surgery do not yet have an alternative to the public health service. "Private medicine in Poland cannot perform complex heart operations or transplants," said Wojciech Pawłowski, chairman of Luxmed.
Warsaw's biggest private hospital is Centrum Medyczne Damiana, which has 40 beds and performs around 2,000 operations a year. The center recently opened a surgical ward, equipped for all operations apart from heart surgery. According to Chairman Krzysztof Urbaniak, advanced surgical operations such as heart transplants require the backing of a large private hospital with at least 200 beds and four wards, including an outpatient and a 24-hour intensive care ward. Until such a hospital is created, patients have no choice but to use public hospitals.
Nowak said the absence of private Patients' Funds also presents a further barrier to the growth of private medical services. Patients wanting to use a private health plan cannot opt out of the state health insurance plan and have to pay for both, which makes private healthcare expensive. This is compounded by a lack of legislation governing the work of health insurance, so that Poles only have access to individual and company medical plans. As a result, the size of the private healthcare market and the services that medical centers can provide remain stunted.
"Up to 10% of the population of developed countries have private health insurance that substitutes for public healthcare," Nowak said. "On the Polish market this could be around 7% (2.6 million) if users of private healthcare did not have to pay for public healthcare as well." According to Nowak, there are only about 300,000 Poles using private and company medical plans.
Greg Goodale
