N'tl healthcare plan worries insurers

Private medical providers may lose business Private clinics fear losing their contracts with Patients' Funds while insurance companies are concerned there is still no basis for developing a health insurance market if the government goes ahead with plans to create a National Healthcare Fund. Last week Health Minister Mariusz Łapiński announced a new National Healthcare Act, which the government wants passed in June. It would abolish the three-year-old system of 17 regional Patients' Funds by January 2003 and create a single coherent healthcare policy. Public health insurance contributions will flow to the central budget and will be distributed by 16 regional departments of the national fund according to budgets fixed by local governments and approved by the Health Ministry. Private medical firms say that local government will stop buying medical services from the private sector and instead favor its own providers. "The system will make it hard or even impossible for money to flow from the public healthcare system to private healthcare providers," said Jerzy Nowak, chief medical consultant of German insurance company Allianz Polska. At the moment Patients' Funds, or Kasa Chorych, can negotiate to buy medical services from both public and private healthcare providers, such as hospitals and clinics, a system that has helped to cultivate the private medical services market. But local governments own the public healthcare facilities in their regions and it would be against their own interests to give contracts to private firms, Nowak said. The Health Ministry's plans would affect companies like Centrum Medyczne, a private Warsaw clinic that receives 8% of its revenue from a contract to provide one-day surgery for Mazowiecka Kasa Chorych. "We were hoping that if both the patients and the Patients' Fund were satisfied … the value of the contract would increase and we would expand our facilities," said Iwona Łaszcz, president of Centrum Medyczne. "I assume that if local government has to support large, unprofitable hospitals then it will be difficult for a private medical center to sell its services without links to local government." Krzysztof Urbaniak, chairman of the Damian medical center and head of the Association of Healthcare Employers, said it would be difficult for local governments to afford private medical services as pressure to support their own facilities, many of which are badly run and outmoded, would drain their budget allocations. "It would be very hard (for local government) to close a hospital with infrastructure problems or poor financial performance because the resulting job losses would be controversial in the current economic climate and the local population would protest the closure of the hospital," Urbaniak said. "The problem would be solved if private insurance companies could function on this market, providing an additional flow of funds to develop this rather shallow medical services sector." No state guidelines But for private insurance companies, the health minister's proposals contain no clear message on how a private medical insurance market, for which there are no state regulations, could work in Poland. Nowak said that insurance companies could sell health insurance if they were able to buy medical services from the state healthcare system. But to attract clients these services would have to be of a higher grade than those offered under the state insurance system. "But I believe this two-tiered system of public healthcare charges would be against the Constitution, since all Poles have the constitutional right to free state-provided healthcare of the highest available level," Nowak said. The current healthcare system is still a long way from transparency in reflecting the cost of treatment, preventing insurers from calculating costs or premiums, according to Adam Taukert, spokesman for Poland's largest insurance group Powszechny Zakład Ubezpieczeń (PZU). "What we need is the ability to determine the cost of treatment for individual patients, this would allow insurers to work out the size of premiums that would allow us to pay out settlements," Taukert said. "To determine the real cost of treatment we need a medical services market, while at the moment we have a state monopoly. There is no healthy competition."