Prescription for trouble
The patients In the first few weeks of his tenure at the Health Ministry, Łapiński pleased patients by promising that he would ensure equality of service and reduction of bureaucracy via the abolition of the Patients Funds responsible for allocating money in the system at the local level. More recently he promised that as a result of his review of prescription charges the average patient would end up paying around 20% less for medicines prescribed by his doctor. This was a rash claim that has come unstuck in the light of day. A new limited list of drugs for which prescriptions were to be subsidized was put into operation and research shows that prices for prescription users actually rose by 4-8% depending on the research agency publishing its findings. Yes, some prices have fallen, but on average prices for prescribed drugs have gone up.
The doctors Łapinski has annoyed doctors by attacking their trade union and professional association representatives. When they criticized his proposal to centralize the administration of the health service and proposed their own solutions he stopped inviting them for consultative meetings. He has also slandered Konstanty Radziwiłł, the chairman of the Medical Association, by saying that he is a lobbyist for one of the drug companies and that he has not practiced medicine for eight years. The latter charge is certainly untrue - Radziwiłł has his general practice in the estate where I live.
The nurses This was comparatively easy and in many ways unavoidable. The promised higher pay for nurses has not materialized. This is now a tradition in Poland. Every government pledges that it will do something for the nurses and then does not deliver.
The drug companies Good for him I hear you say. At last someone is trying to reduce the cost to the taxpayers of those greedy profiteering drug companies touting expensive medicines when generic drugs would do just as nicely. Yes, the minister has put the drug companies in a tight spot and made some of them cut their prices. The problem lies in the fact that the saving has not trickled down to patients and in some cases companies qualifying for the list of drugs subsidized on prescription have been handed a virtual monopoly position in their area of treatment. Take the treatment of asthma. Until recently patients could obtain subsidized medicines from three providers. Now they can get only one. This means that the company that won the day has cornered the market by simply reducing the price it charged for the medicine.
The existing regional Patients Funds Not just because he plans to abolish the organizations they work for and put them all under the ministry's control. He has accused some of their bosses of malpractice and made it crystal clear that those who got their jobs under the previous government may find it hard to retain them under the new set-up.
The journalists Łapiński is certainly communicative. Press conferences and electronic media appearances are in plentiful supply. The trouble is that his bedside manner with journalists consists of raging at all who question him and accusing them of having ulterior motives. Not a good way to win friends and influence among the hack fraternity. Not bad for just six months in office. To this list we might add President Aleksander Kwaśniewski's adviser on public health, who got attacked for daring to question the centralizing tendencies of the reform (he was accused of being a consultant for some of the Patients Funds Łapiński has proposed to dismantle and opposition MPs whom he simply ignores). Is Łapiński sailing close to the wind and risking dismissal? Probably not. The man who really matters, Prime Minister Leszek Miller, is on his side. Despite agreeing to hold meetings with those groups Łapiński has excluded, Miller wants to see Łapiński continue with constituting the central health fund. Having criticized the previous government for getting everything wrong in health, education and social insurance, Miller is happy to see a minister determined to put a new system in place and is prepared to give him the time to deliver the goods. Łapiński's centralizing instincts may well be close to his heart.
Chris Mularczyk is a Warsaw-based consultant. He can be e-mailed at cmularczyk@wbj.pl
