Private doctors worry new system aims to cut them out

The Health Ministry's draft bill on a new national health care system has raised serious concerns among private health care providers. Many doctors who invested their life savings in private clinics under the current regional Patient Funds system are afraid that the new system will favor public hospitals and lead private providers into bankruptcy. "The bill is very general and doesn't mention private one-day surgical care wards as entities that will be contracted under the new system," said Stanisław Płonka, the owner of Racibórz-based medical center Lecznica Św. Łazarza and vice chairman of the Non-public Health Care Employers Association. "We're afraid that with no specific article in the law about contracting private services the new national fund, which under the bill would replace the regional Patients Funds, will simply contract operations in public hospitals only." Under the current system, all the 17 patients funds contract medical services with both public and private medical centers. By next January, Health Minister Mariusz Łapiński plans to abolish the Patients Funds system that was created under the previous government's 1999 health care reform. The system, which has been widely criticized since its inception, contracts medical services on a regional basis. Łapiński is instead proposing a return to a centralized national health fund controlled in Warsaw. The bill describing the new system, which is due to be sent to Parliament by the end of this month, is currently being considered by the medical community.

Meanwhile, private surgical clinics are serious competitors to financially troubled public hospitals, whose debt hit zł. 7 billion ($1.75 million). "And we provide the same kind of surgeries two or sometimes three times cheaper than public hospitals," Płonka said. "While their debts keep growing, we're generating a profit. And the number of post-surgery complications is several times lower in private clinics." In Silesia, there are private 86 clinics, Płonka said. The Silesian Patients Fund (ŚKCh), which disburses public funds to hospitals and clinics in the region on a per-need basis, has already contracted 80,000 operations in private clinics this year. According to Płonka, under the proposed law, the ministry might be tempted to support public hospitals by contracting as many services as possible, leaving nothing for private institutions. But according to Renata Furman, Łapiński's spokeswoman, the absence of private surgical clinics in the draft bill doesn't mean they will be ignored in the new system. "Any application for contracts, no matter whether it comes from a private or public institution, will be considered in an equal way," she said. "But it's a good time to send us all the opinions about the draft so we can react to them." But private health care providers argue that they need a clear and transparent law that would guarantee their rights. "Otherwise, we might be simply ousted from the market with the silent acceptance of the ministry," Płonka argued. Elżbieta Radziszewska, a deputy from the Civic Platform (PO) party and a member of the parliamentary health care committee, said the threat to private clinics was real. "If the bill mentions in-patient medical services, one may assume that such a general term also includes private, one-day surgical wards," she said. "But since the entire contracting system is going to change, the risk (to private providers) exists because there is room for different interpretations of too general laws." "Maybe we should think about ways of securing the interests of such clinics by naming them in the final version of the bill. Fortunately, there is time to propose changes to the bill before it's submitted to the Sejm."

Not what the doctor ordered Jacek Bołàdź, who owns a private surgical ward in Tarnowskie Góry, Silesia, told the WBJ that clinics established during the past three years may have serious financial problems if they do not get contracts with the public health care system. This year, Bołàdź, who opened his clinic 10 years ago, must depend mostly on patients registered with the ŚKCh. "But obviously, all will depend on the prestige of a specific clinic," he said. "Many of them were established shortly after 1989 and long before the reform. They were doing extremely well operating on private patients only, so if the system changes and they won't have the right to treat public patients, some of them will survive anyway." According to Płonka, the majority of private clinics provide health care standards comparable to any Western clinic, but to get to that point they had to invest a lot of money. "They are small clinics, but some had to invest even $2.5 million-$5 million to maintain high standards," Plonka said. "It was usually the doctors themselves who either invested (their) personal property or took out bank loans that were guaranteed by their contracts with the Patients Funds." He added that if the government's policy changed and private clinics were not included in the new health care system, many clinics would go bankrupt. "We will be punished for our dynamism," he said. "And all we need is a stable and predictable system. No government can completely change its financial policies in the health care system within one year. We'll defend ourselves to the very end."