Private hospitals hope for growth under new system

Even in Warsaw where there are almost 30 private health care centers and one private hospital, the market is by no means saturated, practitioners said. (See also The List, page S5)
"I think there is plenty of room over the next two years for (private) clinics," said Greg Eaton, director of Warsaw's American Medical Center (AMC), which focuses on family medicine. This autumn the center plans to open a 2,000 square meter facility with 12 beds and a surgical ward.
Private operators believe they will continue to see business grow through two avenues. First, they are trying to sign contracts with the 16 Patients Funds established under the health care reform. In this way, they will be able to participate in the public system. At the same time, they believe that the quality of service they offer will keep patients coming back even if they have to pay for services themselves.
"In the private system you have a direct possibility to control the quality of service," said Dr. Marek Ploszczynski, managing director of Warsaw's Centrum Medyczne Damiana, a clinic that also has a 20-bed hospital, an intensive care unit and a surgical ward. The hospital is currently in negotiations to sign a contract with a Patients Fund.
And the private operators believe that services outside those paid for by the Funds will continue to see strong demand. They noted that the number of patients visiting private clinics and hospitals has jumped in recent years, dispelling the notion that such services are only for the rich.
Of the approximately 25,000 private, paying patients on Falck Polska's register, 16,000 are with a company plan, and 6,000 are private patients. "It grows constantly," said Jacek Ziolkowski, country manager for Falck, which has been operating here for the past seven years and provides both basic and emergency care.
In 1998, Falck Polska had revenue of zl. 11 million ($2.8 million) in its medical division. But Ziolkowski claims that the company has been operating at a loss because it has opened other clinics in Szczecin, Poznan, Gdansk and Krakow.
"When you are establishing a branch, you need at least two years to break even," Ziolkowski said.
Lecznica Omega on ulica Ptasia in Warsaw has almost 10,000 patients, a number that has increased by 200% since 1996, said Dr. Jerzy Libich, a pharmacologist and owner of the clinic. Currently, 50 physicians are working at the clinic, an increase of about 100% since 1996. But because of the financial crisis of late last year, profit for 1998 went down to $95,000 from $123,000 the year before.
Such private operators argue that patients find better quality care at their facilities than at state-run operations. In the state system, patients must go to a clinic and sign up for an appointment. The wait can be hours long while the consultation time with a physician can be as little as 10 minutes. Doctors seen are usually specialists and it is still not common to find family practitioners in Poland as compared to North America.
"It's a lot different from how it's done here," AMC's Eaton said.
That's not to say that public facilities do not have their pluses as well, something even private operators acknowledge.
"A public organization has more sophisticated equipment," Libich said. "But the care of patients is not on the same level."
Libich's biggest concern is with the new Patients Funds, something he himself has difficulty completely understanding and a development he attributes to a drop in his client list.
The fact that patients can now choose their provider so long as it has a contract with a particular Patients Fund has given people wider choice and more reason to go to clinics participating in the public system, Libich said. He added, though, that the situation is due to change when people see the difficulties involved with working in the state health care system.
"I think they will come back to me," Libich said.
But the reform isn't making a dent in business at some clinics. Ploszczynski said that since the health reform began last January, Damian's patient list has increased by 20%.
Some private operators have already signed contracts with a Patients Fund for special services, while others are still in negotiations.
But some clinics, like AMC, are not interested in getting involved in the public system, sighting incompatibility in prices. But Eaton mentioned the possibility of private health insurance appearing within a couple of years. This will make the medical business more competitive and bring in more finance, allowing for newer equipment and newer training programs. "That in itself will be a huge driver," for more competition in the field, he added.
"We are waiting for that," said Dr. Jan Mlynarski, an obstetrician and manager of Lecznica Lekarzy Specjalistow Sigma, which specializes in plastic surgery and obstetrics. Private health insurance will help both patients who want to have an operation and doctors. "(Patients Funds) have no money," Mlynarski said.