Reforms in doubt
Gathering storms around the tottering national health service are set to shake the Miller government and its flagship health care reform by unleashing problems which may not be easy to resolve, according to industry commentators.
Some health officials have raised doubts as to whether the Health Ministry can now win support for its plans to reintroduce a centralised medical insurance system in the wake of a recent revelation of excessive and conspicuous spending by the ministry's head, and growing opposition to the change from key health service personnel.
Health Minister Mariusz Łapiński, who is supposed to pilot the change, was politically weakened after censures from the press and political opposition for approving the purchase of two luxury limousines at a cost of more than €75,000 apiece, while hospitals are running out of cash. There was serious unrest in some Silesian hospitals fuelled by protesting medical staff.
Reports also surfaced that the ministry's promotion office spent another €50,000 on informational compact discs on which Łapiński describes the advantages of the return to the old centralised health fund. The information on the CDs was dismissed as useless by managers of hospitals and called "a scandal" by Ewa Kopacz, an MP of Platforma Obywatelska and a member of the Sejm Health Committee, who added that Łapiński had declared on several occasions how socially sensitive he was and that his sole concern was to improve services for patients.
Even though Łapiński defended the purchases, saying that other ministries bought cars of similar standard and that EU ministers had even more expensive vehicles, some industry professionals cast doubts about whether the minister could gain public support for health insurance reform, which would replace the existing regional health insurance funds with a centralised one.
Said Krzysztof Szlubowski, spokesperson of the regional health fund in Mazowsze: "Only the centralisation of the system, in the form of the National Health Fund, is a chance, although I am not sure whether Minister Łapiński is cunning enough to win the public opinion for the reform."
Szlubowski puts the media reports in a different light. "The healthcare system can never have enough money," he said. "Łapiński is the first minister who openly says where the problem lies; therefore, he has powerful interests groups against him."
According to Szublowski, the real problem lies in the structure of the medical profession, where the heads of hospital wards send patients to their own private clinics and earn huge amounts of money, while the so-called ordinary doctors and nurses work for virtually nothing. It is also an almost closed caste, with positions inherited within a family.
And the money involved is not insignificant. The Mazowiecki Health Fund, for example, spends O1 billion a year. This fund will not see a significant reduction in the money available this year, unless the current 8% health tax is reduced. When Finance Minister Grzegorz Kołodko convinced the prime minister that a tax increase of 0.25% was bad for the country's economy, Łapiński was ordered to persuade the Senate to cut it back to the previous level of 7.75%, just a few weeks after the minister convinced the Sejm this tax increase was the only way to save the health system.
"In our fund, it would mean a drop of expenditures by about 7%-8%, or €3.75 million to O4.5 million, which would not be a catastrophe, but it may mean some staff reductions," Szlubowski said. "But I understand Kołodko because the problem is not in the amount of money available, but how it is being spent."
Although Szlubowski throws doubt upon the effect of this spending spree on further healthcare reform, he is impressed with the result of the previous action of Minister Łapiński, who managed to introduce price controls for drugs sold in the country.
"The reform was introduced in April, so everybody had made small reserves of the drugs they used regularly, terrified by the media hysteria and visions of bare shelves in the chemists," he said. "Even I did that. Starting in May, our fund noticed an immediate improvement in the amount spent on drugs. Previously, their prices grew like mad and always exceeded our prognosis, despite the fact that we were assuming some increase. Now we save about O5 million every month on drugs, and it is money we can spend on other medical services."
Szlubowski believes that Łapiński's personality could help push through further industry reform.
"Maybe because Łapiński is so harsh and brutal he will not stop where others got scared," he said.
"What's needed is a public discussion about the real problems of the health system, not populist reporting about the cars the ministry bought, which are probably really no different from the cars of every other ministry," Szlubowski said.
But even some of Łapiński's critics disagree that a centralised health care system would eliminate the problems of the current one.
Kopacz, who pointed out that the amount spent on the cars was about the same as the annual budget of a small hospital, said: "The system of insurance health funds did not work, but replacing it with a centralised system would not eliminate the expensive middle agent in the system. The National Health Fund would be simply a clone of regional health funds and would not introduce savings."
Some health officials have raised doubts as to whether the Health Ministry can now win support for its plans to reintroduce a centralised medical insurance system in the wake of a recent revelation of excessive and conspicuous spending by the ministry's head, and growing opposition to the change from key health service personnel.
Health Minister Mariusz Łapiński, who is supposed to pilot the change, was politically weakened after censures from the press and political opposition for approving the purchase of two luxury limousines at a cost of more than €75,000 apiece, while hospitals are running out of cash. There was serious unrest in some Silesian hospitals fuelled by protesting medical staff.
Reports also surfaced that the ministry's promotion office spent another €50,000 on informational compact discs on which Łapiński describes the advantages of the return to the old centralised health fund. The information on the CDs was dismissed as useless by managers of hospitals and called "a scandal" by Ewa Kopacz, an MP of Platforma Obywatelska and a member of the Sejm Health Committee, who added that Łapiński had declared on several occasions how socially sensitive he was and that his sole concern was to improve services for patients.
Even though Łapiński defended the purchases, saying that other ministries bought cars of similar standard and that EU ministers had even more expensive vehicles, some industry professionals cast doubts about whether the minister could gain public support for health insurance reform, which would replace the existing regional health insurance funds with a centralised one.
Said Krzysztof Szlubowski, spokesperson of the regional health fund in Mazowsze: "Only the centralisation of the system, in the form of the National Health Fund, is a chance, although I am not sure whether Minister Łapiński is cunning enough to win the public opinion for the reform."
Szlubowski puts the media reports in a different light. "The healthcare system can never have enough money," he said. "Łapiński is the first minister who openly says where the problem lies; therefore, he has powerful interests groups against him."
According to Szublowski, the real problem lies in the structure of the medical profession, where the heads of hospital wards send patients to their own private clinics and earn huge amounts of money, while the so-called ordinary doctors and nurses work for virtually nothing. It is also an almost closed caste, with positions inherited within a family.
And the money involved is not insignificant. The Mazowiecki Health Fund, for example, spends O1 billion a year. This fund will not see a significant reduction in the money available this year, unless the current 8% health tax is reduced. When Finance Minister Grzegorz Kołodko convinced the prime minister that a tax increase of 0.25% was bad for the country's economy, Łapiński was ordered to persuade the Senate to cut it back to the previous level of 7.75%, just a few weeks after the minister convinced the Sejm this tax increase was the only way to save the health system.
"In our fund, it would mean a drop of expenditures by about 7%-8%, or €3.75 million to O4.5 million, which would not be a catastrophe, but it may mean some staff reductions," Szlubowski said. "But I understand Kołodko because the problem is not in the amount of money available, but how it is being spent."
Although Szlubowski throws doubt upon the effect of this spending spree on further healthcare reform, he is impressed with the result of the previous action of Minister Łapiński, who managed to introduce price controls for drugs sold in the country.
"The reform was introduced in April, so everybody had made small reserves of the drugs they used regularly, terrified by the media hysteria and visions of bare shelves in the chemists," he said. "Even I did that. Starting in May, our fund noticed an immediate improvement in the amount spent on drugs. Previously, their prices grew like mad and always exceeded our prognosis, despite the fact that we were assuming some increase. Now we save about O5 million every month on drugs, and it is money we can spend on other medical services."
Szlubowski believes that Łapiński's personality could help push through further industry reform.
"Maybe because Łapiński is so harsh and brutal he will not stop where others got scared," he said.
"What's needed is a public discussion about the real problems of the health system, not populist reporting about the cars the ministry bought, which are probably really no different from the cars of every other ministry," Szlubowski said.
But even some of Łapiński's critics disagree that a centralised health care system would eliminate the problems of the current one.
Kopacz, who pointed out that the amount spent on the cars was about the same as the annual budget of a small hospital, said: "The system of insurance health funds did not work, but replacing it with a centralised system would not eliminate the expensive middle agent in the system. The National Health Fund would be simply a clone of regional health funds and would not introduce savings."
