Votes beat health any day
Still, few doubt that the reason the government staged a turnaround on co-payment in its health reform plans last week was that such a policy is a vote killer.
The fairly modest co-payment rates proposed - at zł.2 for a trip to a family doctor, zł.5 for a visit to a specialist and zł.10 for a hospital stay - were not, however, the issue. What public opinion won't accept is the principle of it. Co-payment flies in the face of the citizen's constitutional right to free and equal health care access (even though prevalent bribery within the health service means that right is largely fictional).
Despite a recent poll, conducted by AC Nielson Polska and commissioned by a new grouping of 25 separate patients' organizations, that found that over 80 percent of Poles believe the health system would not take care of them should they fall ill, it seems the public is not prepared to contribute financially to make the system better. This is no surprise, says Edward Bramley-Harker, a health care specialist with NERA, a UK-based economic consultancy. In countries with a tradition of state health care, he says, co-payment generally meets with furious resistance. And Stanisław Borkoski, director of health insurance at petty domestic insurance prince PZU agrees with him, saying, "Just look at Great Britain."
Health care expert Adam Kruszewski, a partner at private equity firm Enterprise Investors, meanwhile, points out that funds are wasted on a grand scale within the present health care system. So, principles apart, users may have good reason not to entrust their hard-earned cash in the hands of the state health system.
On the face of it, the SLD is right to trash the plan. For, according to Bramley-Harker, such low rates of co-payment would actually bring little to the budget, so the potential income from co-payment is just not worth the political risk.
But according to Kruszewski, it's not that simple. "These co-payments were never intended to bring in more money," he says. The main problem for state health care systems in Western countries is that, no matter how bountiful the supply of services, the demand will always outgrow it. Symbolic co-payment, then, wasn't meant to bring in money, but to restrain demand for services - to keep the bored, the lonely and hypochondriacs from visiting doctors for no good reason.
Still many, though, think the bill had a second function, which was to pave the way in public opinion for bigger but optional co-payments for better and quicker services; for a two-tier system, that is. Any paving will have to wait, though, as the government has now assured journalists that the life-support machine for co-payment has definitively been switched off. "Significant health reforms require a really long-term - say five year - perspective," says Kruszewski. Four year governmental terms mean that effective reforms bring pain, but no electoral credit to the government that introduces them.
The fairly modest co-payment rates proposed - at zł.2 for a trip to a family doctor, zł.5 for a visit to a specialist and zł.10 for a hospital stay - were not, however, the issue. What public opinion won't accept is the principle of it. Co-payment flies in the face of the citizen's constitutional right to free and equal health care access (even though prevalent bribery within the health service means that right is largely fictional).
Despite a recent poll, conducted by AC Nielson Polska and commissioned by a new grouping of 25 separate patients' organizations, that found that over 80 percent of Poles believe the health system would not take care of them should they fall ill, it seems the public is not prepared to contribute financially to make the system better. This is no surprise, says Edward Bramley-Harker, a health care specialist with NERA, a UK-based economic consultancy. In countries with a tradition of state health care, he says, co-payment generally meets with furious resistance. And Stanisław Borkoski, director of health insurance at petty domestic insurance prince PZU agrees with him, saying, "Just look at Great Britain."
Health care expert Adam Kruszewski, a partner at private equity firm Enterprise Investors, meanwhile, points out that funds are wasted on a grand scale within the present health care system. So, principles apart, users may have good reason not to entrust their hard-earned cash in the hands of the state health system.
On the face of it, the SLD is right to trash the plan. For, according to Bramley-Harker, such low rates of co-payment would actually bring little to the budget, so the potential income from co-payment is just not worth the political risk.
But according to Kruszewski, it's not that simple. "These co-payments were never intended to bring in more money," he says. The main problem for state health care systems in Western countries is that, no matter how bountiful the supply of services, the demand will always outgrow it. Symbolic co-payment, then, wasn't meant to bring in money, but to restrain demand for services - to keep the bored, the lonely and hypochondriacs from visiting doctors for no good reason.
Still many, though, think the bill had a second function, which was to pave the way in public opinion for bigger but optional co-payments for better and quicker services; for a two-tier system, that is. Any paving will have to wait, though, as the government has now assured journalists that the life-support machine for co-payment has definitively been switched off. "Significant health reforms require a really long-term - say five year - perspective," says Kruszewski. Four year governmental terms mean that effective reforms bring pain, but no electoral credit to the government that introduces them.
