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Poland 2005 Hit Summary

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Poland 2005 Hit Summary European Health Systems in Transition Observatory on Health Systems and Policies HiT Summary Poland Fig. Average life expectancy at birth in Poland compared with selected countries and regional averages, 970–2003 80 75 70 65 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 Czech Republic Germany Hungary Lithuania Poland EU average EU average for Member States joining 1 May 2004 Source: European Health for All database, June 2005. Note: EU: European Union. Overview development of a positive attitude in the society towards the health system and health reforms. After the introduction of health reforms initiated in 1989, the new Law on Health Care Services Health expenditure and GDP Financed from Public Sources (2004) further In 2002, total expenditure on health in Poland as a reformed the current law in areas defining: the percentage of GDP reached 6.1%: 2.6 percentage responsibilities of the Ministry of Health, the points lower than the average of 8.7% for governance of the National Health Fund and countries belonging to the EU prior to May 2004, health planning. While significant achievements, European Observatory such as greater longevity, shorter hospitalization on Health Systems and Policies stays, improved primary health care, and a WHO Regional Office for Europe greater focus on health prevention and promotion, Scherfigsvej 8 DK-200 Copenhagen have been accomplished, numerous challenges, Denmark such as unfavourable demographic trends, an Telephone: +45 39 7 7 7 Fax: +45 39 7 8 8 underfunding of the public health system and E-mail: [email protected] limited access to care, continue to hinder the www.euro.who.int/observatory HiT summary: Poland, 2005 and 0.5 percentage points below the average of in negative natural population growth as in new EU Member States. Unemployment has been many other EU countries. It is estimated that by increasing since 1991 and was 18.1% in 2002, up 2050 there will be 31.9 million inhabitants in 0.7% from the 2001 figures, while the inflation Poland. The proportion of people over the age rate has been decreasing: it was 1.7% in 2002, of 65, currently 12.9% of the population (2003) down from 5.5% in 2001. Total expenditure on is projected to increase to 37.9% in 2025. In drugs accounts for about 2.4% of the country’s 2002, 62% of the total population lived in urban gross national product (GNP) and are among the areas. highest in Europe. Average life expectancy Following years of decline during the 1970s and Introduction 1980s, average life expectancy at birth began to increase after 1991, reaching 78.9 years for women and 70.5 years for men in 2003. Government and recent political This figure is expected to rise to 81.4 years for history women and 72.2 years for men in 2020–2025. The Republic of Poland is the largest country Nevertheless, there is still a vast life-expectancy in central and south-eastern Europe (CSEE) in gap between Poland and western EU countries, population and in area. In 1989, Poland was the which has only recently started to recede; since first country among the CSEE countries to re- 1991, life expectancy at birth in Poland has establish democracy after 44 years of communist developed in parallel with the average of other rule. The parliament has a lower house (Sejm) new EU Member States. and an upper house (Senat). The President of the Republic of Poland is elected in a general election Leading causes of death for a five-year term. In the most recent presidential and parliamentary elections in September and Cardiovascular diseases are the major cause of October 2005, respectively, Lech Kaczynski´ from death in both men and women (about 50%) in the nationalist-conservative Law and Justice Party Poland. They are followed by neoplasms (24%) (PiS) was elected president and his party won and external causes such as injuries and poisoning the parliamentary elections as well, winning 155 (about 10% for men and 4% for women). seats in the Sejm. The new PiS Prime Minister Kazimierz Marcinkiewicz leads a minority government, in which the independent Zbigniew Religas has been nominated as the new Minister Historical background of the of Health. Poland has been a member of the EU health care system since May 2004. The Polish political system lacks stability, which translates into minority During the period of Polish independence governments, such as the current government, and between 1918 and 1939, health services were frequent strategic changes in policies. During the expanded, and a limited Bismarckian social period 2001–2005, six different ministers headed health insurance system, covering 7% of the the Ministry of Health. population, was introduced. The Ministry of Health was created in 1945 Population during communist rule and during that time, In 2003, the population in Poland was estimated administration of the health care system was at 38.2 million. In recent years, the number of strongly centralized, albeit with differences births has fallen below that of deaths, resulting compared to the Soviet model. HiT summary: Poland, 2005 2 Access to health services increased during the through its regional branches. The NHF contracts 1950s, when coverage was extended to include all with service providers for the supply of health state employees. In 1972 coverage was expanded services. to agricultural workers. Territorial self-governments are responsible Reforms in the 1970s centred on creating for three domains: general strategy and planning integrated networks of care for health and social based on the identified health needs in a given services in each district. Integrated health care region, health promotion, and the management management units, the ZOZ (Zespól Opieki of public health care institutions. The local Zdrowotnej), were established and the Ministry centres of Public Health fall under the voivodship of Health was renamed the Ministry of Health self-government, county hospitals fall under the and Social Welfare (1960). county level and the local authorities (gminas) are Health sector reforms in the 1980s aimed at responsible for primary care services. decentralization. In 1983, the ZOZ were given greater political and administrative powers. Planning, regulation and This was followed by further decentralization, management the strengthening of primary care and the The NHF functions as the primary payer for introduction of compulsory health insurance health care in Poland making the fund responsible and sickness funds in 1999. After a change of for the management and planning of health government, the sickness funds were abolished services. Planning in Poland is elaborated by in 2002 to be replaced by a centralized National the NHF on the basis of National Health Plans Health Fund (NHF). However, this was ruled that indicate the volume and scope of health unconstitutional by the Polish High Court and services for the given population. These plans a new Law on Health Care Services Financed are approved by the Ministry of Health. The from Public Sources was passed in August 2004 NHF contracts the delivery of health care either to accommodate the court ruling. through competition for public funds or through negotiations. The National Health Programme is responsible for trying to improve the health Organizational structure of status of the population and related quality of the health care system life indicators. The state is responsible for regulation in The stewardship, management and financing Poland through legislation such as the Law on functions in the Polish health care system are Health Care Institutions. divided between the Ministry of Health, the NHF and territorial self-government administrations. Decentralization of the health care The central government, represented by system the Ministry of Health, is responsible for national health policy, major capital investments The 1997 Law on Universal Health Insurance and medical science and education, with established the framework for mandatory health administrative responsibility only for those health insurance, including universal health insurance care institutions that it directly finances. Medical contributions and budgetary expenditures from academies, university hospitals and research the state budget, and budgets of voivodship, institutes are semi-autonomous but are ultimately county and commune authorities. accountable to the Ministry of Health. The NHF has the responsibility for planning The NHF, governed by 9 members of the fund and resource allocation in the Polish health care council, finances the health services provided system, carried out by the decentralized NHF to insured persons from social contributions branches. HiT summary: Poland, 2005 3 Health care financing and specific groups of the population (the unemployed receiving social security benefits, those receiving expenditure social pensions, farmers, war veterans and others), and investments in public health care Poland has a mixed system for public and institutions. The major part of funds allocated private financing. Public financing comes for the implementation of health programmes is from universal health insurance contributions, transferred to the National Health Fund. Funds voluntary insurance premiums, budgetary from the state budget are also used to cover health expenditure from the state budget and budgets services provided in life-threatening situations, in of voivodship, county and commune authorities. case of accidents, or during childbirth to persons Private financing includes both formal and who are not insured and thus do not pay health informal sources of payments as well as pre- insurance contributions. paid plans. Revenues generated from the contributions Health insurance contributions are the major are pooled at the NHF. The NHF is the main public source of health care financing and are payer for health services, contributing 80% of mandatory; it is not possible to opt out of the total public spending on health while the state system on the grounds of level of income, budget contribution is around 10%.
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