The Polish health care system is based on the principle of universal coverage and universal access to health care. According to Article 68 of the Polish Constitution, everyone has the right to have access to health care. Until 1999 the health care system was financed directly from the state budget. Since 1999 there is an earmarked tax (health-care contribution) that finances most of the health care provision in Poland. Currently, the health care system is financed from one central National Health Fund. The health care contributions for those who are not receiving wages or other labour income based on a contract or receiving pensions (i.e. the unemployed, farmers) are financed from the public funds, following the notion of universal coverage. The government is obliged to provide free healthcare to young children, pregnant women, disabled people, and the elderly. Compulsory health insurance covers 98 % of the population and guarantees access to a broad range of health services.
However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall proportional: While financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures, particularly in areas such as pharmaceuticals, are highly regressive. With population ageing, the difficulties to finance health in Poland may increase. Around 70 % of the health expenditure came from public sources and over 83.5 % of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers (World Health Organisation 2013).
The main challenges of the healthcare system include low quality care and accessibility issues, as well as the rising demand for medical services due to the ageing process. Focusing on the efficiency of the poorly funded system, the Ministry of Health faces criticism for not undertaking sufficient activities aimed at the improvement of quality of services and shortening waiting times. Criticism especially concerns oncology, where the mortality rate is high (Eurostat: standardized mortality rate of 296.5 compared to 268.5 in the EU-28 in 2011) and increasing, with poor survival indicators. Also, the Supreme Audit Office pointed at inefficiencies in the implementation of the National Cancer Control Programme(effective since 2006) criticising a poor response rate of cancer screening (at the level of one-third), the lack of aggregate data on screenings and patient history, and long waiting times for radiotherapy (Chłoń-Domińczak et al. 2015).
Long-term care remains underdeveloped, being mainly a family responsibility, for reasons which include the poor provision of services, early retirement of women, and tradition. The family is still identified as the main caregiver for elderly people with limitations on the activities necessary for daily life (Golinowska et al. 2014).
LTC has not been separated as a sector, with services fragmented in the health and social sector, thus it is difficult to clearly assess the size of LTC in financial or employment terms. It is estimated that the total public expenditures on LTC oscillate around 0.7 % of the GDP, well below the EU-27 average of 1.8 %.
The functional disability rate is high, accounting to about 1 million of the elderly in need of care, however the provision of care services is insufficient: Cash benefits are targeted to the poor, coverage of care services (usługi opiekuńcze) is low, as is the availability of public residential care, with the access barriers of a disability evaluation test and co-payment. Private sector services are expensive and – in case of home care – often provided in the grey economy. Care provided within the family is rarely combined with part-time employment (only 6.1 % of labour market actives combine part-time work and care for children or incapacitated adults).
The development of a formalized non-family LTC is in the initial stages and is similar in both sectors, medical and social. Only recently did the health care system reform of 1999 provide an opportunity for the development of public LTC institutions that are separate from hospitals. As a result, hospital departments were transformed into nursing and care institutions. Institutional care is simultaneously provided in the social sector. Stationary and semi-stationary homes are administered as part of the social assistance (welfare) scheme. (Golinowska et al. 2014)
At the present stage of LTC development, there is no specific regulation that comprehensively covers the issues of care services for the elderly, the institutions providing these services, the rules of access to them, and the ways of financing them. (Golinowska et al. 2014). Thus, the challenges that LTC faces include the development of accessible, coordinated, transparent, and client-friendly system of services, available to functionally impaired elderly and children, as well as informal care support by training and the possibility to combine work and care. (Chłoń-Domińczak et al. 2015). However, policy proposals regarding long-term care concentrate on improvement of existing framework for services rather than introduction of a comprehensive long-term care system.
- Chłoń-Domińczak, A., Topińska, I., & Sowa, A. "ESPN Country Profiles. Poland. 2014-2015". European Social Protecion Network, Brussels (2015).
- Golinowska, S., Kocot, E., & Sowa, A. "Employment in Long – term Care. Report on Poland". CASE Network Studies & Analyses No. 473, CASE - Center for Social and Economic Research (2014).
- World Health Organisation. "Poland: Health system review 2011". Health Systems in Transition 13(8) (2013).