Poland is to adopt a controversial new system to finance health care from the start of 1999. Under the new system all employed people must contribute a tax deductible 7.5% of their gross salary to the healthcare system in one of 16 new administrative regions. Contributions for the unemployed will come from within the state budget.
In return, Poles will now have the right to choose a family doctor from those retained under contract by the health service administration. These doctors will be responsible for referring patients for further treatment to specialists or to hospitals, both of which will also function under contract. Patients will be free to opt for alternative services beyond the financing system but must then pay all excess costs.
Despite criticism of the proposed changes by doctors, the press, and members of both the opposition and the governing coalition, President Aleksander Kwasniewski signed the reform bill into law on 24 August. The president admitted that the reform contained flaws, including inadequate funding provisions and limited means for retaining the services of medical doctors.
However, the passage of the reform package through parliament indicated a general agreement that the current system was no longer tolerable--that is, a market based system could no longer be disguised as one of universal free health care.
Parliamentary critics assert that the new programme will be hopelessly underfunded and that contributions should be at least 10% of gross salaries. Some have even suggested challenging the new law in the constitutional tribunal on these grounds.
There is also expected to be a shortage of family doctors, as there are currently only enough to care for about 2% of the population. Furthermore, there is little hope that the best doctors will choose to join the new system rather than maintain their more profitable private practices.
Few people are optimistic about the prospects for success of the new system. Signals from abroad are not very promising either. In the Czech Republic a similar system was introduced more than four years ago. Since then, severe budget deficits and even bankruptcies have plagued regional health administrations.