The Health Care System
The constitution of 1952 guaranteed universal free health care. In the last two decades of the communist era, however, such care became progressively less dependable for those without informal support networks or enough money to buy health care outside the official system. As early as 1970, Polish governments recognized the need to reform the cumbersome, inefficient national health care system, but vested interests in the central planning system prevented meaningful change. From the beginning, administration of the system was inefficient. The structure of the medical profession did not supply enough general practitioners, and medical personnel such as dentists and nurses were in short supply. Treatment facilities were too few and crowded, preventive medicine received little attention, and the quality of care was generally much poorer in rural areas. As in other communist countries, the finest medical facilities were reserved for the party elite.
In the postcommunist reform period, constriction of the state budget and fragmentary privatization of medical practices made the availability of health care unpredictable for many Poles. After inheriting a deteriorating health care system, Polish policy makers placed their near-term hopes on reducing bureaucracy, encouraging self-government in the medical profession, shifting resources to more efficient departments, and streamlining admissions and diagnosis procedures.
In 1992 Poland had fifty-seven hospital beds per 10,000 citizens, about half the ratio of beds available in France and Germany. The ratio had been declining since the 1960s; in 1991 alone, however, over 2,500 beds and nearly 100 clinics and dispensaries were eliminated in the drive for consolidation and efficiency. Already in the mid-1980s, about 50 percent of the medicines officially available could not be obtained by the average Pole, and the average hospital had been in service sixtyfive years. Because the reform budgets of the early 1990s included gradual cuts in the funding of the Ministry of Health and Social Welfare, additional targeted cuts of 10 to 20 percent were expected in clinics and hospital beds by 1994. The long-term goal of Polish health policy was a complete conversion of state budget-supported socialized medicine to a privately administered health system supported by a universal obligatory health insurance fee. Under such a system, fees would be shared equally by workers and enterprises. Before introduction of that system, which was not expected until at least 1995, interim funding was to depend heavily on a patchwork of voluntary contributions and local and national health-care taxes. Even after 1995, however, planners projected that the state budget would continue contributing to the national health care fund until the insurance system became self-sufficient. The state would now contribute directly, however, bypassing the old health care bureaucracy.
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