Presentation on theme: "Centre for Health Statistics"— Presentation transcript:
1Centre for Health Statistics Statistical Officein KrakowCentre for Health StatisticsHealth care sector in Poland: the history of financing and organization
2Health care system prior to 1989 SIEMASZKO MODELPublic health service model typical for eastern communistic countries - members of the Union of Soviet Socialists Republics (ZSRR)Centralized health care – all decisions made on the state level by Communistic Party leadersState-owned health care facilitiesFinancing from general taxation
3Consequences Chronic overstaffing Low level of motivation / decline in moral standardsDeclining efficiencyInsufficient salaries for health care professionals (corruption)
4Quasi market of health care services between 1990 – 1998 (a period of transition) Introducing the universal coverage with a comprehensive program of health careDistributing services through facilities owned and run by the stateFinancing from general taxation (the Ministry of Health)Initial steps to decentralization of ownership and private ambulatory medical servicesImplementation of “family doctor scheme”Gmina has became responsible for primary care and voivodship for many other servicesA new model for the general practitioner role for delivery of primary cost reduction care
5Consequences Over centralization Over specialization Regional inequalitiesRegional rationing and misallocation of resourcesProblem of informal payments to public health care providersLack of costs awareness
6highly developed health care financing system AIM of the reforms:meet the health care needs of population by providing health care services of high qualityhighly developed health care financing system
7Legislation’s Acts 1989 Act on the Establishment of a Medical Chamber 1990 Local Government Act1991 Health Care Institutions Act1991 Nurses and Midwives Self Government Act1991 Act on Payment for Drugs and Medical Materials1993 Law on Abortion1994 Law on Nurse and Midwives Professions1995 Regulations on transfer of budgets to self-managing institutions1997 Law on Physicians Profession1997 Law on Universal Health Insurance1997 General Health Care Act1998 Law on Universal Health Insurance – Amendments
81997 General Health Care Act Universal participationMandatory principleSocial solidarityAutonomous and self-governing schemeThe state guarantees the security of the insurance schemeentire population will be covered by insurance under the same conditions and no population group will be excludedeveryone will be required to pay income tax-based insurancethe costs of health insurance are borne by all insured persons; there will be equal access for insured persons; insured people will be covered despite the extent of their risk; and contributions will be re-distributive
9Reform of the administration system in Poland 49 voivodships16 voivodships
10Health care system after reform 1st of January 1999 (1) National health insurance program based on Bismarck’s social health insurance modelCompulsory health insurance scheme (for all citizens)Decentralization – transfer of decision rights from the state level to regional and local levelsSickness Fund as a third player - payer (16 insurance founds+ 17th found for different groups of proffesionals)Introduction of the primary health care institution (POZ) – general practitioners play a role of gate keepersFinancing- public fraction in healthcare spending (health insurance contributions through a payroll tax and expenditures of state, regional and local government budgets) and private fraction in healthcare spending (household expenditures)
11Health care system after reform 1st of January 1999 (2) Financing:health insurance contribution – 7,5% of income – monthly deducted by employer and paid directly to the insurance foundunemployed and retired – contribution covered by the stateout-of-pocket paymentsIntroduction of a hospital accreditation systemPatients’ right to choose health care providerContracting health care services as a new tool of planning and controlMarket competition between providers
12Diversity of responsibility on governmental levels (2) Voivodship (Regional level):secondary care in voivodship hospitalproviding acute careplanning health care services, organizing the structure of health institutionsallocating foundsPowiat (District, local level):the owners of health care organizations within their territorydistrict hospitalsGmina (Municipality):primary care
13ConsequencesMisuse of market mechanism in terms of high autonomy among Sickness FoundsIncrease of public expenditures on inpatient care and drugs reimbursementWrong allocation of resourcesInequalities between Sickness Founds located in different voivodshipsGrowth of out-of-pocket expenditures + informal co-paymentsIncrease of public expenditures due to high rate of unemployment
14Health care system after reform 23rd of January 2003 (1) Sickness Funds were replaced by the National Health Fund (NFZ) with 16 regional branches + 1 centralNFZ located out of the public budgetary finance constructionCentralization of responsibility for financial and human capital service plan realizationThe Insurance Law - insurance contribution will increase from 8.25% in 2004 to 9% in 2007Many providers combine a private practice with part-time employment in the public sector
15Health care system after reform 23rd of January 2003 (2) Creation of a Polish Health Technology Assessment AgencyIntroducing a system of waiting lists but not for emergency servicesIntroducing the National Drug Policy (transferring the market share from branded to generic drugs)Introducing the basic package of health care servicesHospital networks
16Dimensions of the analysis of health care sector financing in Poland Financing of the health care servicesProduction of the health care servicesFunctions of the health care servicesKind of costFinancing sourcesFinancing agentsCurative and rehabilitative careProvidersThe National Health FundSalariesIndependenthealth care units(SPZOZ)Long-term careInsurance contributionPharmaceuticals and medical equipmentProvision of health care servicesDependenthealth care units(NZOZ)State budgetTaxesHealth administration and health insuranceNon-medical costs of treatmentTerritorial self-government unitsOffices ofphysiciansand dentistsEmployer’s expendituresAdministrationAncillary services to health careMedical carecentres (ZOL)HouseholdsUpkeep of infrastructureHousehold’s disposable incomesPrevention and public healthNursing centres(ZPO)OutsourcingEmployersFunctioning of the systemPrivate insurersInvestmentsPharmacies
17Financing sources – health insurance contributions Health insurance contributions - the biggest financing sourceIn Poland, the universal health insurance system has been in effect since 1 January 1999, when the health care contribution was introducedContributions are transferred to the payer - National Health Fund (NFZ) from the Social Insurance Institution (91% of the total, the real growth of financial means acquired from this source in the period of amounted to 48%) as well as from the Agricultural Social Insurance Fund. The total growth of revenues higher than the GNP one.The majority of Poles are subject to obligatory health insurance.Persons who are mentioned in Art. 66 item 1 of the Law on health benefits financed from public means are subject to obligatory health insurance, whereas persons mentioned in Art. 68 of the Law are subject to voluntary health insuranceFrom the moment, when system was introduced, the general revenues from contributions expressed in current prices has risen by 19 bilions of zl (around 80%) - the health insurance contribution’s rate has risen from 7,5% of the base in 1999 to 9,0% in 2007
18Financing sources (2) - taxes For some insured persons the health insurance contributions are financed directly from the budgetary revenues:farmers, unemployed without the benefit, persons receiving child-care benefits and war pensions, soldiersThe stable level of budgetary financing is predicted in the futureExpenditure on health care, which comes from the state budget, is spent by: the Ministry of Health, the Ministry of Interior and Administration, the Ministry of National Defence, the Ministry of Justice as well as the Ministry of Labour and Social PolicyLevel of financing; stable for (around 4 bln zl), some growth since 2007 – financing emergency service. The flow of funds mainly in form of the purposeful subsidies
19Financing sources (3) - employer’s expenditures Law on Occupational Medicine Service: employers (corporations) are obliged to finance occupational medicine services (preliminary, periodic and control medical examinations, as well as preventive care related to working conditions) for their employeesFinancing of medical services including diagnostics, often combined with preventive medical examinations, within medical subscription packages purchased by employers at health care institutionsExpenditure on preventive medical examinations is employer’s costs of obtaining incomeA rapid growth of financial means: from 545 mln zl in 2002 to 1,3 bln zl in 2007
20Financing sources (4) – Households’ disposable incomes Estimation: based on household budgets survey, household notes its expenditure and incomes in a special budgetary bookNet income = combination of funds in household disposition – (prepayment for income tax from natural persons + contributions for social and health insurances) + savingsNet income = disposable income + savingsThe average monthly expenditure on health care per capita incurred by households amounted to zl in 2006The total amount of direct health care expenditure incured by households in 2006 amounted to: 16,8 bln zl** stands for minimal direct health care (out-of-pocket) expenditure beard by households, since it may not include the informal payments for health care services.
21Production of the health care services – costs in the health care system in Poland The total costs of the health care system has been rising steadly: from 41,6 bln (1999) to 70,4 bln (2007) – 70%Main causes of rapid growth:results of requirements regulated in the „ustawa 203” – independent health care units (SPZOZ) had to incur debts in order to finanse the increasing value of personel salaries,Law on Pubic Aid and restructurization of the independent health care units of 15 April 2007 was established to solve this problem. Additional costs for SPZOZ: preparation of restructurization plans.
22Costs in the health care system – main trends Significant increase in salaries-related costs and costs of drugs: a growth by 12,2% in 2006 and nearly 8% in 2007 respectively.Rapid growth also for other kind of costs: medical materials, orthopaedic equipment, electricity, out-sourcing, upkeep of infrastructure, non-medical costs of treatment.The biggest part = personel salaries + cost of drugsA recent domination: before 1999 – salaries, – costs of drugs Drugs: 37% of the total in 2003, latter improvement – 31% in 2007!!! The most dynamic trend - financial liabilities in form of tax charges and debts repayment; a growth by 728% forNoticable improvement: a decrease by 16% for – enormous hospital debt is decreasing.
23Total health care expenditure – OECD comparison Where we are???Comparison with selected OECD countriesConclusion:level of total expenditure on health care in Poland, Mexico and Turkey belongs to the lowest among the OECD countries