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Tuesday, June 26, 2007

Healthcare in Poland

Sick of waiting, Time for action!!! by Andrew Pescod from flickr (CC-NC-SA)

Currently in Poland there's a lot of discussion about the healthcare system. Poland has a mostly state-run healthcare. Not only the health insurance is public, even the hospitals are operated by the government. The former is probably a good idea, considering how horrible the healthcare system is in the only developed country where it is privately run. The latter is a relic of the Communist era which refuses to die.

In the last few months doctors and other healthcare workers were constantly protesting, demanding increased government spending on health care - primarily demanding better salaries. The media completely failed to do their job and didn't provide any real data on health care or health care financing whatsoever. We bloggers need to fill in the gap.

The data wasn't particularly hard to find. It's available from WHO European health for all database (HFA-DB). The comparison is for all 12 "New EU" countries in group and individually, plus "Old EU" and "EU total". I didn't include old EU countries here, as their situation is significantly different, so it wouldn't be particularly meaningful.

CountryLife expectancy (2005)Infant mortality per 1000 births (2005)Healthcare spending as % of GDP (2004)Healthcare spending in USD PPP (2004)
Bulgaria72.6*11.65*8671
Cyprus79.54*3.01*5.81128
Czech Republic76.193.397.31412
Estonia72.895.445.3752
Hungary73.026.237.91308
Latvia71.067.87.1852
Lithuania71.336.846.5843
Malta79.445.969.21733
Poland75.126.426.2814
Romania71.88*16.84*5.1433
Slovakia74.37.27.21061
Slovenia77.584.158.71815
Whole EU78.445.178.72334.32
Old EU79.63*4.34*9.292729.1
New EU73.968.716.51869.61


* - data for 2004

The spending figures are total spending - that is public + private. As you can see healthcare in Poland is somewhat better and somewhat cheaper than "new EU" average. It's still far behind the old EU, but it's not really a crisis situation, especially since the results are improving and the spending is increasing - between 2000 and 2005 life expectancy increased 73.95 to 75.12, infant mortality fell 8.11 to 6.42. Between 2000 and 2004 spending increased as percent of GDP from 5.7 to 6.2, and in USD PPP from 587 to 814.

So the protests seem to be primarily politically motivated. The situation is fairly good compared to other countries in similar situation and is steadily improving. Another thing strongly implying political motivation is the sudden support for the protesting doctors from the normally vehemently anti-union opposition party Platforma Obywatelska.

15 comments:

Peter Cooper said...

Generally, hospitals are state owned in the United Kingdom too (there are private hospitals, but their range of services are poor in comparison, many use the state hospitals for operating theatres, etc).. and it's not because of communism :) I think it's because when it comes down to certain things, it makes sense to nationalize. The US is seeing the evil that can come from the commercialization of healthcare.

taw said...

Peter Cooper: I don't have any hard data, so I didn't talk much the issue, but I don't see any reason for nationalizing hospitals.

In case of health insurance there's a long list of issues why market is likely to be inefficient, from information asymmetry, through incentives going the wrong way (insurers profit by refusing care) and the issue of being bound to a single insurer pretty much for life if you develop any condition (as others won't cover "preexisting conditions"), to insurers using political lobbying and their disproportionate lawyer firepower in courts to make it as difficult as possible for patients to challenge their decisions.

In privately run hospitals paid by national health insurer all the incentives go the right way. The hospitals profit by providing quality care, by lowering their administrative costs, and so on. Cost of medical procedures can be reliably estimated due to a fully functioning market. The only way private hospitals can profit from lobbying is by increasing government health care spending, what's not a particularly bad thing.

Some countries seem to run their health care systems this way, like Canada, and it seems to work just fine.

Mike said...

I don't know, if you live in Poland, but, after reading your post, I assume you don't. This is not the problem of money quantity designated for health care, but a problem of spending it. Most of it is consumed by administration (NFZ - National Healthcare Fund). If you're checking statistical data, please do it more precise - compare average salary in Poland (~2800PLN) with average doctor salary (after 15 years of work ~1600PLN) and average nurse salary (~1000PLN - it really doesn't depend on seniority). Then probably you'll see that this is not a politically motivated protest, but the fight for better life for them and their families. And a piece of advice - try to read/watch/listen more independent media.

taw said...

Mike: None of your assumptions are backed by reliable sources, and as far as I know they're all completely false.

I couldn't find any more recent data around, but according to the Green Book by Polish Ministry of Health in 2002 average monthly salaries were 2229.80 PLN for all sectors, 2959.74 PLN (133% of average) for doctors, and 1546.92 PLN (70% of average) for nurses.

That's hard data, and it clearly shows what's the real reason for the protests.

mike said...

"None of your assumptions are backed by reliable sources" - of course they are, you've gave the link.

fact 1: p. 90, table: about a half of doctors are working in two or more places

fact 2: p. 90, last paragraph: "salaries in health care are lower than in other areas"

fact 3: p. 93, table: there is no separation between public and private health care, so the salaries in public sector are overstated by salaries in private sector.

fact 4: p. 93. last two phrases: Distance between nurses' salaries and country average salary has grown. In 1998 nurses' salaries were 94% of average salary, when in 2002 only 75%.

fact 5: p. 205, chapter 6, second phrase: "The fact is, that salaries are lower than they sould be", consequences of this are listed further in this chapter.

fact 6: here you can look at data of salaries from 2004, according to GUS.


Modern health associate professionals salaries (except nursing) in _public_ sector.
(years of work) Healthcare salary Average salary
--------------------------------------------------------------
(less than one year) 1248,44 1607,03
(2-4) 1427,62 1878,93
(5-9) 1605,76 2285,62
(10-14) 1579,91 2413,91
(15-19) 1596,73 2334,51
(20 yr and more) 1727,65 2560,02

taw said...

Mike: Could you provide URL to your data ?

mike said...

here - its a .xls spreadsheet

taw said...

Mike: The document you linked doesn't list salaries of doctors, only a very general "healthcare and welfare" category ("Ochrona zdrowia i pomoc społeczna").

mike said...

Taw:

Ok. here you have more precise and more recent (2006yr) statistics. It is shown that average salary among _specialist_ (specialist is a doctor with I or II grade of medical specialization) is 1800PLN. using this data of average salary in Poland in 2006 and data from previous link you can see that 75% of specialists are below country's average salary - ~2500PLN.

But I think we've lost the main thread of our discussion. I do not agree with opinion that doctors were inspired by any political fraction. This is only used as an excuse by our government, especially by our prime minister. This is their "same old song" repeated every time, when somebody says they are bad. There always is secret force which is trying to destroy their best intentions. The good thing is, that more and more people is stoping to belive in that. In every survey, leading political fraction - PiS - is going down.

On the other hand, I agree with you that _now_ it is some kind of political protest. But at first reasons of this protest were very simple:
1. low salaries in whole public health care
2. raises of salaries in National Health Fund - the cash machine for everything connected with public health care
3. disproportions between salaries in health care area and in health administration (National health Fund)
here's the link.

Please, stop spreading untrue propaganda - leave this for politicians, they're better than you in it.

Anonymous said...

I assume you're referring to the United States as being a nation with terrible results from a private run system, but that's just not the case. Compare the 5-year cancer survival rates of the United States and the UK. They're nearly twice as high in the US.

If you want an MRI or a CT, they're generally avaialbe same day in the US. You might wait months in Canada, which is why many Canadians go south for healthcare.

You hear complaints of 45-million uninsured. And yes, this is a problem in the US. Sort of. Until you begin considering that 30-40% of those are illegal Mexican and Latin American immigrants who have no right to be in the country whatsoever. And that the fastest growing sector of the uninsured are young professionals with high incomes--i.e. those who could afford healthcare but don't buy into it due to their good health and willingness to take a risk.

When it comes to results, there isn't a healthcare system in the world that does a better job. Particularly considering your average American far outworks his European counterparts in terms of time at the office. You can make the argument that it's over-expensive. Or that arenas of prevention (e.g. obesity) are under-utilized in the US.

But saying the system is a disaster is at best questionble--particularly as the European socialist models begin to collapse due to flagging birthrates and a failure to reproduce a new generation of taxpayers.

taw said...

Anonymous: American healthcare system is a disaster. And it loses in every relevant statistic, like life life expectancy and infant mortality.

You can cherry-pick data on stuff like waiting times for MRI, but that's simply because if you're poor you're simply not going to get it at all. In Europe there's standard medical triage, so non-urgent cases have to wait.

Your remarks about Mexicans are so unbelievably racist that I'm not even going to reply to them.

Brad said...

The problem is that the United States wants to emulate Canada and their model of health care. This would be terrible because it would make everything more crowded. And besides, why should I have to pay for someone else's health care through my tax dollars. Canada also forbids the practice of privately paying for your own health care.

http://www.angelfire.com/pa/sergeman/issues/healthcare/socialized.html


And to look at the statistic of 45 million, it isn't racist for anonymous to say that. How is that racist? Tell me? In what way is that offensive. It is not entirely true but it isn't racist. The majority of the people that make up that 45 million are temporarily out of health care. In the US most people get their health benefits from their job. When people switch from job to job they don't have health care. So the people that make up this statistic aren't the poor that can't afford it.

http://www.cbo.gov/ftpdoc.cfm?index=4210&type=0&sequence=1

Rui Vilela said...

I went to a Health care center in Lodz. And It was a positive shock to me. System is free for UE citizens. It's fast, really fast. I can see specialist in a matter of days, if not in same day. Blood check results on next day.

Health problems are solved in record time. It's just bad that such professionals receive so less money for so much knowledge.

In Portugal the system answer is very slow, especially for specialist appointment and cirurgies. And Private prices are scandalous. (5-6 times more than private sector Poland, and so and so you wait one week). And Stomatolog is a luxurious topic... (This people belong to an elitary in Portugal, unfortunaly)

LukaszFranciszekSwiniarski said...

"And besides, why should I have to pay for someone else's health care through my tax dollars."

What? How do you think your current insurance works? If you don't use it you get your money back? Goverment or private this money will always go away from you, so why don't give it to the needing instead. Also if money goes through goverment you have ways to check how it is spend, while you have no insight on how does companies spend their money.

As for the healthcare in Poland, the number for doctors salaries are unreliable. 1700 PLN (800$) monthly as an average would indicate that a lot earn around 1200 PLN (500$) or less when I never met a doctor to be as poor. Perhaps the figures should presented in manhours to be more precise

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