Poland: Health in the service of capital?

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, by MALEWSKI Jan

This article is based on one of the reports at the European healthworkers conference, held in the International Institute for Research and Education in May 2011. See (ESSF article 22173): Statement from the European Conference for the defence of a public health service and (article 22172): European conference for the defence of a public health service and other national reports.

Financed by the state since 1950, the Polish health system has suffered budget restrictions since the mid-1970s. Low wages, the lack of medical personnel, the introduction of increasingly frequent fee-based services (imported medicines and so on) in the hospitals during the 1980s, generalised corruption going hand in hand with the development of fee-based “cooperative” health centres and the rejection of the dictatorship after the coup of December 13, 1981, have generalised a rejection of statism and idealisation of the “private”, deemed to be more efficient, within society.

 Counter-reforms

The first counter-reform, introduced by the government of Jerzy Buzek in 1997, sought a mixed financing of the health system (partially by insurance, partially by the state budget) and led to the creation of 16 regional insurance funds, financed by contributions deducted along with income tax. This decentralisation was combined with the creation of autonomous public and non public health centres which led to numerous abuses allowing an initial accumulation of capital in the health services sector. In 1998 ownership of local hospitals was transferred from the state to the regions, cantons and localities, henceforth responsible for their deficits.

In 2004 the regional funds were transformed into regional departments of the National Health Fund (NFZ) which finance the health services, whether public or not, by annual contracts. This system of contracts has limited the resources of public hospitals and other health centres, leading to the impossibility of financing certain medical procedures when the annual number of such procedures specified in the contract was attained. The waiting time for patients was thus increased, forcing them to resort to private care, not reimbursed but available rapidly, allowing the accelerated development of capital in the health sector.

The neoliberal government of Donald Tusk passed a law in April 2011 on health care activity which obliges regions and municipalities who have not “commercialised” [1]. hospitals, to cover their deficit within the three months following the closure of annual accounts. Those regional or local authorities who wish to “commercialise” their hospitals or health centres can request the cancellation of their legal obligations (debts and so on). This law also forbids the creation of new public health centres, with the exception of the creation of a new body through the merger of two pre-existing public bodies.. Finally the law envisages the possibility of extending the working time of some medical professions and making nurses work in these commercialised enterprises not only on the basis of a work contract but also as “individual entrepreneurs” on the basis of a commercial contract, which allows the employer to avoid financing their social security. Finally the government envisages a 3% increase in the amount of the obligatory employee’s social security contribution to finance the health sector deficit.

 The goals of the government

Zbigniew Zdónek, doctor and health sector organiser for the Polish Party of Labour, explains the current counter reform: “Last year the NFZ spent 57 billion zlotys (14.37 billion euro) to finance health care. Poles have spent as much from their own pockets for medical visits, care and medicines. This will increase further because society is ageing and our health expenditure will increase. That means that in one year we spend half of what during the last ten years we had paid on the accounts of private pension funds. And as it happens, at the same time that recent modification of the state pensions reform has deprived — rightly — the capital market of nearly 20 billion zlotys, paid into it at a loss over the last ten years, thus increasing the state debt, as the prime minister Donald Tusk himself remarked, the road has been opened for new health insurance. The health care reform reduces hospitals to the role of typically mercantile enterprises, financed by various payers. In this way the prime minister has opened to the capital market access to much more money. . It appears that he does it in our interest. Ten years ago, when he was in coalition with Solidarity Electoral Action, it was also in our interest that he reformed pensions — today he has to take a step backwards because his solution was too costly to the Polish state.” [2].

“The politicians of the Civic Platform know how to enrich themselves to the detriment of public resources. They have 20 years experience, Two years ago they introduced their project through the health ministry, who limited the skills of generalist doctors, forbidding them from diagnosing and correctly caring for patients. This apparently insignificant gesture reoriented patients towards specialised medical centres. Millions of patients turned towards specialists, but the ministry did not envisage the finance for that and as the specialists no longer had contracts, they could not treat these patients. Public hospitals received them, because they had to do it. But The limits of the medical procedures for hospitals were not increased, that is they did not have the financing for these extra patients. That led to their growing indebtedness. Then the minister began to say loudly that it was about public resources and that commercial companies would be more efficient. But what trade in the world could make a profit if it was not paid in part for the provision of services in the case of the so-called over-charged hospitals? This is how the death of public hospitals has been planned; It has opened the road for them to be taken over by private capital. The key for this is the recent law, signed by president Komorowski, who only a year ago said that the privatisation of the hospitals was contrary to his ideals” [3].

 The effects of privatisation

Examples of what has happened due to hospital privatisations already carried out are not lacking. Thus at the public hospital of Ruda Slaskaa, privatised two years ago , the mayor A. Stania (PO) had to devote 200,000 zlotys of the town budget every month to finance the new public limited company, Yet the free trade union “August 80” at this hospital and the Polish Party of Labour had drawn up a draft plan to save the hospital. Citizens came together to sign a petition demanding the maintenance of the public hospital in return for a citizen’s contribution of 10 zlotys a month for each adult inhabitant.. Thus, the inhabitants could take control of the hospital, helping its funding through 5 million zlotys collected annually! In three years we would have a modern hospital and all the money collected could be used to develop prevention and care for the sick. And what have we instead? A commercial company that generates each month a shortfall of 200,000 zlotys and the prospect that it will eventually be privatised, because this is the law…. of the market " [4]

But at the municipal elections of November 2010 the mayor responsible for these machinations lost and was replaced by Grazyna Dziedzic, head of a citizens’ initiative list supported by the Polish Party of Labour. The head of the canton of Krosno Odrzanskie, also a member of PO, transferred the management of the cantonal hospital to a public limited company in Szczecin. This resulted in the “miracle” typical for this kind of move: it reduced the costs of care and the wage bill. In this canton of 60,000 inhabitants, only one doctor was employed in the internal department, who was also the head of this department, the medical director of the hospital, the palliative care physician and the diabetes centre doctor… With such staff reductions the company made large profits and at the end of the year it was able to buy one of the hospitals for 6 million zlotys. Z. Zdónek commented: "Patients suffering from heart attacks had no guarantee of medical transport, there was no doctor capable of receiving a critically ill patient. People would die. But it is not them that matter, but profits…“ [5]

 Victorious Resistance!

The head of the canton of Swidncia, a PO deputy, heavily indebted, attempted to “commercialise” the public hospital “Latawiec”". The nurses and midwives union OZZPiP, supported by “August 80” and the Polish Party of Labour, objected. “We are against the commercialisation and therefore the privatization of the hospital” explained Elzbieta Pieprz, President of the Spišský OZZPiP at a public meeting last March.

“We want to defend our jobs! We are ready for all forms of struggle, including sit-in strikes. When nurses agree to work with commercial contracts, it already causes conflicts. But a private employer wants the maximum amount of savings. Privatisation will put in danger not only jobs, but also employment contracts“said Marta Galeczka of the nursing self-management council”Latawiec” [6]. . On April 13, a Committee for the Defence of the Public Hospital of Swidnica was created. "We are fighting for the good of the employees, because objectively working in a public hospital is better than in the private sector. But we also struggle in the interests of our patients. The cases of the hospitals in the vicinity, Swiebodzin, Dzierzoniow or Zabkowice Slaskie, show that they only care for cases that could not be transported or light cases, which are profitable. Patients with more severe illnesses are sent to us. Private hospitals go where the profit is, because that is what the Commercial Code imposes on them” said Elzbieta Pieprz, calling for the constitution of the Committee [7]. The Committee brought together trade unionists (OZZPiP and August-80), professional organisations (nurses, midwives and doctors), political parties — as well as the Polish Party of Labour (PPP), the Alliance of the Democratic Left (SLD, social liberal) and Law and Justice (PiS, populist right), patients and many citizens of Swidnica. The committee’s petition has received thousands of signatures. Finally the authorities climbed down - on June 2 the cantonal commission which was to present the “commercialisation” project ended its work, without daring to propose such a project!

This article was written with the help of Zbigniew Zdónek (doctor, health sector organiser for the Polish Party of Labour), Iwoana Borchulska (national vice-president of the OZZPiP), Krystyna Ptok (vice-president of the OZZPiP in the region of Silesia), Elzbieta Pieprz (president of the OZZPiP of Swidnica) and Luiza Nowaczynska (OZZPiP activist at the “Latawiec“ hospital in Swidnica), who introduced on the situation in the Polish health sector at the European Conference for the Defence of the Public Health Service on May 7-8, 2011 in Amsterdam.

Footnotes

[1by commercialisation we mean transformation into a commercial company, even if the region, town or canton remains owners of the shares of this enterprise

[2Z. Zdónek, “Donaldyzacja sluzby zdrowia” (“The donaldisation of the health service”), article published in the weekly of the free trade union “August 80”, “Kurier Zwiazkowy” number 363, April 6, 2011

[310. Z. Zdónek, “Wszyscy jestesmy Olewnikami” (“We are all victims like the Olewniks), “Kurier Zwiazkowy”, number 367, May 25, 2011

[411. Z. Zdónek, “Jak sie kreci lody na sluzbie zdrowia” (“How to get rich from the health services”), “Kurier Zwiazkowy”, number 350, November 24, 2010

[512. Z. Zdónek, “Kurier Zwiazkowy” number 367, May 25, 2011

[613. “Kurier Zwiazkowy”, number 361, March 23, 2011

[7“Kurier Zwiazkowy”, number 364, April 13, 2011