But I am insured
Universal public healthcare is based on insurance. As with all insurance, it is characterised by the existence of an insurance premium paid by the person at risk in exchange for insurance coverage provided in the form of defined benefits. However, in the case of public general health insurance, we become insured “automatically”, i.e. by law, the premium is deducted from our remuneration (or paid by the entrepreneur in the same way as income tax) and goes to the National Health Fund (NFZ). But there are also groups of insured people who do not pay premiums to the National Health Fund, such as the unemployed or students. Hence the universality of this insurance, which is an expression of the state’s protectiveness. Unfortunately, the same universality affects the incompatibility with the needs of insured people in case of illness.
Although the efficiency of the health service was not good before, the pandemic has drastically shown how short is the “duvet” that NFZ must cover health services with. The regulations adopted in 2022 only worsened the existing difficult financial situation. Highly specialised services, medical rescue, medicines for people aged 75+ and pregnant women, financed so far from budget funds, have been transferred to NFZ. The real decrease in the funds allocated by NFZ for health services was also caused by the regulation suspending the financing of insurance premiums for students, soldiers and children from orphanages from the state budget.
Supplementary insured
Therefore, despite the fact that the basis for financing health services in Poland is public universal healthcare, it is not an effective way to ensure protection in case of illness or health disorder, which no one denies anymore. The only question left is how to fix it. I share the view that the healthcare system includes both public health insurance and supplementary private health insurance of an individual or group nature. Unfortunately, the complementary role of the health insurance market is not recognised by the legislator, which remains deaf to the projects of introducing a tax relief enabling the deduction of private health insurance premiums from the amount of income tax.
Condemned to public healthcare, we should recognise its basic nature. However, only supplementing this protection with additional private health insurance (possibly also a medical subscription) may lead to the provision of healthcare in line with our needs. Faster access to medical services, a wider choice of medical and therapeutic entities is possible only by supplementing the use of the so-called basket of benefits guaranteed by NFZ.
Increasing the number of services provided and shortening the waiting time for an appointment guaranteed under private health insurance is a relief for the public sector. According to the data as at the end of 2022, 4.08 million Poles use private insurance, which provides a real relief to the public sector. This means that it is possible to finance more or more expensive health services from the funds collected by NFZ. Of course, supplementarity should not mean duplication and double (or even triple in the case of entrepreneurs) financing of the same services. The complexity of protection is a topic for a separate column.
What about this age
On average, we live shorter and shorter. The average life expectancy of men in Poland in 2021 was almost 72 years and was two years and three months shorter than in 2019. In the case of women, the average life expectancy was almost 80 years and was two years and one month shorter than in 2019. Of course, this trend is influenced by the pandemic. Its consequences on the medical care system are still felt, e.g. in the form of the so-called health debt. In Poland, the mortality rate due to civilisation diseases – cardiovascular, malignant tumours and diabetes – is increasing. According to the data of Statistics Poland (GUS), they are the most common cause of death in the country (65%).
Quick access to health services provided by professional medical personnel extends life.
Author: Dorota Maśniak
Associate Professor w University of Gdansk, Head of Insurance Law Laboratory
