The gap in health care affects Poles and the economy

Luc Williams

PLN 22.1 billion – this is the estimated gap in the health care system in Poland using the definition of the Swiss Re Institute and the Geneva Association, based on non-reimbursed direct household expenses for health services. They do not take into account the amounts on medicines, on which Poles spend PLN 16 billion annually, and unrealized health expenditure, among others. due to lack of funds, queues and distance to medical facilities. According to the Polish Insurance Association (PIU), if Poland wanted to catch up with countries where the health care system is rated the highest, it would have to cope with a gap even five to six times larger, i.e. reaching up to PLN 100-125 million per year. We are talking about the countries with the highest results on the EHCI (European Health Consumer Index) health protection index, i.e. Switzerland and the Netherlands. PIU experts also emphasize that little will change in the situation of citizens if reducing the gap only involves adding additional money to the health care system. This, as they say, must be a well-thought-out process in which the money will be spent on specific activities. What? First of all, on appropriate prevention and outpatient care, which will effectively prolong healthy life, but also on quick diagnosis and implementation of therapy at the earliest possible stage of the disease, which affects the results of treatment of chronic diseases and cancer.

The insurance sector, which is already developing standards for optimal allocation of funds, can participate in these changes, i.e. increasing financing for prevention, improving diagnostics and effectively managing patients in the health care system.

PIU has developed a mathematical model that shows where the Polish health care system could be if spending on it were increased, but in a targeted manner. It is based on the principal component analysis (PCA) method. It allows you to illustrate the impact of specific changes in health care spending on other health systems operating in Europe.

– Together with the report’s partner, the consulting company Milliman, we took into account parameters commonly used in reviews of health care systems and reports by the OECD and the European Commission, says Dorota M. Fal, advisor to the PIU management board, adding that for the purposes of the study, the analysis covered 26 health systems. in Europe, which were checked in terms of structure, resources, inputs and effectiveness.

The comparative analysis took into account the relationships between three components. These are, firstly, health care expenditures in the system and the health status of the population, measured by life expectancy and the number of deaths that can be avoided thanks to prevention. Secondly, the number of doctors and the morbidity and mortality resulting from cancer. The third component is related to the structure of expenses in the health care system and the proportion between expenses for outpatient and hospital care. In addition, each country is assessed on the quality of its health care system from the patient’s perspective. The basis for this was the EHCI 2018 index (Euro Health Consumer Index), created on the basis of the analysis of 46 features related to: patients’ rights, access to specialists, the number of viral infections, availability of health care facilities, vaccination coverage and the use of antibiotics in treatment. The analysis shows that countries whose health systems are rated the best are characterized by relatively high health spending in relation to GDP, and the baseline health of their populations is better. This is significantly influenced by the cancer detection rate and the number of doctors. In addition, these countries have a more balanced structure of expenditure on outpatient and inpatient treatment. An example of a country where health care expenses are redirected to outpatient treatment (more than twice as high as expenses for hospital treatment) is Portugal.

When looking for a remedy to eliminate the gap in the protection system, Poland should follow the example of countries such as Switzerland, the Netherlands and Norway, which have targeted and high expenditure on health care. Only then will key parameters improve, including: such as life expectancy or the number of preventable deaths. The average life expectancy in these countries is approximately five years higher than in Poland, and the number of deaths that can be avoided thanks to prevention is up to 50-60 percent. lower. In Poland, life expectancy is 75.5 years and the number of preventable deaths is 344 per 100,000. people – we are below the OECD average of 80.3 years and 237 per 100 thousand, respectively. people.

PIU simulated changes in two variants. The first one simply assumes an increase in health care spending. In the second simulation, it was assumed that a change in health care expenditure would result in changes in other variables (e.g. mortality due to cancer, number of doctors, number of beds). This assumption means that additional expenditure will affect both the structure of expenditure and the health of the population at the level achieved by European countries with higher expenditure on health than Poland.

It turned out that the first simulation did not significantly improve the situation of Polish patients compared to other countries. The second one is yes, because expenditure on health care will be accompanied by effects in the form of changes in other characteristics. Therefore, spending on prevention and systemic activities resulting in an extension of life expectancy are of key importance. Life expectancy is influenced by ensuring quick access to treatment, which is further related to the availability of doctors, and providing funds for the implementation of more effective diagnostic and treatment methods.

Due to the interdependence of many factors, effective allocation of expenditure requires structural changes in the health care system, including: shifting the emphasis to outpatient treatment and reorganizing hospital treatment. Since expenditure should be accompanied by specific effects, PIU estimates the gap in the health system to be much larger than the generally accepted definition. It is worth investing in such changes, because a better-organized patient care system allows for higher efficiency, including cost effectiveness, compared to systems in which private visits and tests are financed from own funds.

Experts note that health insurance organized by insurance companies may reduce the gap in the health care system. The developing health care infrastructure, extensive experience in effective patient management in the system and coordinated care that guarantees faster recovery respond to systemic challenges that would change the image of health care in Poland. The patient has a chance to see an appropriate specialist sooner. They can also benefit from appropriate diagnostics and therapy.

At the end of 2023, 4.8 million Poles had private health insurance, an increase of almost 14%. compared to the previous year. Poles spent PLN 1.7 billion on them. In addition, Poles use prepaid medical subscriptions, often paid for by employers within specific networks of health facilities. Employers also co-finance or finance health insurance for employees.

Experts note that filling the gap will have a positive impact not only on the patient’s protection system, which will allow the patient to live longer in good health, but also on the country’s GDP.

A sick patient is a non-working employee, which means increasing expenses related to his absence from work. According to the report of the Social Insurance Institution, in 2023 these expenses amounted to PLN 26.7 billion. For comparison, a year earlier it was PLN 25.5 billion. In 2023, 27 million medical certificates on temporary incapacity for work were issued for a total of 287.2 million days of sickness absence. The main reasons were diseases of the musculoskeletal system and connective tissue (17%) and diseases of the respiratory system (14.5%). An additional cost to the economy is that related to productivity lost due to sickness absence. The total loss in this respect was estimated in 2023 at PLN 106.9 billion, or PLN 362 per day for each day of absence. This translates into 3 percent. GDP.

Unreimbursed household expenditure on health care (PLN billion) / Dziennik Gazeta Prawna – digital edition


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