Healthcare Opportunities – Insurance we’re up for that!

Having spent most of my career in healthcare it is always a pleasure to have the opportunity to lead an event in this area. This week’s joint British-Polish Chamber of Commerce (BPCC) and British Embassy healthcare policy working group took the format of a panel discussion on Health Insurance with a number of leading specialists taking part in the panel and a number of leading specialists contributing actively from the floor.

We went on for 2 hours and didn’t exhaust the subject. There is a lot going on and you know it really seems as we are making headway. A real driver of market development is Polish Union of Insurers (PZU) coming out with its health insurance package. Just imagine the opportunities as more financing comes on stream into the health system.

The experts on the day were Dorota Fal, an expert adviser to the PZU; Tomasz Pawlęga, Director of Health Insurance at the Ministry of Health; Aldona Zygmunt, Corporate Affairs Director at AstraZeneca; Richard Sands, Strategy Director at Medicover and Tomasz Jędorowicz, a well known healthcare expert. I have to give a special mention to Jacek Graliński from Centrum Zdrowia Dziecka (The Children’s Memorial Health Institute), who brought a very practical management element to the discussion!

The meeting kicked off with an update on health insurance from Dorota Fal. Big ticket challenges are the rollout of insurance – supplementary first in a way which optimises the system. Yes, the system needs more financing but there are also opportunities to improve care by improved management systems and to take ownership of health – a moral component which is an underlying theme for patients and stakeholders in the system. A lively discussion you may imagine!

A question frequently asked around the world, usually as elections approach, is “is there enough money in the system?” In the context of Poland and the current contribution of the public sector, the answer is definitively no. However, this merits a closer look. Over the last ten years as the economy has developed, the Polish population has come to expect better healthcare – something that is entirely normal as people get wealthier.

Looking at OECD benchmarks, the Polish state is under spending by an order of 2 to 3 percentage points of GDP less than the median 8-9%. That translates into lengthening waiting lists for diagnostic and medical procedures; overspend in the delivery of services; pressures on payments and restricted access to innovative treatments. The state sector is financed currently by tax contributions – a tenable situation five years ago with rapidly declining unemployment and widespread salary increases as Poland enjoyed a post EU accession boom. Then came the slowdown – what next?

Poland’s constitution lays out the vision for the nation’s health very clearly. It is the right of all citizens of the country to have access to free healthcare. Within that framework there is excellent scope for delivering a high quality system. The legislation for different levels of service provision has been approved. By necessity a big component of that is funding, although that is not the only challenge. The type and location of services must be well defined – primary, secondary and tertiary care; access to innovative diagnostics and medicines at the appropriate time; the relationship between the public and private sector (which is often unclear and full of distrust); and increasingly, patient choice. Focusing on the latter, it becomes clear that the system is not just about money or the lack of it.

Public sector spend on healthcare in Poland is around 60 billion zlotys per year. It is estimated that another 30 billion zlotys is contributed directly though informally by the Polish patient. Around 70% of medicines in Poland are funded out of the patient’s pocket. In parallel to the state sector clinics, there is a rapidly developing range of privately-owned diagnostic and treatment centres. These are either run on a fee-for-service basis. Increasingly, the large insurance companies are developing insurance products – some even enable the co-funding of medicines. Many healthcare professionals have second jobs in private clinics. A large tranche of EU funds is available over the next five years to modernise the provision of infrastructure and to upgrade the system – including human capital development. A number of private hospitals are planned and the state sector is flirting with PPP (a hospital financed this way is being developed by the city of Zabrze).

Proposals are in place for a fully fledged national insurance based system which has been developed with the constitutional mandate in mind. This solution would guarantee, along with the inflow of additional funds, increased financial efficiency, prudent and rational utilisation of funds and above all high quality, open and accessible healthcare. Such a system would enable private and public payers to compete against each other. Private health funds would have the opportunity to co-manage public healthcare funds. Competition between payers would lead to greater efficiency as every entitled person would become a customer, not a petitioner as currently is the case with the National Health Fund. An increased number of institutions involved in the management of public healthcare funds would guarantee better quality and organisation of medical services provision.

The debate is hot and the stakes are high. However if we follow basic logic and thought processes and introduce a splash of ethical and efficient management there is a clear road ahead. The economy is developing and people want and expect better care. The system needs more funding; that is unlikely to come from government in the short-term. There is already a culture of insurance. There is room for personal contributions to a fund based on ability to pay. Supplementary and complementary insurance are well accepted norms across the world. The insurers and private providers are in the market and expanding rapidly. Management systems and competencies are present in Poland – they need to focus on the health system. And by the way – my health is at the top of my priority list. I want the best care possible. Watch this space.