What will the election bring to health?

The fact that former Health Minister Adam Niedzielski dropped out of Law and Justice's electoral lists altogether was predictable. True, even a few days before the announcement of the final shape of the lists, some of the trade media speculated that perhaps Niedzielski had only lost his first place, but it was even certain that Jaroslaw Kaczynski's party was eager to get rid of the ballast that Niedzielski was becoming for it. Especially since the campaign strategy was based on plans to overtake part of the Confederation's electorate - and on these voters the former head of the health ministry acts like a bull's-eye. This, of course, does not mean that Niedzielski has completely and irrevocably said goodbye to the sphere of public activity - to the surprise of quite a few participants, he visited the Economic Forum in Karpacz, where, admittedly, he did not appear in panels devoted to health (he was a guest at a session on the reconstruction of Ukraine, which immediately set off rumors, that he would become an advisor to the Ukrainian government, although at the same time it was announced that such a mission had been undertaken by former Deputy Health Minister Krzysztof Łanda, there is no special chemistry between the two men, to say the least), but in absentia he received thanks "for his consistency and proficiency" in the matter of the Law on Quality in Health Care.

Here, however, there was no talk of sensationalism. In contrast to the fall off the list - at the last minute - of Tomasz Latos, a long-time MP, for many years first vice-chairman and for five-plus years chairman of the parliamentary Health Committee, undoubtedly one of the most important and influential figures in health care in recent years. And - here, too, there is no doubt - the natural leader of the Law and Justice Party in the district, which achieved an impressive 60,000 votes in the last parliamentary elections. Why did Latos find himself off the list for the Sejm? All explanations on the matter (first that he would run for the Senate, then that he had been promised a seat in the European Parliament) have either falsified or make no sense - if Latos were to replace his party rival Kosmas Zlotowski in the EP, the latter would have to be guaranteed a seat in the Polish parliament, and Zlotowski is not running. There is speculation (Tomasz Latos himself does not want to comment on what happened) that the MP "got a ricochet" in the visa scandal - two of his colleagues were linked to Edgar K., who was charged in the case.

Not a sensation, but a certain surprise, however, is the presence on the Law and Justice list of Andrzej Sosnierz, a perennial critic (in the first and second terms) of the United Right's policies on health care issues. So¶nierz, by the way, left the club in the ending term, co-founding a circle that usually votes with PiS (though not always), but acutely on a large part of the flagship projects - including the quality law - he clearly sided with the opposition.

As for personalities, the lists of the Civic Coalition are undoubtedly less colorful - here the return of Bartosz Arlukowicz, former Minister of Health, can be considered a surprise. The transfer from the Senate to the Sejm of Prof. Alicja Chybicka is also a surprise, although not a very big one.

In total, several hundred representatives of the medical profession, including 135 doctors and dentists, are running for the Diet and Senate. Already without descending to the level of names, one can consider as a sensation the numerous presence of almost twenty representatives of the medical profession on the lists of the Confederation - a party whose leaders speak either about the ideas of "veterinarization of health care" (Janusz Korwin-Mikke), or that, that anyone should be able to treat, not just people who once went to university (which, by the way, will soon become a reality, people who never went to university will be able to treat), and invoke the authority of the "old country woman" (Slawomir Mentzen).

Personalities, names - they are not only interesting, but also important, because on them depends (at least to some extent) the quality of legislation and decisions made. However one assesses, for example, the record of Health Committee Chairman Tomasz Latos, one has to do justice to the fact that he blocked one of the most harmful ideas of "his" minister (quotation marks justified, as the disagreement between Adam Niedzielski and Mr. Latos could also be felt at Health Committee meetings), i.e. the law on hospitality. What is key, however, are the programs with which the parties go to the elections.

In matters of health - no surprise. Misery, that is - nihil novi. The program proposals of the two main rivals - especially looking at the challenges that the health care system faces and will face - are striking in their duplicity.

Law and Justice: follow-up

The ruling party has found itself in a difficult situation, and, to put it bluntly, stuck in the trap of its own years-long propaganda of success, based on the fiction of 7% of GDP for health. Jaroslaw Kaczynski's party, while maintaining that things are moving in the right direction, can only promise the system and its stakeholders a great continuity, the foundation of which is a "historic" and "unprecedented" increase in funding. "We will ensure the stability of health care financing. This is a prerequisite for any reform effort. Therefore, in accordance with the statutory guarantee, the financing of the healthcare system will steadily increase to the level of 7% in 2027." - So reads the "Secure Future of the Poles" program. Staying in the realm of parallel realities, the reality of party programs and pre-election promises, one has to go to the very beginning of the chapter on health care to learn that "the main goal of Law and Justice's health policy is concern for public health. - We are pursuing and will consistently pursue measures to increase life expectancy and improve the health system's ability to respond to possible future health crises.

It sounds surreal, not least because it was precisely during the years of the Law and Justice government that the life expectancy parameter first decelerated and then radically shortened in 2020-2021 by about two years, which, of course, must be attributed to COVID-19, but the question of how far those in power can be absolved of responsibility for the tragic pandemic record, one of the worst among highly developed countries, remains open, and as the Supreme Audit Office report published in September, for example, indicates, there is much to debate and there is, in fact, much to investigate.

For quite a fresh answer to how Law and Justice understands public health concerns is brought by, for example, what is happening around HPV vaccination. On the one hand, "Poland has joined the elite" (a statement made by the Minister of Health in May 2023, when vaccination enrollment started, by the way, this "elite" is already more than 120 countries in the world, running vaccination programs against the human papillomavirus), serious public funds have been committed to purchasing vaccines and financing vaccinations, on the other - the Ministry of Education and Science, headed by a politician who, as the rumor has it, has ambitions, if the elections are won, to take over the reins of government, refuses to conduct educational, promotional, vaccination campaigns in schools, due to fears of sexualization of children. Because experts appearing on Radio Maryja believe that the best way to prevent infection is sexual abstinence until marriage. Officially - vaccination is included in the National Cancer Strategy adopted by the government (bravo!), semi-officially - an important politician of the party is just annihilating the vaccination program, based on the message that the HPV vaccine protects against numerous types of cancer. Caring for public health in theory and practice.

There is no better example of "great continuity" than the area of medical staff training. "Growing health awareness makes us want to see a doctor more and more. Increasing the number of specialists is a priority. We have been doing this consistently year in and year out [BozSig1] slowly out of the staffing crunch resulting from neglect related to education," the program's authors explain. Greater accessibility to medical services, however, does not mean a remodeling of thinking about these services, as experts advocate - in the direction of shifting competence to other medical professionals. No - "greater availability of doctors means reducing patient waiting times for appointments. The first step towards this goal should be increasing the number of students in the medical and other medical faculties." However, the addition of "other medical faculties" should not deceive anyone - there is no dynamic growth in the number of seats in "other" faculties. - We are not stopping and want to continue the process of training specialists. We are opening medical faculties at many universities. Thanks to the new centers, high school graduates no longer need to migrate to large cities to study medicine, which will help ensure equal access to specialists throughout the country," lectures the intentions of Jaroslaw Kaczynski's party.

Is there any novelty? Not really - even the "Good Meal" program, pulled out for a banner (i.e. for an election spot), can be commented on with the words of the song "but it's been done before..." (and it didn't work out).

Civic Coalition: change, but what kind of change?

Symmetrism is a bad thing, but neither does the Civic Coalition's program abound in innovative - and above all rational - promises. Come back... KO has not presented a program at all, only promises for the first hundred days in government. And perhaps for this reason, among these promises, one can look in vain for a trace of the announcement of an increase in public spending on health (something that the party's politicians have consistently, as opposition, demanded). What, on the other hand, is on the list of promises or commitments of Donald Tusk's party. There is, first and foremost, a whole bloc on women's reproductive rights - from the legalization of abortion up to the 12th week of pregnancy, to the abolition of prescriptions for emergency contraception, to the financing of in vitro from the state budget, to guaranteed free anesthesia at childbirth. This is the first moment when the red light goes on. The author of the promise is apparently still operating in a reality from many years ago, in which charging for such a service (in a public entity, operating under contract) was possible. The problem at the moment is not that hospitals offer paid anesthesia, but that many of them do not guarantee it at all - due to a shortage of anesthesiologists. In turn, this is a systemic problem, a very serious one - and one that requires serious thought and a serious response.

There is an even bigger problem with the promise to lift limits to hospital services. A problem, in fact - problems. Taking this announcement literally, one has to calculate, experts say, an additional cost of 23-25 billion zlotys - just for hospital services. From where, if there is not a word about increasing outlays in the promises? But the real problem lies elsewhere - the only right (and, in fact, necessary) direction of change in health care is to invert the pyramid of benefits (a hackneyed term, but true). Experts, both in Poland and the entire group of developed countries, are unanimous: the health policy of countries should focus on keeping citizens away from the health care system in general (public health, primary prevention, then secondary prevention) for as long as possible. Once they have to use it, to keep them in outpatient, primary and specialized care for as long and as much as possible. They should go to hospitals as a last resort. This shows the direction of financial flows (behind the benefits provided): Outpatient care, in the Polish case primarily specialized care, which should even take over some of the services (if only the lion's share of diagnostics) from hospitals.

Opposition proposals (3-5)

What do the parties that are likely to take the next three seats put on the electoral, health, table?

The left, in addition to the block on women's rights, primarily demand 8 percent of GDP for health, unfortunately - with no indication of funding sources. And a flat fee for medicines for all, regardless of age (PLN 5, identical to the 2019 program, despite high inflation).

The Third Way wants the National Health Service to guarantee obtaining services within a certain timeframe (maximum two months) - if this proves impossible, the payer would reimburse the cost of a private visit. The committee of Szymon Holownia and Wladyslaw Kosiniak-Kamysz also talks about shortening medical studies from six to five years and simplifying the path to specialization. As for the amount of outlays on health - the Third Way stops at 7 percent of GDP, while promising voters a return to the tax deduction for health premiums.

The Confederation, in addition to the "promise" of veterinarization and deregulation of the medical profession (because that's how the ideas should be read, so that "everyone" can be treated), talks about health vouchers - and this would be a postulate from the "meaningless" category, if its meaning were understood at least by all Confederation activists. It isn't, because there is no shortage of voices in the party about the possibility of "collecting" vouchers to finance treatment (while the program says quite clearly that the idea is to equally distribute the proceeds of the health premium among all citizens and give them the opportunity to get insurance in the institution of their choice, public or private).

Source: "Health Service" 9-10/2023.