All that... Candidates have to say about health

Poland is among those European Union countries that spend the least on health care. According to the latest Health at a Glance report, per capita spending in our country amounted to 1.9 thousand euros. In comparison, Germans spend 5.3 thousand euros, and Czechs spend almost 2.9 thousand euros. The EU average exceeds 3.5 thousand euros. We fare badly when comparing the percentage of public spending on health. Realistically, we spend about 4.8 percent of GDP, while in the Czech Republic this indicator oscillates around 8 percent, and the EU average is 9 percent of GDP. The NFZ's finances are creaking at the seams, because although in nominal terms the NFZ's budget has even doubled over the past few years, this is actually to a huge extent the result of high inflation in 2020-2023, and - to some extent - high economic growth.

However, much faster than outlays, the cost of the health care system grew. It can be said that health inflation has outpaced and is outpacing general inflation, and this is also taking a heavy toll. The main reason is the revised 2022 law on minimum wages in health care, but demographics, aging population, technological advances, availability of innovative therapies, etc. are important drivers of costs. Some candidates may think that the costs of the health care system can be reduced, but this is simply not true - highly developed countries spend a lot and a lot on health care, and will continue to spend - even more. The discussion about taking spending up a notch is taking place in countries that spend twice and more on health than Poland.

The passage of the law lowering the health premium by the parliament and its veto by the president provided an opportunity to direct, if only for a moment, public attention to the problem of a starved health care system, but this attention did not linger for long (and the topic of lowering or not lowering the health premium itself does not seem to have had much impact on the presidential campaign).

So what do the candidates who fall into the mainstream have to say (about health)?

Rafal Trzaskowski

On the candidate's website, under the "My Idea for Poland" tab, the topic of health care is missing. This is a change from 2020, when the candidate of the Civic Coalition announced a strong commitment to this area and promised that as president he would demand from the government a jump in spending to a real 6 percent of GDP. A sign of the times, you might say - the COVID-19 pandemic was beginning, after all.

Now, apparently, in Rafal Trzaskowski's opinion, times have changed enough to think about... reducing health spending. - It is necessary to stand on one's head to reform the health service in such a way that makes sense, to look for opportunities to reduce some of the costs, to bring about a reduction in this premium that is milking our entrepreneurs. And I think that the first step that goes towards lowering the health premium is a good idea. And yes, I support this type of solution. (...) If one reduces the premium, it will force one to be even more seriously active in dealing with cost-cutting," he said in March. And in recent days, commenting on Andrzej Duda's decision to veto a bill lowering the premium for entrepreneurs, Trzaskowski argued that... a lower premium means more revenue for the National Health Service, because if the number of companies increases, more entities will pay the premium.

Karol Nawrocki

- No more chaos in the health service, the Law and Justice civic candidate promises, and announces measures to create patient care centers. That's not all, however - Nawrocki wants to introduce the principle of priority for Poles in accessing treatment. However, NFZ data does not support the suggestion, flowing from this demand, that Polish citizens should have to wait for access to treatment because of the rush - by default - of refugees from Ukraine. What's more, ZUS and NFZ data prove that the health premiums paid by Ukrainians working in Poland more than compensate for the medical expenses of Ukrainian citizens, not just those who receive benefits under special provisions enacted in connection with the outbreak of full-scale war in Ukraine in February 2022.

Slawomir Mentzen

The Confederation's program on public services can be reduced to their abolition (conditioning the main point of the program, i.e. a significant tax cut), but in this election Slawomir Mentzen does not talk about his "ideal world," following the advice of Andrzej Sosnierz, a former PO and PiS politician, one of the co-authors of the 1998 reform of the health insurance funds and later president of the National Health Fund, focusing on the postulate of abolishing the NFZ and replacing the monopolistic payer with health insurance funds or private insurance companies competing for the contributions of the insured. This is a "return to the past" - because this was one of the main assumptions of the reform of Jerzy Buzek's government, but it very quickly proved impossible (too difficult) to implement, if only because of the underestimation of the health premium. In Switzerland, which the leader of the Confederation often cites in his speeches, health premiums vary in amount, but they are differentiated primarily by the declared level of the patient's own contribution, borne by the patient when there is a need for treatment.

Szymon Holownia

The leader of Poland2050 has not included health care among his priorities in this presidential campaign. During one of the debates, he declared that as president he would appoint a cross-party team, made up of representatives from all political forces, whose task would be to present - within a year - a plan for changes in health care, which would be implemented regardless of the results of the next parliamentary elections and possible changes in government teams.

At the same time, Holownia is a major proponent of lowering the health premium for entrepreneurs. He said of the health premium in the spring: - She does not cure anyone's health. She kills Polish companies, Polish small firemans, enterprises, one-person entrepreneurs," he argued as recently as last year.

Magdalena Biejat

The Left's candidate, deputy speaker of the Senate, is a staunch opponent of lowering the health premium, she conveyed her position personally to Andrzej Duda, while during the debate in the Senate she fought, along with most of her club's senators - including Deputy Health Minister Wojciech Konieczny - to ensure that the Senate does not approve the bill in the form passed by the Sejm. She saw the reduction of the health premium for entrepreneurs as an attempt to reduce funding for health care and putting the public system in even more trouble than it is currently experiencing as an attempt to further privatize health services.

At the same time, the Left candidate advocates abolishing the health contribution as such and replacing it with a health tax, constituting a specific part of PIT and CIT, which would increase, significantly, health expenditures. Biejat also advocates reorganizing the ownership structure of hospitals so that inpatient facilities in each province are managed by a single entity. In her view, only such a change could realistically enable the transformation of hospitals, which are currently bogged down in local politics, but also formal competence obstacles.

Adrian Zandberg

The Together Party in the fall of 2023 did not enter the government because of - officially - disagreement with increasing health care funding to 8 percent of GDP. It is hardly surprising that this demand is now on the election agenda of one of the party's main leaders. Razem has been building its position first as part of a coalition supporting the government, and for the past few months as part of the formal opposition, thanks in part to its clear message on issues related to the financing of the health care system and criticism (usually constructive) of its functioning. Here the voice of the Left and Together, though separate, sounds similar: - The state must radically increase health spending, because the system is functioning badly primarily because it is underfunded. - As president, I will protect the health of Polish women and men from quiet privatization," he promises, because, like Magdalena Biejat, he believes that politicians' maintenance of health care financing at dramatically low levels is destined to lead to the functional privatization of the sector.

Adrian Zandberg also wants changes in the system so as to combat its pathologies. He demands, among other things, an iron curtain between the private and public health care systems. Doctors would have to choose whether to work and earn in public entities or run private practices.