Health Systems in Transition, Poland: Health system review

1 PolandHealth system reviewVol. 13 No. 8 2011 Health Systems in TransitionDimitra Panteli and Anna Sagan (editors) and Reinhard Busse (Series editor) were responsible for this HiTEditorial BoardEditor in chiefElias Mossialos, London School of Economics and Political Science, United KingdomSeries editorsReinhard Busse, Berlin University of Technology, GermanyJosep Figueras, European Observatory on Health Systems and PoliciesMartin McKee, London School of Hygiene & Tropical Medicine, United KingdomRichard Saltman, Emory University, United StatesEditorial teamSara Allin, University of Toronto, CanadaJonathan Cylus, European Observatory on Health Systems and PoliciesMatthew Gaskins, Berlin University of Technology, GermanyCristina Hern ndez-Quevedo, European Observatory on Health Systems and PoliciesMarina Karanikolos, European Observatory on Health Systems and PoliciesAnna Maresso, European Observatory on Health Systems and PoliciesDavid McDaid.

2 European Observatory on Health Systems and PoliciesSherry Merkur, European Observatory on Health Systems and PoliciesPhilipa Mladovsky, European Observatory on Health Systems and PoliciesDimitra Panteli, Berlin University of Technology, GermanyBernd Rechel, European Observatory on Health Systems and PoliciesErica Richardson, European Observatory on Health Systems and PoliciesAnna Sagan, European Observatory on Health Systems and PoliciesSarah Thomson, European Observatory on Health Systems and PoliciesEwout van Ginneken, Berlin University of Technology, GermanyInternational advisory boardTit Albreht, Institute of Public Health , SloveniaCarlos Alvarez-Dardet D az, University of Alicante, SpainRifat Atun, Global Fund, SwitzerlandJohan Calltorp, Nordic School of Public Health , SwedenArmin Fidler, The World BankColleen Flood, University of Toronto, CanadaP ter Ga l, Semmelweis University, HungaryUnto H kkinen, Centre for Health Economics at Stakes, FinlandWilliam Hsiao, Harvard University, United StatesAlan Krasnik, University of Copenhagen, DenmarkJoseph Kutzin, World Health Organization Regional Office for EuropeSoonman Kwon, Seoul National University, Republic of KoreaJohn Lavis, McMaster University, CanadaVivien Lin, La Trobe University, AustraliaGreg Marchildon, University of Regina, CanadaAlan Maynard, University of York, United KingdomNata Menabde, World Health Organization Regional Office for EuropeEllen Nolte, Rand Corporation, United KingdomCharles Normand, University of Dublin, IrelandRobin Osborn, The Commonwealth Fund, United StatesDominique Polton, National Health Insurance Fund for Salaried Staff (CNAMTS)

3 , FranceSophia Schlette, Health Policy Monitor, GermanyIgor Sheiman, Higher School of Economics, Russian FederationPeter C. Smith, Imperial College, United KingdomWynand van de Ven, Erasmus University, The NetherlandsWitold Zatonski, Marie Sklodowska-Curie Memorial Cancer Centre, PolandHealth Systemsin Tr a n si t i o nAgencja Oceny Technologii Medycznych (Agency for Health Technology Assessment in Poland), I Lipska, E KiersztynCentrum Medyczne Kszta cenia Podyplomowego (Medical Centre of Postgraduate Education), I Wrze niewska-WalCentrum system w Informacyjnych Ochrony Zdrowia (Centre for Health Information Systems ), W Borkowski, M Dmowski, R Maci gMinisterstwo Zdrowia (Ministry of Health of the Republic of Poland), F Doma ski, A Le niewska, M Marek, D Pozna skiNarodowy Fundusz Zdrowia (National Health Fund), M Czy ewski, M Ksi ak, M widerek, A Terka, K WiktorzakNarodowy Instytut Zdrowia Publicznego Pa stwowy Zak ad Higieny (National Institute of Public Health National Institute of Hygiene), P Gory ski, K Kuszewski, B WojtyniakUniwersytet Jagiello ski (Jagiellonian University), I Kowalska, A Mokrzycka, C Sowada, C W odarczyk Uniwersytet dzki (University of dz), M widerekUniwersytet Warszawski (University of Warsaw), A SobczakEuropean Observatory on Health Systems and Policies, A Sagan, D Panteli, R BusseHealth system Review2011 Poland.

4 The European Observatory on Health Systems and Policies is a partnership between the WHO Regional Office for Europe, the Governments of Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics and Political Science, and the London School of Hygiene & Tropical :DELIVERY OF Health CAREEVALUATION STUDIESFINANCING, HEALTHHEALTH CARE REFORMHEALTH system PLANS organization and administrationPOLAND World Health Organization 2011, on behalf of the European Observatory on Health Systems and PoliciesAll rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in address requests about the publication to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen , DenmarkAlternatively, complete an online request form for documentation, Health information, or for permission to quote or translate, on the Regional Office web site ( ).

5 The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation country or area appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned.

6 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its and bound in the United 1817-6127 No. 8 Suggested citation:Sagan A, Panteli D, Borkowski W, Dmowski M, Doma ski F, Czy ewski M, Gory ski P, Karpacka D, Kiersztyn E, Kowalska I, Ksi ak M, Kuszewski K, Le niewska A, Lipska I, Maci g R, Madowicz J, M dra A, Marek M, Mokrzycka A, Pozna ski D, Sobczak A, Sowada C, widerek M, Terka A, Trzeciak P, Wiktorzak K, W odarczyk C, Wojtyniak B, Wrze niewska-Wal I, Zelwia ska D, Busse R. Poland: Health system review . Health Systems in Tra n sit ion, 2011, 13(8):1 193. ContentsContentsAffiliations ..vPreface.

7 ViiAcknowledgements ..ixList of abbreviations ..xiiiList of tables, figures and boxes ..xvAbstract ..xixExecutive summary ..xxi1. Introduction .. Geography and sociodemography .. Economic context .. Political context .. Health status ..82. Organization and governance .. Overview of the Health system .. Historical background .. Organization .. Decentralization of the Health care system .. Planning .. Health information management .. Regulation .. Patient empowerment ..433. Financing .. Health expenditure .. Sources of revenue and financial flows .. Overview of the statutory financing system .. OOP expenditure of private households ..79 Health Systems in transition VHI .. Other financing .. Payment mechanisms ..864. Physical and human resources .. Physical resources .. Human resources ..1045. Provision of services .. Public Health .

8 Patient pathways .. Primary/ambulatory care .. Specialized ambulatory care/inpatient care .. Emergency care .. Pharmaceutical care .. Rehabilitation/intermediate care .. Long-term care .. Services for informal carers .. Palliative care .. Mental Health care .. Dental care .. Complementary and alternative medicine .. Health care for specific populations ..1516. Principal Health reforms .. Analysis of recent reforms .. Future developments ..1627. Assessment of the Health system .. Stated objectives of the Health system ..1657. 2 E q u it y .. User experience and equity of access to Health care .. Health outcomes, Health service outcomes and quality of care .. Health system efficiency .. Transparency and accountability ..1768. Conclusions ..1779. Appendices .. References .. Principal legislation .. HiT methodology and production process.

9 The review process ..193 AffiliationsAffiliationsInstitutionAutho rsAbbreviationFull Polish nameEnglish nameAOTM Agencja Oceny Technologii MedycznychAgency for Health Technology Assessment in PolandI Lipska, E KiersztynCMKPC entrum Medyczne Kszta cenia PodyplomowegoMedical Centre of Postgraduate EducationI Wrze niewska-WalCSIOZC entrum system w Informacyjnych Ochrony ZdrowiaCentre for Health Information SystemsW Borkowski, M Dmowski, R Maci gMZMinisterstwo ZdrowiaMinistry of Health of the Republic of PolandF Doma ski, A Le niewska, M Marek, D Pozna skiNFZN arodowy Fundusz ZdrowiaNational Health FundM Czy ewski, M Ksi ak, M widerek, A Terka, K WiktorzakNIZP PZHN arodowy Instytut Zdrowia Publicznego Pa stwowy Zak ad HigienyNational Institute of Public Health National Institute of HygieneP Gory ski, K Kuszewski, B WojtyniakUJUniwersytet Jagiello skiJagiellonian UniversityI Kowalska, A Mokrzycka, C Sowada, C W odarczykU Uniwersytet dzkiUniversity of d M widerekUWUniwersytet WarszawskiUniversity of WarsawA SobczakThis list represents professional affiliations of the contributors at the time of writing and may not represent their current place of Health Systems in transition (HiT) series consists of country-based reviews that provide a detailed description of a Health system and of reform and policy initiatives in progress or under development in a specific country.

10 Each review is produced by country experts in collaboration with the Observatory s staff. In order to facilitate comparisons between countries, reviews are based on a template, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a seek to provide relevant information to support policy-makers and analysts in the development of Health Systems in Europe. They are building blocks that can be used: to learn in detail about different approaches to the organization, financing and delivery of Health services and the role of the main actors in Health Systems ; to describe the institutional framework, the process, content and implementation of Health care reform programmes; to highlight challenges and areas that require more in-depth analysis; to provide a tool for the dissemination of information on Health Systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries; and to assist other researchers in more in-depth comparative Health policy the reviews poses a number of methodological problems.