Definition of the "Health Benefit Basket" in Poland

Definition of the "Health Benefit Basket" in Poland
Author(s): Adam Kozierkiewicz, Wojciech Trąbka, Artur Romaszewski, Krzysztof Gajda and
Dariusz Gilewski
Reviewed work(s):
Source: The European Journal of Health Economics, Vol. 6, Supplement (Dec., 2005), pp. S58S65
Published by: Springer
Stable URL: http://www.jstor.org/stable/20069429 .
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Original Papers
Eur J Health Econom
2005
[Suppl 1] 6:58-65
Adam Kozierkiewicz
Wojciech Trqbka Artur Romaszewski
Dariusz
Gilewski
Krzysztof Gajda
Institute of Public Health, Medical College, Jagiellonian University, Crakow, Poland
DO110.1007/S10198-005-0320-3
Published online: 29 October
2005
? Springer Medizin Verlag 2005
Definition
Benefit
care
of the health
Fundamentals
form
system
care
Health
in Poland
of various
sibility
remains
but
sectors,
patients,
gions when
the
1990s
the respon
sically
it is carried
and
were
framework
health
general
in
founded
by Article 68 of the Constitution
states
that:
health
their
with
economic
to
right
regardless of
shall
status,
access
equal
a
has
(a) Everyone
care, (b) Citizens,
1997
which
be provided
care services
fi
to health
nanced from the public funds by the pub
lic authorities;
the conditions
are
pe of services
(c) Public
laws,
propriate
to provide
obliged
to children,
vices
the sco
and
to be detailed
in the ap
are
authorities
care
health
special
ser
dis
women,
pregnant
abled persons, and the elderly, (d) Public
authorities
are
ic diseases
and
obliged
to counter
epidem
potentially
health
prevent
outcomes
threatening
of
on
reform
redefining
introducing
ba
the
of the
state
role
mechanisms,
and management.
institutions
insurance
activi
their
ty by virtue of the Law of Universal Health
Insurance
of 1997, with
amendments
from
1998. This established 16Regional Health
Insurance (Sickness) Funds along with the
Health
Insurance
formed
men,
Fund
workers"
at
which
operated
to the Law
cording
Health
surance,
health
care
Funds
covered
workers,
(army
and
workers)
railway
Funds
sign
families,
In
Health
contracts
with
Health
Regional
(ad
voivodships
particular
ministrative regions) populated by 1-6mil
After
inhabitants.
2000
there were
no
degradation.
legal barriers to the Health Funds extend
Prior to 1989 the Polish health care sys
tem fell under a public integrated model,
ing their
zens were
sometimes
called
ged gradually
over
was
government
er and
the
its Soviet
for
named
the major
"Semashko"
time.
both
model,
and
ideologist,
In this
chan
the
system
insur
the principle
via
of services,
provider
health facilities owned and administered by
regional
representatives
(Voivods,
"Governors").
in a given
area was
ical presence
equipment.
The
determined
or absence
The
of the government
country
benefit
of specialists
had
basket
by the phys
begun
I EurJHealth Econom Suppl 1 2005
and
to re
activities
free
to other
to choose
regions.
the Health
Citi
Fund
focused
and
quality
on
relations"
"proper
own
in their
Still
rather
the Social-Democratic
In
regions.
Government
initiated a centralization of the system by
merging all Health Funds into a unified
universal National Health Fund (NHF)
16
with
of
branches.
regional
recentralization
2 years
technical
there
2005
and
with
Insurance
twice,
lasted
substan
and
problems
the period
from
were
six Ministers
re-written
process
system
burdened
the Health
pletely
tervention
The
the
of
and was
ings. During
level. Ac
areas.
in adjacent
were
providers
tial
police
their
interregional
of Universal
institutions.
"uni
for so-called
with
2001
of universal
commenced
they
preserving
1
re
neighboring
certain Health Funds began
persons
however,
On
in some
except
absorbing
and decentral
freedom,
the
1999
January
process
focused
quasimarket
individual
health
lion
environmental
as the
early
the
ized responsibility
the
as
system
1980s, albeit rather slowly. Until the end of
greater
care
S58
care
the health
tem. Most
of
in Poland
Basket"
out principally by the social security sys
aspects
the'Health
of
shortcom
2001
was
Act
one
until
of Health,
com
after
of the Constitutional
in
the
Tribunal.
One of the reasons given by the Tribunal
in declaring
the
tions
an
the
and
to which
services"
is entitled
person
insurance
"condi
concerning
of
scope
insured
health
was
law unconstitutional
lack of definition
under
the
law.
irrespective of their place of living. Health
had
Funds
become
autonomous
organiza
tional and property institutions, but they
still remained public and managed funds
collected
through
under
premiums
the su
pervision of a public "boards," with the
principle aim of providing insofar as their
budget allowed the best health care to all in
sured
In
persons
in their
reality,
however,
competition
region.
there
between Health
was
little
Funds for
Regulation of the benefit basket
are
There
ments
various
scope
required
for
defining
conditions
legal
the
acts
and
of
services
docu
entitlement.
and
In
im
of regulations
the most
are those based
most
and
portant
general
are
the Constitution.
More
upon
specific
the hierarchy
the laws ratified by Parliament
President,
which
regulate
certain
and the
areas
of
Abstract
social
life and
low
include
and
institutions,
health
The
activities.
obligations
to
laws
of public
and
provide
to persons
benefits
listed
be
?
Social
organs
rules
ensure
various
in need:
for social
insurance
Health
ance
scheme
citizens
of Polish
tion
and
zdrowotnej
k?w
2135).
Labor
code
cine
Penal
both
and occupational
law which
relations
regulates
which
als regarding
protection
health
areas,
authorities
179, poz.
?
Road
eases
(Ustawa
mental
r.
health
1982,
zm.io)
?
Laws
122, poz.
poz.1384
(Usta
w
wychowaniu
r. o
tawa,
niu
ushig
Dz. U
r. Nr
6 December
Nr
241, poz.
99, poz.
Dz.
and
Dz.
58 z 2003
Nr
mise
so-called
assessment
the
govern
are
by nature
and
legal
fundamental
while
their
able waiting
issue
to some extend
it
times
of Health on accept
for health
services.
Keywords
Health
practical
benefit
Health
prin
National
regulations/
plans
Health
priorities
Poland
health
programs
services
application.
and there
obligatory,
administrative
noncompliance.
there are additional
for health
to individ
available
and mechanisms
Both
are
establish
a list
law and a pro
The second
although
sued from the Ministry
and
scope
in the
isbeing dealtwith legallyby regulations is
dele
regulating
the
in part by defining
an institution
to establish
technology
laws contain
of services
laws
and
The
sanctions
In addition
to
for
acts,
legal
documents
most
one
the only
referring
of
important
discussed
of services
alogue
here
these
is a cat
"contracted
(so-called
are purchased by the
products") which
25
(Ustawa,
Ratown
U. Nr
are
The
to
catalogues
appendices
the procurement
in the
documentation
113, poz.
services
920) which
(Us
r. o swiadcze
in need.
regulate
the
of the na
care
of purchasing
procedures
medycznego,
2073 ?raz z 2003
and
functioning
financing
tional rescue
and
system
ed to persons
of these
gal nature.
i
1231, z p?zn.
system
2002,
ratownictwa
January
Dz.U
drogowym,
r. poz.515
z
p?zn.zm.).
solved
NHF.
Pa?stwowym
Medycznym,
1207, z p?zn.
zm.13)
(Ustawa,
1997, r. o
Poland's
Union. The first
to the benefit basket which are not of le
and
alkoholizmowi,
ictwie
20
ruchu
ciples
trzezwosci
147, poz.
problems-which.
on the rescue
July 2001,
problem was
of specific exclusions
decrees
1143),
law and, second,
to the European
users
that
26 October
(Ustawa,
przeciwdzialaniu
U. z 2002 r. Nr
regulates
in 2004,
changed
first the verdict of the Con
insurance
accession
the
uals in Poland. The underlying logic of
the legislative process in Poland provides
2001,
Dz. U. Nr 111,
psychicznego,
z
535,
zm.), drug
(Usta
poz.
p?zn.
wa, 24 April
1997, r. o przeciwdziala
niu narkomanii,
Dz. U. z 2003 r.Nr
r. o
code which
and ab
stitutionalTribunal invalidatingthe existing
1842).
traffic
conditions
zdrowia
198 iNr
for two reasons:
health
to
gations
regulations/decrees
on a technical
level both
r. o ochronie
1994,
abuse
public policy. The situation
iNr
959
the
lacked an effect on
has
rights and obligations of public roads
Many
i zakazeni
zakaznych
126 z 2001
19 August
r.
128, poz.
96, poz.
largely theoretical
stract and therefore
2003,
basket" has
for years among
to be
has tended
remains open,
dis
z, 6 September
Nr
r.Nr
Nr
of "health benefit
hotly debated
Polishpublic,but until recentlythe debate
care of Polish
Dz. U
Gajda
in Poland
The subject
the
regulates
13 January
(Ustawa,
1175 OT2LZz 2004
and
against
as infectious
such
r. o chorobach
alcohol
which
Tr?bka
Krzysztof
Abstract
557, z
90, poz.
are under
who
o cudzoziemcach,
coping with specific problematic
24, poz.
Basket"
the obligations
regulate
p?zn.zm),
karny
U. Nr
Wojciech
Romaszewski
Definition of the "Health Benefit
been
be
of public authorities and individu
z
(Usta
1997, r.-Kodeks
Dz.
in
nr 21 z
jednoliry, Dz.U.
pracy-tekst
z
27
1998 r. poz.94
(Ustawa,
p?zn.zm;
r.,
June 1997, o shizbie medycyny
pracy
Dz.U. Nr 96 poz.593).
wa,
DariuszGilewski
crimes
foreigners
residents
and
ach, Dz.U.
on
Law
medi
employers
employees,
mea
the health protection
cluding
are
sures that
to
employers
obliged
r.
26
Kodeks
1974,
June
pay (Ustawa,
Laws
137,
zm.9).
p?zn.
?
Artur
rights and obligations of non-Polish
tween
?
January
Kozierkiewicz
ubez
the issues
regulates
con
treatment
of persons
and
wykonawczy,
210 z 2004
Nr
Adam
(Usta
systemie
Dz. U. Nr
of committing
6
wa,
? Springer Medizin Verlag 2005
code which
victed
27 Au
occu
o
spolecznych,
887 z p?zn.
zm.).
of crime
opieki
ze srod
Dz.U.
publicznych,
poz.
?
large propor
residents,
finansowanych
r. poz.
piecze?
regulates
(Ustawa,
long-term
r. o swiadczeniach
2004,
gust
a
and
of noncitizens,
short-
_
law which
insur
and obligatory
some 99%
that covers
the universal
for
both
and nonactive
1998,
2005 [Suppl 1] 6:58-65
0198-005-0320-3
DO110.1007/sl
coverage
groups,
active
13October
Eur J Health Econom
establishes
security
population
pationally
wa,
-.
law which
security
provid
health
services
and goods within the universal health in
surance
in the
between
providers,
included
"products"
are
catalogues
contracts
vice
The
system.
then
the NHF
to be
provided
the
subject
and
the
of
ser
to the "ben
eficiaries."
O Table 1 presents a list of laws and de
crees which determine the benefit basket
in each of the existing subsystems. The
I
EurJ Health Econom Suppll -2005
I S59
Original Papers
level of detail in defining the scope of the
to which
benefits
are entitled,
persons
dif
fers in the Acts. It isworth noting that in
case
each
states
the Act
is entitled
who
(covered) to a certain kind of protection
and what
it is, sometimes
protection
so
and
the circumstances
defining
tions under
which
ent purposes
we
al
condi
can differentiate
three
and
institutions
lev
els of explicitness of definitions in the ben
efit basket:
and,
pliance
Local
(re
regulations.
are
for
governments
responsible
on their territories.
Laws
activities
with
gional)
establish
supervises
and
practical
applications.
crees cannot
exceed
is understood as
Explicit: That which
providing specific medical procedures
immunization
for
and actions
(e.g.,
those mentioned
B), namely
hepatitis
in the law or
regulation
?
care
area of health
have
beneficiaries
_
That
Implicit:
care
that health
ally
ment
gener
some
is provided,
etc.
efficient,
ministries
"benefit
times with additional formulation as
all necessary,
With
?
of Sejm
and
basket"
define
various
issuing
regulations
of the
parts
some
in more
are determined
benefits
de
tail and some others in less detail, which
means that the level of explicitness of defin
ing the benefit basket ranges from implicit
to explicit.
a rule,
As
(decrees)
regulations
aremore detailed in the benefits definition
than
laws,
and
the
than
the Constitution.
se of the most
sal Insurance
are more
laws
specific
in the ca
However,
prominent
the Act
Law,
the Univer
Act,
the ben
encloses
efits definition on all three levels of detail.
Obligations of the public authorities
derived from the legal regulations are
financed
amount
diture
from
public
to 70%
of the
health
total
Private
in Poland.
which
sources,
products
process
was
not
ting general
conditions
established,
which
(es
of contracting
take
places
?
associations
representing
The
diture)
is mainly
insurance
private
supplemental role of private
and quasi-insurance.
no benefit
expenditure,
be discussed;
the only
regards
can
basket
exception
discussed
tional medicine,
As
viders
catalogues
between
of the services.
in certain
dy
S60
in Poland.
is the
The
central
legislative
government,
I EurJ Health Econom Suppl 1 2005
care
is a wide
sometimes
area,
and
o
1990
(Ustawa
ubezpiecze
i ich rodzin,
z
p?zn.zm.)
decrees.
is a pri
which
medicine,
system,
to
according
of employers,
arrangements
Mental
health
abuse
Infectious
tion
and
on
vided
?i
substance
disorders
diseases,
covering
services,
sub
preven
partly
pro
basis.
mandatory
Prisoners
suf
and
problems.
treatment
a
abuse,
for persons
from mental
fering
stance
_
and
benefits
comprising
and
foreigners
centers,
covering
residing
all necessary
interventions
in
for persons
with limited freedom.
Q Table 2 describes the kind of document
that regulates the benefit basket in each
subsystem and the level of precision in de
termining the basket, which refers to the
distinctions mentioned
care
Health
to it and which,
below.
in defining
supreme
areas of health
law and
law
precise,
3 the most
above (1 the least
precise).
it isdifficult to define which actions belong
is occupa
the benefit basket
Parliament
?
medical
rity. For
Roles of partners
-.
system. The
are later
placed
the NHF
and the pro
insurance
health
from
insurance
funded
closed
Definitions of the benefit basket
payment
out-of-pocket
related
chasing health services and goods within
the universal
functions
insurance
grudnia
insur
health
services
and often
prevention
covering
some forms of
care.
health
outpatient
re
Rescue
benefits
system,
comprising
on national
from regulations
sulting
rescue
services.
and rescue
system
are
timated as 30% of the total health expen
with minor
social
of prepaid
catalogues
professionals.
as
to the procure
appendices
published
ment
in the process
of pur
documentation
farmers'
vately
the
mo
social
social
by
is a
which
OECD definitions, often in the form
NHF protectorate and with participation
of providers
re the 10,000
but here
Occupational
was
under
system.
it contains
regulated
and
formalized
in 2005
although
documen
system,
than
concept
20
in the
rolnik?w
spolecznym
z i998r. Nr 7 poz.25
Dz.U.
to exist
the list of
of defining
until recently,
a formalized
of set
process
The
"products"
in contracts
expen
expenditure
surance.
insurance
niu
(so-called
In some of the Acts included inO Table 1
of its role
z dnia
ing legal provisions.
The NHF defines catalogues of services
are
which
purchased
"products")
institution
insurance
that im
the
health
by
in
health
universal
plements
mandatory
cause
ance,
chambers
upper
law and
Procurement
Social
wider
ed to health protection. The Sejm drafts
laws thatmust be approved by the Senate
and signed by the President. The Govern
(e.g., primary
mentions
which
the
regu
re
system,
insurance
lated decrees.
the Constitution,
adopts
its provisions
dedicat
with
others,
among
session
and
(lower
of Parliament),
care)
?
i.e., a joint
presented
tation belongs to this system, which is
not a legal act but is discussed here be
Regulations/de
the area determined
the government
insurance
lated by health
establish their
ministries.
health
Social
regards to the benefit basket, theNational
Senate
to which
rights
of
Assembly,
Semiexplicit: That which outlines a
certain
each
Acts
individual
areas:
lowing
by the specific law, and they are issued by
?
re
regulations
in Q Table 1 are aggregated here into fol
mechanisms,
regulations/decrees
respective
the
acteristics;
legal
principles
while
their
their
garding the benefit basket and their char
com
and
agencies
land with
its adminis
through
tration
public
For pres
it is available.
specting (in theory) a subsidiary principle,
regulates the activities of both individuals
bo
re
tional
classification
cation
for Health
to social
for example,
the present
study,
the OECD
secu
Classifi
(International
Func
Accounts-Health
tions) was used to define boundaries of
the health care system. Q Table 2 presents
areas/subsystems
of
health
care
Social health
insurance
system
func
in Po
Most
health
ered within
tem, which
detail.
After
jor changes
services
the social
we
and
health
therefore
are deliv
goods
insurance
sys
discuss
debate
lengthy
in the law
and
in 1997
in more
two ma
and
2003
Table 1
List of documents
1. Health
law
insurance
Decree
on dental
Decree
on basic and supplementary
pharmaceuticals
on pharmaceuticals
ill
for chronically
Decree
care
Explicit
Semiexplicit
+
+
+
-
+
-
+
-
Decree
on prevention
+
-
Decree
+
-
Decree
on prevention
services, school medicine
on medical
good and materials
Decree
on medical
+
Decree
on spa therapy services
on highly specialized
procedures
Decree
Services
services
2. Mental
health
3. Social
4. Farmers
social
5. Penal
vices
excluded
tions
gery
law
with
rescue
system
services
law
law
Decree
on prevention
measures
for employees
Decree
on prevention
measures
for self-employed
12. Occupational
law
medicine
Decree on occupational
medicine
in defense
+
services
+
in internal affairs
medicine
on occupational
+
in penitentiary
medicine
on occupational
in National
medicine
diseases
provided
it
that
Moreover,
and
Railways
+
The
as
of employees
with
Regula
On
the basis
of these
reg
previously
legal
presented
the so-called
defines
are
that
purchased
ca
of health
catalogue
a number
of parts/
includes
The
in Q
presented
of
catalogue
in a uniformed
Table
services
way
to various
set of appendices
tracts with various
immunizations
that
person
in accordance
products"
products
insured
services
the NHF
chapters,
of treatment
these
provisions
lished
immunization
was
services
unless
"contracted
re
law
groups
but
3.
is not
pub
as a
rather
models
of con
It
of providers.
is published in electronic form usually in
law
on obligatory
Decree
the
means
the costs
abroad
1408/71/EC.
ulations
services
14. Road traffic
of
these
law, which
of an
in the scheme.
on
va
tas
by Parliament.
reimburse
incurred
were
services
on obligatory
gen
of nervus
treatment
list of
to the
ratified
not
tion
on occupational
full
diagnostics
are
and others
Decree
and
treatment
also
according toArticle 25 of theAct, theNHF
does
or
Decree
sur
treatment
illness,
but
and
A
appended
must
be
code
13. Infectious
vac
cosmetic
stimulation
diagnostics
treatment.
law
10. Rescue
Decree
list of ser
te disorders, hyperbaric chamber in SM
9. National
Decree
accommodation
injury,
operations
change
Pa
cov
in the compulsory
for malformation,
law
8. Law on foreigners
Decree
must
and
plastic
package,
it is not necessary
when
gus,
11.Labor
funds.
homes
the guaranteed
pub
such as vaccina
basket,
included
of epilepsy
abuse
public
from
service
not
which
is a negative
There
lic health
code
7. Drugs
separate
at
re
at the
or prosecutor,
by
themselves.
statements
court
nursing
residing
er the cost of food and
measures
insurance
abuse
required
medical
other
of
for a driv
expertise
the
public
cover
not
obtained
tients
decree
6. Alcohol
and
from
does
as reimbursement
of certificates
quest
are covered
der
Missing
basket
cination
on rehabilitation
Decree
financed
such
services,
of
law
insurance
funds,
the benefit
services
ing license
or forensic
law
protection
care
the cost
documentation
procurement
health
some
+
+
benefits
transportation
Implicit
16 of the Act on
to Article
According
the benefit basket and its level of explicitness
determining
drivers
health
tests
of
October
the
year
the
preceding
year
of contracting. Q Table 3 was developed
of an official
of the
publication
an
of a prod
and presents
aggregate
of NHF
internal doc
list from a variety
on a basis
NHF
and
the Law
re services
was
210,
in 2004
adopted
health
insurance
2004,
pos.
the beneficiaries,
surance
the entire
vices.
from
rights,
range
Publicly
into 22 different
laws
replace
(Letter
i.e., EU
the
gained
of available
citizens
right
health
services
categories,
of
existing
no.
law
with
in
to access
care ser
are divided
for example,
agnostic
tests
ry diagnostic,
Issue
the new
2135). Under
funded
resources
public
to
ca
on health
of 27/08/2004
funded
di
tection,
prevention
early detection
pulsory
laborato
medical
including
at health pro
services
aimed
of diseases
of diseases,
vaccinations,
re, outpatient
specialist
tient care. The Minister
eral
legal obligations
and
including
primary
services,
of Health
for issuing
injuries,
com
health
and
has
uct
uments.
payment
parts
inpa
sev
form
the regula
logic
the way
of products
in which
and monitoring
nomencla
it is used
purposes.
for
Some
are
in the
of the catalogue
published
and are
of legal acts and appendices
into contractual
rewritten
for
conditions,
ca
tions partially forming the benefit basket.
These are specified inO Table 1.
The
ture reflects
example,
dentistry,
spas, and medical
prod
ucts (including orthopedic) while others
are developed fully by the NHF experts.
EurJHealth Econom Suppl 1 2005
I S61
Original Papers
Table2
Benefit basket and an explicitness
1 least precise, 3 most precise)
in distinguished
of its description
areas (L Jaw,R regulation, A nonlegal
Social
Social
Occupa
Rescue
Mental
health
insurance
tional
system
health
insurance
system
medicine
system
document,
Infectious
Prisoners,
diseases
foreign
and
ers under
substance
state
care
abuse
L R A
HC.1 Services
HC.1.1
curative
Inpatient
Basic medical
L R A
L R A
L R A
L R A
3
3
1 -
2-3
1
-
-
1
-
-
3
care
and
1
-
services
diagnostic
HC.1.3.3
L R A
care
HC.1.3 Outpatient
HC.1.3.2
2
care
HC.1.2 Day cases of curative
HC.1.3.1
L R A
care
of curative
care
Outpatient
dental
All other
specialized
2
3
3
2-3
care
health
HC.1.3.9
All other
curative
care
HC.1.4
Services
outpatient
of curative
home
2
care
HC.2 Services
HC.2.1
of rehabilitative
care
-
-
rehabilitative
care
1
1 2
3
1 -
3
Inpatient
HC.2.2 Day cases of rehabilitative
___
-
___
___
___
i
1
1
care
HC.2.3 Outpatient
care
HC.2.4
Services
rehabilitative
1
of rehabilitative
care
home
HC.3 Services
of long-term
care
nursing
HC.3.1
Inpatient
long-term
care
nursing
HC.3.2 Day cases of long-term
nursing care
HC.3.3
home
Long-term
nursing
care:
care
HC.4 Ancillary
care
services
HC.4.1 Clinical
Patient
and emergency
2-3
laboratory
HC.4.2 Diagnostic
HC.4.3
to health
1
imaging
transport
2
2
2
3
-
2
rescue
HC.4.9 All other miscellaneous
services
HC.5 Medical
goods
dispensed
to outpatients
HC.5.1
Pharmaceuticals
and medical
HC.5.1.1
S62
nondurables
Prescribed
medicines
I EurJ Health Econom Suppl 1 2005
2
3
-
2
-
Table2 (continued)
Benefit basket and an explicitness
7 least precise, 3 most precise)
of its description
areas (L law, R regulation, A nonlegal
in distinguished
Social
Social
Occupa
Rescue
Mental
health
insurance
tional
system
health
insurance
system
medicine
system
document,
Infectious
Prisoners,
diseases
and
foreign
ers under
substance
state
care
abuse
L R A
HC.5.2 Therapeutic
medical
durables
HC.5.2.1
Glasses
devices
L R A
L R A
L R A
L R A
L R A
L R A
and
and vision
prod
2
3
and
2
3
ucts
HC.5.2.2 Orthopedic
other
devices
prosthetics
aids
2
3
HC.5.2.4 Medicotechnical
2
3
2
3
HC.5.2.3
Hearing
devices,
incl. wheelchairs
HC.5.2.9
All other miscellaneous
medical
durables
HC.6 Prevention
and public
health
services
HC.6.1 Maternal
HC.6.2 School
and child health
2
2
3
2-3
services
2
2
3
2-3
2
health
HC.6.3 Prevention
of communicable
12
3
of
1 2
3
3
3
diseases
HC.6.4 Prevention
noncommunicable
diseases
HC.6.5 Occupational
1 2
care
health
-
HC.6.9 All other miscellaneous
health
public
Other
services
dations oblige theNHF to finance it, as in
schemes
the case of infectious
A
number
of
laws
the other
regulate
teristics
of
the remaining
are that
schemes
they usually rely on public funds and imple
ment social and public policy in delivering
services
and
to various
goods
population
private
funds,
for example,
tionalmedicine which obliges employers to
certain
provide
ees. The
special
kind
to
of services
regulations
often
employ
on
focus
underprivileged populations, such as the
mentally ill and alcohol and drugs addicts,
to make
sons
them.
available
who
necessary
would
It is interesting
otherwise
to note
services
not
to per
regulations
regarding
ben
health
efits to which various groups in Poland
The
range
of available
fits is clearly quite wide, and the justifica
varied.
for
are also
entitlements
respective
in both
However,
public
and
pro
fessional opinion there is no such a thing
as the "benefit basket" in Poland [1].This
is also frequently the reason adduced to
explain why the health system works so
poorly.
of
the functions specified in these special reg
system
fit basket
a way
basket
and
professionals
There
is no
systematic
in
research
appeal
clearly
for the provision
for different
of a bene
reasons:
strong
many
pa
patients
demand
more
which
necessary,
ered
bene
this area, but the different parties in the
receive
that many
trative
benefit
rights,
make
benefits
This study presents the legal and adminis
tions
occupa
their
to se
have
claimed that the lack of explicit listing of
Discussion
are entitled.
groups. Some of the schemes obligatorily
engage
cure
sche
mes providing services and goods to Polish
inhabitants (seeQ Table 1 ).General charac
tients who feel lost in the system see in
the envisioned
diseases.
then
under
places
physicians
to
and perform
prescribe
cov
services
that are not eventually
ex
the
On
the
other
hand,
payer.
by
pressure
plicit formulation
in the insurance
controversies
medical
of "products"
system creates
and
criticism
procedures
purchased
substantial
because
some
are omitted.
In 1999-2000 theMinistry of Health
and Social Welfare publicly expressed its
to the
development
commitment
of a de
fined basic benefit basket. This propos
al was hotly disputed at the time, with a
number
of groups
because
it was
often
the concept
opposing
seen as a way of lim
EurJ Health Econom Suppl 1 -2005
I S63
Original Papers
Table 3
care
Primary
Outpatient
care, surgical
Outpatient
care, medical
SHAcategory
Characteristics
HC.6.2, HC.6.3
and internal medicine
Provided by general practitioners,
specialists.
pediatricians,
nurses
Contains also school
and midwives.
The care is supported
by general-practitioner
nurse activity
HC.1.3.3
Contains
approx.
HC.1.3.3
Contains
consultation
and
HC.6.1,
diagnostic
care, diagnostics
care, general
Hospital
HC.4.2
Contains
HC1.1
Contains
50 invasive
(surgical) procedures
services
tests that must
22 imaging
Contains
nuclear medicine
care, oncological
HC.1.1, HC.1.2
Contains
chemotherapy
care, nononcological
HC.1.1, HC.1.2
Contains
for nononcological
chemotherapy
and day care
provided
therapies,
(with invasive
surgical
therapy)
HC.1.1, HC.1.2
nuclear
care-radiology,
a set of
with
together
cost
separately
care cases; both
hospital
(conservative
care physicians
by outpatient
care physicians,
at their own
them
by
financed
procedures
and medical
provided
of outpatient
be provided
1400 different
approx.
procedure)
Hospital
and short
HC.1.3.1,
diagnostics
Outpatient
by SHA categories
by National Health Fund with classification
Categories of "contracted products'' purchased
description, valid for 2005
or without
with
hospitalization
medicine
Hospital
care and day care
in hospital
both
of neoplasm,
therapy
Hospital
in hospital
therapy
Dentistry,
children
Dentistry,
general
women
pregnant
Dentistry,
Contains
approx.
40 procedures
available
to children
HC.1.3.2
Contains
approx.
70 procedures
available
to all insurers
HC.1.3.2
Contains
services
that are available
Contains
rehabilitative
both
services
contracted
Separately
in inpatient
Contains
rescue and emergency
HC.1.2
Contains
approx.
and substance
Psychiatric
abuse
HC.1.1, HC.1.3.3,
therapy
Contains
services
HC.2.1, HC.2.2,
Contains
rehabilitation
HC.2.3, HC.2.4
classified
of settings),
(a category
services,
air and ground
both
services, mainly
in day care
provided
etc.)
therapy,
provided
in spas
by psychiatrists,
in all kind of settings
care
Contains
HC.3.1, HC.3.2,
provided
and physiotherapists,
by physicians
long- term nursing
care and hospices,
care, but also palliative
in all kinds of settings
HC.6.4
promotion
services
in all kinds of settings
HC.3.3
Health
oxygen
available
HC.1.2
Rehabilitation
Long-term
transportation
20 not otherwise
(incl. hemodialysis,
women
manner
and ambulatory
HC.4.3
services
both
(up to 18 years) only
for free to pregnant
and treatment
B), provided
(e.g., hepatitis
HC.1.3.2
SpasHC.2.1, HC.2.3
Emergency
cases
Contains
prevention
and early detection
programs
made
was
for noncommunicable
diseases
and prevention
iting available health care and thus saving
money. The debate prompted theMinistry
to seek
outside
consultants'
ject was
aimed
ing the range
in the form
assistance
advice.
at
The
consultation
"verifying
of services
and
purchased
of
pro
arrang
by
the
Health Funds" regarding determination of
the
range
of guaranteed
services,
the
so
called basic benefit basket, with specifica
tion and terms of their provision [2].The
formulated
vices
were
range
and
expected
of
ser
description
to serve as the basis
for the Health Funds in drafting contracts
with
service
ed to serve
S64
providers.
as a tool for
It was
also
performance
I EurJ Health Econom Suppl 1-2005
ment
of particular
Sickness
Funds,
by the Health Insurance Supervisory Of
fice and theMinistry of Health.
In January 2004 the Polish Constitu
tional Tribunal announced its finding
(Trybunal
orzeczenie,
Konstytucyjny
7 Jan
uary 2004, r. (Sygn. Akt K 14/03) that the
existing
health
law was
insurance
sufficient
the
precision
may
scope
expect
of services
from
tional health system asmentioned
Constitution
("Conditions
and
the na
in the
scope
of
intend
services will be detailed in the appropri
assess
ate
law," Paragraph
62). The
Government
i year
approx.
a new
to prepare
the new
In formulating
ferent
were
possibilities
was
tain a list of medical
are
in the
performed
considered
dif
law many
considered.
the
that
suggestion
was
uncon
stitutional because it failed to define with
that beneficiaries
given
law to fulfill this requirement.
law
One
con
should
procedures which
This
system.
unrealistic,
idea
es
however,
pecially because of the short period avail
able for drafting the law. There were
strong
must
voices
distinguish
se services
charge
to the effect
within
that
are
the
that
some
clearly between
provided
system
fully
and
those
one
tho
free of
that
must be paid for either partially or in full
by
made
was
the patients.
This
differentiation
a group
of
assembled
by
experts
by the Minister
also
cept
a
of
make
cal
the
would
assessments
technology
interventions
of medi
in the
participate
on
inclusion
process
and
decision-making
exclusion
and
establishment
which
institution,
special
[3]. The con
of Health
considered
of the
in the
interventions
benefit basket for universal health insur
ance.
because
Finally,
was
there
no
pre
vailing opinion as to the final role of the
assessment
technology
not
established.
it was
institution,
the Minister
However,
of Health was required by stipulations in
the last paragraph of the insurance law to
"undertake
zational
whose
structure,
to make
health
medical
to
to establish
efforts
technology
with
procedures,
which
procedures,
by
chasing
in insurance
an
organi
task would
be
assessment
of
special
were
regard
to pur
Fund."
subject
Certain
changes
law, namely
attachment
the
of
a list of excluded procedures, together
with a promise to establish an institution
of health
the legal
and Constitutional
Corresponding
Adam
solved
assessment,
technology
controversy
between
Parliament
Tribunal.
author
Kozierkiewicz
Jagiellonian University
Crakow, Poland
Medical
College,
e-mail: [email protected]
Acknowledgements
The results presented here are based on the
Benefits and Service Costs in
projecf'Health
is funded by
Europe-HealthBASKET" which
the European Commission within the Sixth
Framework Research
Programme
(grant no. SP21 -CT-2004-501588).
References
1. Golinowska S, Kozierkiewicz A, Sowada C (2004)
Poza_dane kierunki zmiany systemu ochrony zdro
wia w Polsce. Miedzy racjonowaniem i racjonaliza
2.
cja,.CASE,Warsaw 2004
Banta D, Chapman S (ed) (2002) Standard of
health services purposed in the national health in
surance system. TNO prevention and health. Min
istryof Health
3. Wbdarczyk (ed) Zesp?t ds. Systemowych Przeksz
tafcen w Ochronie Zdrowia (2004) Propozycje zmi
an w polskim systemie zdrowotnym. Ministry of
Health, Warsaw
EurJ Health Econom SuppM-2005
I S65