CHAOS IN POLAND

If socialists took over the Sahara, the old joke goes, there would soon be a shortage of sand. This innate ability to produce shortages shows itself in Europe's present health care situation. More and more people go to see doctors, more and more use drugs and are knowledgeable about health care and yet - instead of clinics and hospitals thriving - national health insurance systems in the European Union are on the verge of financial collapse. They run big deficits, which grow along with the number of patients.

Last month nurses and doctors in many of the public healthcare institutions in Poland went on strike. Radiologists do not want to work longer, nurses want their salary raises paid at last and all protest against the government's new proposal to make hospitals and clinics part of the market economy. But they have already survived several such restructurings, even when they boiled down to putting people out of work without improving the system.

Under the new rule hospitals would not receive state help unless they start to reduce their debts or work out new deals with creditors. Still, since they would be allowed to issue bonds, and take on new debts, the system would not change much. The law, however, has just been rejected in parliament by the opposition. The leader of Civil Platform - one of the opposition parties - explained that the idea of transforming hospitals into companies is just another kind of experiment and the system cannot handle making hospitals comply with simple economic rules.

And the system is this: year after year ineffective public healthcare institutions are running into debts and year after year the state intervenes and with its magic wand makes the hospitals free of their liabilities. Translation: the state makes us all pay the debts of hospitals, preserving a chronically ill public healthcare system. The Ministry of Health explains that the main reason for the growing deficits was that the hospitals and services provided by them were underinvested, that the National Health Fund usually reimburses less than the services are worth. Consequently, the state is responsible for the underinvested services that made hospitals run into debts and left healthcare institutions facing bankruptcy and begging for help.

The Ministry of Health admits that directors of public hospitals usually lack managerial skills and that the public healthcare system is badly organized. The system was allowed to continue, however, leading this year to $2 billion of adjudged liabilities or 0.7 percent of country's GDP, and the adjudged liabilities constitute only about 66 per cent of total debt. The debt was increasing every year, in the period from 2001 to 2004, by about 125 percent on average in comparison with the preceding year. At the same time the number of healthcare institutions without debts was decreasing: at the end of 2001 there were about 44 percent of hospitals without debts, but at the end of 2003 there were only 36 percent. They are in debt mainly to social security, to the providers of drugs and medical equipment and then to their workers......

The situation in France also can give the Polish health minister some cold comfort. It is estimated that by the end of 2004, social health insurance accumulated a $42 billion deficit, about 2.5 percent of French GDP. To "remedy" the situation the French minister of health and social welfare proposes that the deficit be taken over by the National Reimbursement Fund for Social Debt and that future generations will pay off the debt. Furthermore, he proposes to raise social contribution rates, reimburse less per medical contact and make pharmaceutical companies contribute more to the system.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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