Protest by Silesian healthcare workers
In June 2004, NSZZ Solidarność trade union activists from the healthcare sector in Poland's Silesia region staged a protest at the headquarters of the National Health Fund (NFZ). The protesters claimed that the current system of financing healthcare is pushing medical institutions deeper into debt, damaging services and threatening redundancies and the closure of facilities in Silesia. Negotiations between the protesters and NFZ representatives brought no concrete results.
The National Health Fund (Narodowy Fundusz Zdrowia, NFZ) is a state organisation with the role of securing health services for all insured people. It will continue working in this capacity only until the end of 2004, because the Constitutional Tribunal (Trybunał Konstytucyjny) has ruled that the statute on whose basis NFZ operates contravene the Constitution. NFZ operates through a network of branches located in each of the country's 16 regions (voivodships). These branches conclude contracts for the provision of healthcare services with individual medical entities operating in their areas of jurisdiction. As a result, different systems for costing the services provided by medical practitioners are applied in each region. Additional complications are presented for the providers of medical services by the fact that insured patients are eligible for treatment in every region; NFZ disburses to medical practitioners resources for the treatment of patients residing in the given region, plus additional payments for patients from other regions, estimated on the basis of data about such movements registered in the previous year. In 2004, the financial gap arising in the region of Silesia and Dąbrowa due to the incompatibility of these advance estimations with the actual situation has been assessed by the Independent and Self-Governing Trade Union Solidarity (Niezależny Samorządny Związek Zawodowy, NSZZ Solidarność) at PLN 48 million, with another PLN 400 million lost to the region because of cross-region inconsistencies in the fees applicable for various medical services.
On 14 June 2004, a group of around 150 doctors, nurses, assistants and technical staff from the Silesia and Dąbrowa section of NSZZ Solidarność gained entry to the NFZ headquarters in Warsaw, where they demanded that the shortfall in funds be made up to their regional NFZ branch. The union activists maintain that the system of financing healthcare presently applied in Silesia is pushing medical entities deeper into debt, leading to a deterioration of services, and threatening redundancies and the closure of facilities (PL0311102N).
The protest prompted the chair of NFZ, Lesław Abramowicz, to hold talks with the action’s organisers. The union representatives were informed that their demands cannot be met, but the NFZ chair did confirm that the Silesian branch will soon receive an infusion of PLN 15.5 million on the basis of a previous decision. Any further support will be contingent on improvements in the collection record of health insurance contributions. In spite of this rebuff, the protesting union activists left the NFZ offices peacefully. They were subsequently due to decide on the means and timing of further protests.
It appears reasonable to expect that the financial problems of the Polish healthcare system will remain unabated for as long as the NFZ is in operation, ie until the end of 2004. There is nothing to guarantee that the new legal regime to replace it that must now be instituted will do much to improve matters. In the meantime, those involved hope that the hospitals and clinics providing treatment now funded by the NFZ will not become bankrupt while they await an effective overhaul of the system. Practically from the beginning of the political and economic transformation process in Poland, the country’s public healthcare system has been struggling with an endemic cash crisis, and consecutive efforts at reforming the system seem to have done little to improve the situation. The debts of hospitals are mounting and there is a lack of funds for even the basic supplies needed for effective treatment of patients.