Polish hospital dispute drags on

On 5 May 2006, employees of more than 100 public hospitals and medical practices throughout Poland held warning strikes, marking the next stage of the escalating collective dispute in the country’s public healthcare system. Healthcare practitioners are demanding an immediate pay rise and an increase in public healthcare spending up to at least 6% of the country’s gross domestic product (GDP).

Background to dispute

Following a national protest in April 2006 (PL0604039I) and ongoing dissatisfaction among healthcare workers in relation to pay, the new Minister of Health, Zbigniew Religa, announced that doctors and nurses will receive a 30% pay increase from October 2006, rather than at the beginning of 2007. However, healthcare workers are not satisfied with this offer, maintaining that the decision of the Ministry of Health (Ministerstwo Zdrowia, MZ) is far from unanimous on the subject of pay increases. They also indicate that by looking at the proposed legislative changes, any official wage increase will surely be lower than the proposed 30% figure, and they do not believe that such increases will in fact be implemented until 2007. The doctors are seeking a reiteration of Minister Religa’s pledge concerning pay increases in October 2006; they are also calling for an increase in the Polish government’s health expenditure to 6% of GDP in the next budget year (compared with just below 4% of GDP at present).

Adding fuel to the dispute, data for 2005 from the Polish Central Statistical Office (Glówny Urzad Statystyczny, GUS) has revealed that highly-skilled medical personnel in Poland received the lowest pay of all specialised professions. The average Polish physician earned PLN 2,979 (approximately €745) per month before tax, and a specialised nurse or obstetrician earned PLN 1,636 (€409) per month.

Strike action

As protests continued, warning strikes were held on 5 May 2006 in the form of two-hour events staged by doctors in more than 100 hospitals across the country, in the regions of Lódz (50 hospitals involved), Lublin (25 hospitals), Mazowsze (five hospitals), Opole (three hospitals), Pomerania (13 hospitals), Silesia (15 hospitals), Swietokrzyskie (17 hospitals), and Warmia and Mazury (12 hospitals). In some of the hospitals concerned, nurses and obstetricians also joined in the protests. The warning strike extended to those healthcare bodies in which representatives of the medical unions, especially those from the All-Polish Trade Union of Doctors (Ogólnopolski Zwiazek Zawodowy Lekarzy, OZZL), are formally engaged in collective disputes with their employers, i.e. with hospital management. However, the strike is on a larger scale than this: apart from OZZL, 16 other trade unions are also involved in the dispute.

Most of the doctors showed their dissatisfaction by only making themselves available to work on standby and provide essential medical care services; in practical terms, this meant that the hospitals concerned treated patients only in life-threatening situations. Some doctors also handed in group notices of termination with respect to their employment contracts. Meanwhile, members of the All-Polish Trade Union of Nurses and Midwives (Ogólnopolski Zwiazek Zawodowy Pielegniarek i Poloznych, OZZPiP) announced that they would deploy hunger striking as well as working to rule tactics. On 10 May 2006, healthcare workers held a demonstration in Warsaw; on the same day, those doctors who were able to do so took a day off with immediate notice.

Commentary

The malaise of the Polish healthcare system has been ongoing for many years, and all efforts taken to ameliorate the situation to date have proved insufficient. The newly elected government, led by Prime Minister Kazimierz Marcinkiewicz, was forced to address the problem. A coordinated approach to reform measures has represented an important aspect regarding systemic changes in Poland so far; however, the new government has been unable to assure such good coordination. Immediately after Minister Religa publicly promised a 30% pay increase for doctors, his ministry embarked on internal consultations of a draft revision of the August 2004 statute on financing healthcare services (the deadline for consultations elapsed on 5 May 2006). This draft was prepared by the healthcare team of the Trilateral Commission; interestingly, this team does not include a single representative of the physicians’ professional body. Also, the draft amendments, drawn up in late March of this year, do not take into account the 30% pay increases announced by Minister Religa in April.

Jacek Sroka, Institute of Public Affairs (ISP) and Wroclaw University (UWr)

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