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Poland's new government – what prospects for healthcare?

19 November 2015 Brendan Melck

On 25 October, Poland's parliamentary elections took place, resulting in a victory and outright parliamentary majority for the conservative Law and Justice (Prawo i Sprawiedliwość; PiS) party. What implications could this have for the healthcare sector and the pharmaceutical industry in the country?

PiS against private sector
PiS replaced the liberal-conservative Civic Platform (Platform Obywatelska; PO), which had been the first political party to win two successive elections - albeit as the leading party in a coalition - since the transformation from communism in 1989 (in 2007 and 2011). During its time in office, PO presided over changes in the healthcare sector which were strongly opposed by PiS, particularly the conversion of many publicly-run hospitals into limited liability companies / non-public healthcare centres, which continue to provide services under auspices of public healthcare, but are independently run. In a similar way to Viktor Orban's Fidesz government in Hungary, and also Robert Fico's Direction-Social Democracy government in Slovakia, PiS opposes encroachment on the public healthcare system by the private sector.

Previous government oversaw big rise in spending on expensive medicines
However, PO also presided over a very significant rise in spending on innovative and high-cost treatments, particularly oncology medicines, in the years it was in power. Spending on high-cost innovative drugs funded through drug programmes (previously therapeutic programmes) more than doubled during the time PO was in office. While its Reimbursement Act of 2012 received criticism for its clumsy implementation, resulting in considerable upheaval in the ambulatory pharmaceutical care sector in particular, the act achieved one of its central aims - improving access to innovative, high-cost medicines.

PiS plans major structural changes
Whether the PiS government will carry on with PO's pharmaceutical policy is unclear, but looking at its performance in its previous period in office, as part of an ill-fated coalition which governed from 2005 until 2007, the signs are not very positive. For public healthcare in general, meanwhile, PiS has set an agenda which includes proposals for some very fundamental changes to the entire public healthcare infrastructure in Poland.

The most high-profile pledge given by PiS regarding healthcare is that it will abolish the National Health Fund (NFZ). The NFZ is Poland's public sector payor organisation, responsible for paying for healthcare services and for the reimbursement of medicines with the money received from mandatory health insurance contributions. As well as this, PiS plans to get rid of mandatory health insurance contributions, transferring the responsibility for funding public healthcare to the state budget.

Promise to abolish NFZ provides a vent for anger against the 'official'
Promising to get rid of the NFZ was a good election pledge for the party, because the organisation is widely criticised in Poland, being the public face of the 'official' (urzędnik) who makes the decisions on funding public health services. There are serious questions about what PiS plans to replace the NFZ with, however. The process of contracting healthcare services is set to be taken over by voivodeship (regional) governments, and the administrative complications and costs of this process could be significant. And, in the end, it will still be an 'official' in a public body making the decisions. The contracting activities include contracting for hospital services, which includes the funds required for hospital drugs, including high-cost drugs. However, PiS intends to divide the public healthcare budget so that most services will be paid for at the regional level, but highly specialized services and high-cost, modern medical technologies will be paid for centrally by the Ministry of Health (MoH) - including presumably high-cost innovative medicines. What the implications of such a change would be are hard to predict - if this means a closed, separate budget for high-cost and highly-specialised medicine, there could be problems with access to medicines once the budget is exhausted.

Public healthcare spending to rise?
PiS politicians have stated their intention also to raise the proportion of GDP spent on public healthcare in Poland from the current level of around 4.7% to 6%. Konstanty Radziwiłł, a medical doctor and former head of Poland's Supreme Medical Council who has been announced as the new government's health minister, has stated that this goal of 6% of GDP should be reached within 2-3 years. If this were to actually happen, and the extra funds were allocated fairly and evenly, this would, of course, be a very positive thing. However, considering the fact that PiS has made a series of promises -including a policy of PLN500 per month for families who have second, third or more children (as well as for the poorest families with only one child) and a reduction of the retirement age back to 65 for women and 60 for men - that are estimated by experts to cost an additional PLN55 billion per year to implement, it is worth asking where the extra money to make this increase in healthcare spending will come from.

Free medicines for poorer pensioners over 75 planned
Another plan which has featured prominently in PiS' campaign is the introduction of free medicines for poorer pensioners aged over 75 years - according to pharmaceutical news source Rynek Aptek, PiS has calculated that the change would mean that around 280,000 people would be entitled to free medicines. According to Stanisław Karczewski, a senior figure in PiS who has been announced as the new speaker of the Senate, this introduction of free medicines for the worst-off pensioners would be one of the easier pledges to fulfill of the healthcare-related promises.

Will PiS realise its grand plans?
The abolition of the NFZ is attractive as a vote winner, and, indeed, PiS promised the same thing in 2005 at the beginning of its first term in office - although this was in a weak coalition government. The reality of dismantling the NFZ, however, and setting up new structures which will have to perform exactly the same tasks is something else entirely.

In the lead up to the recent election, the PiS candidate for Prime Minister, Beata Szydło, spoke often of putting the patient at the centre of thinking on healthcare policy. Fine words, but the chances of the intentions behind them being wrecked in a storm of growing public debt remain very high indeed.

Brendan Melck is a life sciences analyst for IHS
Posted 19 November 2015

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