In search of economic rationality: the experience of the Polish National Health Service

This paper discusses the problems of the use of economic incentives as a management tool in the Polish National Health Service, in which the economic approach had long been regarded as morally improper. Health, an important ethical value, was not to be defiled by direct contact with economic realities. It was only in the early 1980's that it was accepted that the non-economic approach had been destructive for both the performance and the moral climate of the NHS. Significant defects in the previous solutions stimulated a great effort to reorient and rationalize the system. In the 1940's when the Polish NHS was established, it was decided to abolish economic barriers to health care, the free access to which was perceived as essential to socialist health care. While utilization increased, access was still restricted, although not by formal barriers but by scarcity of resources. The situation became all the more painful because a general expectation of easily obtainable health services had been aroused. The health sector as a whole was underfinanced; health professionals were underpaid in comparison with professionals in other sectors; the salary system severed the link between input and reward. More productive individuals took extra jobs in the NHS and outside it, thus threatening the quality of the service. A number of rationalization measures have been taken. Special premiums, combinations of capitation and fee-for-service, new financing mechanisms, and forms of patient cost-sharing are being experimented with or considered.