Poland’s socialized health care system ranks dead last overall, driven primarily by severely limited patient choice.
3 min read · Mar 3, 2023
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By Gregg Girvan, Grant Rigney, and Avik Roy
Introduction
Poland ranks dead last (32nd) in the World Index of Healthcare Innovation, down from 31st in 2021 and 30th in 2020, with an overall score of 35.13. Poland ranked last in Choice (32nd, 39.86) and second-to-last in Science & Technology (31st, 9.18) due to its lack of patient-centered care, weak infrastructure, and low scientific impact.
The one redeeming feature of Poland’s socialized health care system is that it is reasonably stable, ranking 11th in Fiscal Sustainability (58.80); strict price controls and access restrictions keep spending growth in a manageable range — though at a substantial cost to patients.
Background
Prior to World War II, a considerable portion of today’s Poland was part of Germany, and thereby was under the German health care system first installed by Otto von Bismarck in 1883. After 1945, communists imposed the Soviet model of health care, in which health insurance and health care services were owned and operated by the state.
In 1991, after the communist government fell, Poles maintained government ownership of most hospitals and clinics, but devolved public control to the regional level (voivodeships). The National Health Fund (Narodowy Fundusz Zdrowia, or NFZ) remains the single-payer, government-run insurer.
Quality
Poland ranks 29th in the Element Quality, up from 31st in 2021. Poland’s quality rankings are driven lower by multiple elements calculated, including measures of preventable disease (28th), infrastructure (32nd), and pandemic preparedness and response (30th). However, Poland made significant strides in patient-centered customer care, rising to 15th from 31st in 2021. In particular, Poland has among the lowest cancer survival rates in the Index, as well as some of the lowest number of primary care physicians and nurses. The boost in patient-centered care scores stemmed mainly from improvements in the time required to see a physician, patient safety, and transparency.
Choice
Poland’s health care system ranks last for Choice (32nd). While the pre-subsidy cost of health insurance is among the least expensive in the modern world, patients have only a single-payer option that impacts the quality and availability of care. In addition, physician choice is very restrictive, such that patients can only switch to a different primary care physician once every 6 months. And while innovative medicines are available on par with countries such as Sweden and Australia, such choice is hampered by little access to more affordable generics and biosimilars.
Science & Technology
At 31st, Poland comes in second-to-last of the countries in the Index for Science and Technology. Development of medical and scientific innovation in the fields of medicine and biochemistry are virtually nonexistent. Poland ranks better in the medical advancements (24th) because of a decent number of innovative drug approvals, by virtue of being a member nation of the European Medicines Agency. Otherwise, Poland ranks last in the scientific discoveries (32nd) and health digitization (32nd).
Fiscal Sustainability
Despite its weaknesses, Poland’s health care system ranks 11th in the Index for Fiscal Sustainability. In addition to its national solvency (17th) being manageable at a 46% debt-to-GDP ratio, it has reduced its public health spending (11th) over the last 10 years, as well as its growth in public health spending (8th).
