New analysis from WHO shows that the incidence of catastrophic health spending is high in Poland compared to many other European Union (EU) countries. It is heavily concentrated among the poorest households, and largely driven by out-of-pocket payments for outpatient medicines.
Although most publicly financed health services in Poland are free at the point of use, outpatient prescriptions are subject to a complex system of user charges (copayments). Mechanisms to protect households from copayments are generally weak: there are no exemptions explicitly benefiting low-income people or people with chronic conditions, and no caps on copayments.
Financial hardship is also linked to limited coverage of dental care and medical products, and waiting times for outpatient care, which may encourage people to pay out of pocket for over-the-counter medicines or treatment from private providers. Voluntary health insurance offers faster access to care, but it tends to favour better-off people, exacerbating inequalities.
Protecting people from out-of-pocket payments for health
In 2016, Poland began to redesign copayment policy to enhance financial protection, exempting people aged over 75 from copayments for commonly used medicines. Building on this important initiative, new efforts to strengthen financial protection should focus on low-income households and regular users of health care. Extending copayment exemptions to people receiving social benefits would be an effective first step.
Copayment exemptions can be financed by increasing the share of the government budget allocated to health. This share is very low in Poland (11%) compared to the EU average (14%). As a result, public spending on health is lower than expected given the size of Poland’s economy.
WHO supports countries to strengthen financial protection
Financial protection is at the core of universal health coverage, which means that everyone can use the quality health services they need without financial hardship. WHO/Europe, through the WHO Barcelona Office for Health Systems Strengthening, undertakes context-specific monitoring of financial protection in over 30 countries, including Poland. The Barcelona Office also provides tailored technical assistance to countries to design policies to move towards universal health coverage.