Wprowadzenie dopłat pacjentów do świadczeń opieki zdrowotnej finansowanych ze środków publicznych – opinie głównych uczestników polskiego systemu opieki zdrowotnej

Stanisława Golinowska,

Marzena Tambor,

Christoph Sowada

Abstrakt

Introduction of patient payments for publicly financed health care services – opinions of the main Polish health care system’s stakeholders

Introduction of patient payments for publicly financed health care services – opinions of the main Polish health care system’s stakeholders

During the last decades many European governments have introduced patient payments in their public health care system with the aim to improve efficiency of health care provision, contain overall health care expenditure, and also to generate additional resources. In Poland, since 1999 patients have met formal payment obligations when they use dental services. Though introduction of formal patient payments for primary care services, out-patient specialists’ services and hospital services has been discussed, such payments do not exist. Empirical evidence suggests that the successful implementation of patient payments, to a large extent, depends upon public acceptance and political consensus. The paper presents the results of study on attitudes towards formal patient payments for publicly financed health care services, among different groups of Polish health care system’s stakeholders (health care consumers, providers, insurers and policy makers). The data are collected via focus group discussions and in-depth interviews carried out in Poland in June–October 2009 as part of project ASSPRO CEE 2007. The results are used to out-line policy recommendations.

Słowa kluczowe: dopłaty pacjentów, reforma systemu opieki zdrowotnej, Polska
References

Abel-Smith B., Mossialos E., Cost Containment and Health Care Reform: A Study of the European Union. „Health Policy” 1994; 28: 89–132.

Golinowska S., Tymowska K., Poland, w: Johnson N. (red.), Private markets in health and welfare. An international perspective.Berg Publishers Limited, Oxford 1995: 137–153.

Robinson R., User Charges for Health Care, w: Mossialos E., Dixon A., Figueras J., Kutzin J. (red.), Funding Health Care: Options for Europe.Open University Press, Buckingham 2002: 161–184.

Ministerstwo Zdrowia, Finansowania ochrony zdrowia w Polsce. Zielona Księga II, Golinowska S. (red.), Wydawnictwo Medyczne Uniwersytetu Jagiellońskiego „Vesalius”, Kraków 2009.

Tambor M., Pavlova M., Woch P., Groot W., Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. „European Journal of Public Health” 2010. doi: 10.1093/eurpub/ckq139.

Tymowska K., Opieka zdrowotna: korzystanie, finansowanie, bariery dostępu i opinie społeczne, w: Czapiński J., Panek T. (red.), Warunki i jakość życia Polaków. Warszawa 2006.

Pavlova M., Tambor M., Groot W., A conceptual model for the analysis and assessment of patient payments policies. Brief no. BP-1/2009 ASSPRO CEE 2007. http://www.assprocee2007.com/ASSPRO%20CEE%202007%20PB% 201%202009.pdf

Górecki W., Opłaty dodatkowe za usługi pozamedyczne w szpitalach. CSIOZ, Warszawa 2005.

Górecki W., Opłaty za usługi medyczne w szpitalach w opinii Polaków. Za a nawet przeciw. „Menadżer Zdrowia” 2010; 1: 32–35.

Carrin G., Hanvoravongchai P., Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries? „Human Resources for Health” 2003; 1(6): 1–10.

Bennett S., The impact of the increase in user fees: a preliminary investigation. „Lesotho Epidemiological Bulletin” 1989; 4: 29–37.

Kim J., Ko S.,Yang B., The effects of patient cost sharing on ambulatory utilization in South Korea. „Health Policy” 2005; 72: 293–300.

Kupor S.A., Liu Y.-C., Lee J., Yoshikawa A., The effect of copayments and income on the utilization of medical care by subscribers to Japan’s national health insurance system. „International Journal of Health Services” 1995; 25(2): 295–312.

Manning W.G., Newhouse J.P., Duan N., Keeler E.B., Leibowitz A., Marquis M.S., Health insurance and the demand for medical care: evidence from a randomized experiment. „American Economic Review” 1987; 77: 51–277.

Newhouse J.P., Free for all? Lessons from the RAND health insurance experiment. Harvard University Press, Harvard 1993.

O’Grady K.F., Manning W.G., Newhouse J.P., Brook R.H., The impact of cost sharing on emergency department use. „The New England Journal of Medicine” 1985; 313: 484–490.

Selby J.V., Fireman B.H., Swain B.E., Effect of a copayment on the use of the emergency department in a health maintenance organization. „The New England Journal of Medicine” 1996; 334: 635–641.

Creese A., User charges for health care: a review of recent experiences. „Health Policy and Planning” 1991; 6: 309–319.

Sepehri A., Chernomas R., Akram-Lodhi H., Panelizing patients and rewarding providers: user charges and health care utilization in Vietnam. „Health Policy and Planning” 2005; 20(2): 90–99.

Sowada C., Współpłacenie – szanse, zagrożenia i warunki szerszego zastosowania w systemie powszechnego społecznego ubezpieczenia zdrowotnego. „Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarządzanie” 2004; II(1): 11–22.

Golinowska S., Integracja społeczna osób niepełnosprawnych. Ocena działań instytucji. IPiSS, Warszawa 2004.

GUS, Podstawowe dane z zakresu ochrony zdrowia w 2008 r. Warszawa 2009.

Wendt C., Grimmeisen S., Rothgang H., Convergence or Divergence in OECD Health Care Systems? w: Cantillon B., Marx I. (red.), International Cooperation in Social Security: How to Cope with Globalisation. Intersentia, Antwerp 2005: 15–45.