As Poland goes to the polls to elect a new president today, the outcome of the vote could have dire consequences for the country's healthcare system if the leading candidate's plans to commercialise hospitals go ahead, a new study has warned.
A report by a British sociologist, Peggy Watson, argues that the result could represent the final nail in the coffin of public health services in Poland, where hundreds of thousands of people cannot afford private medical care.
Writing in the British Medical Journal, Dr Watson, of the University of Cambridge, argues that while attention has been focused on Barack Obama's attempts to close the affordability gap in healthcare in the US, the reverse has been happening in Poland, where the rich-poor divide is as wide as in America.
Poland's snap election was called after President Lech Kaczynski was killed in April, along with his wife and 95 other senior political, military and religious figures, when the plane carrying their party crashed in fog in western Russia.
The country's hospitals, described as the last bastion of a publicly funded health service, have been the subject of a 10-year privatisation battle. In 2007, the last time the government tried to launch a commercialisation programme, the attempt was vetoed by Mr Kaczynski.
Since his death, however, the government has pledged to revisit its plans. The policy would essentially give Poland's hospitals full market status – the same legal standing as any other company – and open the door to privatisation.
Critics of the plans suggest they would hit hardest the people who need free healthcare the most, in a country where many already struggle to afford dental care and medicines.
"While discussions over Barack Obama's healthcare changes have recently dominated the international media, the radical health reforms taking place in post-communist Europe have met with silence," Dr Watson wrote. "A system is emerging in Poland where better care is being offered to people who are better able to pay. Much has been said about the country's growth, but levels of poverty are high. The hospitals are the last bastion of an even health service. There is a real danger that private companies would bring that to an end."
The issue exploded on to the agenda late last week after the Conservative candidate Jaroslaw Kaczynski, twin brother of the late president, challenged the liberal front-runner, Bronislaw Komorowski, to a live televised debate on the issue, after a court found he had wrongly accused his rival of seeking to privatise healthcare. However, hours before they were due to start on Friday night, both campaign teams announced the debates would not go ahead.
Then, in a swift reversal of Mr Komorowski's victory, the appeal court ruled that the lower court had "omitted to examine" certain pieces of evidence presented by Mr Kaczynski and referred the case for a new hearing.
Government contributions to healthcare have been set deliberately low, in the expectation that it would lead people to seek more private care and that private health insurance would develop to fill the gap.
According to one recent survey, a little over 47 per cent of people with no source of earned income, 26.4 per cent of people on old-age pensions and 43.4 per cent of those on disability pensions were unable to afford the drugs they needed, compared with 7 per cent of the self-employed. More than half of disabled pensioners and unemployed people were found to be unable to afford to pay for dental care.
When Donald Tusk, Poland's pro-free-market Prime Minister, came to power in October 2007, private equity and several large insurance companies began to wait anxiously to see if he would liberalise the health system to allow the further development of markets. Several health insurance companies had started activities in Poland, including PZU, Allianz, Generali, Inter Risk and Axa.