Health Care in Poland

In this publication I am explaining the structure of health care system in Poland. I do know the importance of understanding and being able to use health care in country where I live. Therefore, I made my publication describing this system in Poland. So have a look please on a list below with subjects covered.

• National Health Fund – NFZ
• Health care system – 3 levels
• L4
• Medicines
• Private Health Care

National Health Fund – NFZ – Polish health insurance

Health insurance in Poland is covered by National Health Fund (Narodowy Fundusz Zdrowia – NFZ). Allow me to quote here statement from my source, which is an official state website of the Ministry of Health in Poland:

Anyone who is subject to compulsory health insurance is insured (e.g. an employee, a person who runs a business, a pensioner, an unemployed person) as well as a family member of the insured person who has been registered for insurance.

Source in Polish: click here

But what does this actually mean for you? If you are any of example mentioned above (employee, own business owner, a pensioner or unemployed person registered in labor office), then you and your family are entitled for health care insurance . Is it for free? No. Who pays for it? We all do. In a form of so-called health care contribution (składka zdrowotna), which is obligatory and paid by each single person having own business or employment contract. It is 9% counted off your gross salary if you are employee and at least 362,34 zł (data from last quarter of 2020) if you have your own business. Since “the general costs” of having own business in Poland is a subject for series of an additional articles, I would rather stop here.

So from my point of view, here is the more important questions: What does the NFZ cover? If you are insured with the National Health Fund, you can take advantage of medical examinations and advice (if necessary, also at home), outpatient and inpatient treatment, therapeutic rehabilitation and preventive healthcare. Services may be provided by public and non-public institutions, by medical professionals, or by a group medical practice or a group practice of nurses and midwives, if they have signed a contract with the National Health Fund for the provision of healthcare services in a given area.

3 levels of the Health Care in Poland

If you know already, what is the NFZ, let’s exlpain structure of using our health care.

Level 1 – Primary health care

You are entitled to free diagnosis and treatment by a primary family doctor / general practitioner – GP (Lekarz Podstawowej Opieki Zdrowotnej – POZ). In order to clarify, GP equals POZ in Poland. So called POZ should be your primary care physician to whom you report in case of illness, periodic check-ups and vaccinations. During your first visit you have to sign up for it by completing the appropriate declaration.

Usually, on this occasion, you also register yourself and your family with a nurse. It is best if the whole family uses the same practice or health care clinic – thanks to this, the specialists working there will have more information about the whole family, which, in the case of certain diseases, facilitates treatment and diagnosis. Since this article has already over 2400 words, I made dedicated article about GP / POZ doctor and clinic only. I explained there in details, why would you need to have POZ in Poland and what are the advantegaes of it. Link here. However, I highly recommend to finish this post first, since both articles are related with each other.

Level 2 – Specialist treatment

This means outpatient specialist care. If your GP / POZ decides that you need specialist treatment, he or she will fill in for you a referral to a specialist (skierowanie). Then you will go to outpatient specialist care (ambulatoryjnej opieki specjalistycznej – AOS). You have the right to choose any specialist clinic (the one to which you are referred) from among those with whom the National Health Fund (NFZ) has signed a contract. However, one referral entitles you to enroll into the specialist only once.

How long is a referral valid? They need to be “renewed” if you haven’t started treatment in the last 730 days. If the specialist decides that you need to come to him for another consultation / examination, you do not need to have a new referral. A new referral will be necessary when you have finished treatment with a given specialist and a new health problem has appeared that requires diagnostics and treatment with AOS. In such case, you need to make an appointment with your GP / POZ first. A referral is not always needed. There is a group of specialist/doctors you do not need a referral to:

• psychiatrist
• gynecologist and obstetrician
• oncologist
• venereologist
• dentist

Level 3 – Hospital (Szpital)

Both GPs and specialists can refer you to a hospital. You have the right to choose any hospital in Poland, provided that it has an agreement with the National Health Fund (NFZ). In a situation where it is necessary due to your health condition, you can also be referred to the hospital by a doctor who has not signed a contract with the National Health Fund (i.e. one where you are treated privately), and you do not have to pay for hospital treatment. However, you do not have the right to free tests or free consultations with a specialist on the basis of a referral from a private doctor – only a doctor who has a contract with NFZ or works in a facility with such a contract can refer tests covered by NFZ.

A referral for hospital treatment remains valid until the date of patient admission is agreed. You can also go to the hospital alone, without a referral, if you have had an accident, poisoning, trauma, labor has started, or if your health is in danger or if your health suddenly deteriorated. In such case, you supposed to look for so “Emergency entrance” (Szpitalny oddział ratunkowy – SOR).

The hospital does not have to admit you to a hospital ward immediately – it depends on your health condition and the possibility of admitting you at the moment of visiting hospital. This rule does not apply in the event of a sudden threat to life or health. In such a situation, the hospital must see you immediately to save your life and health. If this is not possible (for example because it does not have the appropriate equipment or there is no department dealing with a given health problem), hospital must ensure that you travel by appropriate medical transport to the hospital appropriate for you.

L4 – sick Leave

In the case of the disease or any other health condition because of which you cannot work, the doctor issues an L4 certificate – so-called Sick Leave. The certificate and its duration will be issued on the base of your current health condition. You can also obtain an L4 certificate for childcare, in case that you need to take care about your child which is not older than 18 years.

How does the process look like? The doctor, during a visit at his place, tells you that on the base of your health condition exemption is needed. In such case, he fills in e-Exemption (e-Zwolnienie). E-exemption is simply an electronic leave, thanks to which you do not have to provide the leave to the employer (if you are an employee) or to ZUS (if you run a business). The e-exemption will be automatically sent to the profile of the Electronic Services Platform of the contribution payer and to the Social Security (Zakład Ubezpieczeń Społecznych – ZUS) system.

If you are issued with sick leave while having a contract, running your own business or being registered in labor office , you are entitled for  sickness allowance (zasiłek chorobowy) which is 80% of your salary from contract or average from last 12 months in case of being self-employed. Situation is slightly different for pregnant women and in case of an accident at work – in such situations you would be entitled for 100% of your salary entitlement from your contract.

L4 – Example with Salary

Let’s take simple example here. In case of having salary 5000 zł gross from my contract, working 40 hours per week and having L4 for 1 week (02.11 – 08.11) in November 2020. Month November has 21 working business days. 1 week of L4 is equal with 5 working business days. As we know this, lets count the salary which you would have received “per day” on the base of your contract entitlement. 5000 zł gross divided by 21 days equals with 238,1 zł per day.

So 80% from 238,1 zl equals 190,48 zł. This means, that in case of having Sick Leave for 5 days, your salary during L4 certificate duration would have been reduced by 20% which in this specific case is results with 47.62 zł less per every day. Taking into the consideration above given example in a monthly scale, salary would be lower by 238,1 zł, so you would have received around 4761,9 zł gross. Still, despite the fact, that we talk about rules taken from labor code, my example may not be completely relevant with for example additional rules about bonuses in a company where you work.

Medicines

Off course, the doctor will most probably prescribe you the medicine. So you need to visit pharmacy and buy it. NFZ refunds part of the costs of most common medicines for most common health issues in Poland. But! It is only a partial refund, which may variate between 80% and 20%. It may be fully paid by you as well. Rules about medicine refund are changing every few months. Therefore, the best what can I advise in here, is to follow official state website of the Ministry of Health (available in Polish only), with the newest list of medicines which are refund.

There are also 2x ways of receiving prescription here – physically on the paper as well as online – via Patient Online Account (Internetowe konto pacjenta). In both cases, prescription contains details about proportion of price which would be refund by NFZ.

Finding a medicine might be challenging as well. I remember situation from last year, when I could not find a medicine for my son in pharmacies in my closest neighborhood. High number of children from our school got infected and prescribed for the same medicine in pretty short time frame. I found that day app called: “Kto ma Lek?”, which literally means: “Who has the medicine?”. You might check there the availability of specific medicine in specific pharmacy instead of running through the city from one pharmacy to another. App is available on mobiles, as well as via browser – just click here to check it.

Private Health Care

The Polish state health care system has many disadvantages, the worst of which seem to be:

• Difficult access to specialists or hospitals (2^nd and 3^rd level)
• Long queues of patients waiting for treatment
• Indebtedness of public health care institutions
• Backwardness of the health service in the field of medical service management. For example registration, treatment dates. Also, low level of use of information technology

This brings up the question about alternatives. Except possibility to visit a doctor privately who would have charge you between 100 zł and 200 zł for each single visit, you might as well become a beneficiary of private medical subscription. The most common brands performing such services in Poland are Luxmed and Medicover. They managed to create facilities all over the Poland in every single bigger city.

How does it work?

Idea behind is really simple – you get specific package of private services for monthly fee. Off course – higher fee equals more services in the package. Price bracket in here on the day of writing this post ranges from 70 zł to 360 zł monthly for the most expensive package of services. Worth mentioning here is the fact, that some of the corporations are giving this private health care package to their employees within contract entitlement. You need to keep in mind, that having private health care is an optional thing right now, which does not relieve you of paying health contributions to NFZ.

• New technology used in case of private health care, which allows you to book a visit with the internist (1^st level) or specialist of 2^nd level via internet, mobile app or phone without going out of home.
• Private health care has modern facilities with patient friendly waiting rooms. Most often they also have a dedicated place for the youngest one, called: “micro playground”. Parents will understand.
• Private facilities are mostly better equipped.
• The staff (except the doctors) is much younger and there is a much greater chance of finding someone who speaks English than in the case of old fashion state medical facility. You can read more about language difficulties in Poland in another article which I recently published – just click here to check it.
• Waiting queues for specialists of 2^nd level are much shorter than in case of state health care.
• The biggest disadvantage here is that in case of any more complexed issues, doctors from private facilities cannot give you referral for performing test covered by NFZ –if – you did not choose them as your own GP. Actually this is something tested by one of my colleagues – thanks Daniel 😉
• Private medical institutions do not have machines to perform the most advanced test as in case of state hospitals which are not allowing to use their equipment by external companies.

Summary of Health Care in Poland

Polish state health care system is covered by NFZ, which is paid by us – taxpayers. So private care is an alternative for state care, which is very often overwhelmed and underfunded. Don’t get me wrong here – doctors are the same in both types of facilities. Nurses in both cases are giving you the best service which they can provide. It is not about attitude of staff, but about prosaic state system which according to me supposed to be modernized and in line with the level of private care available in Poland. Let me know please what are your thoughts in here. Would you like me to get deeper in any of discussed subjects which I touched in this post? Let me know in comments below.

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pacjent.gov.pl; nfz.gov.pl; gov.pl

Source