“I don’t see any profound breakthrough here, and I believe this conference was organized mainly for Prime Minister Donald Tusk to hear it,” Dr. Piotr Kusznieruk, Rector of the Warsaw Medical University of Applied Sciences, told Niezalezna.pl while commenting on the healthcare reform proposals presented by Health Minister Jolanta Sobierańska-Grenda. According to the expert, the changes proposed by the Ministry of Health “will not rationally solve anything,” while public trust in the healthcare system can only be rebuilt “once the downward trend comes to an end.” “For now, the media continue to reveal new pathologies,” he added.
A Political Rescue Plan
On Wednesday, Health Minister Jolanta Sobierańska-Grenda presented a draft package of healthcare reforms. It was intended as a response to the scandals exposed in recent weeks – including those involving Warsaw’s Southern Hospital and the hospital in Mogilno – as well as to Donald Tusk’s highly publicized ultimatum.
The minister’s proposals include eliminating excessive salary disparities, restricting so-called “dual employment” by physicians, introducing a centralized electronic waiting list for planned procedures, ensuring equal treatment of patients, and banning preferential treatment in so-called VIP lounges.
Sobierańska-Grenda stressed that the planned reforms are aimed at restoring public trust in the healthcare system, improving patient safety, and making healthcare spending more efficient. However, it is difficult to avoid the impression that the real purpose of the announcement was to contain a growing political crisis.
Temporary Measures Rather Than Reform
Niezalezna.pl asked Dr. Piotr Kusznieruk, Rector of the Warsaw Medical University of Applied Sciences, to comment on the proposed reforms.
“This is not a reform. It is a temporary repair effort – and a very cautious one at that – focused mainly on closing the most controversial issues, and even that is being done rather ineffectively,” he said.
Dr. Kusznieruk noted that the minister’s remarks made it “difficult to determine whether the gross hourly pay cap of PLN 240 applies only to employees working under standard employment contracts, or whether it is also intended to address what is actually the system’s greatest pathology – contract-based employment.”
He emphasized that healthcare workers employed under standard labor contracts are generally not the source of the system’s problems because “they are the cleanest part of the system. They do not work simultaneously in multiple locations, they are covered by labor contracts, and they are obliged to perform their duties at a designated workplace.”
“The greatest pathology of the system is the widespread use of contract-based employment, which creates excessive salaries and makes compliance with labor law impossible. It turns out that someone can work in two different places at the same time or even work remotely. This reform does nothing to solve that problem,” he said.
No Breakthrough in Waiting Lists
Commenting on the proposal to monitor waiting lists, Dr. Kusznieruk argued that “it will not shorten waiting times.”
“It may not even make them more rational. Monitoring queues only tells the ministry how long patients are waiting. A truly rational system would prioritize those who need treatment most urgently while delaying procedures for less urgent cases. But everyone on those waiting lists is ill and requires treatment. This is not a real solution. Moreover, emergency departments will continue to be used to bypass waiting lists for planned procedures,” he explained.
“I don’t see any profound breakthrough here, and I believe this conference was organized mainly so that Prime Minister Donald Tusk could hear that some kind of healthcare reform was being presented. However, the healthcare reform proposed by the minister will not rationally solve anything,” Dr. Kusznieruk added.
A Deeper Reform Is Needed
According to the expert, the reform “should be far more comprehensive and focus on entirely different issues.”
“First, a national register of medical services should be introduced so that the National Health Fund (NFZ) knows exactly how healthcare services are being delivered. Second, we need to move from a treatment-based system to a cure-based system. Physicians who treat patients effectively and return them to good health should be rewarded, rather than encouraging endless referrals from one doctor to another that only inflate the number of appointments and procedures,” he explained.
Without New Pricing Rules, Excessive Salaries Will Remain
“The most important element of any healthcare reform is a completely new pricing system for medical services, so that absurd situations such as doctors earning PLN 26,000 per hour no longer occur. Medical service valuations must reflect reality. The Agency for Health Technology Assessment and Tariff System has performed poorly, and nothing in this reform suggests that it will improve, because virtually none of Minister Sobierańska-Grenda’s proposals addressed the agency,” he said.
Public Trust Will Not Return Overnight
Referring to the minister’s pledge to rebuild public trust in the healthcare system, Dr. Kusznieruk argued that “trust can only begin to recover once the downward trend has been reversed.”
“For now, the media continue to reveal new pathologies within the system, mainly concerning salaries, but also catering contracts and other issues. Public confidence in healthcare continues to decline. People are also becoming less willing to contribute additional funding because they have concluded that no matter how much money is injected into the system, it ultimately ends up being paid out through salaries or various unjustified benefits. The system is simply full of leaks,” he said.
“Once the system is tightened up and its quality genuinely improves, trust will undoubtedly return. But none of Minister Sobierańska-Grenda’s proposals will change anything fundamental. The most important issue is access to healthcare services delivered at an acceptable standard. When diagnostic imaging – one of the greatest achievements of modern medicine – is cut back, and two months later we learn that the scale of excessive salaries is enormous, the public is left completely bewildered,” he added.
Dr. Kusznieruk concluded that any debate on healthcare reform must begin with a fundamental question: “Is the healthcare system for doctors or for society?”
“Today, society increasingly feels that it exists primarily for doctors and medical staff. When we learn that Minister Sobierańska-Grenda herself has an unusual management contract guaranteeing exceptionally generous benefits well above normal standards, it is hardly surprising that the public loses trust in those who make decisions or provide treatment,” the expert concluded.