THE ROLE OF INSURANCE IN HEALTH CARE SYSTEM

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1 Warsaw College of Economics and Computer Sciences Insurance Institute in Poland THE ROLE OF INSURANCE IN HEALTH CARE SYSTEM Edited by Romuald Holly Warsaw

2 Chief Editor: Mikołaj J. Kruczyński Text forming: Anna Marczyk Translations verified by: Adam Piechal Copyright 1999 by Wyższa Szkoła Ekonomiczno - Informatyczna & Krajowy Instytut Ubezpieczeń 1 st edition Warsaw 1999 ISBN Printing and binding: MWM Publishing ul. Gościniec 28 b, Stara Miłosna 2

3 The promotion of health insurance is an activity of universal interest and substantial significance. For financial institutions, health insurance is one of the conditions of their business existence. By succeeding in this important insurance market niche, we can improve the economical effectiveness of life insurance and pension plans. Also, improved health allows insurance companies, pension funds, financial institutions and us - their clients live better and survive longer. This is why the role of health insurance in all countries is maturing. Now, as Poland catches-up in this area, neighboring countries will soon follow. Leta C. Finch Romuald Holly 3

4

5 CONTENTS FOREWORD... 7 I. THE HEALTH CARE LOOKING FOR CONTEXTS... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. HEALTH INSURANCE FACES OF MORAL HAZARD (W. CEZARY WŁODARCZYK)...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. SICKNESS RISK IN SOCIAL SECURITY SYSTEM (TADEUSZ SZUMLICZ)...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. THE SYSTEM OF SUPPLEMENTARY INSURANCE IN THE UNIVERSAL SYSTEM OF PUBLIC HEALTH CARE (ROMUALD HOLLY)...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. II. REFORMING THE HEALTH CARE SYSTEM THE POLISH CASE...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. TWO REFORMS: BACKGROUND AND STRATEGY OF PUBLIC HEALTH INSURANCE REFORM AND SOCIAL SECURITY REFORM ( MARCIN MASNY )...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. HEALTH INSTITUTIONS COMING INTO BEING AS A RESULT OF THE HEALTH CARE SYSTEM S REFORM ( PIOTR SAWOSTIANIK )...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. SOCIAL INSURANCE WITH REGARD TO MODIFICATION OF FUNDING METHODS FOR THE POLISH HEALTH SECURITY SYSTEM ( MIKOŁAJ J. KRUCZYŃSKI )...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. HEALTH INSURANCE SYSTEM DEVELOPMENT ( MONIKA KAMIŃSKA )...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. THE REFORM OF HEALTH PROTECTION SYSTEM THREATS AND ODDS. ( ALDONA FRĄCZKIEWICZ - WRONKA)...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. III. PRAGMATICS AND METHODOLOGY OF HEALTH INSURANCE...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. UNDERWRITING HEALTH INSURANCE - OBSERVATIONS AND CONCERNS.( HUW PRICHARD)..BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. UNIVERSAL COMMERCIAL HEALTH INSURANCE IN POLAND.( ZBIGNIEW ANDRZEJEWSKI)...BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. 5

6 HOW HEALTH INSURANCE CAN BE SUPPORTED BY LIFE INSURANCE.( ŁUKASZ KALINOWSKI)... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. DEVELOPMENT OF HEALTH INSURANCE PRODUCTS.( KRZYSZTOF ŁYSKAWA)... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. IV. SYSTEMS OF FINANCING THE HEALTH CARE... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. CHANGES WITHIN THE SOCIAL SECURITY SYSTEMS.( ANDRZEJ KORONKIEWICZ)... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. THE INFLUENCE OF HEALTH INSURANCE ON THE AMOUNT SPENT BY THE STATE ON THE HEALTH CARE - ECONOMETRIC MODELS ( JADWIGA SUCHECKA)... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. V. SELECTED ISSUSES OF THE HEALTH CARE... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. SPONTANEOUSLY COMING INTO EXISTENCE POLISH HEALTH CARE ENTITIES (NON-GOVERNMENT) OFFERING PAYABLE SERVICES..( MONIKA BUJOK )... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. FUNDAMENTAL RELATIONS WITHIN POLISH HEALTH CARE SYSTEM VERIFICATION BASED ON ECONOMETRIC MODELLING..( BARBARA KISZYCKA, MICHAŁ CHARKIEWICZ )... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. CIVIL LIABILITY INSURANCE IN HEALTH CARE SERVICES.( MARIA GASIŃSKA )... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. ECOLOGICAL CONDITIONS OF SOCIAL HEALTH.( VIOLETTA KORPOROWICZ)... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. DISEASES AS A THREAT TO LIFE- TRANSFORMATIONS IN THE POLISH HEALTH INSURANCE SYSTEM AND CONTRACT SYSTEM IMPLEMENTATION..( PAWEŁ KLESZCZ )... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. THE UKRAINIAN-POLISH HISTORICAL PARALLELS AND PROSPECTS OF MEDICAL INSURANCE IN UKRAINE.( VASYL P. MAKHNO, VALERIY S. ERMILOV )... BŁĄD! NIE ZDEFINIOWANO ZAKŁADKI. 6

7 FOREWORD The book presented comprises texts of the selected papers delivered during a scientific conference held in Warsaw on June 16,1999, run by the Insurance Institute in Poland and the College of Economics and Computer Sciences in Warsaw. Besides, the book includes some texts submitted by the participants of the I International Congress of Health Insurance arranged in Cracow, on November 1999 by the Insurance Institute in Poland and the Vermont Insurance Institute, USA. The criteria for texts selection, as well as the contents layout of this book effect from the leading objectives of both conferences, focussed respectively on: the conditions of health insurance development in Poland and on the role of insurance, and particularly the commercial insurance in the system of health care. The leading idea of the Warsaw conference was shared by both its organizers and participants belief, that the currently reformed Polish system of health care and health protection calls for additional, important modification and systemic improvements vital to its possibly efficient operation. A matter-of-fact discussion of the subject requires formulating uniformly understood assumptions, objectives and prerequisites, accumulating the necessary facts, defining the actual state of-the matter of the assessed health protection system in Poland. Hence the subject of the conference was describing, based of the selected parameters, the current situation of the state of health care in this country, wording out forecasts of the changes caused by the implemented reform, as well as on this very background determining the most significant conditions for the prospects of health care system development in Poland. One of the goals of the conference was the supply of argument for the thesis of 7

8 the need for adjoining a parallel subsidiary system to the general system of health insurance. That adjoined system would in turn comprise mainly the offer of the commercial insurance companies. It then becomes important to recognize the potentials of companies themselves as well as their aptitude to design appropriate offers and directing them to the market. This refers to both Polish companies as well as their foreign counterparts, which while making use of their great experience, would like to deal with the enormous niche in the Polish market. None the lesser important is in this respect the cognition and possibly precise definition of the actual social needs, subjective feelings and expectations in this respect, as well as aptitude to making use of the parallel system of commercial insurance. Against what/which diseases or what illness related risks are then the particular sociodemographic groups or circles of Polish community are interested in being insured? What means are they ready to put into that extra protection? Such and the like questions were the one of the significant issues discussed by the conference participants. Implementation of the postulated modification into the general system of health protection, meaning organization of the complementary system of subsidiary insurance, created mainly by commercial insurance companies, calls also for precise diagnosis of the structure itself of health service in Poland, the degree of its readiness to rendering medical overstandard services in close cooperation with insurance companies. The diagnosis indirectly indicates then both the range and the price of the insurance offer of those companies, which, all the same, shall determine the actual potentials and prospects for implementing in Poland the mentioned subsidiary system. According to the expectations of the organizers, the papers by particular authors have presented the broad context of health protection conditions in Poland, both forecasting further development of the public health service system, its actual, future shape, as well as determining the needs and potentials for including commercial insurance in the health care system. To a lesser extent the concrete expectations have been exposed from the part of the health protection system from the underwriters, as well as the needs and expectations of those, most concerned the present day and future potential clients of the system. Unfortunately, there is no reliable data or research on the 8

9 matter. We still trust, that the achievement of our conferences will considerably contribute to the more profound conceptualisation and better accuracy of research, that will be taken up in this field as well. The scope of expectations with this regard has been showed already by suggestions announced by Congress speakers and participants. Some of these issues are taken into consideration by the program and agenda of our Congress. Some of them are presented in this book in the scope and shape we have received up to now from authors. We do believe, that this very publication may be regarded not as a mere evidence of the current way of thinking of the contemporary system of health protection and its reforming, but also as the evidence of the mature character of the very thinking the assumptions applied, practical fact illustration, argument provided or quoted. Warsaw, 15 th November 1999 Romuald Holly 9

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