Political analysis of the conception of the Polish National Health Fund

Background After the fall of communism, Poland implemented one of the widest reaching programmes of socio-economic reforms. However, in comparison health system reforms were less radical. At the end of the 1990s a change process had been started, but the political fight for power has heavily influenced the health reforms and led to two different reform concepts being implemented over a period of a few years. Aim The paper assesses the chances of implementation of the reform proposed in 2001 to recentralise health financing and organisation by replacing regional sickness funds by a National Health Fund. A hypothetical model is proposed which is placed at the start of the reforms and compares the model to the actual political course observed. Methods PolicyMaker software was used for a political mapping analysis. The policy content (goals and mechanisms) was based on official political documents as well as verbal declarations made by key policymakers in the media, newspapers and magazines. Results The analysis showed that the political situation was in favour of the government implementing a single National Health Fund. Nevertheless, this generated a strong resistance by the political opposition, experts and health care workers which could be a substantial obstacle for the realisation and effectiveness of the implemented model. The feasibility of the project could have been increased by implementing a number of strategies aimed at modifying the attitude of key stakeholders and by introducing the proposed reform as part of an overall improvement of the work environment for health professionals. Conclusions The concept of a National Health Fund generated important opposition against the proposed changes in the health care system. With its majority in Parliament, the government was nevertheless able to establish the new system. The actual course of the reforms however contained a large number of formal errors, which led the Constitutional Court to rule the reform as unconstitutional. Substantial imperfection of the reform caused a destabilization of the whole health care system. In addition, defeat of the reform caused a decrease of electoral support for the governing coalition.