NEWS  ASSOCIATION  MEMBERS  FUTURE MEMBERS  OSSN STATUTE  CONTACT  PO POLSKU		Rational Healthcare System Code 1. Free choice of the insurer by the insured, with regard to both primary (general) and additional (voluntary) insurance, as an inalienable right of the insured and the basis of the system's diversity The proposed model is based on competition among the insurers who manage the premiums of the insured. Their competition should cover both the primary system (general health insurance) and the additional system (voluntary health insurance). 2. Free choice of the service provider by the patient as the basis of competition on the market of healthcare services Free choice of the service provider is an inalienable right of the insured patient (in keeping with the slogan "money follows the patient" which until now has not been realized). All the assumptions of the "model" included in this code aim at actual, rather than just verbal, possibility of choosing the provider by the patient. 3. The state and the local government act primarily as regulatory bodies for the system (by establishing rules of law) and as supervisory powers to ensure economic and medical safety of the system The fact that the state will cease to act directly on behalf of the general health insurance system does not mean that its role will be marginal. On the contrary, the state and the local governments must perform important duties under the new system. However, their actions must concentrate on the creation of good law and its effective execution. 4. Service providers enter the system without tendering to ensure equal opportunity and transparency on the market of healthcare services The current tendering procedure restricting entry into the system does not ensure equal treatment of all service providers. However, elimination of tenders does not mean that all service providers will be entitled to provide medical services reimbursable with public money. Invitations to tender will be replaced with strictly defined medical standards of outfitting and equipment of the establishments as well as the professional qualifications of the personnel, developed in close cooperation with representatives of the medical community. The fulfilment of those requirements will automatically "license" the provision of medical services reimbursable with public money. 5. Unlimited number and value of health services as the basis of equal treatment of service providers and patients Statutory guarantee of unlimited number and value of health services is an indispensable condition for equal treatment of all service providers and, even more importantly, for equal treatment of patients. Current limits on the number of healthcare services should be replaced with other mechanisms to balance the demand and supply of healthcare services, such as: strict definition of each healthcare service financed by the insurer, the ability to control legitimacy of provided specific services, and direct contributions by patients to the cost of some of the services. 6. Uniform reimbursement for the same services as the basis of equal treatment of service providers and patients Uniform reimbursement paid out by a given insurer to all contracted insurers who have provided the same service will be negotiated between the insurers and a representation of service providers on the basis of standard, uniform healthcare cost accounting. At the same time the principles of financing institutes and clinics will be changed so as to provide funds necessary to cover the cost of teaching and scientific research. 7. Standardization of healthcare services as the basis for improved functioning of the system Standardization of healthcare services, prepared in close cooperation with representatives of the medical community, is required to ensure both the economic control (of the expenditure of public money) and the medical control, which will safeguard the rights of the patients. Standardization of services will cover the model of medical procedure, the professional qualifications of the personnel, and the outfitting and equipment of the centres. 8. Contribution by the patient to the medical treatment costs as the basis for an effective system of control and elimination of unjustified use of services The requirement to co-finance the treatment costs by the patient is not driven by the desire to obtain addition funds for the system. It is a sine qua non for improved consumer behaviour and implementation of an effective system of control. Without co-payments the system of unlimited financing of healthcare services cannot be realized. Due to social factors such co-payments must be set at a low, almost nominal level, so that they do not prevent access to the healthcare services. Co-payments are not incurred by people who have income below the subsistence level. The existence of direct contributions by the patients to some of the health services will enable the creation of additional, voluntary health insurance. 9. Service providers can introduce prices exceeding the value of reimbursements which guarantees market verification of rates and prices as well as enables the opening of the market of voluntary additional insurance The system of uniform reimbursement for the respective services will allow application of prices exceeding the prices used in reimbursement of the healthcare costs incurred by the patient. Such solution will enable the financing of non-standard services and, more importantly, it will also enable the market verification of the prices and rates established during cost negotiations. This solution will result in the emergence of a varied market of voluntary health insurance, which will offer additional, voluntary insurance schemes (platforms), ultimately minimizing the financial contributions of each patient. System's safety will be ensured by intensified anti-cartel inspections, the ban on the application of higher prices in life-threatening conditions of the patient, and the systemic exclusions of the selected healthcare services having decisive role for the medical safety of the system. 10. The programme of secularization of liabilities correlated with the programme of restructuring, commercialization, and privatisation of SPZOZ as the basis for the solution of the debt problem and the rationalization of the functioning of public healthcare institutions (ZOZ). The debt level of independent healthcare institutions is a threat to the functioning of the whole healthcare system. Lack of funds in the central budget and in the budgets of local governments calls for the application of modern financial instruments. The process of permanent indebtedness of public healthcare institutions must be stopped with restructuring actions, without which secularization is impossible. The tendency of public ZOZ institutions to get into debts limits the value of assets of the entity purchasing the liabilities and eliminates the possibility of acquiring credits by the local government. The above-mentioned principles are just a summary of the rational model of common healthcare insurance. However, the authors of the study are in possession of all the requisite detailed solutions allowing its application in practice. An important addition to the optimal system of healthcare should be its flexibility, i.e. the ability to gradually adopt changes which will be necessary for the functioning of the system while preserving the basis the system and shielding the service providers, the insurers, and the patients from the risk of more deep-reaching reforms.