Poland Overview
The Republic of Poland is the largest country in central and eastern Europe, in terms of both population (38.2 million) and area (312 685 square kilometers). In 1989, Poland was the first country among the central and eastern European countries to re-establish democracy after 44 years of communist rule. After a severe economic downturn in the early 1990s, Poland's macroeconomic situation has stabilized, showing steady growth since the mid-1990s. In May 2004, Poland was admitted into the European Union (EU). Poland has a mixed system for public and private health care financing. Social health insurance contributions represent the major public source of health care financing. Health insurance contributions are mandatory. The National Health Fund (NHF) with its regional branches administers the social health insurance scheme. The NHF has the responsibility for planning and purchasing public financed health services.
Primary Health Care
The primary care system was in the past 40 years based on a network of health service units located where people live, work or study. Until recently, there was no concept of a family physician or general practitioner. In the 3300 primary health care centers in the country in 1998, primary care physicians were mainly specialists in internal medicine, obstetrics/gynecology or pediatrics. In rural areas, primary care was provided through small polyclinics or outpatient centers staffed by an internal medicine specialist, an obstetrician-gynecologist, a pediatrician, a dentist, a midwife, nursing and ancillary staff. In the smaller villages, the primary health care centre could consist of one doctor and a nurse. In urban areas, primary care services were provided in large polyclinics, which also housed some specialist services and diagnostic facilities. Emergency care was provided by district ambulance services and in emergency care units.
Since 1991 a family medicine model with primary care organized around individual or group physician practices has been discussed. To support this new model the College of Family Physicians in Poland was set up in Warsaw in 1992. Since 1993 specialist training in family practice has begun and since 1995 primary health care has been provided by growing number of group practices or by family practitioners on contract with the health insurance funds.
Family doctors are contracted on a capitation basis, taking care of patients who have registered on their lists.
Human resources, education and training
Poland had 2.4 doctors per 1000 inhabitants in 1996 and is regarded as having too many specialists with more than three specialists for every primary care doctor.
There are eleven Medical Schools in the country. Undergraduate medical education lasts for 6 years followed by a compulsory pre-registration year internship. Vocational training (residency) in family medicine takes four years, with a shorter retraining course for physicians who are already internal medicine specialists, pediatricians, surgeons or gynecologists.
Residents spend about one third of the whole training period in family physicians offices. To get the family physician diploma they need to pass the specialty exam, which consist of 4 parts: multiple choice question test, objective structured clinical exam, communication skills exam and oral exam.
Links:
National Exchange Coordinator for Poland
Dr Magda Moszumanska (szuma25@poczta.onet.pl)