职业医学与健康事务

抽象的

Private Health Insurance as a Financing Source of Occupational Medicine (OM) in Poland: Opportunities and Dilemmas

Izabela Rydlewska-Liszkowska and Alicja Sobczak

The article raises a question of covering occupational health services (OHS) by private health insurance. Such an idea has been recently promoted in Poland in order to diversify financing sources and strengthen market forces in relation to occupational medicine (OM). However, its implementation in a long-existing, highly regulated and comprehensive Polish OM system (characterized in a synthetic way by the Authors from the legal, organizational and macroeconomic points of view) brings about several issues to discuss and solve, including a scope of OHS insurance, the relations between private insurers and OHS providers, exchange of information, obligations of employers. Therefore, introduction of OHS insurance products requires adopting legal regulations concerning the definition of OM/OHS as well as the detailed range of insurance coverage (types of risks and benefits covered under standard and extended policies, such as preventive medical examinations, workplace health promotion programs, health care services provided in case of accidents and occupational diseases, etc.). Lack of precise regulations in this area may potentially result in certain unintended and negative consequences, including a significant and uncontrolled growth of OHS costs, applying different (unequal?) protection standards for employees working in the same sectors/ branches/ workplaces and the so-called “cream skimming” phenomenon limiting health insurance scope to the most financially effective insurance “products”. Finally it should be emphasized that successful implementation of OHS private insurance policies requires introducing fiscal incentives (tax reliefs for employers on OM insurance costs). Otherwise employers will be more likely to purchase OHS in the old ways - from medical firms (OHS as the core element of “medical packages”) or directly from OHS providers.