system faced the problem of an aging population, and the healthcare system proved inefficient and woefully mismanaged" (Misiag & Niedzielski, 2001).
Reforms have been implemented in the years since the fall of the highly centralized communist system in 1990. The most significant of reforms was the establishment of national health insurance that all Poles are required to purchase. In this system, which was put in place on a regional basis in 1999, the focal point of entry into the system is the primary care physician, who acts as gatekeeper for the system at large and who may refer patients to specialists as required (Lenain, 2000). The health insurance fund makes reimbursements to caregivers at all levels of the system.
So much for the ideal vision of health-care delivery in Poland. In fact, so-called "informal payments," the name given to premium cash outlays by patients to health-care providers for services to which patients are legally entitled for no payment, are a common feature of medical care in post communist countries, including Poland. They are said to be a holdover from the communist era, during which incentives were more or less de rigueur for recipients of health care or many other supposedly no-cost services (Gaal, 2006). They are euphemistically called gifts, but their ultimate effect is pernicious:
They can undermine official payment systems, distort the priorities of the health system, reduce access to health services and impede health reforms. They can also provide undesirable incentives and encourage unprofessional behavior, including rent-seeking behavior by health workers. (Allin, Davaki, & Mossialos, 2006)
Researchers for Transparency International, a nongovernmental organization that makes country-by-country reports on corruption available to the United Nations and to the public more generally on the Internet, have found that in Poland the artificial incentives extend all alo...