Healthcare in Poland

I mentioned how I wanted to talk about the health care here a while back when I had the chance to actually experience it a bit for myself. I keep putting this post off because I really don't have all the information needed to answer all the questions that may come up, I only have what I know and what I think I know.

Maybe we should start with a little perspective, and a little story...

Within the first couple days of getting our house ready to sell back in Austin, Martin sliced his finger badly with a sharp blade. He was removing some old linoleum from the laundry room, trying to save 500 bucks and ended up basically chopping off the entire pad of his left pointer finger. I was oblivious to all of this since I was at my parent's house getting the kids to bed,eating ice cream, and watching cable. He showed up around midnight with his finger in a bandage and the rest is history. He now has a scar shaped life a smiley face. Or a frown-y face, whichever way you look at it.

When checking in at the hospital he had to pay the co-pay of $150 ( E.R....all the Urgent care facilities were closed by then) and fill out some papers. He was then told that he would "settle" with doctor who was doing the stitches at a different time.

Martin: Wait, I thought I paid the co-pay for the E. R. and then everything else is taken care of?

Lady: No. You are just paying us for the hospital fees, the doctor takes separate insurance and is just here doing rotations. He'll settle up with you later.

(we had been through this before once with Felek, Martin knew what she was talking about)

Martin: My understanding is I just pay the co-pay and that's it, the doctor works for you.

Lady: Oh, no sir, just walking in here and putting your name on this sheet cost at least 2,000 dollars to the insurance company. That's just the up front costs for our facilities, administrations fees, etc. That doesn't include the price of the stitches, that will be in a separate billing to your insurance.

2 months later we got a bill in the mail, here in Poland, forwarded to us, 800 bucks for the stitches because our insurance only covered part of the procedure because the doctor was indeed out of our network.

Total cost of stitches for us:  950 dollars.
Total cost of stitches period: something more than 3,000 dollars

Total cost of stitches at the private clinic where I got my x-ray done, well, let me go check where they have their prices listed...

Type of service	Price (PLN)
Surgery, Vascular and Proctology
Sewing the wound	100
Orthopedics
Sewing the wound	100

That's 100 zloty/35 U.S. dollars for sewing up a wound. Clearly this is vague but I'm gonna go ahead and guess that 3 stitches to a pointer finger wouldn't be much more than that. And no, there are no other costs. If you go in for "sewing a wound" you go in and get the wound sewn up. And you pay the nice people at reception, and they give you a receipt. 100 zloty is about 35 U.S. dollars.

This may seem overly simplistic but it is exactly what we experienced. I was flabbergasted when I went in for my x-ray and consultation. I really could not believe it. It was completely amazing. I left there with my head spinning as to why in America, not 3 months earlier we had paid almost 1,000 dollars out of pocket ( after paying premiums every month and a co-pay) for 3 stitches and it actually would have been cheaper to fly all the way to Poland to have it done!

(I have to throw this in there, to be fair... going to a private clinic here is exactly like going to your doctor or to an Urgent Care or Minor Emergency care center int he U.S., so definitely the costs would be lower at those places, compared to the hospitals. If Martin had gone to one of those places it would only have cost him around 45 dollars out of pocket for the co-pay...I think.)

Wow.

I kept trying to think of a way that the U.S. system of health care was better but I couldn't. The insurance plans for families, through a company, especially with only one working parent, and several children, was, for us, close to about 8k a year. And just as we were leaving, since the passing of the health care reform (the insurance companies words, "preparing for Obamacare"), those prices started going up, almost 50% a year for our family. 12k a year for health care! On top of that still paying co-pays, still paying out of pocket deductibles for certain services, and then , if you're super unlucky, having  a doctor work on you in some hospital somewhere that just doesn't take your insurance at all and you are stuck with the bill. That's expensive enough to move a family from a "stable income" to "barely making ends meet", just to provide health care for their family.

But why is it like this?

Another story.

My father in law went in for some cardiology tests a few years ago. Routine tests, takes a few hours, with all the machines, etc. In the U.S. when you get any type of services done and your insurance pays for it, you still get a statement in the mail with an itemized list of the services and the cost. You know, THIS IS NOT A BILL. His statement looked something like this...

cardio stuff                    $ 900

other cardio stuff           $ 1100

miscellaneous                $ 11,000

Total                            $ 13,000

He called and asked about the "miscellaneous". The lady on the other end told him, "administration fees and malpractice insurance, standard costs".

No American is surprised by this really. We know that's what's going on. It's the lawsuits and the amount of insurance the doctors and hospitals have to pay for to cover their behinds from the lawsuits, that makes health care so incredibly expensive. That and the mounds of paper work to keep all of that in check. To keep you in check. To make sure that everyone pays and gets paid. It's insane. And criminal. And there is no apparent solution.

Public health care in Poland is a little different of course from our experience at the private clinic. And from what I hear, it's not a really great experience (comparatively). Much like how medicare works in the U.S. If you have never dealt with medicare in the U.S. or paid out of pocket at a public clinic then you are fortunate. And I mean that as graciously as possible, because those public clinics are not pleasant, the doctors are not the happiest on the planet and your fellow patients are often indeed in a desperate way. My few chances of needing and using them were somewhat traumatic for a rather innocent and sheltered middle class American. This is what private insurance in America keeps you from seeing and experiencing. In Poland the public health care is much more... how shall I say this..."alive". Many people use it for various reasons. Although I have been told that most people, even the poorer among us, have some form of private insurance or will pay out of pocket because it's so affordable and makes those rare visits that much easier and pleasant. But, if you cant ever afford out of pocket, or insurance fees (which by the way, cover everything...you pay the fee for the insurance you choose and there are no co-pays or other costs... it's just covered 100%...you choose the plan that best suits your needs and budget) then there is a public system, with all the stereotypes that come along with that. Long waits for doctors and E.R. visits. Sometimes waiting months for surgeries that are not "necessary" to sustain life. The clinics are not as nice on the inside. I have only been to one public hospital here and aside from the incredible lack of public restrooms and the somewhat dilapidated state of the building, it was pretty similar to hospitals in the U.S.

That, and there are no private hospitals here. This means that anything costing over a certain amount or anything requiring a certain amount of time recovering in hospitals is always covered by the state. Which means that, in general , you have your "catastrophic coverage" automatically from the government (which also means that you don't have to buy any insurance at all if you are relatively health and just pay out of pocket for the occasional x-ray or consultation...people can even give you "gift cards" to private clinics... this can save you tons of money and is certainly an incentive to live a healthy lifestyle) Which might be my biggest concernshould I ever want to have a baby in a hospital or need some sort of procedure. But we will wait til that time comes, and possibly even be pleasantly surprised, or just avoid it as much as possible and seek alternatives.

Public health care here is paid for by income taxes, just like Medicare in The U.S. Just like the new health care will be in the U.S. Taxes pay for the public services. Taxes here are not crazy high. There are only two tax brackets, 18% and 32%. The majority of Poles fall into the 18% range. I point this out only to show that out of that 18% they manage to provide health care for the whole country. Because, whether you want to or not, you are enrolled in the public health care system here. There is no government insurance to buy. There is just your citizenship, which guarantees you coverage without paying any money over and above taxes. That includes doctors, surgeries, prescriptions, crutches, etc.

I really and truly cannot wrap my head around all of this. You hear about other countries and their health care situations, but really, America's has to be the most unique, and quite possibly one of the worst among the first world countries out there, and not a thing has been done to fix it. I have family members that have horror stories about major medical expenses and how the paper work alone is like a separate job to tackle at the end of the day. Trying to deal with the companies, the government, should you need assistance, and just all the hidden costs and fees. Life saving prescriptions taking half your paycheck each month. It's incredibly disheartening.

I've only been here for 6 months. I'm no expert. I know a lot about American health care, I've done the research and I've had to deal with it, often times in very unpleasant ways, both public and private. I know that there will be horror stories out there about Polish health care and miracle stories about the American system. Everyone has had different experiences and has different opinions. But I do know this. I feel a huge weight lifted knowing we will not have to deal with paying the American insurance premiums anymore and all the other hidden costs. I am so grateful that Poland seems to have a working system, and that it's good and affordable for our large family.

 Many of my readers have had opportunities to use the Polish health care system. What do you think?