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Specific information about Polish healthcare system?


arn1234 1 | 3
26 Mar 2016 #1
Hello everybody!

I fail to find very specific information about Polish healthcare in English and I would have liked to know how Polish people get paid back by their public or private insurance after they go to their doctor or get a treatment. Do they have to show a specific insurance card and to pay first? Do they usually have to pay in cash or by credit card?

Thanks so much in advance!
mafketis 37 | 10,907
26 Mar 2016 #2
If you're insured then you don't pay anything for services that are covered by the National Sickness Fund (NFZ). You always go to your family doctor first and when you get a referral it's considered proof of insurance when you take the referral somewhere else.

If you go private (or opt for non-covered services) then you pay 100% for that with no repayment.
OP arn1234 1 | 3
26 Mar 2016 #3
Thanks!
And when you go to the family doctor do you have to advance the fee then you are paid back by the NFZ? As for when you go private can you subscribe to private health insurers that will pay you back as well?
mafketis 37 | 10,907
26 Mar 2016 #4
And when you go to the family doctor do you have to advance the fee then you are paid back by the NFZ?

No. You don't pay anything. Of course not everyone is insured in the national public healthcare system, but there's a computerized national data base of who's covered and how. A family doctor won't accept you if you're not insured. (My situation is maybe not typical as my "family doctor" is the outpatient clinic at a research hospital but I've never paid anything there or for any services obtained on referral).

As for when you go private can you subscribe to private health insurers that will pay you back as well?

I'm not sure how the private insurance sector works (I just use the public system). When I've used private services I just pay as the services are rendered and there's no compensation.
OP arn1234 1 | 3
26 Mar 2016 #5
Thanks!
So maybe when you go to a clinic and that you are insured you pay nothing to the family doctor and when you go to a General Practitioner you pay then you are reimbursed by the sickness fund?
delphiandomine 87 | 18,086
26 Mar 2016 #6
No. You don't pay anything if you visit a doctor that has a contract with the national (public) health fund. Doesn't matter what kind of doctor it is - if they have the contract, you're covered as long as your national health insurance is valid.

If your visit isn't covered by the national health fund, then you either pay, or your insurance company pays.
mafketis 37 | 10,907
26 Mar 2016 #7
. Doesn't matter what kind of doctor it is - if they have the contract, you're covered as long as your national health insurance is valid.

Unless you want a service that's not covered in their contract with the NFZ in which case you find another healthcare provider whose contract includes the service or you pay (with no compensation).

I had this situation where I had a referral but the place they recommended didn't include anesthesia for the procedure I needed (and I wanted anesthesia) I could either pay or find a different provider that did provide anesthesia as part of their contracted services (I managed the latter but many people can't and either do without or pay out of pocket).
kpc21 1 | 753
26 Mar 2016 #8
A family doctor won't accept you if you're not insured.

There might be a case that you know that you should be insured and the system shows you aren't. Then you have to sign a special paper that you claim it's a mistake and you have to explain it with your employer who is in most cases responsible for your insurance.

The previous system was such that every employee had a special booklet where the employer had to stamp regularly that the health insurance has been paid by him to the ZUS. And you had to take this booklet with you when you went to the doctor. Then they were going to start this computer system so they stopped issuing new booklets, but it turned out the start of the system had a delay of a few years. So if someone had no more free place for stamps in the booklet, he had to show at the doctor a document from the employer confirming that the employer has paid the insurance (which looks so:

formularze.iform.pl/zdjecia/formularze/6471/1329589097raport-miesieczny-dla-osoby-ubezpieczonej.png
- and shows also the specific amounts of money paid, so it betrays how much the patient earns, so it might not be comfortable, but it was a temporary solution).

As the people before me said, if you are insured in the national healthcare system (which is done by the employer, employer of a family member, in some minor cases by a university, or you can pay the insurance or your own), you don't pay absolutely nothing for anything that is covered by the healthcare system. Unless something is paid by the healthcare system only partially, of course (it's often so with different dental services, there are also some medicines for which the country pays a part of the price, for all other medicines you pay the full price), and unless you go to a doctor that has no agreement with the healthcare authority (NFZ) - sometimes you have to wait months or even years for some medical services provided for free, and then you have to pay and go private.
OP arn1234 1 | 3
27 Mar 2016 #9
Thanks a lot! And in the copayment pharmaceutical scheme, do I have to advance the whole fee or just pay the (for instance) 50%? What if I have a Private Health Insurance, do I have to be paid back because I advanced the fee or I just pay the small part that is uncovored by the PHI?
mafketis 37 | 10,907
27 Mar 2016 #10
And in the copayment pharmaceutical scheme, do I have to advance the whole fee or just pay the (for instance) 50%

I can't speak about private insurance, but when you get a prescription from a doctor with a contract with the national system the doctor indicates how much is reimbursed on the prescription itself (for example 30% or 50%) and then the pharmacist applies that to the cost and its subtracted before I pay. I don't concern myself with it at all.

addendum. just asked a friend in the medical field and he says some private doctors have a governmental contract for prescriptions only in which case prescriptions by them are handled just as public doctors.

If a private doctor has no contract with the government then it's all out of pocket for the patient.
kpc21 1 | 753
31 Mar 2016 #11
An interesting issue is that to get a refund from the government for a pair of glasses, you need to get a prescription from an eye doctor that has a governmental contract and to get to this doctor you need a referral from a GP doctor.

And you don't get the refund directly when you are buying the glasses, like it is with the medicines. You must go to the NFZ premises, often wait in a queue, fill in a form, and only then they return a part of the glasses price. Or alternatively you can send this form through the post.
johnny reb 50 | 7,153
5 Jun 2021 #12
Hats Off
The Polish government is dropping visit limits for specialist physicians which will be a major improvement for Poland's healthcare system.
pawian 223 | 24,535
5 Jun 2021 #13
The Polish government is dropping visit limits for specialist physicians

I am sorry johnny but it is only on the paper. And the Polish saying is that the paper will accept anything. We can also call it science fiction plan - like the one about Martians landing on Earth one day.

Yes, I read about it but we also need to supply this optimistic news with experts` opinions. And they are quite brutal - nothing will change for better coz there are simply too few doctors in Poland to cover all needs.

A few years ago, when doctors went on strike and threatened the government with emigration, some maniacal PIS politicians reacted: Let them go! We shall manage without them!

Today we see the results of this sick approach of the ruling rightards.
mafketis 37 | 10,907
5 Jun 2021 #14
PIS politicians reacted: Let them go! We shall manage without them!

True. PiS and their supporters aren't very well at imagining future problems....

They follow the old sociopath tactic:

1. Say you're doing something.
2. Do nothing.
3. ????
4. Profit!!!!!!!!!
Ironside 50 | 12,438
5 Jun 2021 #15
@mafketis
Who is? Do they even bother to think about it?
pawian 223 | 24,535
5 Jun 2021 #16
Tell us more about PiS and their supporters. Don`t be shy. :):)
mafketis 37 | 10,907
5 Jun 2021 #17
Do they even bother to think about it?

The political environment in many/most countries selects against long-term thinking.

In some areas this is understandable and not terrible.

But telling doctors to leave the country is next-level stupid and incompetent.

If KO had any sense whatsoever (I'm skeptical but hopeful) they'd run that moment 24/7 the next elections. But they have their own stupid biases... (on principle against providing publicly funded healthcare to the extent needed - PO's plan was to beef up the then existing system with the private sector which was.... not wise.

Every government in the last 25 years has done stupid mistakes in healthcare policy but PiS outpaced them....

The original Kasa Chorych system was not terrible (and allowed for local initiative and innovation) but was shut down too soon and replaced with the over-centralized NFZ.


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