Prevention is better than cure

According to the National Transformation Programme — the health programme for 2022–2027 — the focus should not so much be on treatment as such, but primarily on prevention.

This also applies to the fight against modern-age diseases, such as obesity and related metabolic diseases or alcohol and tobacco addiction. What policies, what programmes should health care policy take into account to improve the infamous rise in the incidence of modern-age diseases — these were the topics discussed by experts during the panel discussion, “State versus pragmatic health economics”.

Will Poles heal themselves?

– “First of all, it is important to point out that the health system in Poland is too much oriented towards the so-called “recovery base”, said Dr. Krzysztof Łanda, physician, entrepreneur, Deputy Minister of Health between 2015 and 2017. – “We have an extensive hospital base, a specialist base, to treat diseases. And it is well known that prevention is better than cure. Meanwhile, we spend very little on prevention and health promotion in Poland”, he noted.

In his opinion, there is a lack of well-structured prevention programmes, which would be implemented with strict rigour. And it looks a bit as if the state has put health education in the hands of... the Internet because that is where Poles most often look for advice on how to live healthily. According to Dr. Łanda, possible arguments that there is not enough money for such programmes are more of an excuse. The revenue from public levies imposed on stimulants is very large, and it is a wonder why the state does not use it to its full potential.

More prevention

– “The most cost-effective, i.e., the most cost-efficient health care programmes are early interventions, such as vaccination and primary prevention”, Marcin Czech, Deputy Minister of Health for 2017–2019, a specialist in epidemiology and public health, added in the interview with “Rzeczpospolita” daily.

– “Hence, expanding the vaccination schedule and thinking about it not only from the perspective of the paediatric population, i.e., children, but also from the perspective of adult vaccination seems a very sensible investment and a good decision. This early intervention means that people do not get sick, do not get infected, do not get complications, do not turn up at GPs, do not receive specialist treatment, and therefore do not involve the most expensive health care resource, which is hospital treatment”, explained M. Czech.

Budget hole

– “The basis of modern health economics is the economic analysis of the law”, stressed Prof. Robert Gwiazdowski, lecturer at Łazarski University and tax expert at the Adam Smith Centre. – “There is a superstition that economists deal with oil, prices, or GDP. But equally important is the economic analysis of the law, e.g., in terms of tax legislation. This also applies to the health market, which is heavily regulated”, noted Prof. Gwiazdowski.

As he recalled, Poles pay health insurance premiums, so-called NFZ contributions. Products that are harmful to health are also heavily taxed — these include tobacco products and alcohol (excise duty), but also sugar (so-called sugar tax). The question is whether the proceeds of these public levies are well used and the system well structured?

Experts have many doubts about it. Revenues from excise duty or sugar tax go into the state budget, or as participants in the debate said, “fall into a big black hole”. As so-called undesignated money, it is not earmarked for specific needs, e.g., treatment of lung cancer or other tobacco-related lung diseases, or diseases resulting from alcohol abuse. Nor are they used for appropriate prevention programmes.

Taxes and health

One can also have reservations about the design of the tax system. – “We are not learning from countries that are successfully implementing health-oriented policies, such as Sweden or the UK. Sweden has recently announced that it has become a tobacco-free country as the percentage of “smokers” has fallen to just 5; it is the first EU country with such a huge success”, said Krzysztof Łanda.