Pole position

First published in ITIJ 132, January 2012

Emerging from the dark years of its turbulent past, a vibrant Poland is pioneering medical tourism, as Roger St. Pierre reveals

Variously attributed to either Conrad Hilton or Charles Forte, the old mantra that ‘location, location, location’ are the three magic keys to success has its dark side.

Being strategically set at the very heart of modern Europe has served Poland’s economy well in recent years, but its historic role as a buffer state between the might of Germany to the west and Russia to the east accounts for a turbulent and too often tragic past. Today, the so-called Third Polish Republic also has borders with Slovakia and the Czech Republic to the south, the Ukraine, Lithuania, Belarus and the Russian enclave of Kaliningrad to the east, while it fronts the Baltic Sea in the north.

Unlike several of its neighbours, what ranks as the European Union’s ninth most populous state is surprisingly homogenous, some 98 per cent of its 38-million population being ethnic Poles – though, as wages and living standards in Poland rise, immigrants are starting to be drawn to the country from across Europe and beyond.

This is already having an effect in rising house prices and pressure on the nation’s healthcare system. At the same time, continually strong foreign direct investment and the money brought back by the many thousands of Poles who left to seek their fortune working in such places as the UK and Ireland during the Western European boom years has helped bring about a marked rise in living standards.

Having been admitted to the European Union (EU) in 2004, Poland succeeded Hungary as holder of the EU’s rotating presidency in July 2011 – a role that has spotlighted its rapid progress from a bedevilled satellite of the USSR into a modern industrial nation with a nominal GDP of $12,500 per capita (61 per cent of the EU average).

Medical matters

Operated via private insurance companies that have a contractual relationship with the government, Poland has a compulsory health insurance system, with contributions paid jointly by employees and employers. It is operated by Narodowy Fundusz Zdrowia (NFZ) – the National Health Fund. New businesses qualify for a two-thirds’ discount in their contributions to the fund for the first 24 months.

There is reciprocal coverage for citizens of other EU nations, though this does not cover all services.

It is mandatory for medical doctors and dentists practising in Poland to be registered with Naczelna Izba Lekarska (the Polish Chamber of Physicians and Dentists). A compulsory post-graduate system has recently been introduced, based on the continuous professional development systems currently in use by more prominent European and North American nations.

Emergency medical treatment in Poland is provided by local hospitals through the health ministry’s funding of Ratownictwo Medyczne (RM) (Emergency medical services). Physician-led, the operating system is similar to the German, French and Spanish delivery model, excepting that the physicians travel in the ambulance rather than separately.

The present shortage of specialist emergency doctors means that physicians from other specialities – including anaesthesiology, intensive care, paediatrics and traumatology – are set to be used in the ambulance system until 2015, by when it is hoped that enough fully trained and qualified emergency doctors should be available. Paramedics will by then be expected to have successfully completed a three-year Bachelor’s degree.

Eventually, as in the Anglo-American model, paramedic-led ambulance crews will respond to most emergency call-outs, with physicians only being in attendance in life-threatening situations.

Most Polish ambulances are built to European Standard CEN 1789. Besides the vehicles operated under RM aegis, there is a range of private ambulance services operating across the nation.

Operated via private insurance companies that have a contractual relationship with the government, Poland has a compulsory health insurance system

Strategically located in major cities across the country, some 23 helicopter ambulances are currently operated by the state-run Polish Lotnicze Pogotowie Ratunkowe (LPR) organisation, with fixed-wing aircraft available for longer flights.

Replacing earlier Soviet-era machines, the helicopters are state of the art EC-135 models, funded by the government. They have been built to meet the existing JAR OPS-3 European standard for air ambulances.

Assistance I.C.E

Besides a presence for key international assistance companies, Poland has spawned several major organisations of its own. Typical is Europejskie, which provides services through Euroalarm Assistance Prague, a division of the Europaische Reiseversicherung group.

Says director Beata Kalitowska: “Poland now has a highly sophisticated medical infrastructure and we are today judged by the most rigorous international standards. We provide assistance in the Polish language 24 hours a day and have 11 other languages on call through our highly trained team.”

Operating in Poland since 1995, Coris Varsovie, an assistance company, is part of the only international network that is fully independent of any financial organisation.

“We provide assistance both in Poland and abroad,” comments a company spokesman. “Each of our staff members can speak fluently in at least two languages, which means we can deliver our services in Polish, English, French, German, Spanish and even Arabic and Japanese – with support from 45 regional offices and 150 representatives around the world."

Mondial Assistance opened its Polish office in 1999 having operated in the market since 1991 and works closely with the Russian Federation government to provide assistance services to the growing numbers of Russian visitors to Poland.

These and other assistance providers enjoy a good working relationship with both the state and private sectors of the healthcare industry.

“The infrastructure is now in a healthy state,” comments Piotr Godlewski at SOS Agencja Funeralna, a Warsaw-based assistance company that specialises in repatriating the bodies of patients who could not be saved, The surfeit of bureaucratic red tape and endless form filing that marked the Communist era has now largely gone.

In recent times, tourism has been becoming an increasingly important component of the Polish economic mix and it currently rates as 17th in the list of those countries most visited by foreign tourists.

Emergency medical treatment in Poland is provided by local hospitals through the health ministry’s funding

The country’s pioneering work in the field of medical tourism is becoming an increasingly important component in this success story. The once impoverished and backward country now enjoys an increasingly high UN rating in terms of human development and standard of living. According to a recent Credit Suisse survey, the Poles are the second most prosperous workforce in Central Europe after the Czechs. The country has 40 per cent of the region’s 500 biggest companies.

Despite a number of temporary slumps and other setbacks – not least the recent tragic deaths of President Lech Kacsyriski and 89 other high-ranking Polish officials in an air crash near the Russian city of Smolensk – Poland has set the pace among Europe’s former Eastern Bloc countries in transforming itself from a Communist planned economy into a modern free market economy.

The privatisation of formerly state owned small and medium-sized enterprises has continued apace, while other sectors, including banking, have also been liberalised and new laws have made it easier for entrepreneurs to set-up new businesses. This trend has been especially notable in the health sector where medical tourism has boomed, especially in the field of cosmetic dentistry.

Easy to reach by air from across Europe – and most of them served by low-cost operators – such cities as Warsaw, Krakow, Wroclaw, Szczecin, Torun and Gdansk have become magnets for those seeking affordable private treatment in modern, well-equipped hospitals, clinics and other medical facilities, staffed by highly skilled personnel.

The recent ‘Poland Medical Tourism Market 2013’ projection study by TechSci Research revealed that continuing 15 per cent annual growth can be expected in Poland’s medical tourism sector, with much of it coming from Germany and the UK.

According to the report: “Medical tourists are heading to Poland for cheaper and quicker surgical treatments. The market has been driven by a number of favourable factors, including low waiting times, low-cost treatment facilities and proximity to most European countries.”

The absence of any visa requirements for travel to Poland from within the EU is also helping. Poland’s entry into the EU, in 2004, and the subsequent implementation of standard regulations and policy frameworks similar to those of other member countries, has provided a strong push to the country’s burgeoning medical tourism industry.

As an example, the highly regarded Damian Medical Centre, in Warsaw, offers cosmetic surgery, implants, eye operations and dental treatment at less than half Western European prices. Poland’s spas and health resorts are equally attractive to foreign visitors, with spa residential costs running at least 20 to 30 per cent cheaper than in Germany.

The privatisation of formerly state owned small and medium-sized enterprises has continued apace

It’s now a close-on 300,000 patients per year market and growing. In the opinion of TechSci Research, the pace could be a whole lot faster if a serious marketing and promotional effort were to be implemented: “At present it is just a word of mouth thing,” comments their report. Says a spokeswoman for Medical Poland, a pioneer in the medical tourism field: “Patients are now flocking here for eye surgery, cosmetic work, dentistry and general surgical procedures. We offer them the very best levels of treatment in the most comfortable conditions, with English-speaking specialists treating each and every patient with the utmost care.”