EGALITARYZM CZY ZASADA POMOCNICZOŚCI W FINANSOWANIU OPIEKI ZDROWOTNEJ
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Date
2008
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Wydział Prawa i Administracji UAM
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EGALITARIANISM OR THE SUBSIDIARITY PRINCIPLE IN THE FINANCING OF HEALTH SERVICE
Abstract
The progress in medicine has given rise to a rapid increase in the costs of health care, and today
many states are finding it increasingly difficult to finance them. Although financial difficulties are
primarily encountered by poorer states, those with more means are also beginning to feel the burden
of high cost o f medical services. Therefore, it will not be out of place even to suggest that we are
currently experiencing a crisis in the financing of health service.
This crisis has been the result of the egalitarian manner in which medical costs have been
reimbursed or covered from public funds in a system in which everyone, regardless their financial
status, has been an equal beneficiary of the system. Despite continued efforts to repair the existing
status quo in health care, not much has been improved, and the few reforms have not changed much,
save for a decision to increase public funds for medical services (which usually also meant higher
personal health care contributions) or an introduction o f organisational changes which only
marginally improved the situation. However, as experience shows, such measures are not
a satisfactory solution as they are incapable o f stopping the growing costs of medical treatment, or the
pathologies generated by the egalitarian system of financing the health care sector.
In the author’s opinion, the only solution in this crisis situation is replacing the obsolete system
based on the egalitarian beliefs with the principle o f subsidiarity. According to that principle, the costs
of ALL medical services should be refinanced fully from the public funds but only and exclusively in
the case o f those patients who really need them and cannot otherwise afford them. Further, it should
be of secondary importance whether the institution which has provided the service was public of
private. The remaining citizens should be obliged to participate partially or fully in the cost of
treatment, while the existing health care contributions should be classified as the tax for the poor.
Only such a solution seems to be logical, just and fair, and not causing a permanent havoc to
public finances. Its implementation would, however, require an amendment to the Constitution of the
Republic o f Poland, and more specifically its article 68 clause 2. Following that, a number of little
popular but necessary, and very difficult detailed issues would need to be resolved and implemented.
All we need is hope that a brave legislator will eventually undertake to implement the necessary
long-term reforms in the best interest of the state and its citizens.
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Ruch Prawniczy, Ekonomiczny i Socjologiczny 70, 2008, z. 2, s. 23-30