Tuesday, January 17, 2012

Wolves in white coats

Polish pharmacists have now joined doctors in protesting against the new prescription drug refund law. For the good of the patient, naturally.

Pharmacists are closing their doors for an hour a day. Some are refusing to fill any prescriptions unless life threatening.

Doctors' refusal to decide the level of refund in line with the new law means pharmacists are afraid they will be left to pay if a drug is refunded for the uninsured.

The new law was to make doctors accountable for deciding how much the state will refund prescription drugs and make them pay if a patient was refunded but was uninsured. The government has already bowed down to doctor pressure, though they continue to protest. For the good of the patient, naturally.

The thing that irks me is that pharmacies in Poland are little more than purveyors of aspirin, cold medicine, vitamins and French cosmetics. They have gone through a dramatic transformation in recent years in terms of renovation and presentation.

Unfortunately, the focus is profit, not patients. In the search for medicine that is not super common but not uncommon either, I have personally gone from pharmacy to pharmacy only to find none of them sell it. Today, I went to one pharmacy that said on the door it refused to fill prescriptions and then naturally didn't have what I needed. They did have a lot of vitamin c, however.

I think Polish pharmaceutical market needs to be radically opened up. Supermarkets have to be let into the vitamin, OTC and related markets. Pharmacists can work at pharmacies specialising in prescription drugs. The rest we can buy where we like or where is cheapest.

Pharmacies like to pretend they have some sort of special relationship with the patient. That's why they wear the white coats, I guess. But next time check out the stationary they are using. It'll invariably be from one drug company or another. Profit is the motive.

I have no problem with this. But if profit is your overlying motive, as is obviously the worry in regards to the drug refund protest, let's make it a real business, open it up to supermarket competition, drive down prices, shift lineups for stuff that does need a specialist to prescribe, and shorten lineups for those that really do need prescription drugs and a little better care.

Friday, January 13, 2012

Tit for tat

Poland's ruling coalitions fight and stab and bicker and cat-fight and tussle and pull hair and kick at each other. The lack of this truculence made the Civic Platform (PO)-Polish Peasants' Party (PSL) ruling coalition in 2007-2011 so strange. But let bygones be. The fights are back.

The PSL was the first to take off the gloves. Prime Minister Donald Tusk presented the new PO-PSL government's often prickly fiscal and economic reform plan in mid-November. Problem is, the prime minister doesn't seem to have consulted the PSL.

The PSL has since the speech opposed seemingly all of it. The PO wants to raise the retirement age to 67 for men from 65 and for women from 60. The PSL calls this barbaric. It instead wants women to be able to subtract three years for each child birthed from the statutory retirement age. If you have 10 kids, technically you could retire at 37…just to be clear, the PSL is mum on the level of retirement benefit.

The PSL doesn't want soldiers, police officers and the like to lose the ability to retire after 15 years of service (I once met a 40-year-old pensioner, though he was working). The PO wants a minimum of 25 years and a minimum age of 55.

The PSL doesn't want farmers to pay much in health-care contribution. The PSL didn't want the amount employers pay for a workers' contribution for disability payments to be raised. It is skeptical of capping local government deficits, tighter EU integration and Poland lending 6 billion euros to the IMF.

PM Tusk has found the PSL's conduct infuriating. In late December, he even said that if the PSL didn't back the reform plan, it was hard to talk about a future for the coalition.

But Tusk might have the last laugh. The PSL violated the electoral code for an infraction in the 2001 elections. It was ordered to pay 20 million zloty, including 9 million for the actual violation and 11 million in interest. Finance Minister Jacek Rostowski was able to forgive the repayment of the interest. Surprise, surprise, he ordered earlier this week the full amount to be repaid.

Your move PSL.

Monday, January 09, 2012

Speed traps to help out budget?

Finance Minister Jacek Rostowski wrote a recent "love" letter to European Monetary and Economic Affairs Commissioner Olli Rehn in which he outlined how Poland would reduce its budget deficit as fast as demanded by the European Commission. Rostowski did chastise the EC for a lack of "transparency" -- the Finance Ministry is clearly so transparent -- but for the most part it was boring public finance stuff…until the statement "a newly introduced road speed enforcement system should yield further revenues, estimated at 1.2bn PLN in 2012."

Ahem, excuse me, but the police are going to raise 1.2 billion zloty from speeding tickets? Jesus H Murphy.

Recent data said there were 18 million cars. Though this doesn't include trucks and buses, it would mean some 67 zloty per car in speeding tickets just in 2012. Let's say with trucks and buses some 50 zloty a head.

But babcias tend not to drive overly fast. There are also more and more less experienced drivers who follow the "drive defensively" rule. I thus have the feeling speeders -- little old me, perhaps -- will be stumping up a little more than others for this one.

Boy oh boy am I happy to be ready to help Poland meets its budget deficit goals when a secretary at a mining company can retire at 35, farmers don't pay health-care, social security or taxes, and the government drives the latest BMWs.

Wednesday, January 04, 2012

Prescription for change

Be careful of what you wish for. I urged the government to bust a gut and get cracking. The good news is they did. The bad news is that it has been a disaster.

The new year brought with it joy for all (I'm sure) but also far-reaching changes to the way the government refunds prescription drugs. Doctors are now obliged to say which drugs are refunded and by how much. If a patient turns out not to have public health coverage, then the doctors are liable.

Doctors are not happy about bearing responsibility for what appears to be a bureaucratic decision. Instead of saying how much a prescription should be refunded, they are stamping them with a statement that the decision is up to the National Health Fund (NFZ).

So, a poor patient gets the prescription for some life-saving drug, gets the NFZ stamped version and goes to the pharmacy. The pharmacist doesn't know whether any refund will be honoured with such a stamp since it technically violates the law. Some pharmacists are thus refusing to give any refund in case they are liable one day.

Leaving aside controversial changes to the prescription drug refund list, the above basically sums up the problem. As always, who gets screwed in the end? We patients.

How do you know something in Poland is important? Prime Minister Donald Tusk holds a press conference.

Tusk met doctors on Wednesday and later announced that room for a compromise existed. Though he was sure to blame the whole mess on doctors, noting there would be no problemo if doctors had followed the law, he said he would work toward suspending any potential fines for drug refunds until a national insurance system was up and running. . .

. . . Erm, wait. There's no such system already? You wanted doctors to vouch for a patients' insurance coverage even though there's no national registry or easily searchable database. Hmmm. Maybe this could have been done first.

Monday, January 02, 2012

Get to work!

No more lollygagging. No more dragging your heels. No more saying you can't do anything because the president is bad or the opposition is bleh or there's a crisis. No more excuses. The moment of truth is at hand.

For the senior ruling Civic Platform (PO) it is crunch time. Prime Minister Donald Tusk appears to understand this. His plan for the next four years laid out in mid-November comprises an ambitious agenda that would address a lot of economic and fiscal problems, both short- and long-dated ones. It deserves praise and indeed got it.

But how can one not raise the question of execution risk. Or, how can one believe a government that found a lot of reasons to not do anything in the preceding four years and precious few arguments for doing something.
The next three months will in fact already provide a good measure of whether Tusk's promises will be more than paper tigers and will help Poland become a Central European eagle.

In a just approved government plan, January is to start a busy first three months. The government will kick off with taxing copper and silver mining and then change the way the 9mn or so pensions are indexed. For February and March, the government wants to change tax breaks to effectively increase the tax burden, limit the free-spending ways of local governments, limit baby payment eligibility, limit early retirement eligibility for soldiers and police, and raise the retirement age to 67 from 65 for men and to 67 from 60 for women.

Some progress has already been made. Already in December the government increased the amount employers must pay for their employees' disability contribution by 2 percentage points in a bid to raise some 6-7 billion zlotys.

The European Union economy remains on the precipice regardless of the fact we have all enjoyed a couple week break. The global economy's prospects are tough. Consumer and broad sentiment is grim. In such bleak times, reform strength and stamina could be the difference between buying in and selling off. So, I say to the government, get to work.

...After a famine of Poland X posts in December, I pledge to also, er, get to work ...Happy New Year all.