|1. Background information
a. MEM populations
Looking at Poland in historical terms, it was rather a country of emigration than a country of immigration. According to National Census 2002 foreigners constitute only 0.2 per cent of the total population of Poland (38,126 mln)1. This places Poland among countries that are rather homogenous with regard to nationality. Representatives of nine national minorities and four ethnic minorities live in Poland:
national minorities: Germans (147 094), Ukrainians (27 172), Belorussians (47 640), Lithuanians (5 639), Slovaks (1 710), Russians (3 244), Jews (1 055), Armenians (262), Czechs (386);
ethnic minorities: Roms (12 731), Tartars (447), Lemkos (5 850), Karaites (43) 2.
Since the collapse of communistic regime, Poland started to attract such categories of foreigners as asylum seekers (4563 applications -10048 asylum seekers in 2007), labour migrants who were granted a work permit (12063 permits in 2006), illegal labour migrants (a blind number – even a few hundreds of thousands) and students. Population of immigrants changes also in regard of nationality. The immigrants in Poland come mainly from the former Soviet Union and also from Germany, USA, France and Great Britain. They are well educated and most of them (80%) belongs to age category “20-59”3.
There are relatively big groups of Chinese and Vietnamese in main Polish cities, which is a quite new phenomenon. From a sending country Poland slowly changes into a receiving or transit country. However, it is still one of the countries in Europe with the lowest number of foreigners.
b. Political context
Polish immigration policy has been being adjusted to European policies. On the 21st of December Poland entered a Schengen zone what has had obvious implications for Polish immigration policy development.
Poles’ attitudes towards emigrants have become more and more positive since Poland joined EU. However, there is a difference between “west” and “east” migrants’ perception. The first are appreciated as well educated specialists and the latter, for example Russians and Ukrainians, are associated with crime and unskilled labour.
According to MIPEX policy indicators Polish integration policies are slightly favourable on long-term residence (the best in the EU-10) and on family reunion and access to nationality (the third best)4. Political participation policies and access to the labour market are unfavourable to integration.
2. State of health
Research conducted in area of health of migrants and ethnic minorities in Poland, have been conducted in majority, in centers of scientific research and government institutions (detailed list below).
Research organizations involved in protecting the health of migrants are:
1. Institute of Social Policy at the University of Warsaw
2. Laboratory studies on the social integration of foreigners at the Society for the Institute of Central and Eastern Europe in Lublin
3. Research Center on Migration
4. Center for Eastern Studies
5. Central European Forum for Research and Migrant population in Warsaw
In turn, the institutions of government dealing with the problems of migration and migrants, are:
1. Office of the United Nations High Commissioner for Refugees (UNHCR)
2. IOM International Organization for Migration
3. The Ministry of Labor and Social Policy
4. The National Health Fund Office of International Cooperation
5. The Council for Refugees
6. The Office for Repatriation of Foreign Nationals
7. Department of Family
8. Crisis Intervention Center
9. Warsaw Family Assistance Center
The results of many of these studies are readily available, because they have been placed by leading research institutions on Internet. There are also specific Web portals on topics on migrants, for example, mighealth.net/pl, www.migracje.gov.pl, www.migranci.pl www.migranci.caritas.pl, www.refugee.pl, www.multikulti.org.pl, www.polacy.gov.pl.
3. Health system and entitlement to care
Polish health care system is based on insurance model. It is decentralized character, and local government has its own health policy. In addition, the local government is an owner of a number of healthcare facilities. The financing of medical comes both from the public
and private sources. The main source of health care budget is mandatory contribution for health insurance, which is so called designated tax5. The contribution is collected from citizens
at 9% of the income, and then distributed by the State-owned National Health Fund and its regional branches. The health system is also supplied in addition by the State general budget and the budgets of local government units.
Citizens policyholders in the National Health Fund have free choice of the family doctor (this is Primary Care doctor) and the specialist hospital, provided, however, that they have a contract with the NHF. Family doctor takes responsibility for the prevention, basic care and supervision of specialist treatment process. The doctor directs the patients to specialist by issuing appropriate referral. Exceptions are: Gynecological-obstetric, eye, cancer, psychiatric, venereal and dental specialist clinics, which can be accessed directly.
Access to health care of refugees is governed by Art. 3, paragraph. 1 pkt.2. Law of 27 August 2004 on healthcare services financed from public funds (Dz.U.nr 210 item. 2135, as amended.). In accordance with the provisions of this law, those who have been given refugee status in Poland obtain simultaneously status of an insured person. This law means that refugees have a right of access to health care services, as defined in the Act of 27 August 2004 on healthcare services financed from public funds (Dz.U.nr 210 item. 2135, as amended.).
Refugees (in general - with no breakdown by status)
access to health care in centers for refugees. Primary care treatment. If specialist treatment needed a referral from primary care doctor to specialist.
Free medical care
On the basis of referrals issued by a doctor in the center for refugees specialist or hospital treatment.
Free medical care
Accessibility and quality of care
Research conducted by Polish research institutions seek to identify all the barriers in the access to health care to immigrants and representatives of ethnic minorities. Occurring since the late 90' legislative and administrative changes in the Polish system of health care while aim at improving the quality and availability of health care not only for the citizens of our country, but also for persons temporarily staying in it. But through endless revisions and amendments do not facilitate migrants move within the system.
Conducted among migrants studies have shown that the main barriers impeding access to health care is the need to overcome physical distance. The problem is primarily concerns specialist care. Immigrants who stay in our country, despite well-organized public transport, have a significant problem with mobility and have difficulties with going to a distant specialist (eg due to the location of the specialist clinic in another part of town). 6
Among the immigrants arriving in our country, there are also problems in obtaining reliable information on the availability of medical services, because healthcare workers are sometimes insufficient on this topic. Over the last years the reform of the health care system and the continuing changes in the regulations and financing of the medical services are such that healthcare workers are not always well-oriented in the current regulations and do not always provide accurate information relating to the availability of medical care.
Research also shows that migrants were dissatisfied with waiting for medical services in line, and the lack of access to public assistance specialist without a referral from their family doctor 7. It should be noted, however, that in same situations are all inhabitants of Poland
To remedy insufficient information special brochures are produced in various languages and information is placed on the Internet for foreigners seeking medical care.
Despite the identified barriers, access to healthcare by migrants, in many cases can not be easily improved, because of the governing Polish health law, obligatory for all insured in the Polish health system (for example, a need to obtain a special referral to a specialist for the visit).
6. Measures to achieve change
Despite a fairly homogeneous ethnic structure of Polish population, and as yet, relatively small choice of Poland as a country of destination of migrants, our country by following best practices, seek the MEM medical care standards, which are obligatory in EU. Current Polish legislation precisely regulates the scope and method of financing health care for MEM, and all the changes of the law are designed to bring it, as much as possible, into line with the law in countries of the European Union.
In Poland, interest in the medical care of migrants, ethnic minorities and refugees is produced mainly by government and non-governmental organizations. Also, some, albeit few, scientific research centers deal with the problems of health of persons permanently or temporarily staying in Poland. These centers also usually participate in international projects such as IMISCOE, COST Action, Mighealthnet, using the experience of the countries in which the problem of medical care of immigrants has long been recognized. It is not without significance, that great interest in immigrants is shown by journalists and columnists who devote their attention to social care of persons residing in our country. It appears, however, that substantive changes in the quality of health care for migrants will occur only after the stabilization of the entire health care system and will be forced by increasing flow of foreigners to Poland.