Private Services and the Fragmentation of Maternity Care in Poland

ABSTRACT

As a result of reforms aimed at adjusting it to the market economy, the Polish health care system has become a complicated mix of public and private services. Using as an example maternity services, I show how private services allow a subtle process of patient selection to emerge, contributing to the fragmentation of public care. The process of selection is based on social relations formed between health care providers and patients through the use of private services. This has a negative impact on women who do not have the social or financial resources to engage in private services.

W wyniku reform mających na celu dostosowanie do gospodarki rynkowej, opieka zdrowotna w Polsce przekształcona została w skomplikowaną mieszaninę usług publicznych i prywatnych. Na podstawie świadczeń położniczych, pokazuję, w jaki sposób prywatne usługi zdrowotne stały się „oknami” pozwalającymi na subtelną selekcję pacjentów. Selekcja ta oparta jest na relacjach społecznych nawiązywanych pomiędzy lekarzem/położną a pacjentką przy okazji korzystania z prywatnych usług i prowadzi do fragmentaryzacji opieki publicznej. Proces ten szczególnie negatywnie wpływa na kobiety, których zasoby społeczne i finansowe nie pozwalają na korzystanie z prywatnych usług zdrowotnych.

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KEYWORDS:

• Poland
• consumerism
• inequalities of access
• maternity care
• patient selection
• private/public

Acknowledgments

I thank all the women who kindly agreed to share with me their stories. I also thank Sabina Stan for her invaluable comments, patience and support. I also thank Lenore Manderson, James Staples, Victoria Team, and the three reviewers for their generous feedback.

Notes

1. Over the last decade, some hospitals started to offer epidurals during vaginal births, but many charged an additional fee for this. More recently, many, but not all, hospitals stopped charging and started to offer epidurals as part of the standard care provided under national public insurance.

2. “Designated midwifery care” means that a pregnant woman can choose a midwife who will assist her during labor.

3. In 2017, the average gross monthly wage was just above PLN 4500 (Główny Urząd Statystyczny 2019).

4. “Subscriptions” to particular fully private medical centers are often offered by employers as part of their health benefit plans.

5. My own calculations are on the basis of information provided on the hospital website https://porody.medicover.pl/porod/.

6. My own calculations, based on information provided on GdzieRodzic.info (Gdzierodzic.info | Żeby ciąża, poród, połóg były dobrym doświadczeniem 2019), and hospital websites.

7. “Family birth” is when a woman is accompanied by a birth partner. Until the 1990s hospitals rarely allowed birth partners, but since then family births have become increasingly popular. Until recently some hospitals treated it as a private service and charged fees; more recently, hospitals have started to allow partners to attend cesarean sections, often charging additional fees for this.

Additional information

Funding

This research was conducted as part of the PhD study funded by Research Career Start Grant, Dublin City University, Ireland (2010-2012) and School of Nursing Research Funding for Postdoctoral Staff Grant, Dublin City University, Ireland (2009-2011), PI Dr Sabina Stan (DCU).

Notes on contributors

Maria Węgrzynowska

Maria Węgrzynowska is a social anthropologist who recently qualified as a midwife. She received a PhD from the School and Nursing and Human Sciences at Dublin City University (Ireland) and BSc in Midwifery from Medical University of Warsaw (Poland). Her research focuses on power relations in maternity care and relations between health care and migration. Address correspondence to: Maria Węgrzynowska, Department of Midwifery, Centre for Postgraduate Medical Education, ul. Żelazna 90, 01-004 Warsaw, Poland. Email: [email protected]