Could a reduction in health premiums hurt hospitals? Episode 101

Tomasz Kopiec
There is not enough money and there will not be enough. Anyway, I think Barack Obama talked about the fact that the health care system, any health care system will absorb any amount. Right now it's that difference between deaths and births is already 170,000, I think.

Monika Rachtan
What should the president do once this bill is in his hands? Should he sign and agree to lower the health premium, or is it still worth discussing?

Tomasz Kopiec
It is an interconnected system. So the mechanisms developed in the right way today will result in lower costs for this system in the future with fewer people paying into the system. This is yes, it has to be done. It's not just a matter of access to cheaper land and creating more private housing estates, but it's about providing that access to basic healthcare, good basic healthcare, effective diagnostics and just creating crèches, kindergartens. It encourages people to move away from these urban areas and the city centre towards these more remote areas.

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme. First of all, the patient. There is an ongoing debate about whether health premiums should be reduced. We are well aware that there is a shortage of money in our healthcare system. How will this reduction affect the health of the National Health Fund? This is what I will be discussing with my guest today, and it is Tomasz Kopiec. Good morning, and a warm welcome. Doctor, well, what should the president do once this bill is in his hands? Should he sign it and agree to lower the health premium, or is it still worth discussing?

Tomasz Kopiec
I think that a discussion is needed, because on the one hand we certainly have to recognise the interests of entrepreneurs and the desire for them to bear lower, lower costs after all. On the one hand, it is necessary to recognise the interests of entrepreneurs and their desire to incur lower, lower expenditures in connection with the health care contribution, especially the local, small entrepreneurs. On the other hand, we have actually lost almost PLN 5 billion.

Monika Rachtan
Well, 5 billion. Is this a lot in the context of how much the budget of the National Health Fund currently amounts to? How much do we spend on health?

Tomasz Kopiec
Well, that's not particularly much, as if referring to the entire budget. In fact, it is over 200 billion, a record amount by the way, which is earmarked this year for financing health services. But please remember that this was more or less the amount we were discussing when the year 2024 was coming to an end and the liabilities for overcontracting had to be covered. And here this money was not available. Further transfers had to be made in the state budget in order for these funds to be released to the National Health Fund and to secure these payments. After all, they were not all paid for in many cases either.

Monika Rachtan
Mr Tomasz, and I will ask you about the mood of the medics, because you are the director of a big hospital in Warsaw and you can see in what condition your budgets are. Do you hear that there will be less money? Although, of course, the Minister of Finance assures you that this PLN 5 billion will be in the NFZ budget. So purely economically. Could this harm hospitals? Could it turn out that there will not be enough of this money again?

Tomasz Kopiec
You know, if we look at the obligations that come from the successive pieces of legislation that are coming up and the ones that are already in force, which impose on us at least in the middle of the year to raise salaries again, there is indeed not enough money and there will not be enough. Anyway, I think Barack Obama talked about the fact that the health care system, any health care system will absorb any amount. And it's a bit like that. I mean, we are indeed short of money, wanting to fulfil all the obligations we have, not only from the point of view of, for example, those I mentioned, the increase in salaries, but we are facing huge investment challenges related, for example, to the KPO, in which the hospitals themselves have to cover the VAT arising from the funds they obtain for any further purposes they want to finance. We have powerful tasks ahead of us related, for example, to cyber security and what is happening at the moment. From the point of view of the risks, because on the one hand there are funds from the NIP, but on the other hand the conditions of participation in this competition raise doubts as to whether the majority of hospitals that are even qualified will be able to use these funds, because only 300 entities are qualified for this funding and we have 800 or so in the market that would probably like to apply for such funding.

Tomasz Kopiec
So yes today money in the system every amount is needed to meet objectives, both those arising from day-to-day operations and investment needs.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan. Invited.

Monika Rachtan
There is a lot of talk in the public discussion that the NHF is running a bit on the dash, that there is already a shortage of this money and that this deficit will be huge in the years to come. There are unimaginable amounts. What should be done so that there is more money in the National Health Fund? Or, in general, does it make sense to increase the funding of the NFZ, or would it be necessary to tighten up the system in some way, to spend this money better?

Tomasz Kopiec
I think it is the latter thinking that is closer to me. That is, the discussion about how better to spend the money that is, I mean, we could endlessly increase these needs. On the other hand, one should wonder whether the way we are spending it is the right way. And this is where we should start the discussion, because firstly, let us remember that we know very well what demographics look like. We are getting older, there are fewer and fewer of us, and therefore the outlays we are going to make on health care will affect a smaller and smaller group of people, which means they will systematically increase anyway. Therefore, we should consider whether, if they are growing, we should reallocate this flow of money or move in a different direction, including towards prevention. I am enthusiastic about prevention, both the prevention that we do at the level of inpatient treatment in hospital, but also the prevention that I think should be happening in health education itself.

Monika Rachtan
In the home of every Pole.

Tomasz Kopiec
In the home of every Pole. There, we should develop the mechanisms that will teach us how to manage our health more effectively.

Monika Rachtan
Mr Tomasz, but I said in one episode that I rate Poles' knowledge of health education as one minus, because I think that each of us can talk a lot about our health, but the moment we get caught up in the system, when we have to go from being a citizen to being a patient, we very often get stumped and we don't know which way to go at all, because we haven't been in that situation. Example. A cancer diagnosis. Patients are completely unaware of how, what the next steps are. In fact, they just count on what the doctor says and follow what the doctor says. They are not able to move in any direction themselves. So is all this discussion about health education, about prevention. I have been discussing this for nine years with experts and in my opinion nothing has changed in the home of the Poles. Do you have, do you have any idea how to mobilise maybe in financial terms us to want to use the preventive care that is given to us by the National Health Fund? The example of the 40+ programme, where Poles did not go to get tested.

Monika Rachtan
Prevention programmes where women do not go for mammography. How do we mobilise? Is financial mobilisation a good idea here to make us live healthier?

Tomasz Kopiec
I put forward such theses some time ago, to differentiate between issues such as insurance. Make such a premium dependent on regular examinations. I think that occupational medicine should be involved in this, i.e. that we should actually make payment dependent on regular systematic examination, which would be confirmed in the system, as in the Scandinavian countries. These examinations should, of course, be dependent on the age at which we are. This regularity should be increased. The older we get, the more we certainly do not fulfil the potential of occupational medicine. And where I can, I talk about it, but also awareness. I teach students at the Medical University of Łódź and I see that this awareness, if it is even with students, is no longer with their parents. There is a discussion about healthy food, for example. I always like the healthy food shelves in the shops. I wonder about that, then the other food in the shops is unhealthy. I understand, but it is. One of the elements of the classes I teach. There is just a discussion about the composition of these products that are on sale and in these small shops, or in the bigger ones, the large format ones, and there we actually do not read at all, we do not think about what meals we are taking in.

Tomasz Kopiec
The role of junk food somewhere these fast foods, they affect our health and we also don't discuss how lamentable the effects of this food are.

Monika Rachtan
But I also noticed recently, if we are already talking about nutrition of Poles, that it was once said in the media, it was said that kebab is the healthiest fast food. I absolutely do not agree with it, and I do not think we should consider healthy fast food and unhealthy fast food; fast food is simply unhealthy. However, how many kebab stalls have sprung up in my area is. Recently walking past such a stall I was thinking Jesus, who eats there? Well, I can't imagine. I don't eat meat, so there's absolutely nothing for me there. On the other hand, I wonder what kind of Polish person, who reasonably cares about their health, would go to such a place and order a kebab? If there are so many of these stalls, it means that we don't eat it once a month, but probably twice a week. Again, where is the error here? Is this communication in the media missing? Is the message missing? Is no one mobilising us to eat healthy? Well, because if that's how we choose, well, I don't know if it's a lack of awareness or if it's just laziness.

Tomasz Kopiec
I think there is a lack of awareness, but it has to be a profound social campaign, conducted for years, which will make us aware of the risks that are associated with not eating properly. It is a matter of gamification, which should encourage Poles to start moving, if only through the points they earn in individual applications, because if we don't eat healthily, we should at least move, So that there's a chance to burn it off in some way, whether it's those 10,000 steps, 15, 20, or all sorts of other health challenges that we do for ourselves, But yes, this discussion of the relationship between unhealthy eating and these health-promoting behaviours should be exposed somewhere, and we should certainly discuss it in this way. But what you mentioned, the 40+ programme has not been very successful, let alone when we discuss health education and what happened quite recently, which is to make health education not a compulsory subject.

Monika Rachtan
Do you think it should be a compulsory subject?

Tomasz Kopiec
I absolutely believe that it should be a compulsory subject. We need to raise awareness of the concepts, we need to teach semantics so that kids at this point know and are even able to influence their parents. A good example is my child who smoked years ago. Cigarettes, who said Dad, I want you to live a long life. Therefore, stop smoking. I as a result of this appeal.

Monika Rachtan
It resonates, doesn't it?

Tomasz Kopiec
That is how it is. I, as a result of this appeal, actually gave up smoking after many years of smoking, convinced that I was actually forgetting that I was not just living for myself, I was also living for her and for. For possible grandchildren. Therefore, this discussion needs to take place at the family level. What you mentioned, but it has to, it has to come out of the level of actually thorough education, blending in. As I say, into health management as a key element. If we leave the choice today, and health education will probably be the last lesson, probably and it takes place on Friday. Therefore, naturally the kids will not choose. Yes, I regret that the sexual component of this sex education, let's call it controversial, I don't want to judge it. He influenced the fact that the other very many points related to health education did not become compulsory. Perhaps we should have simply excluded the sexual component at this point, made it optional, and made the other elements compulsory. We absolutely have to discuss health and its quality and health management for the future.

Monika Rachtan
Do you think that it is how politicians shape the issues related to health premiums? With health education? I will honestly admit that as a woman, as a mother, this promise of health education in schools was a reason for me to make certain choices when electing a particular party. And I have the feeling that I was cheated, because it wasn't done the way I wanted it to be done. When a presidential candidate, who I thought was a rational person, says that health education doesn't have to be compulsory, I just felt like throwing a tomato at the TV when I heard that. And I wonder how much the politics and the election campaign we are in today determines our health. And that's for many years to come, because there is still no good opportunity to introduce decent health education in schools.

Tomasz Kopiec
And let me put it this way I have lived half a century already. And this encourages me to make observations about not connecting the election campaign with what happens afterwards in the political discussion and the possible effectiveness of the legislation introduced. These are two different realities.

Monika Rachtan
But it seemed that this health education was the sort of thing that wouldn't hurt anyone. Well who would have thought they would be arguing about health education?

Tomasz Kopiec
Well, I mean, you know, I think that politicians today, in this situation of such powerful geopolitical tensions, but before that, they can argue about anything.

Monika Rachtan
As you can see.

Tomasz Kopiec
As we can see, as we know. However, this is important. I mean, I would not want to transfer our responsibility for health to the level of politicians, because then it will certainly not work out if we are not able to. If we, as parents, are constantly signing waivers so that our children do not take part in sporting activities for various reasons, and this is what is happening, and we hear about parents dismissing their children from sporting activities and not encouraging them to exercise, then this will actually translate into a deterioration in our health. And what will translate into higher costs for the health system as a result? We will therefore be introducing remedial medicine all the time rather than preventative medicine and, as a result, the cost to the system will be much, much higher and we will not be able to keep up with the declining demographics of Poland to cover such a massive cost.

Tomasz Kopiec
So it is an interconnected system. So the right kind of mechanisms educated today will result in lower costs for this system in the future with fewer people paying into the system. This is so, this has to be done.

Monika Rachtan
Mr Tomasz, it seems to me that we talk about children's health education all the time in this discussion on health education, but from what we see, from what you have also said, it is our children who do not need this health education at all. It is this group of 30, 40, 50, 60-year-olds, people who are de facto still active and who decide how we educate these young people. They are the ones who need health education, and we are the generation who have not been educated. I remember, in high school I went to a biology and chemistry class and next to every system of our body there was a section last, last page on diseases. And it was done in such a way that we were learning different processes, concepts and this last was, this last page and our biology lady always said and this is what you read, you won't get it on the test at home. So I feel like we're the kind of generation that hasn't been educated at all, and yet we've been thrown into the internet, where it's full of fake news, full of misinformation and we're the ones who should educate ourselves first.

Monika Rachtan
But then what is it that health education teachers have to do with us? Come home and make us read books about how to live healthy?

Tomasz Kopiec
Surely it will be better this way than the builders who remind on the internet, They talk about how to treat cancer patients. And that's unfortunately the drama of such people finding a hearing in society. But you know, I mean I think any way would be a good way for us to improve the awareness of our choices, those especially pro-health choices, or at least be aware of how we were degrading our health and how that was affecting at least our future morbidity. But yes, I mean I think we should at least at a level. And here there is a big role for the local government to remember that the local government in its budget has funds for prevention and health promotion, if not at the central level, then at the level of the local governments, at the level of these local communities. We should indeed be discussing the implementation and, above all, prevention, or at least health education. Even at the level of such weekend, different kinds of events organised that will raise, raise our awareness. We already know that mammobuses, for example, are not particularly popular. In one country, mammography examinations have recently been abandoned altogether, as they are considered to be very painful for women.

Tomasz Kopiec
But even if one were to consider that mammography was in some way actually improving the awareness of women in Poland, please note that offering mammography screening to people in rural areas during the harvest season was sorely missed, and later there was a crackdown on the fact that ladies were not taking part in screening. You have to adjust to the rhythm of work in the areas, in the rural areas. But I think there is a big, big role for the managers of the communities, the local ones at the level of the municipalities, at the level of the districts, to make the inhabitants aware, to make them aware and to encourage them to do so, because, after all, they pay taxes to these municipalities. It is from these taxes that the municipalities develop. Again, these municipalities are running campaigns to encourage people to settle in the municipality. Today I think it is necessary to approach. We call it public health, such a habitat approach, but. But to sort of encourage that, alongside health, to build at least incentives for young families to start having children, because I have a massive problem with births. Yes, at the moment it's this gap between deaths and births is already 170,000, I think.

Tomasz Kopiec
So let's not just manage health from the point of view of what is happening now, but let's think about how we will manage health in the future, already for those new residents, already in terms of how families want to have children within the individual municipalities. And here the systems need to be more developed, not only from the point of view of access to primary health care or some basic hospital provision, but also from the point of view of crèches and nursery schools, for example.

Monika Rachtan
I think this determines Polish women and Polish men. Young people do not decide to have children very often. Recently, I have come across a statement where a girl says that she does not want to have children and that this is her decision, without arguing it in any way, but I wonder whether this factor just related to the availability of crèches, kindergartens, medical care, does it decide, or whether there are other reasons. Maybe this geopolitical situation.

Tomasz Kopiec
It is one element of having a conversation with students about this. I like to have such discussions. Alongside health dedicated to why things happen, I ask questions, we divide into groups, we discuss in such debates in class and that is certainly one element, that is, this care for. Whether it's access to nursery places, access to pre-school, childcare, which later on, with actually, If they appear still. Single motherhood appears, then here too there is a massive problem of how to manage your time, how to use it, Because employers also do not create conditions and do not exactly go along. Maybe those who are in better financial shape.

Monika Rachtan
Or they have experienced the situation themselves.

Tomasz Kopiec
Exactly, they can answer that. So this problem is more complex. But this system of incentives for that should definitely exist. I think it is a bit easier to manage this in smaller communities. I know some municipalities near Łódź, where I come from, which manage this very well and, in fact, this causes migration from the big city to these smaller, in this ring of Łódź, places. It's not just a matter of access to cheaper land and creating more private housing estates, but it's also about providing this access to basic healthcare, good basic healthcare, effective diagnostics and just creating crèches and kindergartens. It encourages people to move away from these urban areas and the city centre towards these more remote areas. And I think this is the direction, but it is the managers of individual, as I say, municipalities who should build multidimensional and, I think, much longer-term strategies than just one term of office. Health strategies.

Monika Rachtan
It's also difficult and simple, because if we have these terms of office in the local government, we can see that here there is an idea, there is a concept for it, and when this power changes all the time, it's difficult to establish some single plan of action, some proper plan of action. But I got curious about these discussions with the students. These debates and deliberations, because I think we should listen to the voice of young people, and they will tell us what they expect, and we should somehow open up to these expectations and find solutions that will help them simply live better. And students are talking about lowering the health premium. How are they approaching this? Do young medics touch this topic at all? Do they even think about the fact that they will be seeing patients on the National Health Service and everyone says they will have private practices?

Tomasz Kopiec
They are not aware of this. Believe me, our education system is not causing this in the education system. At medical universities, the health care system is not discussed extensively and its foundations are not explained. Unfortunately, and I regret to say this, it would actually be necessary to deepen the knowledge. Of course, there are those who are interested, who will always want to go to this, to this source, but for many young people, for many young students, they do not understand what the health care system is like and the problems that exist in it, they mainly touch on the issue of remuneration, that is, whether when they enter the system, whether when they practise a particular profession in the future, it and in some way it will be regulated by some legislation, What will be the minimum salaries? What benefits will they have by entering this system without thinking about how complicated this one is. What are the problems affecting the health system at the moment? Then this education. I have had the opportunity quite recently, and have been for some years now, to be such an enthusiast among the young people at the university of discussing that every academic year should end with an Oxford debate between the graduating, graduating classes, and that there should be a letter every year, which will be addressed from the university, and indeed these students to the Ministry of Health, saying this.

Tomasz Kopiec
We would like the system to look like this, like this or like this.

Monika Rachtan
A very interesting initiative.

Tomasz Kopiec
To make this voice heard and to ensure that, above all, graduates in medicine or paramedicine or physiotherapy are able to exchange their insights among themselves. So different, after all, because they will fill different roles in this system. But they should understand each other's positions, because today the system is a system of communicating vessels, with different professions coexisting, and we know how they are divided up, for example in parliamentary or senate committees, when we discuss the classification into particular groups due to the increase in the minimum salary. Something that has been going on in the system for several years now. And these people do not speak with one voice, often not understanding each other's arguments. They show all the time that it is nurses or doctors who are more important, nutritionists have been left out altogether. Physiotherapists or diagnosticians also raise their arguments. So it would be worthwhile today to start speaking with one voice and to understand and identify the problems of the health care system at all. If we don't do this at university level, well, I'm afraid that later on it will be a bit too late and those involved will of course want to know.

Tomasz Kopiec
In fact, I see such discussions which we have in the hospital with doctors, when they come with me and discuss individual pay rises or how certain things should be financed, or at least how investments should be made in the hospital, here I have to explain at length, often, the principles according to which a public hospital operates, especially to people who work in private, often medical businesses, and who only residually, sometimes involve their time in the public system. With them it is most difficult to understand that we are operating under the rigours of, for example, public procurement law and the investment process takes much longer than a private clinic, which makes decisions here and now to go for a particular technology because it is attractive. We would also like to do it this way, only we have to get it through the social council, we have to adjust it, we have to put it in the financial plan. We have to have the funding, we have to do a tender or just the mode, use the competitive procurement mode. This is dragging on. Yes, it drags on, it goes often in a month and if we have appeals and other things, it sometimes stretches for example.

Tomasz Kopiec
Up to six months. And this is a powerful problem today of being competitive and this competition that is between public and private hospitals.

Monika Rachtan
Whether in fact privatisation, partial privatisation is the solution here. Do we need a strong minister or health minister who will look at these problems and know the system inside out? Do we need the kind of manager who simply comes in from a hospital where the debt has been wiped out? A hospital that is making money and functioning well, talk about a public hospital and will be able or able to reach out to those hospitals that are still in debt, that are still failing, because there is clearly something missing here.

Tomasz Kopiec
I think it is to answer the first part of the question, that is, the health system is actually made up of private and public actors. I have been involved in such a debate a few times on the fact that there is actually a synergy between the two. Some of the money should actually go to the private system on an equal footing with the public system. I am in favour of this as much as possible, provided that the same tasks are performed by private public entities. That is to say, if we differentiate something on the level of ownership only, then we have private owners and a public owner, and they are to have equal access to services, to funding from the NFZ, then they have to be provided with the same tasks, because I save lives today by having an ED or an emergency room. Private entities often do not, because these are services which are cost-intensive, and a private entity which is not bound by contract with the National Health Fund can quite freely choose the services it wants to provide, even if the patient comes to pay for them commercially. I, on the other hand, have to provide the whole spectrum of services, or in fact all of them, which, which refer the patient to our facility.

Tomasz Kopiec
So only if we are to have a similar or the same funding mechanism from the public side, surely the same responsibilities we should also have, and not just cherry-picking partial things. As far as the minister who goes to. And we have had some really great ones in the past. These are not people who are unaware of the problems of the health system, and we have discussed this many times with all possible ministers. I say we as managers of the health system. These diagnoses and many of them have arisen. On the other hand, there is the question of political agility, of course, and a strong minister will not solve the problem. This discussion should take place much more broadly, that is, at the level of political parties dedicated to dedicated solutions, to specific people who. Find support in the majority of their camp of origin and build. Building a long-term health strategy for the state. It seems to me that today we should. I often say this, but we should no longer be discussing how to repaint the room once again. What we really need to do is to completely overhaul the way it works. For example, with this financial incentive that you mentioned.

Tomasz Kopiec
That is, to shift some of the responsibility for the health care system onto the patients, because today it cannot be that those people who are healthy pay an equal premium with those who are very ill and consciously degrade their health by, for example, choosing to smoke, choosing some kind of stimulant and their treatment costs a fortune.

Monika Rachtan
I repeatedly say, when I am at the National Cancer Institute, for example, that I have great heartache when I see cancer patients smoking in front of the Institute building and yet receiving such expensive treatment that stands next to that patient and that patient continues to waste their health. But I have heard it said recently that nicotinism is a disease and that we should treat alcoholics just as we should treat people who choose to take drugs, so the person who smokes is also on an equal footing with the system because they are guaranteed that by the constitution and that they are simply sick with nicotinism. Therefore, nicotinism and the consequence of nicotinism, namely lung cancer, must be treated. And I internally disagree with that, because I think that a person who. Another thing I have heard is that a person who smokes cigarettes pays an excise duty when they buy them. It's just that from this excise duty the money does not go into the health system.

Tomasz Kopiec
Well, exactly. That is to say, let us then consider that we are equating all possible stimulants in such a way that if anyone is addicted to anything, it should be considered a disease. Well, be that as it may, then let us simply introduce a catalogue of all stimulants. In fact, let us tax all stimulants, and in fact some of the money goes straight into, goes into the budget at the moment for this treatment.

Monika Rachtan
I think if we solved this wisely by introducing really high taxes, firstly the number of addicts would drop dramatically. Secondly, we would also have a lot of money in the National Health Fund.

Tomasz Kopiec
Or there would be a grey market and contraband would be created. It was also the case, unfortunately, that as the price went up there was this other, second market. Because the problem is, I think, people's awareness. It's simply that addicts have to want to stop being addicted. I mean for them. We are not going to figure out how they are going to stop being addicted. I will cite my own example and that of my child. So it is simply that there are some people who will always smoke already. But those who don't smoke should have a privilege in the system and if we can't induce it at the level of actually the constitution, that is, to privilege those people on, for example, access to health care, then let's privilege those people in paying the health premium or in having this regular check-up saying that if you actually take care of your health, manage your health in a skilful way, you can always, there can always be diseases, we don't discuss that. But if you regularly examine yourself, if you regularly do laboratory diagnostics, imaging, if you inform the system about your health and you can see that you are doing that, well then have some relief from that.

Tomasz Kopiec
Yes, and it seems to me that this is how it should be structured. Punishment will always have a bad connotation and the state will get away with it. On the other hand, the relief that comes from behaving in some way above the norm. I think it would be much more beneficial and would encourage the fact that, by simple means, we would pay less, lower taxes, or our tax-free amount would increase. This could be constructed in various ways. On the other hand, this type of system would certainly influence the health-oriented activities of many people. Especially because today, if we want to, and as many people, including my friends, get older, this awareness is growing, I see it that way. I have colleagues who are becoming more active. They are dropping weight, they are starting to eat, to eat healthily. Of course, there are also people and there are exceptions where it works the other way round. What is to be deplored is actually the increasing number of people with diabetes and these obese people that we have in society.

Monika Rachtan
Well, that's right, and it's a very big threat.

Tomasz Kopiec
Well, but then again we are discussing the issue of health education.

Monika Rachtan
That's right.

Tomasz Kopiec
And these eating habits, among others.

Monika Rachtan
We met today to talk about the health premium, because the discussion in the media is very heated. Should this 5 billion be taken out of the budget or not? But it seems to me that this 5 billion is such a drop and a bit of a substitute topic for the election campaign. And this discussion about the system is what politicians should be discussing today, just as we are discussing today the deep problems that really plague our system. That's what they should be discussing. And that 5 billion seems like a total nothing when you look at the amount of problems that, that affect the system. And is it like that, because probably like me every 2 3 days you sit down at a round table, there is a debate. You talk to each other, managers, doctors, but then nothing comes out of it de facto, well, because anyway, where politics happens, well, it all doesn't get through, there's no understanding of it, there's no capacity, because I'm not talking about the Minister or the Minister of Health who are currently in the Ministry, it's as if the whole party doesn't understand it, who can make decisions.

Monika Rachtan
And is there any chance to involve the Prime Minister, for example, to invite him to this discussion. Was there any willingness at all on your part to start talking there, and not to cover the whole discussion about the system with these five billion zlotys?

Tomasz Kopiec
Of course, and such discussions take place every time, regardless of which Prime Minister we try to have, I am talking about us as either academia or the Polish Federation of Hospitals, in which I also have the honour of being on the board, But these kinds of discussions do take place, Because health care is one of the key elements, especially in today's threats. Hospitals are part of the critical infrastructure, so there is absolutely an awareness on the part of the managers and the Prime Minister of how important these problems are. However, just as I will return for a moment to the issue of this proficiency, because it is not that the Minister, she has great advisors. These are practitioners In this team dealing with health care, and especially with treatment, there is a group of outstanding managers who have worked, have healed hospitals and know its problems. On the other hand, we are also under the rigour of many legal acts which function in the health care system, and there are probably already a thousand of them at the moment, which are often mutually exclusive, often do not harmonise with each other, and often influence the fact that certain decisions cannot be taken both at the central level and at the level of individual beneficiaries, for example subsequent financing.

Tomasz Kopiec
And as I mentioned, a long-term strategy that will take us from those things that are really fundamental to the health system. The smaller ones we will come to gradually. It should happen. Successive governments in their short terms of office try to solve problems here and now, without thinking long-term and long term about the health care system, about the health of Poles. We have been constantly discussing the issue of overcontracting, we have been discussing the digitalisation of health care for 20 years. Now we are talking quite a lot about cyber security, because the number of attacks has increased. I, for one, am enthusiastic about the discussion that cyber security needs to be approached like conventional security and the state, at the level of the regulator, should define rules according to which hospitals, which are part of the critical infrastructure, will be secured directly by the state. And today we have a voice in the discussion, often from the ministry, saying that it is the hospital that should have IT specialists, should have a budget and should secure itself. That is to say, every Smith should buy himself a rifle and at this point safely protect his home from an invading attack. Well, that is not true. If we are part of some structure that is supposed to provide security for Poles, then it is the role of the state to provide that protection.

Tomasz Kopiec
At least that's what I believe.

Monika Rachtan
But it's also this discussion about this uniformity that we've had many times before in the context of hospitals, because we see how putting hospitals into some kind of single system helps to put a lot of things in order. If everyone has their own cyber security, this hospital yes, this hospital, yes, then we will not protect ourselves from attacks. There is no chance of that happening.

Tomasz Kopiec
Of course it is. And this discussion means I believe I often give this example of the flood, that is, how the different systems stopped communicating with each other. In the flood, the latter could have communicated with each other. It seems to have flooded some kind of power system related to batteries and, in fact, everything went down. It was not possible to communicate. Hospitals need a separate power supply, both in terms of the IT network and the internal network, so that we are able to exchange information with each other in crisis situations, so that we are able to receive orders, for example, or to receive, execute, carry out tasks. Today, we are operating on the public Internet, and today we are being subjected to a number of attacks. We do not have the competence to do this. I do not have officers trained to protect the hospital from attack, but I do have IT specialists who are willing, as part of their passion, often, because the salaries are not unattractive. To deal with hospital cyber security, but also outside the funding from the National Health Fund, which is, whose purpose is to treat patients. I do not have the resources to spend millions on cyber security today.

Tomasz Kopiec
I have said many times we can spend the money and make the decisions ourselves if there is funding from the regulator, saying that we are providing X amount of funding to you every year for the next five years and you prepare for it at that point. If you can't do it yourself, we will give you a lead officer who will prepare it in cooperation with you to protect you. We do not have that today. I, today, feel a bit helpless, because I have to decide whether I have to spend on VAT related to the KPO, whether I have to spend on treating patients, often expensive, often expensive methods, because we are a hospital operating at the highest level of reference, or whether I have to decide to secure myself from the cyber security side. A colleague says the director of the MSWiA hospital in Krakow, which was subjected to a cyber security attack, has procedures in place which were of course analogue, which meant that he was able to admit more patients just moments after the attack. Well, but let's imagine a situation where actually this attack is going to be carried out on a very large number of facilities at the moment.

Monika Rachtan
At one time.

Tomasz Kopiec
At one time and we are totally out of operational capacity. Let's take a look at how the train management system was paralysed last Monday, if I'm not mistaken, or Tuesday, maybe Wednesday at Warsaw Central Station? After all, everything came to a standstill. Nobody was even able to give information on when the train would arrive.

Monika Rachtan
And what would happen if such an attack were just launched on all Warsaw hospitals?

Tomasz Kopiec
That's right.

Monika Rachtan
Well. It turns out that probably the PLN 5 billion we are discussing today in the election campaign in the context of the health contribution is a minor problem compared to what Polish hospitals are facing. My guest, but above all your guest, was Dr Tomasz Kopiec. Thank you very much.

Tomasz Kopiec
Thank you very much.

Monika Rachtan
And I thank you today for your attention. This has been a Patient First programme. I invite you to follow us on our social media and thank you for being with us.