According to Article 68 of the Polish Constitution everyone has a right to have access to health care. Citizens are granted equal access to the publicly funded healthcare system, which is free for all the citizens of Poland provided they fall into the "insured" category. This usually means that their health insurance is paid for by their employer, or are the spouse or child of an insured person. However, private healthcare use is extensive in Poland. Patients who are uninsured have to pay the full cost of medical services. The government is obliged to provide free healthcare to young children, pregnant women, disabled people and to the elderly.
What happens if you need to see a doctor?
If you need to see a doctor (specialist) you have to register and wait about 2-3 months (sometimes longer, even 9 months). If you want to see your General Practitioner (GP) you have to register on the same day, but the GP will not prescribe diabetes medicines/equipment unless it is an emergency. You can buy test strips without prescription in pharmacies, but you have to pay full price. If you are running out of insulin you can go to the hospital and they can prescribe you some. If you are an EU citizen, it is very useful to have an european insurance card with you.
Who decides what doctors can prescribe?
The Main Pharmaceutical Inspectorate is the regulatory body in Poland that ensures the safety of patients through supervising and controlling the manufacture of and trade in medicinal products. The European Medecines Agency (EMA) is also a regulatory body for Europe.
Practically, what is it like to live with type 1 diabetes in Poland?
When it comes to medicines, the cost of most insulins are almost 100% refunded, but some are more expensive than others (i.e. Lantus, Levemir, Humalog). Glucose meters are provided for free, and you can get one at the hospital. You can also get one in a pharmacy but you have to pay. Test strips are cheap but you can only get500 each perscription. So if you see your doctor every 3 months you will only have 500 strips for those 3 months. Most people with type 1 diabetes have a disabled person card so they get extra money for their medicines (about 35 Euros monthly). Insulin pumps are 100% funded by the government, but only for people under 26 years old with Hb1Ac below 9.0%. If you are under 26 years old and you have pump, you will get infusion sets for free. If you are older than 26 years old and you have a pump, you have to pay for infusion sets (30% payment). Since 2018, CGMs are partly refunded for people under 26 years old (30% payment). Other things like batteries, needles or lancets you need to buy yourself.
As for the pregnancy and diabetes, thanks to Great Orchestra of Christmas Charity, in Poland we have special programme for T1D women planning pregnancy or who are already pregnant (1 st trimester). They can get an insulin pump, infusion sets, reseivoirs and CGMs for free for the time they get pregnant. There is no age limit. Since 2004 the insulin pumps have been used by almost 3,000 women. This programme is independent from National Health Fund.
According to research, Poland is one of countries with very high discrimination level. Most people (adults) with type 1 diabetes do not tell their employers about their condition. Doctors don’t have much time so even appointments with diabetologist last about 20 minutes and it is mostly about prescriptions. Diabetes educators and dietitians are not in every hospital so it is hard to reach them. We also have some problems with access to insulin – not every pharmacy has every type of insulin and sometimes you have to wait for your medicines to be ordered or even go to another part of the city.
What about getting admitted to hospital?
If you want to be admitted to hospital for lab tests or for specialist treatment it depends on your doctor and the region you are living in. For example in the capitol, Warsaw, children are admitted for complex lab tests every year for at least 1 week. Outside of cities the children are admitted to hospital only if something is really wrong.
Emergency Medical Services in Poland are a service provided by the individual Polish cities and counties. These services are typically provided by the local, publicly operated hospital, and are generally funded by the government of Poland. In a number of cases, the hospitals contract these services to private operators. In addition to publicly funded services, there are a variety of private-for-profit ambulance services operating independently.
How does diabetes care vary throughout Poland?
Unfortunately care varies widely. In every city there is a different approach. In some cities CGMs are very popular and in others not at all. In some places you need to wait about one year to get an insulin pump, but in Warsaw the wait is only one week. In bigger cities the care is more developed than in smaller cities or in the country side.