oecd -波蘭2023 年國家健康概況 Poland - Country Health Profile 2023

StateofHealthintheEU

Poland

CountryHealthProfile2023

TheCountryHealthProfileSeries

TheStateofHealthintheEU’sCountryHealthProfiles

provideaconciseandpolicy-relevantoverviewof

healthandhealthsystemsintheEU/EuropeanEconomicArea.Theyemphasisetheparticularcharacteristics

andchallengesineachcountryagainstabackdropof

cross-countrycomparisons.Theaimistosupportpolicymakersandinfluencerswithameansformutuallearningandvoluntaryexchange.Forthefirsttimesincetheseriesbegan,the2023editionoftheCountryHealthProfiles

introducesaspecialsectiondedicatedtomentalhealth.

TheprofilesarethejointworkoftheOECDandthe

EuropeanObservatoryonHealthSystemsandPolicies,inco-operationwiththeEuropeanCommission.Theteamisgratefulforthevaluablecommentsandsuggestions

providedbytheHealthSystemsandPolicyMonitor

network,theOECDHealthCommitteeandtheEUExpertGrouponHealthSystemsPerformanceAssessment

(HSPA).

Contents

1.HIGHLIGHTS3

2.HEALTHINPOLAND4

3.RISKFACTORS7

4.THEHEALTHSYSTEM9

5.PERFORMANCEOFTHEHEALTHSYSTEM11

5.1Effectiveness11

5.2Accessibility13

5.3Resilience16

6.SPOTLIGHTONMENTALHEALTH20

7.KEYFINDINGS22

Dataandinformationsources

ThedataandinformationintheCountryHealthProfilesarebasedmainlyonnationalofficialstatisticsprovidedtoEurostatandtheOECD,whichwerevalidatedto

ensurethehigheststandardsofdatacomparability.ThesourcesandmethodsunderlyingthesedataareavailableintheEurostatDatabaseandtheOECDhealthdatabase.SomeadditionaldataalsocomefromtheInstitutefor

HealthMetricsandEvaluation(IHME),theEuropean

CentreforDiseasePreventionandControl(ECDC),the

HealthBehaviourinSchool-AgedChildren(HBSC)surveys

andtheWorldHealthOrganization(WHO),aswellasothernationalsources.

ThecalculatedEUaveragesareweightedaveragesofthe27MemberStatesunlessotherwisenoted.TheseEUaveragesdonotincludeIcelandandNorway.

ThisprofilewasfinalisedinSeptember2023,basedondatathatwereaccessibleasofthefirsthalfofSeptember2023.

DemographicandsocioeconomiccontextinPoland,2022

Demographicfactors

Poland

EU

Populationsize

37654247

446735291

Shareofpopulationoverage65(%)

19.1

21.1

Fertilityrate1(2021)

1.3

1.5

Socioeconomicfactors

GDPpercapita(EURPPP2)

28044

35219

Relativepovertyrate3(%)

13.7

16.5

Unemploymentrate(%)

2.9

6.2

1.Numberofchildrenbornperwomanaged15-49.2.Purchasingpowerparity(PPP)isdefinedastherateofcurrencyconversionthatequalisesthe

purchasingpowerofdifferentcurrenciesbyeliminatingthedifferencesinpricelevelsbetweencountries.3.Percentageofpersonslivingwithlessthan60%ofmedianequivaliseddisposableincome.Source:EurostatDatabase.

Disclaimers:ThisworkispublishedundertheresponsibilityoftheSecretary-GeneraloftheOECD.TheopinionsexpressedandargumentsemployedhereindonotnecessarilyreflecttheofficialviewsoftheMembercountriesoftheOECD.TheviewsandopinionsexpressedinEuropeanObservatoryonHealthSystemsandPoliciespublicationsdonotnecessarilyrepresenttheofficialpolicyoftheParticipatingOrganizations.

ThisworkwasproducedwiththefinancialassistanceoftheEuropeanUnion.TheviewsexpressedhereincaninnowaybetakentoreflecttheofficialopinionoftheEuropeanUnion.

ThenamesandrepresentationofcountriesandterritoriesusedinthisjointpublicationfollowthepracticeofWHO.

TerritorialdisclaimersapplicabletotheOECD:Thisdocument,aswellasanydataandmapincludedhereinarewithoutprejudicetothestatusoforsovereigntyoveranyterritory,tothedelimitationofinternationalfrontiersandboundariesandtothenameofanyterritory,cityorarea.Additionalspecificdisclaimersareavailable

here

.

TerritorialdisclaimersapplicabletotheWHO:ThedesignationsemployedandthepresentationofthismaterialdonotimplytheexpressionofanyopinionwhatsoeveronthepartofWHOconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedanddashedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.

?OECDandWorldHealthOrganization(actingasthehostorganisationfor,andsecretariatof,theEuropeanObservatoryonHealthSystemsandPolicies)2023.

1Highlights

YearsPolandEU

HealthStatus

LifeexpectancyatbirthinPolandfellby0.6yearsbetween2019and2022,andat77.4yearsitwas3.3yearsbelowtheEUaveragein2022.Circulatorydiseasesandcancersaccountedformorethanhalfofalldeathsin2021,followedbyCOVID-19.However,COVID-19deathsmayhavebeenunderreportedin2020and2021.

2.62.5

1.6

1.5

-0.6-0.6

2000-20102010-20192019-2022Changesinlifeexpectancyatbirth

EU

Poland

17%

19%

17%

19%

19%

16%

SmokingHeavydrinkingObesity

0%10%20%30%%ofadultpopulation,2019

RiskFactors

SmokingratesamongadultsareclosetotheEUaverage,butthere

isrelativelyhighuseofe-cigarettesamongyoungpeople.Alcohol

consumptionlevelsarequitehigh,butheavydrinkingislessprevalentthanonaverageintheEU.Obesityrateshavebeengrowingslowlybutsteadily,includingamongadolescents.Tobaccosmokingandpoordietarethemajorcontributorstomortality.

Government/compulsoryschemesPrivatesources

HealthSystem

1256

477

3319

710

WhilePoland’shealthexpenditureiswellbelowtheEUaverage,it

Poland

EU

providesuniversalcoverageandabroadpackageofbenefits.Theshareofprivatespendingisrelativelyhigh,at28%comparedto19%acrosstheEU.Themajorityofthisspendingisintheformofout-of-pocket

payments(20%),andnearlytwothirdsofitisspentonmedicines.

010002000300040005000EURPPPpercapita,2021

Effectiveness

Bothpreventableandtreatable

mortalityratesarehigherinPolandthanintheEU,andprogressin

reducingmortalityfromtreatablecauseshasstagnatedoreven

regressedslightlysince2014.Thishasbeenattributedtotheincreaseinmortalityfromischaemicheartdisease,eventhoughthisdiseaseappearstobeunderreported,withheartfailureoftenreportedinits

place.

PolandEU

Preventablemortality

Treatablemortality

275

180

144

92

Age-standardisedmortalityrateper100000population,2020

Accessibility

Therewasanunprecedented

increaseinteleconsultations

duringthepandemic;in2020,

theseaccountedfor22%ofall

consultations(thesameastheEUaverage).Thesharefellto17%

in2021,eventhoughthetotal

numberofconsultationspercapitaremainsamongthehighestin

theEU.

In-personconsultationsTeleconsultations

10

8

6

4

2

0

9%

22%17%

20%21%

Poland

EU

2019

Poland

EU

2020

Poland

EU

2021

Numberofconsultationspercapitaperyear

Resilience

In2020,publicspendingon

healthinPolanddidnotincrease,whileGDPfell.Itsubsequently

rebounded,alongsidetherecoveryinGDP.ThenationalRecoveryandResiliencePlanhasearmarked

significantinvestmentforthe

healthsystem,focusingon

hospitalreformandrestructuring,developmentofdigitalhealthandhealthworkforcestrengthening.

—o—PublicspendingonhealthoGDP

10%

0%

-10%2014/152016/172018/192020/21

Annualchangeinrealterms

MentalHealth

DespitehavingoneofthelowestprevalenceratesintheEU,mentalhealthissuesmaybemorecommonthanreportedinPolandduetolackofawareness,socialstigmaandpooraccesstoservices.Womeninthelowest

incomequintilearemostlikelytoreportdepression.Psychiatrichospitalsremaintheprimarysourcesof

mentalhealthcare,althoughstepsarebeingtakentomovetowardsacommunity-basedmodel,andeffortsarebeingmadetoreducestigmaassociatedwithaccessingmentalhealthcare.

Poland

||

2HealthinPoland

LifeexpectancyatbirthinPolanddeclinedintwoconsecutiveyearsduringthepandemic

In2022,lifeexpectancyatbirthinPolandwas

77.4years,whichis3.3yearslowerthantheEU

average.InthedecadeprecedingtheCOVID-19

pandemic,Poland’slifeexpectancywasincreasingatasimilarrateastheEU,sothatlifeexpectancyhadrisento78.0yearsby2019.Thepandemic

hadagreaterimpactonmortalityinPolandthaninmostotherEUcountries,withlifeexpectancyfallingby1.5yearsin2020followedbyafurther

reductionof1yearin2021,butin2022thetrendwasreversedandlifeexpectancyimproved

(Figure1).

AsinotherEUcountries,inPoland,mentendtohaveshorterlifespansthanwomen.In2022,menwereexpectedtodie,onaverage,6yearsearlierthanwomen.Thisgendergapinlifeexpectancy,islargelyduetomen’sgreaterexposuretorisk

factors–particularlysmokingandexcessivealcoholconsumption(seeSection3).

Figure1.LifeexpectancyatbirthinPolandisapproximatelythreeyearsbelowtheEUaverage

Years

80

78

76

74

76.5

2019202020212022

81.3

81.3

81.2

81.1

80.7

80.7

80.7

79.1

78.2

77.7

77.4

77.2

76.2

76.0

75.3

74.8

74.3

83.2

83.1

83.0

83.0

82.7

82.6

82.4

82.3

82.1

81.8

81.7

81.7

81.7

Years

2022

2010

2000

90

77.4

78

75.5

85

80

75

70

65

Notes:TheEUaverageisweighted.The2022dataareprovisionalestimatesfromEurostatthatmaybedifferentfromnationaldataandmaybesubjecttorevision.DataforIrelandrefersto2021.

Source:EurostatDatabase.

Circulatorydiseasesweretheleadingcauseofdeathin2021

Thebroadgroupofcirculatorydiseases,includingischaemicheartdisease,strokeandother

cardiovasculardiseases,wastheleadingcause

ofdeathinPoland,accountingformorethan

onethirdofalldeathsin2021.Ischaemicheart

diseasewasthemaincauseofdeathwithinthat

group.Almostoneinfivedeathsin2021were

duetovarioustypesofcancer,withlungcancer

remainingthemostcommoncauseofcancerdeath(Figure2).

In2020,thefirstyearofthepandemic,Poland

reportedabout41500deathsduetoCOVID-19

(8.7%oftotaldeaths).In2021,over90200deathsduetoCOVID-19werereported(17.3%oftotal

deaths).Inbothyears,themajorityofthesedeaths(82-84%)occurredamongpeopleaged65and

over.

Polandrecordedhighexcessmortalityratesin

2020and2021

Theindicatorofexcessmortality,definedas

deathsthatoccurred(regardlessoftheircause)

aboveabaselinederivedfrompre-pandemic

levels,providesamorecompletepictureofthe

pandemic’smortalityimpact.The245000excessdeathsthatoccurredinPolandbetween2020and2022accountedforover20%ofdeathsabovethehistoricbaselineoverthesameperiod,whichis

muchhigherthanthe12.6%excessmortality

observedonaverageintheEUforthesameperiod.

04|StateofHealthintheEU|Poland:CountryHealthProfile2023

Figure2.COVID-19accountedforalargenumberofdeathsinPolandin2021

Poland

14.1%,Ischaemicheartdiseases

6.1%Stroke

2.2%

34.8%

Circulatory

system

4.0%

0.9%

Pancreas

Colorectal

Diseasesofthedigestivesystem

1.2%Breast

17.3%

18.0%Cancers

1.0%

COVID-19

Prostate

4.2%

Externalcauses

Alldeaths

520321

0.5%

Transportaccidents

4.0%Lung

2.1%

Diabetes

5.4%

1.1%Falls

Respiratorydiseases

0.9%

Alzheimer'sandother

0.9%Suicide

dementias

1.1%

3.5%COPD

Pneumonia

Note:COPDreferstochronicobstructivepulmonarydisease.

Source:EurostatDatabase(datareferto2021).

Likemostothercentral-easternEUcountries,

Polandexperiencedalargeincreaseinexcess

mortalityduring2021.Thislargeincreaseinexcessdeaths(ofnearly30%)canbeexplainedtoalargeextentbytheoccurrenceoftwomajorCOVID-19

wavesin2021:oneinthespringandoneattheendofthatyear,againstabackgroundoflowCOVID-19

vaccinationuptake(seeSection5.1).Excess

mortalityin2022wascalculatedtobe11.2%.

ThenumberofexcessdeathsinPolandin2020and2021wassignificantlyhigherthanreportedCOVID-19deaths,suggestingthatthedirect

andindirectmortalityimpactofthepandemic

washigherthanthemortalityreportedasbeing

directlyrelatedtothevirus,orthatthefullnumberofCOVID-19deathswereunderreported(Figure3).

OlderpeopleinPolandhaveshorterlifespansandahigherprevalenceofchronicconditionsanddisabilitiescomparedtoEUaverages

AsinotherEUcountries,Polandhasexperiencedademographicshifttowardsanolderpopulationoverthepasttwodecades,withtheproportionofpeopleaged65andoverrisingfrom12%in2000to18%

in2020–alowersharethantheEUaverage(21%).However,thisshareisprojectedtoincreaserapidlyto30%by2050–thesameastheEUaverage.

In2020,65-year-oldwomeninPolandcouldexpecttoliveanother19.2years,whichisnearly2yearsbelowtheEUaverage,whilemencouldexpecttoliveanother14.6years,whichisnearly3years

belowtheEUaverage.However,thegapinhealthylifeyearsbetweenPolishwomenandmenismuch

Figure3.ThenumberofexcessdeathsinPolandexceededCOVID-19mortalityin2020and2021

Numberofdeaths

140000

120000

100000

80000

60000

40000

0

20000

Excessmortality

COVID-19mortality

Excessmortality

COVID-19mortality

2020

2021

Note:Excessmortalityisdefinedasthenumberofdeathsfromallcausesabovetheaverageannualnumberofdeathsoverthepreviousfiveyearsbeforethepandemic(2015-19).

Sources:EurostatDatabase(forCOVID-19mortality)andOECDHealthStatisticsbasedonEurostatdata(forexcessmortality).

smaller(approximately1year)becausewomen

tendtospendagreaterportionoftheirremaininglifeyearswithsomehealthlimitations.

AmongPolesaged65andover,50%ofmen

and60%ofwomenreporthavingmultiple

chronicconditions,whichareamongthehighestproportionsacrossEUcountries.Theproportionsofmenandwomenaged65andoverinPoland

reportinglimitationsinbasicactivitiesofdaily

living,suchasdressingandshowering,are

higherthantheEUaverages,particularlyformen(Figure4).

StateofHealthintheEU|Poland:CountryHealthProfile2023|05

Figure4.RatesofmultimorbidityinPolesaged65yearsandaboveareamongthehighestintheEU

Poland

Lifeexpectancyandhealthylifeyearsat65

HealthylifeyearsLifeexpectancywithactivitylimitation

YearsMenWomen

25

20

15

||

10

5

0

21.0

19.2

17.4

14.6

52%

55%

45%48%

PolandEUPolandEU

Proportionofpeopleaged65andoverwithmultiplechronicconditions

70%60%50%40%30%20%10%0%

MenWomen

60%

50%

32%

40%

PolandEUPolandEU

50%40%30%20%10%0%

Limitationsindailyactivitiesamongpeopleaged65andover

MenWomen

28%31%

22%

30%

PolandEUPolandEU

Sources:EurostatDatabase(forlifeexpectancyandhealthylifeyears)andSHAREsurveywave8(formultiplechronicconditionsandlimitationsindailyactivities).Datareferto2020.

TheburdenofcancerinPolandisconsiderable

AccordingtoestimatesfromtheJointResearch

Centre,basedonincidencetrendsfromprevious

years,almost202000newcasesofcancerwere

expectedinPolandin2022.Figure5showsthatthemainnewcancersitesamongmenwereexpectedtobeprostate(22%)andlung(18%),followedby

colorectalcancer(15%).Amongwomen,breast

cancerwasexpectedtobethemostcommon

cancer(26%),followedbycolorectal(12%)andlungcancer(11%).Theseestimatesareverysimilarto

nationalestimatesofcancerincidencefor2022,

whichanticipatedthatthenumberofcancer

caseswouldincrease,andthatthecancersmost

frequentlydiagnosedinmenwouldbeprostate

(24%),lung(14%)andcolorectalcancer(12%)

whileforwomentheywouldbebreast(23%),lungandcolorectalcancer(10%each)(Wojciechowskaetal.,2023).Arecentpolicyinitiativefromthe

NationalOncologyNetworkaimstoimprovecancerdiagnosisandtreatment.

Figure5.Anestimated202000peopleinPolandwereexpectedtobediagnosedwithcancerin2022

Prostate

Breast

Others

22%

Others

23%

26%

28%

Men

106060new

cases

3%3%

Women95977new

cases

Pancreas

3%

Leukaemia

18%

3%

12%

3%

PancreasBladder

Lung

Colorectal

4%

4%

Kidney

5%

9%

Stomach

11%

8%

15%

Cervix

Ovary

Bladder

Lung

Uterus

Colorectal

Age-standardisedrate(allcancer):696per100000populationEUaverage:684per100000population

Age-standardisedrate(allcancer):458per100000populationEUaverage:488per100000population

Notes:Non-melanomaskincancerisexcluded;uteruscancerdoesnotincludecancerofthecervix.

Source:ECIS–EuropeanCancerInformationSystem.

06|StateofHealthintheEU|Poland:CountryHealthProfile2023

3Riskfactors

Behaviouralandenvironmentalriskfactorsaccountfor44%ofalldeaths

Overtwofifths(44%)ofalldeathsregisteredin

Polandin2019canbeattributedtobehaviouralriskfactors,includingtobaccosmoking,dietaryrisks,

alcoholconsumptionandlowphysicalactivity,

whichisahigherproportionthantheEUaverage(39%).Deathsfromtobaccoconsumptionand

dietaryriskswereaboveEUaverages(Figure6).

AlthoughtheproportionofdeathsduetoalcoholconsumptionwasthesameastheEUaveragein2019,trendsinmortalityattributabletoalcohol

consumptionhaveshownanincreaseforallagessincetheearly2000s.Airpollutionintheformoffineparticulatematter(PM2.5)andozoneexposure

accountedforanestimated8%ofalldeathsin2019(over30000deaths)–twicetheproportionestimatedfortheEU(Figure6).

The2015ActonPublicHealthshiftedthestrategicfocusoftheNationalHealthProgrammefromthetreatmentofcommondiseasestothepromotionofhealthierlifestylesandthereductionofimportantriskfactors.TheneweditionoftheProgramme

for2021-25includesoperationalgoalson:the

preventionofoverweightandobesity,healthy

ageing,mentalhealthpromotion,addiction

preventionandthereductionofhealthrisks

arisingfromenvironmentalfactorsandinfectiousdiseases.

Poland

Figure6.Tobaccosmoking,poordietandairpollutionaremajorcontributorstomortalityinPoland

Tobacco

Poland:20%

EU:17%

Dietaryrisks

Poland:20%

EU:17%

Airpollution

Poland:8%

EU:4%

Alcohol

Poland:6%

EU:6%

Lowphysicalactivity:Poland:2%EU:2%

Notes:Theoverallnumberofdeathsrelatedtotheseriskfactorsislowerthanthesumofeachonetakenindividually,becausethesamedeathcanbe

attributedtomorethanoneriskfactor.Dietaryrisksinclude14components,suchaslowfruitandvegetableintake,andhighsugar-sweetenedbeveragesconsumption.Airpollutionreferstoexposuretofineparticulatematter(PM2.5)andozone.

Sources:IHME(2020),GlobalHealthDataExchange(estimatesreferto2019).

SmokingamongadultshasdecreasedbutremainsabovetheEUaverage

Tobaccoconsumptionisalongstandingpublic

healthissueinPoland,particularlyamongmen.

Smokingprevalencehasdeclinedconsiderably,

from28%ofadultswhosmokeddailyin2001to17%in2019,whichisslightlylowerthantheEUaverage(Figure7).However,anationalsurvey

conductedin2022foundthat30%ofmenand

18%ofwomenwereregularsmokersoftobaccoore-cigarettes(Wojtyniak&Goryński,2022).

Ratesofcigarettesmokingamongadolescents(aged15years)havealsocomedownfrom24%ofadolescentswhoreportedsmokingtobacco

(cigarettes)inthepastmonthin2014to22%in

2022,butthisremainshigherthantheEUaverage(18%in2022).However,theuseofe-cigaretteshasbecomemorepopularamongyoungpeople:30%

of15-and16-year-oldsinPolandreportedsmokinge-cigarettesin2019–aratemorethantwicetheEUaverageof14%.

AlcoholconsumptionamongadultshasgrownbutheavydrinkingislowerthantheEUaverage

Averagealcoholconsumptionamongadults

inPolandwasabout11litresofpurealcohol

perpersonin2021,anincreasefromadecade

earlier(10.3litresin2011).Oneinsixadults

reportedregularheavydrinkingin2019(16.9%),

StateofHealthintheEU|Poland:CountryHealthProfile2023|07

Poland

||

aproportionthatislowerthantheEUaverage

(18.5%),andwhichremainedfairlystablebetween2014and2019.1AsinmanyotherEUcountries,

heavydrinkinginPolandismoreprevalentamongmen(28.1%)thanwomen(8.4%).Theproportionof15-year-oldsinPolandwhoreportedhavingbeen

drunkmorethanonceintheirlifefellfrom26%in2014to19%in2018,whichwasbelowtheEU

average(22%),butin2022ithadincreasedto22%whiletheEUaveragehadfallento18%.

Obesityrateshavebeengrowingslowlybutsteadily

About18.5%ofadultsinPolandwereobesein

2019,whichisahigherproportionthantheEU

average(16%)andhasincreasedfrom16.7%in2014.ComparedtotheperiodbeforeCOVID-19,in2022,theshareofoverweightmenincreasedby3percentagepoints,withthestrongestincreases

seeninmenwithhigherlevelsofeducationand

thoselivinginurbanareas(Wojtyniak&Goryński,2022).Therewasasmallincreaseinobesityratesamongwomen(0.5percentagepoints).

Poornutritionpartlyexplainstheincreasing

prevalenceofobesity.In2019,only9%ofadultsinPolandreportedconsumingfiveportionsoffruit

andvegetableseveryday,whichisadecreasefrom10%in2014andbelowtheEUaverageof12%.

Also,only20%ofadultsinPolandreporteddoingtherecommended150minutesofexerciseperweekin2019,alowersharethantheEUaverage(33%).

Overweightandobesityratesamongadolescentshavealsoincreasedoverthepasttwodecades,butmoreslowlythaninmanyotherEUcountries.Theproportionof15-year-oldsinPolandwhoreportedbeingoverweightorobesein2022wasbelowtheEUaverage(20%comparedto21%).

Figure7.ManyriskfactorstohealtharemoreprevalentinPolandthaninmostotherEUcountries

Smoking(adolescents)

FruitandvegetableconsumptionSmoking(adults)

Vegetableconsumption(adolescents)Drunkenness(adolescents)

Fruitconsumption(adolescents)Heavydrinking(adults)

Physicalactivity(adults)Overweightandobesity(adolescents)

Physicalactivity(adolescents)Obesity(adults)

(adults)

Notes:Thecloserthedotistothecentre,thebetterthecountryperformscomparedtootherEUcountries.Nocountryisinthewhite“targetarea”asthereisroomforprogressinallcountriesinallareas.

Sources:OECDcalculationsbasedonHBSCsurvey2022foradolescentsindicators;andEHIS2019foradultsindicators.

Socioeconomicinequalitiescontributetoinequalitiesinlifeexpectancy

AsinotherEUcountries,theprevalenceof

severalbehaviouralriskfactorstendstofollowasocioeconomicgradientinPoland.In2019,26%

ofadultsinthelowestincomegroupreported

smokingdaily,comparedto16%amongthoseinthetopincomequintile.Thereisalsoasignificantgapintheprevalenceofobesitybetweenpeoplewithlower(22%)andhigher(17%)incomes.

Thegradientistheotherwayaroundwhenit

comestoheavydrinking,asalsoseeninnearlyallotherEUcountries:ahigherproportionofpeopleinthehighestincomegroup(20%)reportheavy

drinkingcomparedtothoseinthelowestincomegroup(11%).

1Heavydrinkingisdefinedasconsumingsixormorealcoholicdrinksonasingleoccasionforadults.

08|StateofHealthintheEU|Poland:CountryHealthProfile2023

4Thehealthsystem

Thehealthsystemremainsfairlycentralisedandoffersuniversalcoveragefortheresidentpopulation

ThePolishhealthsystemisbasedonsocialhealthinsurance(SHI).AlthoughSHIformallycovers

only91%ofthepopulation,itisconsiderednearlyuniversal,asmostofthosewhoareuninsuredliveoutsidethecountrywhilestillbeingregisteredasresidents.PeoplewholackSHIcoverageareable

toobtainoutpatientemergencymedicalcareandprimarycare.Thesystemislargelycentralised,

withtheMinistryofHealthandtheNational

HealthFund(NFZ)inchargeofgovernance,

financingandpurchasing.However,somekey

responsibilitieshavebeendecentralised,mainly

tothe16regions,whichownthelargerregional

hospitals,andthe314counties,whichownthe

smallercountyhospitals.Medicaluniversities

andtheMinistryofHealthownhighlyspecialisedclinicsandinstitutes.Onlyabout15%ofhospitalbedsareprivate.Someprimary