SOCIAL DIAGNOSIS 2015

Transcription

1 Contemporary Economics Quarterly of University of Finance and Management in Warsaw Volume 9 Issue 4 November SOCIAL DIAGNOSIS OBJECTIVE AND SUBJECTIVE QUALITY OF LIFE IN POLAND DIAGNOZA SPOŁECZNA WARUNKI I JAKOŚĆ ŻYCIA POLAKÓW Edited by: Janusz Czapiński Tomasz Panek Raport Diagnoza Społeczna finansowany przez: Warszawa: Rada Monitoringu Społecznego listopad

2 CONTEMPORARY ECONOMICS ABSTRACTED/INDEXED: ABI/INFORM Complete (ProQuest) ABI/INFORM Global (ProQuest) Academic OneFile (GALE Science in Context) Business & Company Profiles (GALE Science in Context) Business and Economics Theory Collection (GALE Science in Context) Cabell s Directories Central and Eastern European Online Library CEJSH Citefactor Directory of Open Access Journals (DOAJ) Directory of Research Journal Indexing (DRJI) ERIH PLUS EBSCO ECONIS EconLit EconPapers EconStor (EconBiz) GENAMICS JournalSeek General Business File ASAP (GALE Science in Context) Google Scholar GREENR - Gale Resource on the Environment, Energy and Natural Resources (GALE Science in Context) IDEAS IndexCopernicus Infotrac Custom Journals (GALE Science in Context) International Business (GALE Science in Context) JIFACTOR Library of Congress (USA) Ministry of Science and Higher Education list of scored journals (rating score 10 pts) ProQuest Central ProQuest Research Library Research Papers in Economics (RePEc) Scirus SCOPUS Social Science Research Network The British Library The Central European Journal of Social Sciences and Humanities The International Bibliography of the Social Sciences (IBSS)/ProQuest Ulrichsweb WorldCat Zetoc Editor in Chief: Marcin Staniewski Deputy Editor in Chief Tomasz Szopiński Stat Editor Henryk Rosłaniec Language Editor Kurt Spurlock Technical Editors Monika Bandyszewska Karol Kowalczyk Associate Editors Zenon Biniek Wiesław Dębski Witold Jakóbik Witold Małecki Danuta Mliczewska Robert Nowacki Włodzimierz Rembisz Grażyna Rytelewska Maria Sierpińska Piotr Szczepankowski Tadeusz Szumlicz Ryszard Wilczyński EDITORIAL BOARD: Nur Adiana Hiau Abdullah (Malaysia) Ruth V. Aguilera (USA) Icek Ajzen (USA) Hrabrin Bachev (Bulgaria) Richard P. Bagozzi (USA) Richard Blundell (Great Britain) Constantin A. Bob (Romania) Udo Broll (Germany) Willem K. M. Brauers (Belgium) Tanja Broz (Croatia) Jelena Budak (Croatia) Barbara Czarniawska (Sweden) Didar Erdinç (Bulgaria) József Fogarasi (Romania) Nicolai Juul Foss (Denmark) Bruno S. Frey (Switzerland) Masahiko Gemma (Japan) Srećko Goić (Croatia) Kjell Åge Gotvassli (Norway) Adriana Grigorescu (Romania) Oliver D. Hart (USA) Roman Horvath (Czech Republic) Shelby D. Hunt (USA) Zoran Ivanovic (Croatia) Søren Johansen (Denmark) Sten Jönsson (Sweden) Lutz Kilian (USA) Judit Karsai (Hungary) Elko Kleinschmidt (Canada) Monika Kostera (Sweden) Stephen F. LeRoy (USA) Csaba Lentner (Hungary) Lena Malešević Perović (Croatia) Victor Martinez Reyes (USA) Eric Maskin (USA) Igor Matunović (Croatia) Ieva Meidute (Lithuania) Garabed Minassian (Bulgaria) Alexandru Mircea Nedelea (Romania) Anayo Nkamnebe (Nigeria) Harald Oberhofer (Austria) Boris Podobnik (Croatia) Nina Pološki Vokić (Croatia) Rossitsa Rangelova (Bulgaria) Assaf Razin (USA) Sanda Renko (Croatia) Domingo Enrique Ribeiro Soriano (Spain) Richard Roll (USA) Steven Rosefielde (USA) Yochanan Shachmurove (USA) Andrei Shleifer (USA) Eduardo Schwartz (USA) Mirosław Skibniewski (USA) Stanley F. Slater (USA) Lenka Slavíková (Czech Republic) Joel Sobel (USA) Jasminka Sohinger (Croatia) Miemie Struwig (South Africa) Guido Tabellini (Italy) Masahiro Taguchi (Japan) Josip Tica (Croatia) Joachim Wagner (Germany) John Whalley (Canada) Gary Wong (China) Shaker A. Zahra (USA) Edmundas Kazimieras Zavadskas (Lithuania) The original version: on-line journal ADDRESS OF EDITORS: CONTEMPORARY ECONOMICS, University of Finance and Management in Warsaw, Warszawa, 55 Pawia Str., room 219, phone: (22) editorial@ce.vizja.pl PUBLISHER: Vizja Press & IT, Warszawa, 60 Dzielna Str. phone/fax: (22) vizja@vizja.pl All articles published in the quarterly are subject to double-blind peer reviews ISSN:

3 Social Diagnosis 109 Please use the following citation when referring to this chapter: Czapiński, J., Panek, T. (). Household living conditions. Health care. Social Diagnosis, The Objective and Subjective Quality Of Life In Poland. Contemporary Economics, 9/4, DOI: /ce Health care 1 2 Janusz Czapiński, Tomasz Panek 1 University of Finance and Management in Warsaw, Faculty of Psychology; 2 Warsaw School of Economics, Institute of Statistics and Demography Abstract According to declarations of households in, over 93% of them used services of health care institutions funded with public funds, but at the same time, almost 54% of them used services of institutions which required them to pay and only almost 7% used services of institutions which were paid up by their employer who purchased subscription or insurance. During the year prior to the study, households which had to buy medicines or health care services usually resigned from sanatorium stays, obtaining dentures or rehabilitation services due to lack of money. In the last four years, the percentage of households which had to make such sacrifices declined significantly in relation to all health care services, except for rehabilitation treatments. Almost half of households spend some money on health services. On average, the most expensive were treatments and ambulatory tests (PLN 591), then medicines and other pharmaceutical products (PLN 376), the so-called proofs of gratitude, a form of bribe, by which respondents tried to achieve faster or better care (e.g. more interest in the patient s state, the choice of operating doctor or the doctor taking care of the patient, faster services etc.) cost on average PLN 377. The average fee in a public hospital amounted to PLN 293 and the amount of a real thank you gift amounted to PLN 148. During the last for years the percentage of households paying for bribes increased significantly as well as the real value of the bribes (by 16.6%) Use of the healthcare system As reported by households in, more than 92% used healthcare facilities funded by the National Health Fund (Narodowy Fundusz Zdrowia, NFZ), but also over half took advantage of services provided by establishments for which they paid themselves, and 7% took advantage of the services paid for by employers who purchased subscription or insurance. The percentage of households that took advantage of medical services paid from all three sources increased significantly compared to previous years (Table ). Table Percentage of households that use healthcare facilities by the source of funding Year of study Public funding Private funding Subscriptions % of households ,50 93,60 92,00 51,00 49,40 49,50 4,90 6,30 6,10 paid by NFZ paid with own funds paid by employer Type of healthcare institution Figure The extent of healthcare service use in the - panel sample Between 2009 and 34 the percentage of households that used services paid by employers that had bought a subscription increased very slightly within the margin of statistical error (by 1p.p., Figure ). In the last two 34 All the changes in health care in the - period pertain to the panel sample from those years, i.e. the households that were examined in, and.

4 Social Diagnosis 110 years, the utilization frequency by households from the selected kinds of health service centres did not change significantly. Table Percentage of households that use healthcare facilities in the last year Socio-demographic group Paid by NFZ Paid with own funds Paid by the employer Socio-economic group Employees Farmers * - Self - employed Retirees Pensioners Living on unearned sources of income Type of household Single family: Married with no children Married with 1 child Married with 2 children Married with 3+ children Incomplete families Multi-families Non-family: Single person Many person Class of place of residence Towns of over 500k k k k less than 20k Rural areas Voivodship Dolnośląskie Kujawsko-pomorskie Lubelskie Lubuskie Łódzkie Małopolskie Mazowieckie Opolskie Podkarpackie Podlaskie Pomorskie Śląskie Świętokrzyskie Warmińsko-mazurskie Wielkopolskie Zachodniopomorskie Income per person Lower quartile Middle 50% Upper quartile * - number of cases too low. The most prosperous households used health services payable on the spot relatively most often in the last year (over 70%), couples with 1 or 2 children (over 60%) and those residing in the largest cities (nearly 60%). Households without unemployed members used paid health services significantly more often than those with the unemployed at over 52% and not quite 42% respectively, as did urban households compared to those in rural areas at nearly 60% of those in the largest cities and only 45% in rural areas. This kind of health service was clearly used the most rarely by households in Warminsko-Mazurskie Voivodship (only not quite 27%). In the last 2 years, we observed a rise in the share of households using paid health services among pensioners (nearly 2p.p.), childless couples (nearly 2p.p.) and those residing in the smallest towns (over 2p.p.).

5 Social Diagnosis 111 Members of households stayed in hospital for reasons other than pregnancy in over 23% of households during the past year. The frequency of hospital attendance does not have a marked variability among the selected household groups and did not change much over the last four and two years (Table ). Table Percentage of households in which a member was in the hospital between and Group Socio-economic group Employees Farmers Self - employed Retirees Pensioners Living on unearned sources of income Type of household Single family: Married with no children Married with 1 child Married with 2 children Married with 3+ children Incomplete families Multi-families Non-family: Single-person Multi-person Class of place of residence Towns of over 500k k k k less than 20k Rural areas Voivodship Dolnośląskie Kujawsko-pomorskie Lubelskie Lubuskie Łódzkie Małopolskie Mazowieckie Opolskie Podkarpackie Podlaskie Pomorskie Śląskie Świętokrzyskie Warmińsko-mazurskie Wielkopolskie Zachodniopomorskie Total Withdrawal from healthcare A lack of funds forced the largest group of households to forgo purchasing medicines, dental care and doctor s care (Figure ). As far as the needy were concerned, the most financially motivated withdrawals concerned trips to sanatoria at nearly 29% of households, purchase of dental prosthetics (over 24%) and dental treatment (over 22%). In the last four years, (Figure ), the percentage of households forced to abstain from medical service did not rise significantly for any type of medical service. However, a significant decrease in those resignations has occurred in case of medicine purchase, trips to sanatoria and denture purchase (over 4, almost 4 and over 3p.p. respectively).

6 medicines dental services dentures doctor services medical tests rehabilitation sanatory hospital Social Diagnosis 112 0,7 28,3 71 0,7 28,1 71,3 0,8 4,6 5,7 6,3 29, ,3 69,3 81,3 80,2 79,4 TAK YES NIE NO NO NEED BRAK POTRZEBY 6,4 25,6 67,9 7 25,9 67,1 6,8 25,8 67,4 6,4 59,3 34,3 7,2 57,8 34,9 7,5 58,3 34,3 11, ,4 13,5 70,2 16,3 13,8 69,8 16,3 4,9 19,1 75,9 5,7 17,7 76,6 6, ,5 14,2 60, ,2 55, ,1 56,6 26,3 13,4 80,5 6,2 16,9 75,9 7,2 17,9 75 7,1 Figure Percentage of households that did not use selected healthcare services due to financial difficulties between and in whole samples The households living on unearned sources of income and those of pensioners had to abstain the most often from buying medicine or medical services for financial reasons in the last year (12% and 5% for hospital treatment, over 51% and 41% for denture purchase, and 53% and almost 45% for dental treatment respectively) (Table ). The frequency of such resignations was much higher in households with unemployed members than without, with the highest difference in resignations from dental treatment (almost 39% and over 19% of resignations reported respectively) and denture purchases (over 40% and over 21% of resignations reported respectively). Considering the type of household, the necessity to abstain from medicine purchase or medical treatment for financial reasons was reported most often by incomplete family and multi-children family households (almost 4% and 3% for hospital treatment, almost 25% and almost 25% for purchase of prescription or recommended medicine, and 33% and over 31% for dental treatment respectively).

7 Social Diagnosis 113 Table Percentage of households that did not use needed selected healthcare services due to financial difficulties Group medicin es dental services Percentage of household which resigned from: medical rehabilit dentures tests services ation sanatori um Socio-economic group Employees Farmers Self - employed Retirees Pensioners Living on unearned sources of income Type of household Single family: Married with no children Married with 1 child Married with 2 children Married with 3+ children Incomplete families Multi-families Non-family: Single person Many person Class of place of residence Towns of over 500k k k k less than 20k Rural areas Voivodship Dolnośląskie Kujawsko-pomorskie Lubelskie Lubuskie Łódzkie Małopolskie Mazowieckie Opolskie Podkarpackie Podlaskie Pomorskie Śląskie Świętokrzyskie Warmińsko-mazurskie Wielkopolskie Zachodniopomorskie Income per person Lower quartile Second quartile Third quartile Upper quartile Total Total hospital The households in rural areas were forced to abstain from those purchases or services significantly more often than the urban ones. The highest percentages of households forced into those resignations were reported in Warmińsko-Mazurskie Voivodship. Over the last four years (Figure ), the share of households forced into this kind of withdrawal did not rise significantly for any health service treatments. However, there was a marked fall in the case of medicine purchase, trips to sanatoria and dental prosthetics (over 4p.p., nearly 4p.p. and over 3p.p. respectively). In -, the share of households forced into financially motivated withdrawals fell significantly. In the case of trips to sanatoria, prescription realization and purchase of medicine the falls amounted to nearly 3p.p. and almost 2p.p. respectively. Over the same period there was no rise in the share of households forced into financially motivated withdrawals from the remaining health service treatments. However, there was a strong rise in withdrawals for dental

8 Resignation type Social Diagnosis 114 prosthetics reported among households living on unearned sources, employees and farmers at almost 8p.p. and nearly 6p.p. respectively, those of couples with one child and couples with many children at nearly 9p.p. and around 7p.p. respectively) and those residing in the smallest towns and largest cities (over 8p.p. and almost 6p.p. respectively). It is also worth noting, that a growing number of households living on unearned sources of income had to forego a hospital treatment because of financial reasons. hospital stay sanatorium rehabilitation medical tests doctor visit dentures dental services recepies 1,6 2,3 2,7 9,9 11,2 11,9 23,8 20,2 22,7 20,7 14,4 15,9 17,5 19,8 23,7 24,6 18,6 22,4 24,0 14,6 18,3 20,1 30,1 31, % 40 Figure Percentage of households which for financial reasons had to forgo medical services and abstain from medicine purchase, despite the need for those, between and in the panel sample Household expenditure on healthcare services We have already mentioned that nearly half of households pay for some healthcare services out of their own resources. Let us see now what this money was spent on during just one quarter prior to the study, and in what amounts (Table ). Table Percentage of households that paid for healthcare in one quarter and average expenditure between - in whole samples Percentage of households incurring such expenditures Average value of expenditures Informal Purchase of payments. Medicines and outpatient healthcare expressions of Gifts as expressions Payments in public pharmaceuticals services gratitude (bribes) of true gratitude hospitals medicines and pharmaceuticals payments in public hospital gifts as expressions of true gratitude nonformal payments official payments for ambulatory treatments and tests Average expedinture Figure Household spending on healthcare in the last three months in the - and panel sample

9 Social Diagnosis 115 Table Households' spending on treatment, diagnosis, medicine and other pharmaceutical products by socio-economic group. Household type, class of place of residence, voivodship and PLN income in whole samples for and in household groups bearing selected cost categories (data for three months) Group Expenditure in PLN Treatment and tests Medicines and similar Socio-economic group Employees Farmers Self-employed Retirees Pensioners Living on unearned sources of income Type of household Single family: Married with no children Married with 1 child Married with 2 children Married with 3+ children Incomplete families Multi-families Non-family: Single person Many person Class of place of residence Towns of over 500k k k k less than 20k Rural areas Voivodship Dolnośląskie Kujawsko-pomorskie Lubelskie Lubuskie Łódzkie Małopolskie Mazowieckie Opolskie Podkarpackie Podlaskie Pomorskie Śląskie Świętokrzyskie Warmińsko-mazurskie Wielkopolskie Zachodniopomorskie Household equivalent income 1 st quartile nd quartile rd quartile th quartile In the last four years, the real rise in whole samples has occurred in the expenditure of households for the nonformal payments, bribes (by 16.6%) and ambulatory services (by 1.1%). On average, the households that reported this particular type of expenditure spent the most on ambulatory treatment and tests (PLN 591), then on medicine and pharmaceutical products purchase (PLN 376); the so-called expressions of gratitude (i.e. bribes) by which respondents tried to achieve faster or better care (e.g. more interest in the patient s state, the choice of operating doctor or the doctor taking care of the patient, faster services etc.) cost on average PLN 377. The average payment in public hospital was PLN 293, and the cost of a real expression of gratitude for the care that already took place was (on average) PLN 148. In the three months preceding the last study, the households of farmers, self - employed and employees spent the most on treatment and diagnosis at PLN 629, PLN 622 and PLN 620 respectively. Couples with 2 or more

10 Social Diagnosis 116 children spent on average PLN 657, those in the largest and smallest towns on average PLN 699 and PLN 633 respectively and in Mazowieckie on average PLN 801 (Table ). In the households without unemployed members, expenditure was significantly higher than in those with unemployed members. The most prosperous households spent the most on treatment and outpatient test. In terms of regional division, Mazowieckie (highest spending at PLN 801) and Warmińsko-Mazurskie (lowest spending at PLN 312) stand out. In the last two years, expenditure on treatment and tests rose significantly among households of farmers, retirees and incomplete families and fell among that of self - employed. Households of retirees, i.e. those with the eldest members, spent relatively the most on medicines and other pharmaceuticals among the households with expenditure of this kind at PLN 477 on average. With regard to household types, incomplete families spent the most at PLN 474 on average. The highest household expenditure on medicines and other pharmaceuticals was noted in the largest towns and the lowest in middle-sized towns ( k inhabitants) at PLN 445 and PLN 386 respectively Readiness to purchase additional health insurance In the last two editions of the Diagnosis we asked household representatives about their readiness to purchase additional health insurance if that guaranteed improved access to medical treatment and better quality of it. We offered the choice of two variants, one below and one above PLN 100. In both editions, interest in additional health insurance was not large and falling (Figure ). This year, ¾ of households refused the opportunity to purchase insurance of this kind and no more than 3% was prepared to pay more than PLN 100 per month for additional health insurance. This fall in interest in additional insurance is surprising, since the spending on outpatient treatment rose significantly in that period. While wealth does have an influence on declared interest in additional insurance, even in the top 1/5 of the most affluent households, half say no, and only 11% are ready to spend more than PLN 100 (Figure ). Education also differentiates interest in additional insurance, though in this case over half of households with higher education also refuse this option (Figure ). Other variables such as socio-economic group, household type and place of residence class have a minor effect on readiness to purchase additional health insurance (Figures ). Over 100 PLN Up to 100 PLN 2,5 2,8 4,2 23,6 24,7 28,7 No 67,1 73,5 72, % Figure Percentage of households interested and not interested in purchase of additional health insurance for up to PLN 100 and over PLN 100 per month in the - and panel sample 5 quintile 4 quintile 3,1 11,2 32,3 39,3 49,5 64,6 Over 100 PLN Less than 100PLN No 3 quintile 1,1 21,4 77,5 2 quintile 1,1 17,1 81,9 1 quintile 0,9 11, % 100 Figure Percentage of households interested and not interested in purchase of additional health insurance for up to PLN 100 and over PLN 100 per month in by level of equivalent income

11 Social Diagnosis 117 Higher and postsecondary Secondary 2,8 7,2 26,8 40,3 52,5 70,4 Over 100 PLN Up to 100 PLN No Vocational 1,7 21,7 76,6 Primary 0,5 9,9 89, % 100 Figure Percentage of households interested and not interested in purchase of additional health insurance for up to PLN 100 and over PLN 100 per month in by level of household head's level of education (the respondent) Living on benefits Retirees Pensioners Self - employed Farmers Employees 0,9 1,0 2,2 0,5 3,8 10,5 9,3 11,1 18,7 18,6 32,5 37,1 53,6 63,7 79,1 Over 100 PLN Up to 100 PLN No 80,9 88,6 87,8 0,0 20,0 40,0 60,0 80,0 100,0 % Figure Percentage of households interested and not interested in purchase of additional health insurance for up to PLN 100 and over PLN 100 per month in by socio-economic group Non-family multiperson Non-family singleperson Multi-person Single-parent Unmarried with children Unmarried without children Married with 3+c hildren Married with2 children Married with 1 child Married without children 0,8 3,0 2,7 1,4 3,6 2,9 3,5 5,5 4,3 4,5 14,5 17,7 18,2 24,7 25,6 27,4 31,9 34,5 47,5 48,9 Figure Percentage of households interested and not interested in purchase of additional health insurance for up to PLN 100 and over PLN 100 per month in by type of household 35,4 59,1 63,6 62,6 70,2 69,0 72,7 79,2 84,7 80,5 Over 100PLN Up to 100PLN No 0,0 20,0 40,0 60,0 80,0 100,0 %

12 Social Diagnosis 118 rural areas towns <20k towns k towns k towns k towns 500 k 1,4 2,7 3,0 3,3 4,5 7,1 19,2 23,7 25,8 29,3 35,1 35,2 0,0 20,0 40,0 60,0 80,0 % 100,0 Figures Percentage of households interested and not interested in purchase of additional health insurance for up to PLN 100 and over PLN 100 per month in by class of place of residence 57,7 60,5 67,5 71,2 73,6 79,4 Over 100PLN up to 100PLN No Assessment of changes in degree of healthcare need satisfaction Despite continuing public criticism of the healthcare system, the percentage of negative retrospective evaluations of change in degree of healthcare need satisfaction fell systematically from 41% in 2000 to 25% in 2009, though in the last four years there has been a rise, admittedly small, in negative ratings (Table ). However, the unusually low percentage of positive opinions is not rising. In comparison with, in the group of households with the unemployed there were significantly more negative opinions about changes in healthcare need satisfaction than in those without such members at over 36% and over 26% respectively reporting negative opinions. In terms of the household types adopted here, negative opinions were formulated most often in the households of single-parent families and in non-family multi-person households at over 35% and nearly 30% respectively. The households that negatively evaluated changes in degree of healthcare need satisfaction lived mostly in largest cities and small towns of k at over 29% from these groups, and in Łódzkie, Warmińsko-Mazurskie and Dolnośląskie Voivodships at nearly 35% in the first and more than 33% in the second and the third of them. Table Assessment of change in degree of healthcare need satisfaction in recent years (since the last wave) in subsequent waves (%) Healthcare need satisfaction Worsened Improved Did not change