To whom does private diagnostics pay in Poland and why? Hanna Fedorowicz (‘Med-Info’ No. 10/2005)

The network of private laboratories has been developing at such a pace, that some people think they will soon dominate the market. Ever more units take decisions to outsource the diagnostic activities.

Today, private diagnostic laboratorieshave only a few percent share in the market of laboratory investigations, yet it may soon change. More and more hospitals use their services. The demand for outsourcing in diagnostics makes the private laboratorie, especially big ones, develop the network of their outlets and units. There is something worth fighting for, as the value of the market of diagnostic investigations in Poland is estimated at some 400 million Euro (1.6 billion Polish zloty). On that market, besides big laboratories, also numerous small labs function, as well as public labs and labs acting as non-public Health Care Units (ZOZ). That market should also become competitive. ‘More private diagnostic firms entails higher quality at lower prices’, says Alicja Gabrylewska, MD, president of the Białystok branch of the Polish Association of Laboratory Diagnostics. ‘Profits made by state-owned laboratories are shared by the hospital as a whole. The laboratory does not retain them, not even for the petty needs necessary for the functioning of the lab.’ That is why, in her opinion, privatisation of hospital laboratories is inevitable. ‘Thanks to that those units will be able to decide themselves how the money made should be spent’, Alicja Gabrylewska stresses further.

Quality first of all

Still, the Polish Council of Laboratory Diagnostics is sceptical about outsourcing. ‘We are not against the privatisation of laboratories, but against the outsourcing of diagnostic services, consisting of taking them out of the Health Care Units (ZOZ)’, claims Henryk Owczarek, the president of the Council. The Council is of the opinion that this may have negative influence upon the quality of services provided, meeting the standards of the Act on laboratories, following good laboratory practice. ‘Of no lesser importance is the maintaining of contacts with wards, for which the analyses and investigations are performed’, the president remarks. ‘The worst situation is when the laboratory is located at a substantial distance from the hospital. Even the best equipment and apparatuses will not be sufficient, as samples may be destroyed in transport.’ The president also highlights the fact, that taking services outside the hospital may entail prolonged time for performing the investigations. ‘ It is not good when the laboratory integrates services, as this causes monopolisation of the market and price increase,’ says Owczarek. Yet most diagnosticians do not share those fears. In their opinion, everything depends upon the level of professionalism and reliability of results. ‘If a private laboratory is in the position to provide that, then why hospitals should not use its services,’ asks Maria Królak from the Lower Silesia Centre for Laboratory Diagnostics by the Provincial Specialistic Hospital in Wrocław. The laboratory there functions as a limited liability company, where the shareholders are both the hospital and a private company.

Fragmented market

In the register kept by the Polish Council of Laboratory Diagnostics, 2412 entities are registered. Those are mainly small diagnostic labs, co-operating with private medical practices or non-public Health Care Units (NZOZ). They are remnants after  the year 1989, when private laboratories emerged on a mass scale. It was enough then to get registered in the register of businesses. Oftentimes, those were family businesses, with 1 or 2 people of staff. The impulse for development was provided by growth of the private sector of medical services, as well as the privatisation of numerous health care units, especially in the outpatient clinic sector, following the reform of the system made in 1999. As for today, there are 13.5 thousand non-public Health Care Units (NZOZ), while less than 3 thousand are public (data quoted after: www.rejestrzoz.gov.pl). Difficulties in financing of the public health care forced the managers of Health Care Units (ZOZ) to cut spending on laboratory diagnostics. Today, when the market is subject to regulations (laboratories have to be registered as non-public Health Care Units (NZOZ), which entails obtaining permission for carrying out the activities from the sanitary and epidemiological station, regulations have also been introduced according to which only suitably qualified persons may be managers of laboratories), the future of small lab units appears uncertain. Small private laboratories are of importance mainly in smaller towns. In cities their life is worse. ‘Small laboratories, if they do not have contracts with the National Health Fund (NFZ) or private medical companies, can barely exist,’ underlines Ryszard Adamski, owner of a private laboratory in Warszawa. ’I think the co-operation with big diagnostic firms is a chance for them.’ Investing on their own in expensive equipment or leasing such equipment may prove a disaster. Only economic results count here. That is why attempts of market consolidation are ever more frequent.

Article from the website:

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