Poland: A large but still under-researched country.
In this issue, we publish five articles on health care eforms, their processes and their results in Poland [1–5]. e thus focus on a country which joined the Organisaion for Economic Collaboration and Development (OECD) wenty years ago in November 1996, and which is by far he largest of the countries that acceded to the European nion in May 2004. In fact, its population is more than twice he size of the Netherlands, four times that of Austria or weden, and eight times that of Ireland – all countries with ealth systems that are studied much more often. In 1996, oland spent 5.2% of its GDP on health (compared to e.g. .0% in the UK and 9.8% in Germany) – a percentage which as risen only slowly, to 5.9% in 2004 (compared to 7.3% in he UK and 10.1% in Germany) and 6.3% in 2015 (compared o 9.8% and 11.1% respectively). Given its rapid GDP growth, xpenditure growth in US$ PPP has been much steeper: rom $431 per capita in 1996 to $771 in 2004 and $1677 in 015, i.e. by almost 300% or the same percentage as in the K but more than twice that in Germany (all figures from ECD Health Statistics 2016). Extensive reform efforts have taken place in Poland ince the start of political and economic transformation n 1989, including the first systemic changes in the health ector [6]. Initial reforms were haphazard and there was ittle continuity in the reform process (e.g. introduction f regional sickness funds in 1999 and their replacement y the centralized National Health Fund only three years ater), which could be explained by varying political agenas of the parties in power and by lack of expertise and apacity to precede reforms by in-depth analysis. However, olicy expertise has since been significantly strengthened nd its impact is clearly felt (e.g. in the developing of he guaranteed benefits baskets in 2009). Moreover, coninuity of the reform agenda was more likely given the arliamentary success of the same political party (PO) in wo consecutive elections for the period 2007 until 2015. any of the articles we have published on Poland deal ith the reforms passed during this period of relative olitical stability, namely the Act of 12 May 2011 on the