Pathologies in hospital foundations? The Ministry of Health does not recognize the problem.
- The Ministry of Health doesn't know exactly how many foundations operate at hospitals and doesn't plan to find out. Meanwhile, these foundations could be used to circumvent the ban on co-financing treatment financed by the National Health Fund.
- In the case we uncovered, oncology patients at the Ministry of Internal Affairs and Administration's Medical Institute were pressured into donating to a hospital foundation to receive modern treatment. Following the revelation, several institutions were subjected to inspections, but the problem may be much broader.
- Experts warn that hospital foundations are a potential source of abuse and conflicts of interest. While they can help save hospital budgets, they often operate in a gray area and without proper oversight.
The Ministry of Health cannot count the number of hospital foundations under its jurisdiction. Nor does it investigate whether such entities are being used to circumvent the ban on co-financing services provided by the National Health Fund. It does not plan any legal changes to the operation of hospital foundations, Rynek Zdrowia has learned.
This is crucial information in the context of our joint investigation with Wirtualna Polska in April of this year. At the time, we revealed that pancreatic cancer patients, in order to receive modern treatment at the Ministry of Interior and Administration's National Medical Institute, were required to donate tens of thousands of złoty to a foundation operating at the hospital. This was the expectation expressed by the head of one of the hospital clinics and chairman of the institute's scientific council , Professor Marek Durlik .
Following our publication, the National Health Fund (NFZ), the Ministry of Internal Affairs and Administration, the Central Anticorruption Bureau, and the Patient Rights Ombudsman initiated an inspection of the hospital. The Supreme Medical Chamber also filed a complaint with the Chief Professional Liability Ombudsman against Professor Marek Durlik. According to our information, the inspections are still ongoing.
In the public debate sparked by our text, claims were made that hospital foundations are hotbeds of pathology and should be further regulated, subjected to greater supervision, or outright banned.
Dr. Grzegorz Makowski from the Warsaw School of Economics, in an interview with the Polish Press Agency, pointed out that a hospital foundation presents a potential conflict of interest. It is an entity attached to a public hospital and operated by a person who is often also the head of the department.
The expert noted that the problem with hospital foundations is that it is not known how many there are because no one has counted them.
"I'll say, somewhat against my will, that perhaps it would be possible to civilize this method of raising additional funds for hospitals. However, we would first have to check how many of these foundations there are, how they operate, etc. And we know almost nothing about it. We only know pathological cases from the media," said Makowski.
The expert emphasized that the creation of foundations is not always motivated by the desire for profit by individuals, but is primarily a result of chronic underfunding and organizational chaos in the healthcare system. Foundations are often created to shore up hospital budgets. Sometimes, a hospital has more than one foundation, and sometimes several are "attached" to different departments.
- If the foundation's activities allow a patient to jump the queue for a given service, one may wonder whether it is a crime or not - noted Grzegorz Makowski.
During the research that led to the report "Corruption in the Polish Healthcare System" published last year, the topic of foundations operating at hospitals came up during interviews with doctors. Makowski emphasized that the doctors themselves said that foundations create a corruption-prone mechanism.
Research has shown that foundations are also used in the struggle within the hospital hierarchy between heads of hospitals. There are also cases where individuals derive specific benefits from the foundation's activities, for example, board members may do so by paying themselves a salary.
We asked the Ministry of Health if it knew how many hospital foundations there are in Poland. We were told that the register of foundations under the Minister of Health's supervision is maintained by the Ministry of Health's Department of Supervision and Control. It includes all supervised foundations – currently over 4,200.
The problem is that the records don't specifically identify hospital foundations. This category isn't legally defined and doesn't exist in any official register. Therefore, the Ministry of Health is unable to determine how many foundations operate at specific hospitals.
Over the past three years, the Ministry of Health has not received any reports of hospital foundations double-billing patients for services or subsidizing higher-quality services (e.g., a separate room for pregnant women). The Ministry has not conducted any inspections of foundations in this regard. The annual inspection plan for foundations focuses solely on verifying compliance with obligations under the Act on Combating Money Laundering and Terrorist Financing.
Foundations are obliged to submit financial reports to the National Court Register and – in the case of foundations with the status of public benefit organisations – publish them on the website of the National Institute of Freedom – Centre for the Development of Civil Society in the Public Information Bulletin.
The Ministry of Health is not considering introducing any legal changes, prohibitions or restrictions regarding the functioning of hospital foundations.
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