Mr Kostro shares his views with EURACTIV’s readers on enlargement, the current situation of health care in Poland and the lobbying efforts of the Polish medical devices sector.
How does the Polish medical devices sector advance its lobbying efforts in Poland and vis-à-vis the EU?
We have only recently created a Chamber of Commerce on the basis of an Association of manufacturers and distributors of medical goods. This Association has been active for more than 11 years. A year ago we decided that the Association was not enough. Our reasons were twofold . Firstly, the general legal situation of Polish healthcare is becoming more and more difficult every year. Secondly, we are closer to EU accession so there are lots of different regulations that will need to come into Polish law.
According to Polish law, a chamber of commerce has a lot more legal possibilities to be active. It has the right to express opinion and influence regulations and generally speaking has much more influence on everything relating to healthcare. If our member companies have legal problems in Poland, the Chamber of Commerce helps them resolve them. Some of our members are competitors of each other. Our rule is that inside the Chamber of Commerce there is no competition, we are there to help everybody – for example, taxes or special or medical area regulations which are or could be difficult for all the players in the market.
What are the most important issues for you to tackle?
We have a number of domestic issues to deal with. A high level of national debt between customers and suppliers is one and a second very important problem is the registration of new products. On the other hand, we are doing everything for our members (the ones who are importers) to streamline procedures as much as possible – just CE marking and about three pages of declarations and that’s it. At the same time (for the exporters) we are trying to gain easier access to the European market.
In your view, how will enlargement influence your sector?
After accession, I don’t know how things will turn out. As we know from past EU accessions, every industry has had troubles. Poland has more than 40 million people in the country. At the same time, the cost of production is relatively low compared to Germany and France. Geographically, we are between Germany and the rest of the European Community and the former Soviet countries. In healthcare we expect next year to be really difficult. Our expectation is that many of the medium size companies will go bankrupt.
The issue of unequal access to healthcare is a big issue in the EU-15 but it will be even more pronounced following the next EU enlargement. How do you see this problem?
We have very good doctors but many of them work abroad. If you compare general conditions, some of our hospitals have higher standards than some private German clinics. But then again some hospitals are so poor that they have to be supported by local communities – for example, by agricultural producers who give food to hospitals because the hospitals can’t provide patients with enough food. So the policies on financing health care in Poland should be reformed. For a big group of Polish people, after accession, access to medical services next year or in the next two years will be even worse than it is now. The situation we are really afraid of is that we will have two different kinds of access and quality of medical services: very high for a very small group of rich people, and rather low for the rest of the population, who will have to wait for many months even when a patient has cancer.
In your view, could the EU do something to reduce health inequalities?
The first thing the European Community can do is to push the Polish government to spend more money on healthcare. But in terms of legislation, some amendments would also need to be made.
What future do you see for the Polish m edical devices industry?
In November 2003, Eucomed and the European Community will help us to speak to the Polish government by organising a round table on healthcare. It is a pity but we are coming to realise that healthcare is not the first, and not even the second most important issue for Polish EU negotiators and the government. If it remains like that for the coming years, firstly, we will have a system of two levels of healthcare (as I mentioned earlier) and, then, to put it simply, people will start to die, as statistics have shown.
Ten per cent of the total national income should be spent on healthcare and then part of the problem would be solved. But there is also another problem. There are many supporting programmes coming from the European Community for different segments of the market, such as healthcare, ecology, SMEs. But securing EU funding is difficult because of the amount of bureaucracy and time it entails. I know for example that for the Phare programme, a significant amount went back to Brussels only because the administration was unable to fulfil all the documentation criteria.
Finally, are you optimistic or pessimistic about EU enlargement overall?
In the first two years – pessimistic. After that, we will see. If we look at the statistics, there are many people with higher education and production costs are low. A lot of people are ready to do something, just waiting for the possibility (mainly through foreign capital) of creating something new. So if this works out well, I’m optimistic. If foreign capital buys up the best part of Polish industry and country (including land) it will have been a mistake, a short-term policy and, the situation in the country would be worse than it is now.