“Children of the transformation” – an ethnography of healthcare reform and Polish primary care

The 1997 healthcare reform brought about profound changes in Poland. Yet decentralising and liberalising the previous Semashko-inspired healthcare model failed to meet the expectations of medical practitioners, now turned entrepreneurs and employers. This article is an ethnographic exploration of doctors’ responses to this major sociocultural reconstruction. Based on research among physicians working in Podstawowa Opieka Zdrowotna (POZ, “Basic Healthcare”), which was newly established in 1997 and immediately opened to the free market, this article shows that Polish primary care doctors still struggle with over-regulation by state institutions. Despite some positive experiences of the 1997 reform, state policies have led to an erosion of practitioners’ freedom and authority. Furthermore, contradicting medical ideologies, such as the insistence on familiarisation with the patient’s story and body, versus neoliberal, standardised and cost-saving regimes clash in the contemporary version of Polish primary care, leaving doctors grappling with undefined professional identities.