Public Spending Discretion and the Local Government Health Care Policy Program

Abstract

Local government units (abbrev.: l.g.u.) bear expenses on their own tasks under public spending discretion – a rule within the constitutional financial independence. However, spending discretion is not unfettered and is subject to supervision of regional chambers of audit (Polish: “regionalne izby obrachunkowe”). The supervision is based on legality critierion. Any interference with the l.g.u.’s decision is allowed only ex post. In particular, it is not permitted to interfere within the spending decisions of local government on the at the decision-making stage.

Performing tasks related to health care, l.g.u. draw up, implement and carry out local government health care policy programs. At the drawing up stage, the program is assessed by the President of the Agency of Health Care Technology Assessment and Tariff System (Polish: “Agencja Oceny Technologii Medycznych i Taryfikacji”, Polish abbrev.: AOTMiT; agency is supervised by the minister responsible for health care issues). Assessing, the AOTMiT’s President applies criterion of financial implications to the local government unit. Negative assessment prevents l.g.u. from carrying out the program. Such assessment, being done ex ante, results in systemic incoherence with the spending discretion, since the spending discretion is supervised and may be interfered only by regional chamber of audit, considering legality criterion.

Thus, de lege ferenda conclusions were formulated to overcome the said incoherence, recognizing general purposefulness of involving AOTMiT’s President in the procedure of assessing local government health care policy programs.