Changes in the Polish health care system, introduced by a Parliamentary Act in 1999, resulted from an urgent need for a more effective provision of health services, which were held in poor esteem by the public. Public expenditure on health care at the time of the reform was equivalent to 4.19% of gross national product, or US$363 at purchasing power parity (PPP) per capita. This amount was considerably lower than in the most developed countries (i.e. members of the Organisation for Economic Cooperation and Development, OECD). The reformers’ main modification consisted of replacing state financing of health services with insurance-based financing. Statutory health insurance covers 99.4% of Poland's 38.2 million citizens. The insurance fee is to be increased from 7.0% of personal income at the beginning of the reforms to 9.0% (at present it has reached 8.25%). The aim was also to achieve relatively stable health care expenditure, independent of the annual political budget allocation. A special administrator was appointed for the Sickness or National Health Fund and was authorised to contract for health services. These market-oriented developments were paralleled by the implementation of special programmes, financed from the Ministry of Health budget, which were aimed at restructuring health care facilities.