At the end of 1990, the Republic of Poland comprised 312,683 square kilometers, and was inhabited by 38.5 million people, 29 percent of whom were below 18 years of age. There are 808 towns and 2,128 communes, with 40 percent of the population living in rural areas. Administratively, Poland is divided into 49 voievodships (provinces) varying in size from 250,000 to more than three million inhabitants, with communes as the second tier. A division of the country into 12- 14 regions with counties as the second tier is currently contemplated.
The Constitution promulgated in 1952 guarantees all citizens free health care. Today, more than 99 percent of the population is covered by state health insurance. The legal, administrative and financial responsibility for health policy and the organization of public health and medical care is in the hands of the Ministry of Health and Social Welfare.
Health care services are integrated, with the health care district forming the basic structural unit for serving the residents of a given territory. Health care is provided at various levels: community, province, regional and national. At the community level, primary health care is integrated with the hospital in what is known as an Integrated Health Care Center (ZOZ). The typical ZOZ covers roughly the territory of the commune or district, but its function is not limited by the administrative division of the country. The ZOZ serves small towns, their surrounding villages, and neighborhoods or districts in cities with populations from 30,000 to 150,000 or more. These are subdivided into reyons of 3,000 to 5,000 inhabitants, who are served by a local primary health care clinic. In addition to ambulatory services, and general, specialized and emergency services, the ZOZ hospital contains at least four specialty wards: internal medicine, surgery, pediatrics, and obstetrics/gynecology. The director of the ZOZ has the