Women who meet the health or age criteria have free access to prenatal tests – assesses the Supreme Audit Office. He also points out that no group of pregnant women is completely free from the risk of birth defects in children, so all of them should be entitled to free tests.
The Supreme Audit Office in the report published on Tuesday emphasized that both the current effects of the Prenatal Testing Program and the control results confirm that access to free, non-invasive tests allowing for the exclusion or detection of malformations in an unborn child and enabling quick treatment – should be provided to all women in Poland, regardless of age.
In the opinion of the Supreme Audit Office, the current age restriction (over 35 years) is not justified in a situation where the frequency of birth defects in children is similar in mothers over and under 35 years of age. Statistics show that no age group of expectant mothers is free from the risk of developing birth defects in babies. The probability of their occurrence varies, but in the opinion of the Supreme Audit Office, these differences are not so significant as to deprive any of the groups of expectant mothers of the right to free tests.
NIK emphasized that extending the availability of free prenatal tests to all expectant mothers will mean a radical decrease in costs for women who have previously performed such tests on their own. The Chamber noted that the average cost of a complete set of research financed from the state budget is approx. PLN 1. PLN per woman, while the same tests in private institutions cost at least twice as much.
The Chamber indicated that the Ministry of Health and the inspected provincial branches of the National Health Fund provided access to the program to women who meet the criteria, however, due to the diversified distribution of test facilities in some provinces, access to them could be limited.
The percentage of women covered by the research differed significantly between voivodships: in 2012, it ranged from just over 3%. in Lublin to 41,5 percent in Silesia, and in 2015 from 8 percent. in Lublin up to 54 percent in Silesia.
Since 2009, the expenditure on the program has been steadily increasing, as a result, the number of women covered by prenatal care has increased: from 31 thousand to 390 in 2009, to 71 thousand 525 in 2014 and 46 thousand. in the first half of 2015
NIK raised objections to the information policy regarding access to prenatal tests; pointed out that although the Ministry of Health undertook activities aimed at improving the knowledge of pregnant women about pregnancy, childbirth and the postpartum NFZ program.
The National Health Fund informed pregnant women about the possibility of carrying out prenatal tests, but in 4 out of 5 inspected departments this information was imprecise and could mislead women, mainly as to the criteria for inclusion in the program (departments: Silesia, Podkarpacie, Mazovia, Lublin).
The majority of doctors referred women who met the applicable criteria to free tests under the program, and reported the possibility of using such tests commercially if the women did not meet the criteria. However – the Supreme Audit Office noted – in half of the inspected establishments, pregnant doctors did not draw up and did not provide the women with an antenatal care plan, which should include the possibility of qualifying a pregnant woman to the prenatal screening program.
In addition to covering all pregnant women in the program, NIK also recommends, inter alia, such a change in the ordinance on standards of medical procedure in the provision of health services in the field of perinatal care, so that it becomes obligatory to inform women up to the 10th week of pregnancy about the possibility of carrying out tests for genetically determined defects.
NIK also sees the legitimacy of activities aimed at popularizing among the branches of the National Health Fund, as a good practice, the division of areas for contracting services provided under the program into smaller areas (e.g. poviats), which should contribute to the improvement of access to prenatal tests.
The audit covered the activity of 18 units (Ministry of Health, provincial branches of the National Health Fund: Małopolski, Mazowiecki, Podkarpacki, Lubelski, Śląski and 12 service providers implementing the prenatal testing program) in the years 2012-2015 (2 quarters).
In response to the post-audit speech, Deputy Minister of Health, Piotr Warczyński announced that work aimed at modifying the program will be intensified. He also announced that the post-inspection application is already being implemented by the ministry in a different form – by order of December 2015, the minister appointed a team for the project of a reproductive health program, which, as an auxiliary body of the minister, will develop a draft of the so-called the operational goal of the National Health Program for 2016-2020, aimed at promoting reproductive health and a project of a health policy program in the field of reproductive health.
Treatment entities replied to the speeches that they had developed “antenatal care plans” and obliged medical staff to include these plans in their medical records and to provide copies of them to patients. (PAP)