New eligibility rules for cataract surgery apply. To get to the queue “at the National Health Fund” you will have to meet several medical criteria. As a result, the queues for reimbursed treatments will be significantly shortened. It will also be more difficult to obtain reimbursement for a surgery performed abroad.
- In the Ministry of Health, the new rules and their consequences were presented by Minister of Health Łukasz Szumowski, Deputy Minister Maciej Miłkowski, President of the National Health Fund Andrzej Jacyna and prof. Marek Rękas, national ophthalmology consultant
- According to OECD data, less than 2016 cataract procedures were performed in Poland in 3. Last year, the government transferred additional funds to this type of operation, which contributed to the improvement of the situation
- There will be more treatments, but they are also to be performed more rationally
- The team of experts has developed criteria according to which people with visual acuity of 0.6 or worse will be eligible for cataract surgery under public insurance, i.e. most patients with cataracts
The minister of health spoke of the fact that the queues for cataract surgery in Poland were (still are) long, but also unreasonably long, already in the spring, noting that many patients are enrolled by doctors for surgeries “in advance”. This created a closed circle: long lines justified also enrolling those patients who did not need the procedure not only for the cito, but also in the foreseeable future, which – of course – made the queues longer. Effect? Until recently, Poland was at the tail end of Europe when it comes to the availability of cataract surgery, also in urgent cases. We were only ahead of Serbia, Bulgaria, Ireland, Romania and Slovakia. According to OECD data, less than 2016 cataract procedures were performed in Poland in 3 per 100 inhabitants over 65 years of age (NHF data were more optimistic – 3890 procedures).
Last year, the government transferred additional funds in the fall, including for cataract surgery – the effects also showed immediately. Poland advanced in the peloton of European countries and was in the middle of the field. We overtook, among others Croatia, Macedonia, Spain, Norway and Iceland and even Switzerland with the result 4061 procedures (per 100 inhabitants over 65 years of age). – The plan for 2018 shows that Poland is finally starting to come to the fore. In 2018, we plan to achieve an indicator of 5200 treatments. We hope that next year we will be in the group of leaders – said Deputy Minister of Health Maciej Miłkowski.
There will be more treatments, but they are also to be performed more rationally. Prof. Rękas admitted that experts have long pointed to the problem of qualifying for cataract surgery. – Increasing the growth of interest in these treatments, including the effect of repetition in the media that the sooner such an operation is performed, the better. The result is that people who do not require this type of treatment soon sign up for the queue – he said.
A team of experts, recognized ophthalmologists, developed criteria according to which people with visual acuity of 0.6 or worse, i.e. the majority of cataract patients, will be eligible for cataract surgery under public insurance. – Each operation, including cataract surgery, is associated with risks. In the case of cataract treatment, these long-term complications affect up to 30%. patients treated. Therefore, cataracts should not be treated as a simple operation – emphasized prof. Marek Rękas.
The primary qualifying criterion is the presence of lens opacities in a biomicroscope after pupil dilatation. – However, patients with visual acuity better than 0.6 to distance with the best correction cannot be qualified for the procedure, except in cases of urgency – said the expert. These urgent cases are exceptions: cataracts, which are an obstacle to the diagnosis and treatment of other eye conditions, such as glaucoma; the development of myopia as a result of first eye surgery exceeding 3,0 diopters; cataracts in people working as drivers, as well as in mentally ill or mentally retarded people. Experts estimate that exceptions will account for less than 5 percent. all treatments performed under the general health insurance system.
The new criteria for the treatment of cataracts also include a qualifying appointment, for which the NHF will pay an additional fee. Objective? Screening of all patients waiting for cataract surgery to assess which patients are eligible for surgery and which are not yet. This visit will be performed by an ophthalmologist from the facility that maintains the list where the patient is to be operated on.
It is not difficult to guess that the qualification visits to which patients are invited will significantly shorten the queues, although the minister was reluctant to answer the scale of this phenomenon. The visit should take place within 30 days of the patient reporting to the healthcare provider. – All the rules apply both to treatments performed in Poland and abroad as part of the so-called cross-border healthcare – Minister Szumowski informed. This means that a large number of patients who planned the procedure in the Czech Republic or Lithuania may not receive a refund, because it will be granted only after confirming their place in the waiting queue during the qualifying visit. Meanwhile, according to the NFZ data, the vast majority of patients reporting to the Fund for cataract reimbursement did not register on the waiting lists in the country at all. – Of the 15729 cataract surgeries financed by the Fund under the directive, only 1798 patients were put on waiting lists for treatment in hospitals in the country, the Ministry of Health reported.
Another novelty is the postoperative visit, which – as Andrzej Jacyna, President of the National Health Fund, said – will have to take place 28 days after the surgery. The doctor is to assess the effects of the operation (NHF will not pay extra for this visit, it is included in the operating rate).