Chronic obstructive pulmonary disease (COPD), a serious disease that gradually leads to respiratory disability and death, is still little known, but we spend at least 400 million from the state budget every year – experts emphasize.
They believe that the social costs of COPD can be lowered thanks to better organization of care for people suffering from it.
Such conclusions can also be drawn from the latest report prepared by experts from the Institute of Healthcare Management at the Lazarski University in Warsaw. Report “Chronic obstructive pulmonary disease (COPD) – an economic and social cost analysis” was first presented on Monday at a debate in the capital.
From the data presented by the co-author of the publication, Dr. Jerzy Gryglewicz, in 2012, the National Health Fund (NFZ) spent over PLN 164 million for the treatment of COPD patients – as part of inpatient treatment, specialist outpatient care and rehabilitation. Even greater are the expenses from the Social Insurance Fund for disability benefits for people with COPD. In 2012, they amounted to PLN 236 million. The report does not include the cost of drug reimbursement for patients with this disease.
“The highest expenses of the National Health Fund were related to hospital treatment and amounted to approx. 125 million (which is approx. 76% of the entire amount – PAP). On the other hand, outpatient COPD treatment expenses amounted to only PLN 34 million (less than 21 percent – PAP), and expenses for rehabilitation, which is an important element of care for these patients – only PLN 5,7 million (over 3 percent – PAP) ” – mentioned Dr. Gryglewicz.
In his opinion, these proportions reflect the poor organization of care for patients with COPD. “Patients with COPD who are well treated in outpatient specialist and primary care do not require hospitalization in most cases. If a patient had access to a specialist doctor, he would not have to be treated in a hospital “- emphasized the expert during the media meeting at which the presentation of the report was announced. He reminded that hospital treatment is the most expensive form of health services.
According to him, the cost of one hospitalization in an exacerbation of COPD is approx. PLN 3. zlotys, and for this amount you could give 80 advice in an outpatient clinic.
“What also worries us is the issue of insufficient expenses for the rehabilitation of these patients, because good pulmonary rehabilitation clearly reduces the number of hospitalizations” – emphasized Dr. Gryglewicz.
Prof. Andrzej Fal, head of the Department of Internal Diseases and Allergology of the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, pointed out that the condition for starting COPD treatment should be quitting smoking by the patient. About 90 percent. of COPD cases is related to this addiction.
“Only quitting smoking significantly slows the loss of lung function in COPD” – noted the specialist. Therefore, in many countries, the first step in treatment of COPD is anti-smoking treatment.
Meanwhile, the latest report shows that in 2012, the Program for the Prevention of Tobacco-related Diseases, which includes the treatment of smoking addiction, included only 194 COPD patients nationwide. Dr. Gryglewicz emphasized that the level of financing of this program by the National Health Fund is so low that from year to year it is implemented by fewer and fewer institutions. For example, in Podlaskie Voivodeship in 2012, not even one patient was covered by it.
Until the publication of the PAP report, it did not receive any comment from the Fund on this matter.
The data from the National Health Fund also show that in 2012 health services were provided to approx. 500 thousand. COPD patients, while experts estimate that the number of patients in Poland reaches 2 million.
According to experts, the main problem is that most COPD patients are not diagnosed with the disease. Its detection can be improved, among others thanks to the education of primary care physicians (POZ) in this area.
Dr Gryglewicz found the changes proposed by the Ministry of Health to add spirometry to the diagnostic test package at the disposal of primary care physicians to be beneficial. Spirometry is the basis for the diagnosis of COPD.
In an interview with PAP, Dr. Piotr Dąbrowiecki, chairman of the Polish Federation of Asthma, Allergy and COPD Patients, assessed that in Poland, access to non-invasive mechanical ventilation for patients with COPD exacerbations is also a problem, which is cheaper than procedures requiring intubation and reduces the risk of serious complications. e.g. pneumonia. In his opinion, it is also necessary to better finance home oxygen treatment, which extends the life of patients with COPD. “We would also like to have access to new bronchodilators that are more convenient for patients to use and can improve treatment outcomes. Patients from other EU countries have access to them. In Poland, however, they are not reimbursed, ”said Dr. Dąbrowiecki.
According to the information received by PAP from the spokesman of the Ministry of Health, Krzysztof Bąk, “in the near future” the minister of health will issue a decision (positive or negative) regarding reimbursement of a new bronchodilator drug containing indacaterol meleinate. (PAP)