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Every year, over 100 Poles go for treatment abroad with the help of the National Health Fund. It is still very little, but the idea of treatment in other countries is worth considering and checking the possibilities.
It is easy to get lost in the regulations regarding treatment options abroad, the more so as changes have been announced for several months, and hardly anyone can say exactly what positive they will give patients, when and if they will come into force. Poles are not alone in Europe in their ignorance of this area of law. Only a few percent of Europeans have at least some basic knowledge about treatment options abroad. A Dutch, Spaniard or Greek begins to consider treatment in a hospital other than the nearest one, either during the holidays, or if he is in serious health trouble, e.g. he has cancer. What will the new regulations change for cancer patients who would like to be treated abroad?
Worst system in Europe?
The prospect of treatment outside Poland seems all the more tempting, the longer you have to stand in line to see the doctor at the clinic, not to mention waiting for an appointment with a specialist or for some treatments. Patients suspect that it would be better and more professional in a German or Swiss clinic. The research of the French institute published in the report “Health Barometer 2010” shows that Poles assess the national health care system the worst of all eight surveyed nations. Nobody complains more than us about queues for health services. However, if you look at the mood of patients around the world, it turns out that it is difficult to find a country where at least half of the patients would not complain about the long waiting time for medical help. Queues are a problem, among others Brits, Americans, Italians and Norwegians. On the other hand, the Germans, the French, the British and the Americans are more afraid than we are of falling into the hands of unprofessional personnel and falling victim to medical errors.
Patients’ moods, however, are not an authoritative and objective showcase of a given health care system, because it is known that some nations are more critical than others (Poles have some of the most negative opinions in Europe, including about their ways, political elites and fellow citizens). Angered by the necessity to wait, we seem to forget about the positives. According to many European specialists, we have one of the best medical education systems on the continent in Poland. Adepts of knowledge from Scandinavia, Greece and Great Britain come to Poland to study medicine for a reason. In the last two decades, many modern equipment has also appeared in Polish hospitals, and the old fears that we are far behind Europe have no basis anymore.
A Pole who uses medical services in Scandinavia for the first time will be very disappointed. You have to pay a part of the fee for medical visits, you have to wait months for simple treatments, private clinics are like medicine, for the price of visiting a dentist in Poland you can keep your family for half a month, and after many operations the patient is sent home almost immediately. In Italy, Poles do not like the differentiation of standards depending on the region. In one case, care may be of a high standard, in the other, ‘fear to go to the doctor’. In Ireland, a Pole is shocked by… similarities to our system. Patients wait in long lines for surgeries, and the flu epidemic causes hospitals to run out of beds and lie in the corridors. A few years ago, the Irish press ridiculed the absurdity of enrolling pregnant women with a waiting year for a gynecologist. “Does the Ministry of Health know how long the pregnancy lasts?” – journalists asked.
Gleit from the minister
The grass is not always greener at the neighbor’s place, but certainly foreign health care has a lot to offer Poles. In many hospitals, treatments can be performed immediately, some offer treatments not offered in Poland, while in others you can get access to the latest generation of drugs. Nevertheless, a patient going for treatment abroad is still a picture mainly from films. In the European Union, patients rarely choose to be treated outside their home country. NFZ equivalents in EU countries spend only 1% of contributions to finance this type of treatment.
In 2008, the National Health Fund considered 152 applications for treatment outside Poland. More than half of the applications were for treatment in Germany, followed by Belgium and Great Britain. Patients applied for treatment outside the European Union only a few times, e.g. in the United States or China. About 15% of applications were refused, as according to the National Health Fund, comparable benefits can be obtained in the country. Most applicants received approval. Every year, among those who send the application, several or a dozen or so people are cancer patients.
In order to obtain consent for treatment, continuation of treatment or diagnostic tests outside Poland, an application must be submitted to the President of the National Health Fund. If we undergo treatment abroad before receiving the decision, we will have to cover the costs ourselves. How is the procedure today?
• We download the application (eg from the website www.nfz.gov.pl).
• We complete part IA ourselves, and then submit the application to a specialist in the relevant field of medicine with the title of professor or postdoctoral degree in medical sciences. This part fills in part II and fragments III, stating, inter alia, the diagnosis, health condition, proposed scope of treatment and name of the facility with the justification for the choice, the expected method and duration of treatment abroad and confirmation that the treatment or test is not carried out in the country, and it is necessary to save lives or improve our health.
• We submit the application to the provincial branch of the National Health Fund. We attach a copy of the medical documentation and a translation of the completed application into English or the language of the country to which we want to go.
• The NHF department verifies the application. He contacts the foreign agency specified in the application and agrees the initial costs. Officials attach the greatest importance to checking whether a given service is not provided in Poland. He can exchange views with a provincial or national consultant in the relevant field. In justified cases, it may indicate another foreign mission. Finally, he passes the application to the president of the National Health Fund, who issues a decision.
The procedure takes up to several days. If consent is given, we take the relevant documents to the country of treatment. The National Health Fund covers the costs of treatment on the basis of an invoice issued by a foreign facility. The fund can also pay for transport, but for the issue of a passport, visa or a possible stay outside the hospital for ourselves or the caregiver we pay out of our own pocket.
The National Health Fund will pay, but …
In June this year, the EU Health Ministers adopted the “Patients Without Borders” directive. The new rules are to come into force in two years, and the legislative work is still in progress. Although the name sounds very promising, according to health economics experts, it will not change much for patients who would like to continue or start cancer treatment abroad. Why?
If you want to go abroad for planned treatment, you will need to obtain the consent of the fund’s president. The National Health Fund (if it will spend it) will pay for the treatment, but only up to the amount that it would have to spend on it in Poland. There are many indications that the patient will initially have to put money out of his own pocket, and only then the National Health Fund will reimburse him as much as for the same medical service in Poland. In most EU countries, health services are valued much higher than in our country, so it will be more profitable for a Polish patient to be treated privately on the spot than to go to a German clinic. Only in countries south of Poland you can find cheaper medical services than ours.
If your application for treatment abroad is denied, there are no longer many options for appeal. As we read on the website of the National Health Fund: “The decision of the president of the Fund in individual cases in the field of health insurance may be appealed to the administrative court.” You can still try to use the path recommended by the European Commission, that is, turn to the SOLVIT network dealing with solving problems resulting from the incorrect application of Community law.
Anyone who can afford it can start treatment in a foreign clinic without the mediation of the National Health Fund. You can ask doctors about the possibility of treatment abroad, and also search for information on your own, preferably with the help of the Internet. Knowledge of English will be very useful. You should contact the selected clinic personally and find out what formalities should be completed, and ask for a preliminary cost estimate of services. Certainly, medical records will need to be translated into the language used in a given country.
Who has the chance
People for whom such therapy gives the greatest hope of saving their lives or improving their health have the greatest chances for treatment abroad with the participation of the National Health Fund. If they do not have such a chance in Poland, and specialists from Germany or Japan claim that they have technology, skills or drugs that, with a certain probability, may bring improvement, the President of the National Health Fund should grant consent to finance the treatment.
It often happens that the idea of treatment abroad comes from Polish doctors who deal with a given case. It is worth asking them whether foreign centers could offer something that we will not find here. Many of them go to international conferences, have contacts in foreign institutions, their experience and knowledge must be used.
It is also worth contacting associations. Sometimes, with their help, it is easier to get something through the NHF. There are patients and families who have experienced similar problems, so they may have knowledge, incl. about treatment abroad, which is impossible not to take advantage of.
Sometimes determination turns out to be the most important factor in the struggle for the chances of successful treatment. On the Internet you can find many stories of patients who, while collecting funds for foreign treatment, started writing a blog, i.e. an internet diary, or, with the help of their friends, organized concerts, auctions, exhibitions to raise funds to cover treatment costs.
Polish patients are convinced that the queues abroad are shorter and that the treatment is more professional. Being in an Italian or Irish hospital, they may be disappointed.
After the change in regulations, the patient will have to spend money for treatment out of his own pocket. The National Health Fund will reimburse him as much as for the same service in Poland.
Worth knowing
Foreign treatment through a foundation
For help in financing treatment abroad, you can apply to some foundations that have set such activity as one of their statutory goals. Such foundations can be found, for example, on the website www.fundacje.org. Their main goal is to make it easier for Poles to choose a Public Benefit Organization to which 1% of the tax can be donated, but at the same time the website is a reliable database of organizations of this type operating in Poland, including their goals and contacts. Of course, each foundation that helps in collecting funds for foreign treatment in various ways requires the submission of appropriate medical documentation. We can choose the facility abroad where we would like to be treated, and present the treatment costs to the foundation proposed by this facility. The Foundation helps in collecting funds – e.g. by organizing fundraising, sending appeals to companies and other donors – which are then collected on the sub-account set up for us, and after the invoice for the medical service has been provided, they are transferred to our, i.e. the payer’s, account. Most often, this type of help is used by children whose guardians have turned to the foundation, but it is also possible to collect funds for an adult.
Text: Sylwia Skorstad, Let’s Live Longer
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