Interview with Minister Bartłomiej Chmielowiec, Patient Ombudsman
What systemic solutions could contribute to limiting the growing number of patients who, for various reasons, have not been operated on, and whose visual condition indicates the need for cataract surgery?
Bartłomiej Chmielowiec, Patient Rights Ombudsman: One of the main solutions in this regard was the lifting by the National Health Fund of the limits for cataract removal from April 1, 2019. At that time, the queues waiting for this procedure were also significantly shortened. The facilities can operate cataract patients without restrictions. However, the situation was complicated by the epidemic. The Minister of Health, taking into account the needs of patients in the field of outpatient specialist care, plans to abolish the limits of benefits to the outpatient specialist care (AOS). This is a good step towards reducing the queue to an ophthalmologist, which will benefit more patients in the long term.
Does the Patient Ombudsman intend to take steps to encourage people to apply for cataract surgery?
Of course. We participate in providing patients with the latest information about the epidemic on an ongoing basis. This takes place, among others via the website, Facebook or Twitter. In the near future, we are planning an educational campaign related to preventive health care. I would like to add that we are in constant contact with patient organizations operating in the Patient Organization Council at the Patients’ Rights Ombudsman. Therefore, we do not rule out that we will arrange a joint action with them, encouraging them to report for planned treatments planned before the epidemic, including those for cataracts.
What is the situation of patients who, fearing COVID-19, did not come for the scheduled cataract surgery? Do they have to go through the qualification path again?
Patients who have already been qualified for the procedure retain their rights by indicating a new date for the planned procedure. They should be re-qualified, including the current clinical situation and the correction of the type of lens used.
What is the patient’s path to cataract surgery?
Waiting for the procedure begins when the primary care physician issues a referral to an ophthalmology clinic. Already on this document should be information whether the patient requires urgent care. The patient should register the referral at a clinic that has a signed agreement with the National Health Fund. If the time between receiving a referral to a specialist and an appointment is extended, the procedure will be delayed. This affects the deterioration of vision and quality of life, and exposes the patient to an increased risk of adverse events such as falls or difficulties in moving and being independent.
Before signing up to a specialist, the patient should visit the website: https://www.nfz.gov.pl/dla-pacjenta/, where you can find information on the waiting time for obtaining the help of an ophthalmologist.
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Difficult access to an ophthalmologist under AOS also seems to be a problem. Could resigning from requiring a referral from a primary care physician help?
Surely. Patients should be able to decide whether to go to their GP or an ophthalmologist. The waiting time for an appointment with an ophthalmologist is several months. To get to it, you need a referral from a primary health care physician, who does not have to diagnose the need for a specialist consultation right away. There is also no institutional system of help for the blind and blind people. Access to the NHF-financed rehabilitation of people with visual impairment is very difficult, and the limit of funding for eyeglass lenses and magnifying glasses for people with vision defects requiring high correction is questioned by patients.
In 2020, the Human Rights Defender received 99 reports on this matter, which constituted 15 percent. complaints about the supply of medical devices. The resignation from the referral would shorten the patient’s journey to an ophthalmologist, which may be particularly important in the case of a sudden eye disease.
Are restrictions on access to ophthalmologists also the subject of complaints to the Patient Ombudsman?
Yes, throughout the epidemic, we receive signals about the lack of access to non-covid health services, including ophthalmology. The epidemic affected the organization of all health services. From day to day we learned about new restrictions, guidelines or decisions regarding, for example, closing specialist departments for infectious diseases. On the one hand, these decisions seemed necessary, and on the other hand, it was done at the expense of non-covid patients in emergency or chronically ill conditions, eg due to cataracts.
In 2020, the MPC received 1676 applications for outpatient specialist care, which accounted for 6 percent. of all complaints, while complaints about hospital ophthalmic services constituted 2 percent.
What do patients with ophthalmic problems complain about most often in their applications addressed to the Patients’ Ombudsman?
The main problem is the limited access to specialist outpatient treatment. As for hospital treatment, the comments relate to the long waiting time for highly specialized procedures, such as vitrectomy or lens implantation for cataract treatment. One of the reasons is the staff shortage. Patients also complain about the limited access to AMD treatment in the drug program, as well as the inability to choose a lens for an additional fee. Many inquiries also concern low subsidies for medical devices issued on request (mainly optical glasses) and poor availability of preventive programs in the early detection of cataracts and glaucoma.
What is the attitude of the Patient Ombudsman to subsidies to medical devices that do not fit into the standard valuation of procedures financed by the National Health Fund? Could the MPC support the efforts of patients to allow additional payments for higher standard lenses?
This problem has not been resolved for years. The guaranteed benefits package offers many possibilities for interpretation, especially in terms of defining the boundary between benefits financed by the National Health Fund and “commercial” services. Patients cannot be denied the right to use modern technologies, including the possibility of financing services from their own resources. However, this should be done according to clear criteria. In the first place, therefore, the parameters of the medical devices that are guaranteed should be determined, and thus the basis for determining the price difference between, for example, a guaranteed lens and a product purchased commercially by the patient.
Authorized press interview prepared by the Journalists for Health Association in connection with the conference Diagnostics and treatment of cataracts in the time of the COVID-19 pandemic. June 2021.
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