Excessively long lines to a rheumatologist, late diagnoses, lack of access to rehabilitation and biological treatment make the social costs of rheumatological diseases, such as pensions, enormous – according to the latest report from patient organizations.
The report entitled Me, the Patient! The perspective of Patient Organizations on the State of Rheumatology Care in Poland was presented for the first time on Tuesday at a press conference in Warsaw. It concerns patients with five autoimmune inflammatory diseases of the connective tissue: rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE).
As the co-author of the report, Monika Zientek from the National Association of Young People with Inflammatory Connective Tissue Diseases, said, let’s get together, rheumatological patients in Poland are put in different queues – waiting for diagnosis, specialists and effective treatment.
As for the waiting time for a rheumatologist, the report revealed a generally large discrepancy between the results obtained by volunteers calling more than 200 clinics in three voivodeships in Poland, and the data provided by the National Health Fund. In the province In Lublin, this time is almost three times longer (30 days instead of 12 provided by the National Health Fund), and in Opole twice as long (60 days instead of 30 declared by the National Health Fund).
A healthy person may think that 30-60 days of waiting is a short time, but making a patient whose leg swells so long is simply inhumane – assessed Zientek. The report shows that as much as 30 percent. patients with rheumatic diseases waiting for an appointment longer than 4 months.
Meanwhile, according to the recommendations of rheumatologists, those patients who receive diagnosis and treatment within three months of the onset of disease symptoms have the greatest chance of achieving remission of the disease (i.e. stopping it and disappearing symptoms).
Zientek pointed out that 42 percent. of the respondents included in the report were diagnosed over a period of more than two years. Only 13 percent were in remission.
Referring to the PAP’s question regarding the waiting time to the rheumatology clinic, the spokesman for the Ministry of Health, Krzysztof Bąk, informed that specialist services in outpatient health care are provided according to the order in which they are reported. If the service provider is not able to admit the patient on the day of reporting, he / she is obliged to put him on the waiting list. The service provider sets the order of admissions and ensures that waiting lists are kept properly or appoints people responsible for the implementation of these tasks – wrote the spokesman for the Ministry of Health.
Moreover, if there is a need to provide urgent services due to the dynamics of the disease process and the possibility of a rapid deterioration of health or a significant reduction in the chances of recovery, the healthcare provider classifies the patient as an urgent case and places it on the waiting list before patients classified as a stable case. In addition, the doctor who issued the referral to the rheumatology clinic has the option of adding an urgent note on the referral, which should speed up the visit, the spokesman explained.
In emergencies, healthcare services are provided immediately – assured Bąk.
He emphasized that analytical work is currently underway at the Ministry of Health to develop solutions to shorten the queues waiting for healthcare services to be provided.
According to Zientek, patients with rheumatic diseases also wait in long lines for rehabilitation, which is an essential element of their therapy. The average waiting time is over 6 months. This means that the average patient has the opportunity to undergo rehabilitation once a year, but there are also those who have a chance to do so once every 2 years, and record holders – once every 6 years. For people with a chronic disease of the musculoskeletal system it is a simple path to disability – explained Zientek.
She also drew attention to the problems with access to expensive biological treatment, which rheumatological patients can receive under drug programs. The data analyzed in the report show that the number of patients admitted to these programs fell sharply in 2011 and remains low. As Zientek explained, in Poland, biological treatment receives only 1 percent. patients, while in neighboring countries such as the Czech Republic, Slovakia, Lithuania or Latvia this percentage is 5%, and in Western European countries – 10%.
The co-author of the report, Rafał Linek from the Association of Patients with ZZSK and Their Supporting Persons, assessed that not only the expenditure on rheumatology in Poland is among the lowest in Europe, but also the money on rheumatological care is spent badly and unreasonably.
In 2012, the National Health Fund spent PLN 405,8 million for the treatment of patients with five rheumatological diseases. Unfortunately, every third zloty was spent on hospitalizing patients, and our diseases do not require diagnosis and treatment in hospitals, Linek said. He noted that the hospital is the most expensive form of treatment.
As an example of absurdity, Linek mentioned that some centers put a patient to the hospital to give him a biological medicine, while the patient could administer it alone at home. However, the resort earns four times as much from it.
The report also calculated that patients with rheumatological diseases spend about PLN 1 billion per year on treatment out of their own pocket, i.e. two-thirds more than the NHF. And you have to remember that 30 percent. of the respondents are disabled, so not very wealthy – emphasized Linek.
In his opinion, the huge expenses of the Social Insurance Institution (ZUS) for these patients prove how ineffective patients with rheumatological diseases are treated in Poland. In 2010, it was over PLN 337 million, of which 94 percent. were the costs of sickness absenteeism and disability pensions. According to Link, the slowness in diagnosing patients and poor access to biological treatment and rehabilitation means that they very quickly become disabled people receiving pensions. The apparent savings of the National Health Fund are soon generating enormously high costs, which we bear as the whole society – he emphasized.
Krzysztof Kucharski from the Association of ZZSK Patients and Their Supporters emphasized that the report also includes guidelines and recommendations for decision-makers on how to improve the condition of rheumatological care in our country.
As explained by the co-author of the report, Marta Kotarba-Kańczugowska from May 3, it was prepared on the basis of: a survey of 275 patients with autoimmune inflammatory rheumatological disease aged 2 to 60 years (mean age 35,5), telexquestions of over 200 rheumatology clinics in three voivodships of Poland (Mazowieckie, Lubelskie and Opolskie) and document analyzes, incl. National Health Fund, Social Insurance Institution, minutes of meetings of the coordination team for biological treatment in rheumatological diseases and professional literature. (PAP)