A patient in Poland who does not receive private treatment is in a hopeless situation. The waiting time for an appointment at the doctor’s, for tests, and for a hospital bed keeps getting longer. The increase in funds for treatment did not improve the situation at all. It gets worse – data from the Supreme Audit Office’s report are terrifying. The Ministry of Health, as usual, assures that it is working on solving the problem.
NIK audited the implementation of tasks by the National Health Fund in 2014. The report – sent to PAP – shows, inter alia, that in many regions there is still a shortage of doctors of selected specialties, and over PLN 346 million was spent on the treatment of unauthorized and uninsured persons. At the same time – as indicated by the auditors – there are positive trends, e.g. reducing the so-called over-performance. The amount not used by the Fund also decreases from year to year; in 2014, it was, however, nearly one billion two hundred million zlotys.
According to the Supreme Audit Office, in 2014 the average waiting time for a health service increased in comparison to 2013 in all examined types of medical services. According to the report, five outpatient clinics were in the lead – ophthalmology, computed tomography, cardiology, orthopedic surgery, and neurology – in these cases the increase was from 21%. to nearly 35 percent There were also significant differences in access to certain services between individual provincial branches of the National Health Fund; only one branch of the National Health Fund provides access to all analyzed services in hospital treatment.
The report shows, inter alia, that the waiting time for the provision of benefits differed depending on the voivodship. “The average actual waiting time for the provision of services, provided in 2014 on the NHF website, was only an approximate measure of waiting time for patients enrolling in a given facility. The method of calculating the reported average actual waiting time for the provision of services selected by the National Health Fund resulted in the fact that the informative value of this data for the patient was limited »- it was noted in the document.
According to the inspectors, the average waiting time for the service, which patients were informed about at the time of enrollment, was as follows: in ophthalmology clinics – 88 days, cardiology clinics – 106 days, trauma and orthopedic surgery – 60 days, and neurological clinics – 64 days. These data differed from the information provided by the National Health Fund, which indicated the need to wait 53 days in ophthalmology clinics, 97 days in cardiology clinics, 34 days in orthopedic and trauma surgery, and 39 days in neurological clinics.
Comparison of the total number of waiting people classified in the medical category “stable case” and the median of the average real waiting time recorded in individual provinces in selected organizational units of service providers
«The discrepancies between the waiting time to selected clinics provided by the National Health Fund and the information about the waiting time obtained by the Supreme Audit Office from service providers resulted, inter alia, from from the fact that the information collected by the Supreme Audit Office is the estimated waiting time for the provision of services, the NFZ obtained information on how long the service was awaited by persons already removed from the list due to the performance of the service. From January 1, 2015, the Fund launched an internet application that allows patients to be presented with the first free date for the provision of services at a specific service provider »- reminded the Supreme Audit Office.
The report also shows that in some voivodeships there were no doctors of specific specialties at all; eg in the field of clinical immunology, there was a shortage of doctors in the following voivodeships: Lubuskie, Opolskie, Podkarpackie, Warmińsko-Mazurskie and Zachodniopomorskie; in turn, no geriatrician provided benefits under the National Health Fund in the province. Warmia-Masuria Province. It also happened that individual specialists looked after the entire voivodeship. For example, in the Lubelskie Province, a contract was signed with four oncology gynecologists, and in the Opole Province – with one oncologist / pediatric hematologist.
The auditors indicate that in only one voivodeship (Pomeranian Voivodeship) all eight types of analyzed health services in hospital treatment were contracted. Patients from the remaining 15 voivodships, who received some services that were not contracted in their area, had to use them in other regions. “This situation was influenced by factors beyond the control of the National Health Fund, including, first of all, the uneven distribution of health facilities, equipment and qualified medical staff in the country” – it was noted in the report.
According to the auditors, there are also positive trends. Including the differences between the value of benefits per one insured and the person entitled in individual voivodships are decreasing.
According to the Supreme Audit Office, there is a possibility of improving access to health services as part of the funds that the National Health Fund already has at its disposal. “Full use of the funds provided for in the financial plan for benefits, as well as the improvement of the tools for detecting irregularities, would reduce the waiting time for granting individual benefits. In the last audited year – 2014 – the Fund did not use nearly one billion two hundred million PLN foreseen in the plan to cover the costs of benefits »- it was stated in the report.
NIK notes that the amount not used by the Fund is decreasing year by year. “The procedures and IT systems used by the Fund so far, in the opinion of the Supreme Audit Office, have still not been sufficiently effective in eliminating irregularities in the settlement of health services provided and in limiting the use of benefits by unauthorized persons” – emphasize the auditors and indicate specific examples, e.g. 274 cases of spending by the Fund (in 2009-2014) funds for multiple extraction of the appendix or gallbladder in the same patient and the reimbursement of antibiotic prices in 2014 on the basis of over 33 prescriptions dispensed after the expiry date.
A spokeswoman for the ministry of health, Milena Kruszewska, asked by PAP to comment on the NIK report, assures that the ministry is working on solving the problem of queues. «The immediate causes of queues are, on the one hand, financial limitations related to the amount of funds at the disposal of the National Health Fund and an insufficient number of doctors. First of all, the resources allocated to the operation of the system should be increased »- argues Kruszewska.
Minister Konstanty Radziwiłł has repeatedly emphasized that funds allocated to health care should increase to at least 6%. GDP. In turn, in order to increase the number of doctors, the ministry plans to increase by 2016 percent from 20. admission limits for medical studies in Polish.
“The problem is exacerbated by the lack of coordination of treatment – therefore one of the ways to shorten the queues should be financing by the payer not individual visits to a specialist doctor or tests, but comprehensive care for the patient” – argues Kruszewska. He points out that the length of the queues is also influenced by organizational issues, and for this reason the ministry wants to increase the powers of family doctors.
“The Ministry is working on solving these problems that have existed for many years, but it requires time and many changes in the health care system,” adds Kruszewska.