For many patients, treatment abroad is the only way to win over the disease faster. While it is not difficult to get to a specialist abroad, it is not so easy to recover money for such treatment. The latest report of the Supreme Audit Office shows that the procedures applied in Poland are extremely complicated.
Thanks to the solutions of the cross-border directive, a patient who is insured in one of the EU Member States has the opportunity to receive treatment in another country of the community – both at healthcare providers operating within the public healthcare system and private healthcare providers.
The patient is obliged to cover the costs of treatment on his own. Subsequently, he may apply to the appropriate institution in his country for reimbursement of the incurred expenses.
The reimbursement of treatment costs is based on the price list applicable in the EU Member State where the patient is insured and can only be provided if the benefit is included in the list of guaranteed benefits of a given Member State.
Changes are needed
The data collected by the Supreme Audit Office for 2013-2016 show that the main barrier to the full use of treatment options abroad was the need to self-finance the procedures by patients who were reimbursed by the National Health Fund after the end of treatment.
As indicated in the report, the fears expressed during the implementation of the directive that the health care system in Poland will be overburdened financially by cross-border healthcare have not been confirmed. – The implementation of new solutions in the years 2014-2016 was allocated a total of over PLN 26 billion from the National Health Fund. However, due to the small number of submitted applications, only about PLN XNUMX million was spent in this period – emphasizes the Supreme Audit Office.
The report indicates that the NHF – in the period from November 15, 2014 to February 10, 2017 – received over 17 thousand. applications (mainly from the voivodships: Dolnośląskie, Opolskie and Śląskie) for reimbursement of costs for treatment abroad in the amount of PLN 54,7 million. – The number of submitted applications was gradually increasing. Still, the number of services reimbursed in this way constituted a small fraction of services provided in the territory of the country – emphasizes the Supreme Audit Office.
Abroad, we mainly treat cataracts
As indicated, applications for reimbursement of cataract removal costs accounted for over 90 percent. all applications submitted in this regard to the National Health Fund. This resulted, inter alia, from due to the lack of satisfaction of patients’ needs by medical entities within the limits specified in the agreements concluded with the National Health Fund and the increasing number of waiting for cataract removal in the country. According to the data of the National Health Fund, at the end of 2015, 536,5 thousand jobs were expected. people, and at the end of 2016 – 538,9 thous.
The NIK report emphasized that this increase took place despite the actions taken by the National Health Fund. They consisted, inter alia, of on increasing funds allocated to such benefits, changing the valuation of benefits and renegotiating contracts. – The new solutions resulted in the allocation of part of the NHF funds to administrative services and securing in the years 2014-2016 a total of over PLN 26 billion to finance reimbursement of costs for treatment abroad. However, a small number of submitted applications resulted in spending only about PLN XNUMX million from the created reserves – emphasizes the Supreme Audit Office.
There is no access to treatment
NIK applies to the Minister of Health, inter alia, for simplification of the procedure for examining applications for reimbursement of healthcare costs obtained in an EU Member State other than Poland and for reimbursement. Mechanisms should also be developed and implemented to ensure that people who have benefited from healthcare outside the country and require further medical observation have access to observation that would be provided if healthcare was used in its territory – indicates the Supreme Audit Office.
In the period from 2014 to 2017, all branches of the National Health Fund received 86 applications for prior consent for planned services abroad.