National Health Fund
According to NIK’s calculations, the Fund controls units with which it entered into agreement to provide health benefits on average every 12-13 years. Basic health care units which render health services to all Polish people (including among others general practitioners, outpatient clinics as well as night and holiday health care) may expect the Fund’s controls every 24 years on average whereas dental outpatient clinics - once in 18 years.
At the same time, a lot of big entities, particularly hospitals, are subject to control a few times a year. These controls, however, leave out the quality aspect and focus on settlements of large contract amounts. As a result of this imbalance, the majority of health care units are not supervised by NFZ and also some scopes of medical benefits remain out of the Fund’s control. Too rare controls mean that the Fund breaches its own operation principle which orders the Fund branches to supervise each unit at least once in five years in terms of the quality and availability of health services.
It is also confirmed by the data from the NIK audit carried out in five NFZ branches. From 2003 to 2012, among 250 audited health care units, hospitals were controlled a few or a dozen or so times. In that period, more than 54 percent entities providing other benefits were not controlled at all.
The main reason of that situation was that the Fund’s President allocated too little funds for control activity - only 0.05 percent of all NFZ costs. As a consequence, there is too little money for controls or for hiring highly qualified staff in control units. The shortage of controllers with medical degree makes it impossible to evaluate the quality and regularity of health benefits.
In response to NIK’s remarks, the Fund’s President intends to amend the ordinance concerning the Fund activity and delete the requirement to control each entity at least every five years. According to NIK, this is a bad solution, both with regard to patients’ health and the state budget. NIK’s opinion is confirmed by the effects of the few controls conducted by NFZ. Their financial benefits were in 2010-2011 over three times higher than the costs of the controls themselves. NIK appreciates efficiency and effectiveness of NFZ branches in terms of enforcing the payment of penalties and unduly transferred amounts.
The Supreme Audit Office also points to inaccuracy of the Central Register of the Insured used by NFZ branches. The data included there are often incorrect or outdated. They therefore do not represent credible information on the status of the insured. They may not be the basis for proper verification of settlements with health care units, either. NIK has addressed the institutions transferring data (Ministry of Internal Affairs, Social Security Office, Agricultural Social Insurance Fund) with a request to improve the manner of data gathering and verification.
National Health Fund
