According to NIK, the NHF financial plan needs to be more bound with strategic activities of the medical care. At the end of the day, preparation and execution of the NHF financial plan should translate into a shorter waiting time for health services and equal chances of healthcare access in various provinces. According to NIK, the waiting times for medical services are still too long. To visit a cardiologist you have to wait more than two months, whereas the waiting time for an endocrinologist’s consultation is three months. It is much worse with hospital treatment. Almost 400 thousand patients are already waiting for cataract operation, whereas the average waiting time is more than one year and a half. Nearly 150 thousand people are waiting that long for hip or knee replacement. The average waiting time for medical rehabilitation is more than one month and a half (it is the case for 450 thousand Polish people these days). Over half a year you have to wait to get to rehabilitation departments in hospitals. It is similar in case of motor organ- and pulmonology rehabilitation.
Diversified access to medical services in various NHF branches is an issue. In Opolskie Province people wait 196 days to be admitted to the endocrinology outpatients clinic, whereas in Lubelskie Province it is only 54 days. The national average is 93 days. Things look the same with eye clinics. In Kujawsko-Pomorskie Province the median of the average waiting time was 54 days, whereas in Podlaskie Province patients were being admitted on an on-going basis. The Fund is not always responsible for that situation. One of the reasons is the unequal access to healthcare all around Poland as well as the deficit of specialist doctors in a given area. According to NIK, directors of the NHF provincial branches should cooperate with local governments already when planning the purchase of medical services so as to guarantee their availability.
NIK has drawn attention to the improper level of prices offered to health care units for certain services. The Fund calculates them based on previous years’ costs as well as general epidemiological and statistical data. That is why, nearly 40 percent of analysed valuations of cardiology services were underestimated and a half of them were overestimated. As a consequence, the medical community is not interested in signing contracts for some services, on the one hand and on the other, public funds are spent uneconomically.
NIK recommends refining methods of valuating medical services to make sure they reflect real costs. The valuation could become a tool compensating for differences in access to health services.
The Supreme Audit Office has found that the health services contracts signed by the Fund did not guarantee an optimum use of the service providers’ potential. In 2012, the hospital bed occupancy rate was 64 percent on average.
NIK also indicates that the absence of uniform principles of calculating unit costs of medical services by the service provider has negative system consequences. Considering that more and more entities turn into joint-stock companies and hence, may potentially declare bankruptcy, some of them may only provide services guaranteeing positive financial results, regardless of people’s health needs. In the long run, the services valued by the NHF below the cost of their provision will be limited and hardly available for patients. Therefore, what becomes particularly important is the valuation based on real costs of the services’ provision, measured in the same manner, including e.g. the type and standard of a given health service.
In 2012, the NHF used nearly PLN 7 billion for the drug refund, which makes up 77.7 percent of the planned amount. It is related to the implementation of new principles under the Drug Refund Act in 2011. They assumed extending the group of limit drugs (in line with the principle that the drug prices are covered by the NHF only up to the limit which often refers to the cheapest drug in that group), making the drug price dependant on whether or not additional tests will be done (e.g antibiogram) and refunding drugs only in line with their registration instructions.
