NIK on National Health Fund (NFZ)

NFZ spent public money without having defined nationwide health priorities. Efforts to reduce waiting time for hospital admission in case of patients with diagnosable and treatable diseases (also in outpatient clinics) were ineffective, either.

As in the previous years, there were slight disproportions among various provincial branches of NFZ in terms of health service availability, measured by the number of contracted services per 10 thousand patients and by the service waiting time.  

Lengthening queues to doctors show that healthcare availability in Poland is getting worse.

In outpatient specialist care (stable cases):

- in ophthalmology outpatient clinics the average real waiting time[1] increased from 32 to 40 days (by 25%); 

-  in cardiology outpatient clinics the average real waiting time increased from 69 to 79 days (by 14.5%);

- in neurology outpatient clinics the average real waiting time increased from  27 to 30 days (by 11.1%);

- in trauma and orthopaedic surgery clinics the average real waiting time increased from 25 to 29 days (by 16%);

- in computer tomography rooms the average real waiting time increased from 25 to 43 days (by 72%).

At the same time in hospital treatment (stable cases):

- in trauma and injury surgery departments the average real waiting time increased from 77 to 95 days (by 23.4%);

- in general surgery departments the average real waiting time increased from 24 to 29 days (by  20.8%); 

- in same-day surgery departments the average real waiting time was 15 days and was on average 3 days longer than in the previous year;

In some of the NFZ provincial branches not all services were contracted as planned, mainly due to medical staff deficits. And so:

• foetal echocardiography, outpatient specialist care or eyesight rehabilitation were not offered to patients in Dolnośląskie Province. The reason was that no healthcare units were interested in providing those services;
• in Świętokrzyskie Province no endocrinology services were rendered. Pulmonology services in stationary conditions were provided by one hospital only. In March 2013, due to medical staff deficits, though, the hospital terminated the contract with NFZ;
• in Zachodniopomorskie Province emergency dentist care was not provided. In the entire province no pulmonology or eyesight rehabilitation services were contracted because of the absence of service providers;
• no ophthalmology services (as part of planned hospital admission) were provided in Świętokrzyskie and Opolskie Provinces.

The deficit of medical specialists becomes a more and more serious problem and starts to pose a significant risk for patients by limiting their access to health services. The education and preparation of medical staff will be the subject of NIK audit in 2015.

The Supreme Audit Office reemphasises that underestimation of prices of services contracted by NFZ in relation to their real costs usually makes healthcare institutions lose interest in such contracts. In the long run it limits the patients’ access to some kind of health services.

On the other hand, as a result of overestimating price and number of some services, too many of  them are provided (even against medical needs!) which leads to ineffective public spending.

The Fund has not developed - in line with internal procedures - nationwide healthcare priorities. According to NIK defining priorities is essential, among others due to demographic changes which will cause an increase of treatment costs in the coming years.

NIK points out that it may be difficult to shorten queues to doctors in the coming years, due to increasing costs of treating the elderly, i.e. above 65 years of age. From 2009 to 2013, the share of these costs in total healthcare service costs increased by nearly 3 percent. According to NFZ estimates in the period 2014-2018, it may be more than 5 percent. It should be remembered, though, that diseases in elderly persons often imply costly medical procedures (e.g. oncological or cardiological ones). This may make the service waiting time even longer or limit the possibility of introducing modern medical technologies. This is yet another argument why NFZ expenditures should focus on key health problems of citizens.