Transcript Fundacja Watch Health Care
30.04.2020
Krzysztof Landa, M.D.
Additional Health Insurance Business Opportunities in the Polish Healthcare System
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Total expenditure on health per capita (USD due to purchasing power parity
)
Source: OECD Health Data 2006, (*) OECD Health Data 2008
Total expenditures on healh (private and public) per capita (2007, USD due to PPP)
Source: OECD Health Data 2009
Basic Benefit Package
The most important changes in regulations were introduced in second half of 2009 – law on BBP. This insurance-budgetary model of healthcare funding is regulated by the law on Basic Benefit Package (BBP). It means that this new law is not mature and there is still a lot of imperfection, divergence, ambiguity what requires constant improvement.
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Drugs Reimbursement List Ambulat ory Care Higly Specialized Procedures
Poland
Hospital catalogue Therapeutic Programms Chemothera py regimens catalogue Dentistr y care Primary Care Prevention Programms Vaccination catalouge Drugs Reimburseme nt List – A, B, C, D Secondary and Tertiary Care Higly Specialized Procedures Dentistry catalouge
Serbia
Prevention Programms Primary Care
Hospital treatment
There are three ways of finansing:
DRG system Therapeutic programs Services contracted separately 30.04.2020
Historical budget
Limits on health services
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What does a decision-maker want to know?
1.
2.
3.
4.
Is this technology of proven efficacy (health benefit and its safety profile)?
What is the strength of intervention in comparison to optional ones? (which is the most efficacious option and what are the differences) Which is the most cost-effective option and what are the differences?
Is coverage of the intervention possible with respect to available resources? What changes should we expect if the technology gets a privileged market position?
The most important requirements of the EU Transparency Directive (89/105/EEC from December, 21 st , 1988) 1.
2.
3.
Supervision of the court over decisions concerning reimbursement and pricing – i.e. a possibility to appeal from the DECISION Supervision of the court is possible only if appellations to the court are considered according to transparent criteria ensuring high reproducibility!
“Each decision on exclusion of a certain category of medicinal products from the national health insurance system must embrase justification based on objective and verifiable criteria and must be published in an appropriate publication.”
The course of decision and appellation – decisions within 90 days following submission of the application (in case of a large number of applications additional 60 days – the applicant must be informed) and within another 90 days following appellation
Main advantages of the new law on drug reimbursement in Poland
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• Economic Committee • Doubled Transparency Committee • Transparent reimbursement criteria • RSS (risk sharing schemes, patient access schemes) WWW.WATCHHEALTHCARE.EU
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Evidence based coverage decision-making – general process
Pricing Agency Negotiations
New price
or risk sharing Rejection
Initial price
by manufacturer in dossier and HTA report REIMBURSEMENT GOES FIRST IN UTYLITARIAN APPROACH
B
1/ willingness to cover
C A Rwanda Cambodia Switzerland UK Hungary Serbia
Cost per QUALY / cost per LYG
Total expenditure on health in Poland [bn, 2007-2011]
Public expenditure Private expenditure Total expenditure 30.04.2020
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Source: ppt Jakub Gierczyński 2010
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Private expenditure on health care
• Fees for medical examination • Fees for drugs • Additional health insurance (lisence fees) • Medical subscriptions (co-payment) • Bribes to get better or quicker access or any access at all 30.04.2020
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Private health expenditure
In 2009 - 28 bn PLN per year
30%
of total medical market in Poland
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Out of pocket payments
Apart of mandatory health premium Poles spend 30 bn for treatment Including 15 bn PLN for drugs 30.04.2020
its two times more than in 2007 WWW.WATCHHEALTHCARE.EU
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Supplementary insurance in Poland attain less than PLN 2.5 billion per year , while the complementary insurance market may reach 15 - 30 billion PLN per year
Additional Public Substitutional Supplying Insuring
Supplementary (alternative) Complementary
Protective Allows for leaving the public system Benefits are granted faster, outside the queue, in a higher standard Benefits which are not covered by public insurance or co-payment Financed directly from taxes, depending on income Financed from contributions, depending on risks Dotations, donations, indirect taxes and other
Source: Classification based on a presentation by Xenia Kruszewska, 2010
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The DIRECTIVE OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL
The Directive on the application of patients' rights in cross-border healthcare
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Council adopts its position on patient's rights in cross-border healthcare The key provisions
As a general rule, patients will be allowed to receive healthcare in another member state and be reimbursed up to the level of reimbursement applicable for the same or similar treatment in their national health system if the patients are entitled to this treatment in their country of affiliation.
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The key provisions
In case of overriding reasons of general interest (such as the risk of seriously undermining the financial balance of a social security system) a member state of affiliation may limit the application of the rules on reimbursement for cross-border healthcare; member states may manage the outgoing flows of patients also by asking a prior authorisation for certain healthcare (those which involve overnight hospital accommodation, require a highly specialised and cost intensive medical infrastructure or which raise concerns with regard to the quality or safety of the care) or via the application of the "gate-keeping principle", for example by the attending physician.
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A cost of an exemplary health service
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Pricing – the most important regulatory mechanism of HI
„Partially guaranteed” = partially covered BP >120%
BBP
100% out of pocket payments or aHI ( „not guaranteed”) (theoretically 1-99% co-payment or a HI trully 20-80% copayment or aHI)
„THE MOONS”: Deimos and Phobos
FIELD A
BASIC BENEFIT PACKAGE
contribution (health premium), tax cheap 30.04.2020
A + B = ACTUAL NEGATIVE BP
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FIELD B expensive 23
Quality of healthcare in Poland
„On a national level, there are some countries where
citizens are consistently negative about the
available healthcare. They feel harm from hospital or non-hospital care is likely, feel at risk of
experiencing adverse events and rate the quality of
their national healthcare poorly and worse than
other Member States. These countries are
Greece,Bulgaria, Hungary, Latvia, Lithuania and
Poland
”.
Report: Patient safety and quality of healthcare, TNS Opinion & Social, European Comission , April 2010
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Quality of healthcare in Poland
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Report: Patient safety and quality of healthcare, TNS Opinion & Social, European
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HIGHER demand than supply
–> QUEUES/ state control
HIGHER demand than supply
-> corruption and bribery
HIGHER demand than supply -> PRIVILEGE (using connections)
•
THE BBP CAN BE PUMPED UP TOO MUCH BUT THE BUDGET IS NOT MADE of RABBER
• The greater the discrepancy, the more severe pathologies in health care Removal of the causes of the disease, eliminates the symptoms
BBP MONEY Form PUBLIC HEALTH PREMIUM
„THE MOONS”: Deimos and phobos
Organized patients
FIELD A FIELD B
$ cheap 30.04.2020
They suffer in silence – they are not organized
AS SEEN BY THE PATIENT
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Access limitations to health care benefits and medical procedures in field A are mainly caused by:
● ● ● ● ● ● ● ● Watiting lits Limits / limiting the size of contract concluded with the payer (NHF) → increasing queues and patient selection Lowered (incorrect) price estimations = benefits are not cost effective for clinic → patient selection stage character of treatment (GP → specialist → diagnostic test → therapy → control visit) Red tape Narrowed/ limited inclusion criteria, e.g. For therapeutic programs Copayment Lack of procedure standard 31 30.04.2020
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How the financial resorces from health premium and BBP can be balanced?
• Icrease health premium or/and higher co-payment • Remove from BBP expensive and not cost-effective health services • Enforce additive health insurance (complementary and suplementary insurance) 30.04.2020
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Co-payment
„Trifles”: 3 pln to a visit 10 pln to hospital addmission HIGH POLITICAL RISK BUT NO CURE FOR THE SYSTEM 30.04.2020
Deductibles (Udział własny) WWW.WATCHHEALTHCARE.EU
High co-payments 33
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The project on „100 conferences”
„Innovative health technologies in …(specific medical field)…. – assessment of accessibility in Poland”
Presentation of therapeutic and diagnostic innovations remining out of BBP in Poland Cooperation with National Consultants and Associations of Specialists E.g. oncology: chemiotherapy (15-16.04.2011), vaccination (May), hematooncology (June) Participants: MDs, Health Insurance, patients’ organizations, media – debates with MoH, NHF, AOTM (AHTAPol) - free participation / www.korektorzdrowia.pl
or www.watchhealthcare.eu
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SOCIAL AWARENESS CAMPAIGN "INNOVATIONS IN ONCOLOGICAL PHARMACOTHERAPY - HOPES FOR PATIENTS, SOLUTIONS FOR THE SYSTEM"
15-16.04.2011
• • • •
PARTNERS:
Polish Oncology Union (PUO) www.puo.pl
Watch Health Care Foundation (WHC) www.krektorzdrowia.pl
Business Centre Club (BCC) www.bcc.org.pl
GREEN PR Agency www.greenpr.pl
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30.04.2020
11.00-11.15
Przedstawienie Komitetu Naukowego kampanii oraz uczestników debaty – moderator spotkania,
red. Krzysztof Michalski 11.15-11.30
Otwarcie debaty przez Minister Zdrowia,
Ewę Kopacz 11.30-11.45
Wystąpienie Prezesa Honorowego PUO,
prof. Marka Belki 11.45-12.00
Wystąpienie Szefa Zespołu Doradców Strategicznych Prezesa Rady Ministrów
dr Michała Boniego 12.00-12.15
Wystąpienie Podsekretarza Stanu Ministerstwa Zdrowia,
dr Andrzeja Witolda Włodarczyka 12.15-12.30
Wystąpienie przedstawiciela NFZ
12.30-12.40
Wystąpienie Konsultanta Krajowego w Dziedzinie Onkologii Klinicznej,
prof. Macieja Krzakowskiego 12.40-12.50
Wystąpienie Prezesa Fundacji WHC,
dr. Krzysztofa Łandy 12.50-13.00
Wystąpienie Prezesa PUO
dr. Janusza Medera
,
13.00-13.10
Wystąpienie Prezesa AOTM
dr Wojciecha Matusewicza 13.10-13.20
Wystąpienie przedstawiciela BCC,
Wojciecha Bociańskiego 13.20-13.35
Podsumowanie wystąpień i zaproszenie do dyskusji,
dr Krzysztof Łanda 13.35-14.35
Dyskusja z udziałem: pracowników naukowych, etyków, prawników, przedstawicieli branży ubezpieczeniowej, organizacji biznesowych, pacjentów i dziennikarzy.
14.35-15.35
Poczęstunek, czas na rozmowy nieformalne
15.35
Transfer uczestników seminarium do hotelu Fort Piontek w Jabłonnie
19.00
Uroczysta kolacja w Pałacu PAN w Jabłonnie pod Warszawą WWW.WATCHHEALTHCARE.EU
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30.04.2020
10.00-10.30
Powitanie uczestników i przedstawienie założeń kampanii społeczno-edukacyjnej „Liczymy się z naszym zdrowiem” w kontekście innowacyjnych rozwiązań diagnostyczno-terapeutycznych dla onkologii,
prof. Tadeusz Pieńkowski
(PTBRP),
dr Krzysztof Łanda
(WHC) i
dr Janusz Meder
(PUO)
10.30-10.45
Wykład inaugurujący sesje medyczne,
prof. Wiesław Jędrzejczak
Konsultant Krajowy w Dziedzinie Hematologii
10.45-11.15
Przerwa kawowa
11.15-14.30
Sesje sponsorowane
14.30-14.50
Jędrzejczak
Podsumowanie przedstawionych prezentacji,
prof. Wiesław 14.50-15.00
Zamknięcie seminarium,
dr Krzysztof Łanda, dr Janusz Meder
(PUO)
15.00
Lunch
16.00
Transfer na Dworzec Centralny w Warszawie WWW.WATCHHEALTHCARE.EU
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Partially guaranteed benefits
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Partners of the Foundation
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Supporting Institutions
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THANK YOU!
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