Prezentacja na temat: "Krzysztof Landa, M.D. Additional Health Insurance Business Opportunities in the Polish Healthcare System 2017-03-24 WWW.WATCHHEALTHCARE.EU."— Zapis prezentacji:
1 Krzysztof Landa, M.D.Additional Health Insurance Business Opportunities in the Polish Healthcare System
2 Total expenditure on health per capita (USD due to purchasing power parity ) Source: OECD Health Data 2006, (*) OECD Health Data 2008
3 Total expenditures on healh (private and public) per capita (2007, USD due to PPP) Source: OECD Health Data 2009
4 Basic Benefit PackageThis insurance-budgetary model of healthcare funding is regulated by the law on Basic Benefit Package (BBP).The most important changes in regulations were introduced in second half of 2009 – law on BBP.It means that this new law is not mature and there is still a lot of imperfection, divergence, ambiguity what requires constant improvement.
5 Poland Serbia Drugs - Reimbursement List – A, B, C, D Higly Specialized ProceduresHospital catalogueChemotherapy regimens catalogueTherapeutic ProgrammsDrugs - Reimbursement ListAmbulatory CarePrimary CarePrevention ProgrammsVaccination catalougeDentistry careSerbiaDrugs - Reimbursement List – A, B, C, DHigly Specialized ProceduresDentistry catalougePrevention ProgrammsSecondary and Tertiary CarePrimary Care
6 Hospital treatment There are three ways of finansing: DRG system Therapeutic programsServices contracted separatelyHistorical budgetLimits on health services
7 What does a decision-maker want to know? 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?
8 The most important requirements of the EU Transparency Directive (89/105/EEC from December, 21st, 1988)Supervision of the court over decisions concerning reimbursement and pricing – i.e. a possibility to appeal from the DECISIONSupervision 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
9 Main advantages of the new law on drug reimbursement in Poland Economic CommitteeDoubled Transparency CommitteeTransparent reimbursement criteriaRSS (risk sharing schemes, patient access schemes)
10 Evidence based coverage decision-making – general process
11 REIMBURSEMENT GOES FIRST IN UTYLITARIAN APPROACH Initial price by manufacturer in dossier and HTA reportPricing AgencyNegotiationsNew price or risk sharingRejectionREIMBURSEMENT GOES FIRST IN UTYLITARIAN APPROACH
12 Cost per QUALY / cost per LYG 1/ willingness to coverCost per QUALY / cost per LYGBCARwandaCambodiaSerbiaHungaryUKSwitzerland
13 Total expenditure on health in Poland [bn, 2007-2011] Public expenditurePrivate expenditureTotal expenditureSource: ppt Jakub Gierczyński 2010
14 Private expenditure on health care Fees for medical examinationFees for drugsAdditional health insurance (lisence fees)Medical subscriptions (co-payment)Bribes to get better or quicker access or any access at all
15 Private health expenditure In bn PLN per year30%of total medical market in Poland
16 Out of pocket paymentsApart of mandatory health premium Poles spend 30 bn for treatmentIncluding 15 bn PLN for drugsits two times more than in 2007
17 Supplementary insurance in Poland attain less than PLN 2 Supplementary insurance in Poland attain less than PLN 2.5 billion per year, while the complementary insurance market may reach billion PLN per yearAdditionalSupplementary(alternative)SubstitutionalComplementaryAllows for leaving the public systemBenefits are granted faster, outside the queue, in a higher standardBenefits which are not covered by public insurance or co-paymentPublicSupplyingInsuringProtectiveFinanced directly from taxes, depending on incomeFinanced from contributions, depending on risksDotations, donations, indirect taxes and otherSource: Classification based on a presentation by Xenia Kruszewska, 2010
18 The DIRECTIVE OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL The Directive on the application of patients' rights in cross-border healthcare
19 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.
20 The key provisionsIn 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.
22 Pricing – the most important regulatory mechanism of HI „Partially guaranteed”= partially covered BP(theoretically 1-99% co-payment or a HItrully 20-80% copayment or aHI)100% out of pocket payments or aHI( „not guaranteed”)>120%BBPregulation by pricing
23 A + B = ACTUAL NEGATIVE BP „THE MOONS”:Deimos and PhobosFunds from the primary contribution (health premium), taxFIELD BFIELD ABASIC BENEFIT PACKAGEcheapexpensiveA + B = ACTUAL NEGATIVE BP
24 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
25 Quality of healthcare in Poland Report: Patient safety and quality of healthcare, TNS Opinion & Social, European Comission , April 2010
26 HIGHER demand than supply –> QUEUES/ state control
27 HIGHER demand than supply -> corruption and bribery
28 HIGHER demand than supply -> PRIVILEGE (using connections)
29 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 careRemoval of the causes of the disease, eliminates the symptomsMONEY Form PUBLIC HEALTH PREMIUMBBP
30 They suffer in silence – they are not organized „THE MOONS”:Deimos and phobosOrganized patients$FIELD BFIELD AThey suffer in silence – they are not organizedcheapexpensiveAS SEEN BY THE PATIENT
31 Access limitations to health care benefits and medical procedures in field A are mainly caused by: Watiting litsLimits / limiting the size of contract concluded with the payer (NHF) → increasing queues and patient selectionLowered (incorrect) price estimations = benefits are not cost- effective for clinic → patient selectionstage character of treatment (GP → specialist → diagnostic test → therapy → control visit)Red tapeNarrowed/ limited inclusion criteria, e.g. For therapeutic programsCopaymentLack of procedure standard
32 Icrease health premium or/and higher co-payment How the financial resorces from health premium and BBP can be balanced?Icrease health premium or/and higher co-paymentRemove from BBP expensive and not cost-effective health servicesEnforce additive health insurance (complementary and suplementary insurance)
33 Co-payment „Trifles”: 3 pln to a visit 10 pln to hospital addmission HIGH POLITICAL RISK BUT NO CURE FOR THE SYSTEMDeductibles(Udział własny)Highco-payments
35 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 PolandCooperation with National Consultants and Associations of Specialists E.g. oncology: chemiotherapy ( ), vaccination (May), hematooncology (June)Participants: MDs, Health Insurance, patients’ organizations, media – debates with MoH, NHF, AOTM (AHTAPol) - free participation / or
36 SOCIAL AWARENESS CAMPAIGN "INNOVATIONS IN ONCOLOGICAL PHARMACOTHERAPY - HOPES FOR PATIENTS, SOLUTIONS FOR THE SYSTEM"PARTNERS:Polish Oncology Union (PUO)Watch Health Care Foundation (WHC)Business Centre Club (BCC)GREEN PR Agency
37 Program – day 1 2017-03-24 WWW.WATCHHEALTHCARE.EU Przedstawienie Komitetu Naukowego kampanii oraz uczestników debaty – moderator spotkania, red. Krzysztof Michalski Otwarcie debaty przez Minister Zdrowia, Ewę Kopacz Wystąpienie Prezesa Honorowego PUO, prof. Marka Belki Wystąpienie Szefa Zespołu Doradców Strategicznych Prezesa Rady Ministrów dr Michała BoniegoWystąpienie Podsekretarza Stanu Ministerstwa Zdrowia, dr Andrzeja Witolda Włodarczyka Wystąpienie przedstawiciela NFZ Wystąpienie Konsultanta Krajowego w Dziedzinie Onkologii Klinicznej, prof. Macieja Krzakowskiego Wystąpienie Prezesa Fundacji WHC, dr. Krzysztofa Łandy Wystąpienie Prezesa PUO dr. Janusza Medera, Wystąpienie Prezesa AOTM dr Wojciecha Matusewicza Wystąpienie przedstawiciela BCC, Wojciecha Bociańskiego Podsumowanie wystąpień i zaproszenie do dyskusji, dr Krzysztof Łanda Dyskusja z udziałem: pracowników naukowych, etyków, prawników, przedstawicieli branży ubezpieczeniowej, organizacji biznesowych, pacjentów i dziennikarzy Poczęstunek, czas na rozmowy nieformalne Transfer uczestników seminarium do hotelu Fort Piontek w Jabłonnie Uroczysta kolacja w Pałacu PAN w Jabłonnie pod WarszawąProgram – day 1
38 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)Wykład inaugurujący sesje medyczne, prof. Wiesław Jędrzejczak Konsultant Krajowy w Dziedzinie Hematologii Przerwa kawowa Sesje sponsorowane Podsumowanie przedstawionych prezentacji, prof. Wiesław Jędrzejczak Zamknięcie seminarium, dr Krzysztof Łanda, dr Janusz Meder (PUO) Lunch Transfer na Dworzec Centralny w WarszawieProgram – day 2
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