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Krzysztof Landa, M.D. Additional Health Insurance Business Opportunities in the Polish Healthcare System 2014-01-01WWW.WATCHHEALTHCARE.EU1.

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Prezentacja na temat: "Krzysztof Landa, M.D. Additional Health Insurance Business Opportunities in the Polish Healthcare System 2014-01-01WWW.WATCHHEALTHCARE.EU1."— Zapis prezentacji:

1 Krzysztof Landa, M.D. Additional Health Insurance Business Opportunities in the Polish Healthcare System WWW.WATCHHEALTHCARE.EU1

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 Package This 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 WWW.WATCHHEALTHCARE.EU4

5 Poland Higly Specialized Procedures Hospital catalogue Chemothera py regimens catalogue Therapeutic Programms Drugs - Reimbursement List Ambulat ory Care Primary Care Prevention Programms Vaccination catalouge Dentistr y care Serbia Drugs - Reimburseme nt List – A, B, C, D Higly Specialized Procedures Dentistry catalouge Prevention Programms Secondary and Tertiary Care Primary Care

6 Hospital treatment There are three ways of finansing: DRG system Therapeutic programs Services contracted separately Historical budget Limits on health services WWW.WATCHHEALTHCARE.EU6

7 What does a decision-maker want to know? 1.Is this technology of proven efficacy (health benefit and its safety profile)? 2.What is the strength of intervention in comparison to optional ones? (which is the most efficacious option and what are the differences) 3.Which is the most cost-effective option and what are the differences? 4.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, 21 st, 1988) 1.Supervision of the court over decisions concerning reimbursement and pricing – i.e. a possibility to appeal from the DECISION 2.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. 3.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 Committee Doubled Transparency Committee Transparent reimbursement criteria RSS (risk sharing schemes, patient access schemes) WWW.WATCHHEALTHCARE.EU9

10 Evidence based coverage decision-making – general process

11 REIMBURSEMENT GOES FIRST IN UTYLITARIAN APPROACH Initial price by manufacturer in dossier and HTA report Pricing Agency Negotiations New price or risk sharing Rejection

12 1/ willingness to cover Cost per QUALY / cost per LYG B C A Rwanda CambodiaSerbia Hungary UK Switzerland

13 Total expenditure on health in Poland [bn, ] WWW.WATCHHEALTHCARE.EU13 Source: ppt Jakub Gierczyński 2010 Public expenditurePrivate expenditureTotal expenditure

14 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 WWW.WATCHHEALTHCARE.EU14

15 Private health expenditure In bn PLN per year 30% of total medical market in Poland WWW.WATCHHEALTHCARE.EU15

16 Out of pocket payments Apart of mandatory health premium Poles spend 30 bn for treatment Including 15 bn PLN for drugs its two times more than in WWW.WATCHHEALTHCARE.EU16

17 Supplementary insurance in Poland attain less than PLN 2.5 billion per year, while the complementary insurance market may reach billion PLN per year Additional Supplementary (alternative) Substitutional Complementary 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 Public Supplying Insuring Protective 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

18 The Directive on the application of patients' rights in cross-border healthcare WWW.WATCHHEALTHCARE.EU18 The DIRECTIVE OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL

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 WWW.WATCHHEALTHCARE.EU19

20 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 WWW.WATCHHEALTHCARE.EU20

21 A cost of an exemplary health service WWW.WATCHHEALTHCARE.EU21

22 Pricing – the most important regulatory mechanism of HI Partially guaranteed = partially covered BP (theoretically 1-99% co-payment or a HI trully 20-80% copayment or aHI) >120% BBP 100% out of pocket payments or aHI ( not guaranteed)

23 BASIC BENEFIT PACKAGE Funds from the primary contribution (health premium), tax FIELD A FIELD B cheap expensive A + B = ACTUAL NEGATIVE BP THE MOONS: Deimos and Phobos WWW.WATCHHEALTHCARE.EU

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 WWW.WATCHHEALTHCARE.EU24 Report: Patient safety and quality of healthcare, TNS Opinion & Social, European Comission, April 2010

25 Quality of healthcare in Poland WWW.WATCHHEALTHCARE.EU25 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 care Removal of the causes of the disease, eliminates the symptoms BBP MONEY Form PUBLIC HEALTH PREMIUM

30 FIELD A FIELD B cheap expensive AS SEEN BY THE PATIENT $ Organized patients They suffer in silence – they are not organized THE MOONS: Deimos and phobos

31 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

32 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) www.korektorzdrowia.pl

33 Co-payment WWW.WATCHHEALTHCARE.EU33 Trifles: 3 pln to a visit 10 pln to hospital addmission HIGH POLITICAL RISK BUT NO CURE FOR THE SYSTEM Deductibles (Udział własny) High co-payments

34

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 Poland Cooperation 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 WWW.WATCHHEALTHCARE.EU35

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 WWW.WATCHHEALTHCARE.EU36

37 Program – day 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 Boniego Wystąpienie 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 Warszawą

38 Program – day WWW.WATCHHEALTHCARE.EU 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 Warszawie

39 WWW.WATCHHEALTHCARE.EU39 Partially guaranteed benefits

40 WWW.WATCHHEALTHCARE.EU40

41 WWW.WATCHHEALTHCARE.EU41

42 WWW.WATCHHEALTHCARE.EU42

43 WWW.WATCHHEALTHCARE.EU43

44 WWW.WATCHHEALTHCARE.EU44

45 WWW.WATCHHEALTHCARE.EU45

46

47 Partners of the Foundation www.korektorzdrowia.pl47

48 Supporting Institutions WWW.WATCHHEALTHCARE.EU48

49 THANK YOU! 49


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