Determining the degree of reimbursement that often depends on the fulfillment of multiple conditions that can change every few months is a meaningless challenge that Polish doctors must overcome on a daily basis. Introducing an independent reimbursement system could bring many benefits, including reducing bureaucracy, redirecting the wasted time of medical professionals toward patients, and ultimately more time for patients, which should translate into improved health care performance in Poland.
Current reimbursement system
The current drug reimbursement system as we know it is often complicated and time-consuming. Doctors are responsible for determining the level of reimbursement for their patients, which requires a thorough knowledge of the intricate and often unclear regulations that change every few months, as well as the conditions under which a particular drug or preparation is reimbursed. This process involves checking the terms and conditions of reimbursement for drugs, especially since these can change every few months, and the changes can include the number of capsules in a package. Suddenly, a package containing 14 capsules of a drug from company X loses its reimbursement, while a drug from company Y still retains it. The changes also apply to 28 capsule packs, but to a slightly different extent... At the same time, the condition for granting reimbursement becomes a different criterion for disease compensation than before. Reimbursement is granted to patients whose degree of diabetes compensation is HbA1c>= 7.5 while previously it was HbA1c>=7, with an additional condition in the case of GFR <59 ml/min before considering the start of treatment, factors that may increase the risk of lactic acidosis must be analyzed, and the starting dose must not exceed 1/2 of the max dose. Those who fail to familiarize themselves with the changes and incorrectly determine the degree of reimbursement risk financial liability. To make things funnier at the same time, the reimbursement conditions on the websites of the Ministry of Health and the National Health Fund differ significantly. No other country in the world has such a convoluted reimbursement system, and attempts to implicate doctors in financial liability like in Poland would end in protests paralyzing the health service. Unfortu...
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