PPOZ alerts: More doctors held responsible by NHF for reimbursement system mess

It started with Neocate LCP, a milk designed for children with severe cow's milk protein allergy and complex food protein intolerance. Although the current reimbursement covers infants up to the age of 1, in some cases, doctors guided by medical reasons (not every child tolerates another Neocate Junior replacement milk after the age of 1!) were forced to continue prescribing Neocate LCP, gradually changing the restrictive elimination diet.

Already at the beginning of the year, PPOZ doctors asked the Minister of Health to analyze the legitimacy of the National Health Fund's massive inspections and legally baseless penalties imposed on doctors. In addition, they requested immediate action to develop a clear and transparent drug reimbursement system that will not ultimately carry harsh consequences for treating patients who require special treatment!

This is because it turned out that the pretext for imposing penalties on poz was not only the prescribing of Neocate LCP. Other drugs, especially painkillers, began to come into play. An example is the situation of a patient severely afflicted by three cancers, who was saved from death due to pain-induced shock by a doctor from Opalenica. Acting in accordance with his own conscience, knowledge, capabilities, the WHO-developed regimen for pharmacological treatment of pain (which is followed by doctors around the world), taking into account the indications of the hospital and the Pain Management Clinic, as well as the slogan promoted by the Ministry of Health that "no one has the right to live in pain"! led the patient out of a severe oncological process. As a result, the severely pained patient recovered, returned to society, and returned to work. Unfortunately, the doctor suffered a severe punishment for this. The National Health Service found that he had to reimburse nearly half a million zlotys for prescribed painkillers.

This example, as well as the widespread referral by specialists for reimbursed prescriptions to primary care physicians, has further exposed the mess in the reimbursement system! As early as November and December of last year, the doctors of the Healthcare Employers' Agreement asked the Minister of Health to define transparent rules for issuing such prescriptions, since the inspections conducted by the National Health Service in their analyses did not (and still do not) take into account recommendations and diagnoses from specialist clinics in the continuation of treatment in the out-of-hours clinic.

- Unfortunately, the list of reimbursement drugs for which it comes to "pay" prescribing doctors is getting longer by the week. Another example is MODULEN IBD, a drug - a foodstuff - for which reimbursement is available to adults and caregivers after the age of 5. Even in cases where the prescription is issued a few days before the birthday but filled at the pharmacy after the patient turns 5 (as suggested by the doctor). It is a normocaloric, norm-protein drug necessary in intestinal diseases (Crohn's and Cron's...). Similarly with other drugs -Auroxetine- from the age of 6...etc. Unfortunately, regardless of medical indications, the NHF charges the doctor with the cost of reimbursement," say PPOZ physicians, who have repeatedly protested in numerous letters sent to the health ministry and even the government against practices that harm not only doctors, but most importantly patients.

- The doctor's role should be to treat, to secure the patient with the necessary medicines by issuing a prescription, while payment for medicines should be a matter for other entities, including the insurer (who collects the premiums). The search for savings should not be at the expense of patients. After all, if doctors, frightened by the specter of high penalties, stop writing drugs with reimbursement, this will mean de facto depriving patients of the possibility of treatment. The penalties imposed on us by the NFZ are not justified either legally, medically or even more ethically. Their purpose is only to intimidate doctors! Reimbursement order should be put in place immediately and should be based solely on clinical indications, and not on artificial restrictions on reimbursed ordination, such as age," stresses Bożena Janicka.

PPOZ doctors based their position on both expert findings and legal analysis. - We are already receiving voices of desperate patients to whom doctors are "afraid" to prescribe drugs with reimbursement. The 100 percent reimbursement for many seriously ill patients is an insurmountable wall. Isn't this enough of an argument to stop harmful practices by the National Health Service? Are patients in Poland to be condemned to suffer? We cannot and do not want to accept this! - PPOZ doctors are sounding the alarm.

Source: PPOZ