AOTMiT: There is a plan for tariffing benefits for 2024.

The decision to include a given group of benefits in the Tariff Plan for a given year is made taking into account objective criteria, which include financial significance for the health care system, social costs and relevance from the point of view of state health policy priorities. Another important aspect is the need to synchronize actions taken by key institutions of the health care system.

Guided by the aforementioned criteria, the area of inpatient services for vascular diseases was included in the 2024 tariff plan, which includes 30 JGP groups from Section Q Vascular diseases, which together account for 4.4% of all groups in the JGP catalog. Section Q concentrates a total of more than 4.6% of the expenses incurred by the National Health Fund for the provision of services specified in the catalog of JGP groups in the type of hospital treatment, and accounts for 2.3% of the number of all hospitalizations provided within the JGP catalog. The results of the analyses carried out so far indicate a high increase in the average value of a single benefit within the section in question, in addition, many groups are characterized by a large number of outliers taking into account the length of hospitalization and heterogeneity in the construction of the group itself. On the other hand, the National Transformation Plan for 2022-2026 announces the entry into force and implementation of the tasks enshrined in the National Cardiovascular Disease Program, which identifies the main challenges and directions of change and development of the health care system in Poland in the field of cardiovascular diseases.

In the course of the Agency's work on the area of vascular diseases, an analysis will be carried out of the feasibility of providing the above services on an outpatient and inpatient basis, with the aim of optimizing treatment and synchronizing the pricing of services provided on an outpatient and inpatient basis.

The cost of medical devices used under product 5.52.01.0001363 Billing with payer approval is significantly higher than the cost of medical devices within a given JGP group. The analysis will aim to introduce JGP benefits containing cost-intensive devices

medical, provided that they are included in the list of guaranteed benefits after evaluation of reasonableness, eligibility criteria and cost-effectiveness justification.

Almost from the beginning of AOTMiT's implementation of tasks related to tarification, the need for valuation of services in the area of inpatient rehabilitation was indicated. Such activities were undertaken in 2016, after which they were suspended due to the reconstruction of the basket of guaranteed services in this area. It should be borne in mind that rehabilitation is important in the treatment of many conditions. According to the recommendations of the European Stroke Initiative, early initiation of post-stroke rehabilitation is indicated as a key component of stroke unit care. In turn, analysis by the Ministry of Health shows that rehabilitation plays an important role in the therapeutic process for cardiovascular diseases such as heart failure. The above arguments support another attempt to price services in this area. The scope of rehabilitation services has been expanded to include services provided in the conditions of a day care center or ward, as well as in the home setting, in accordance with the suggestion of the Tarification Council, expressed in Opinion No. 1/2022 of June 1, 2023, on the Tarification Plan for 2024. The Agency's work will also include other tasks in the area of tariffs of services, particularly important for the current operation of the universal health insurance system, indicated by the Minister of Health as those whose valuation should be reviewed.

In 2024, the agency will also continue its work to obtain data on hospital treatment, the cost of which accounts for the largest share of the payer's health care costs: PLN 64.2 billion in 2021. (53.4% of health benefit costs).

In addition, the Agency plans to acquire data in other benefit areas, which will enable comparative analyses of the costs of various benefits and speed up the process of implementing tariff orders, particularly important for the ongoing operation of the universal health insurance system. Data from health care providers plays a key role in the process of verifying the actual costs of the benefits provided to set tariffs.

Included in the Plan are:

• Areas of inpatient services: services listed in Annex 1 to the Regulation, in the area: vascular diseases, services billed under the TISS-28 and TISS-28 scale for children, guaranteed services with a high degree of innovation, billed under the product: 5.52.01.0001363 Billing with the consent of the payer;
• Service areas in outpatient specialty care: benefits in the area: vascular diseases;
• areas of inpatient rehabilitation services: services provided in an inpatient setting, services provided in a day center or day unit setting, services provided in a home setting.

Source: AOTMiT