AOTMiT: There's a Tariff Plan for 2025

Included in the Plan are:

• areas of inpatient services : services in the areas of facial, oral, pharyngeal, laryngeal, nasal and ear diseases, surgical treatment of breast diseases, as well as selected concomitant services and diagnostic lump sums for non-oncology drug programs;
• areas of services in outpatient specialty care: services in the areas of diseases of the face, mouth, pharynx, larynx, nose and ears, surgical treatment of diseases of the breast, as well as insulin treatment with an insulin pump, children and adults up to the age of 26, carried out in the type of health services contracted separately;
• areas of psychiatric care and addiction treatment services: services in the areas of: sexological and comorbid pathology services and sexual preference disorder treatment program.

Included in the 2025 tariff plan is the area of inpatient services for diseases of the face, mouth, pharynx, larynx, nose and ears, which includes 34 JGP groups from Section C - Diseases of the face, mouth, pharynx, larynx, nose and ears, which together account for 4.9% of all groups in the JGP catalog. Section C brings together more than 3% of the expenses incurred by the National Health Fund for the provision of services specified in the JGP group catalog in the type of hospital treatment, and accounts for 3.4% of the number of all hospitalizations provided under 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 given the length of hospitalization and heterogeneity in the construction of the group itself.

In the course of the Agency's work on the area in question, an analysis will be carried out of the feasibility of providing the above benefits on an outpatient and inpatient basis, with the aim of optimizing treatment and harmonizing valuations of benefits provided on an outpatient and inpatient basis. The tariff plan also includes benefits for selected concomitant services and diagnostic lump sums from the area of non-oncology drug programs. Analyses are currently underway at the Agency to develop tariffs for accompanying benefits and diagnostic lump sums for oncology drug programs.

It is therefore reasonable to continue work in this area to update tariffs for all billing products related to benefits in the area of drug programs. Another area included in the tariffing plan is the services provided in the type of psychiatric care and addiction treatment, in the areas of sexological and intercourse pathology services and the sexual preference disorder therapy program. The National Health Fund has identified these areas as requiring tariffization efforts.

The scope of benefits covered by the Tariff Plan has also been expanded to include benefits under Section J of the JGP catalog for surgical treatment of breast diseases and benefits for diabetes treatment with an insulin pump for children and adults up to age 26, as suggested by the Tariff Council in its Opinion No. 1/2024 of June 6, 2024 on the 2025 Tariff Plan. The Agency's work will also include and other tasks in the area of tariffification of benefits, particularly relevant to the current operation of the universal health insurance system, identified by the Minister of Health as those whose valuation should be reviewed.