EEC: what does the future hold?

"Here and now," however, proved to be too overwhelming a theme, especially since the EEC began exactly in the middle of Black Week - a protest organized by county hospitals and literally dozens of minutes before the first health discussion, counties and county hospitals put forward a radical thesis: if additional funds are not found, if valuations are not raised and funding is not provided for the tasks of hospitals, including the implementation of the increase law, within "two or three months" some entities may simply go out of business. A report by the Union of Polish Counties shows that dozens of facilities are on the brink of bankruptcy at the moment.

Whether this bleak scenario will come true is rather doubtful - however, if even one or two counties were to announce a decision to close a hospital or suspend the operation of key departments, the system would suffer a serious shock, primarily political. That's why the Health Ministry is rather bitching about accelerating the restructuring and consolidation processes. At the EEC on Wednesday, Minister Jolanta Sobieranska-Grenda recalled the announced support (more than PLN 1.1 billion from the Medical Fund for consolidation programs, dedicated primarily, though not exclusively, to district hospitals). The president of the National Health Fund put the matter much more sharply: in Filip Nowak's opinion, we should not continue to pretend that we can maintain a hospital base as extensive as the current one with the current number of acute beds. In his opinion, the regulator gives the tools for change - they are enshrined in the Hospital Act, but also in the new regulations, allowing the transformation of acute wards into planned ones without the risk of losing the status of a "network" hospital.

For its part, the payer makes no secret of the fact that it intends to continue its policy not of cuts - as Nowak stressed - but of rationalizing spending. After the changes concerning diagnostic imaging and endoscopy, changes are being prepared in the financing of the entire AOS and some other services (cataract surgery is mentioned in this context). They are to be affected by the same mechanisms as diagnostic tests - overperformance above the contract will be subject to a degressive rate and delayed payment. According to Nowak, health care providers will thus gain the opportunity to restructure their salary expenditures, as the change in financing conditions will give an impetus to renegotiate very high contracts, primarily for physicians.

The NFZ president also pointed out that there are decisions on the table all the time that remain outside the payer, although the expenditures conditioned by them represent a massive burden on the NFZ budget. These are raises for health care workers and spending on free drugs for seniors and children and adolescents. Admittedly, both solutions were introduced by laws whose amendment is not easy (experience with the salary law shows that it may prove impossible), but the reduction in the scale of expenditures remains the responsibility of the Health Ministry (the reduction in expenditures on free drugs was part of the savings plan prepared by the Ministry of Health in the autumn, but the ministry withdrew from these proposals after they were revealed).