PZ demands removal of obligation on doctors to set reimbursement levels for drugs

As they point out, it is mainly the providers who are currently being punished for the convoluted and inconsistent reimbursement system. This responsibility is not formal or theoretical, but very tangible, concrete and measurable.

According to information provided by the president of the National Health Fund, between 2014 and 2023, the total amount of fines imposed on healthcare providers for improper reimbursement of drugs amounted to more than PLN 61 million. The shocking data shows which entities bore the main responsibility and in what amount:

• Hospitals: about PLN 3 million 300 thousand,
• specialists: about PLN 8 million 800 thousand,
• Primary care physicians: more than PLN 49 million.

- These amounts illustrate the failure of the drug reimbursement system in Poland. Since doctors - educated professionals - are not able to find their way around the intricate system, this proves the problem of the health care system," says Marek Twardowski, vice president of the Federation Porozumienie Zielonogórskie.

"In a situation where hospital debts are growing and the financial situation of other entities is also difficult, the possibility of control and financial penalties for reimbursement from years ago acts as a delayed bomb, significantly worsening the financial problems of the health sector," the doctors emphasize in the petition sent.

- For many years, the PZ Federation appealed to the Health Ministry on this issue, intervened with successive ministers, made proposals, and even came up with a citizens' legislative initiative, says Jacek Krajewski, president of PZ. - Unfortunately, these actions have not borne fruit. Also incomprehensible are the practices of the National Health Service, which does not monitor deficiencies on an ongoing basis and does not warn doctors about errors every month. Instead, it waits many years, conducts a retrospective inspection and imposes gigantic fines with interest. These are uncommon practices in a state of law. What prevents NHF officials, when detecting errors, from responding immediately, informing doctors to correct them? Meanwhile, they wait for months or even years until the fines reach monstrous amounts," Krajewski adds.

The PZ experts also point out that the non-fault misconduct results in the patient receiving the drug more cheaply, but it is the doctor - not the state - who finances the discount, which is then ruthlessly enforced against doctors. "Such solutions are unacceptable in Europe. In Austria, in the case of reimbursement lapses, the doctor is first admonished, and only in the absence of improvement are small penalties imposed. Reimbursement systems in European countries differ, but they are much simpler and easier to use, both for doctors and patients. In England, patients pay a fixed amount for each prescription, regardless of the actual price of the drug, and many chronically ill patients and pensioners receive drugs free of charge. In Scotland, Wales and Northern Ireland, prescription drugs are free. In Italy, the system is fully computerized, and the drug's payment is calculated by the pharmacy. In Poland, doctors have been subject to appallingly high fines in recent years." - The letter to the MZ reads.

- Suffice it to recall the problem of fines imposed on doctors who prescribed Neocate LCP milk replacer to children suffering from severe food allergies. Now the problem involves reimbursement for prescription drugs. One of our POZ providers from the Pomeranian province received a fine of nearly one million zlotys," Marek Twardowski enumerates.

"We emphasize that in many countries in the European Union, the responsibility for setting reimbursement levels does not lie with doctors. In Germany, the patient pays up to 5 euros for a cheaper drug and 10 euros for a more expensive one - that's the whole reimbursement system. In most European Union countries, doctors are not burdened with reimbursement problems. There is nothing to prevent the Polish system from adopting similar solutions. Determining the level of reimbursement should not be the responsibility of doctors. What has been prepared so far by officials of the Health Ministry's Drug Policy and Pharmacy Department is unacceptable. We demand that the obligation to set the reimbursement level of a given drug be removed from doctors and that other, mainly automatic, mechanisms be introduced. However, not the kind prepared by the Health Ministry together with the e-Health Center. The proposed solutions are absurd - they require even more time and will not protect doctors from further failures, leading to high financial penalties from the NFZ, mainly against PCPs. We do not agree that the president of the NFZ, while saving the financial situation of the Fund, should look for money in the pockets of doctors. Enough of these practices, which result in it becoming increasingly difficult to recruit doctors to work in POZ, where they face gigantic reimbursement penalties every day," the PZ experts appeal to the Health Minister.

infra