The extent of reimbursement automation is insufficient

This is just one of their many comments on the Ministry of Health's published report of the team on prescribing and filling prescriptions for finished and prescription drugs. - We still expect that the issue of simplifying the reimbursement rules and removing the responsibility for it from doctors will be addressed, at least in part! - emphasizes Bozena Janicka, president of PPOZ.

PPOZ doctors have been calling for the establishment of new, simplified reimbursement rules, removing the responsibility for determining its level from doctors, for years. In their view - the lack of uniform, transparent rules results in unintended consequences for them, the doctors (financial penalties), as well as patients (lack of availability of drugs).

Work on the new reimbursement system began two months ago. However, the recommendations published in the report of the team appointed by the Minister of Health do not satisfy the medical community, including primarily primary care physicians. In its comments, PPOZ points out that the reimbursement system should be standardized within the framework of specific registered indications, and the obligation to determine the level of reimbursement should be transferred from medical facilities to pharmacies.

- It is the pharmacies, after seeking information from the patient and based on the prepared information system, that should determine the payment in which the drug should be issued, PPOZ doctors point out.

PPOZ agrees with the position that the activity of so-called prescribers is an extremely undesirable phenomenon that should be combated by administrative and disciplinary methods (including deprivation of the right to practice a profession), but, as it stresses, initiatives in this area should not hinder the functioning of properly operating establishments by hastily imposing sanctions. Therefore, it is unacceptable to grant the Patient Ombudsman the authority to impose fines for practices that violate the collective rights of patients without first issuing a decision ordering the cessation of such practices.

- Unlimited authority to issue such decisions would upset the balance between the legal security of medical facilities and the dynamically changing catalog of practices that violate patients' rights. Therefore, we propose other methods to combat prescribers: temporary suspension (blocking) of the entity's activity in case of reasonable suspicion of prescribing in violation of the regulations; introduction of a criminal provision defining the crime of operating a prescriber in an unauthorized manner, or introduction of a criminal provision typifying the crime of repeatedly issuing a prescription by an authorized person in order to obtain a financial benefit, without examining the patient," PPOZ doctors suggest in a letter to the Minister of Health.

However, the methods of combating reprehensible practices should take into account the specifics of the activities of entities with a contract with the National Health Fund in primary care. As PPOZ providers explain - in primary care, it is common - as a continuation of treatment - to issue prescriptions without examining the patient first. However, this does not compromise the safety of treatment, as prescriptions are for patients whose ailments are well known to prescribers and accurately described in medical records. Secondly, it is necessary to precisely define both the prerequisites for criminal liability and such a drastic solution as suspension of the entity - which will certainly not be easy. In the opinion of PPOZ - however, this is necessary to avoid the so-called "freezing effect" among doctors, which could halt the development of telemedicine.

- The primary burden of punishing doctors who support prescribers should be borne by the bodies of the medical self-government in disciplinary proceedings. This is because medical courts will be able to evaluate ambiguous cases more easily and quickly - than criminal courts, which are devoid of medical knowledge and overburdened," stresses Bożena Janicka.

Although the recommendations in the MZ report leave much to be desired and, in the opinion of PPOZ, should be urgently revised, there are also points that lead to balancing the responsibility of those authorized to issue prescriptions, thereby facilitating patients' access to medicines.

- A favorable change under way is the extension of the authority to issue prescriptions for free drugs "S" and "DZ" also to doctors outside of health insurance (PCP, AOS, hospital) to private practices! As a result, every doctor will have the right (and obligation) regardless of the place of providing services to issue "S" and "DZ" prescriptions due to the patient. Every prescriber (including every doctor) is also to be given the opportunity to write a drug to patients at a special discount, PPOZ doctors emphasize.

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