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Krzysztof Landa, M.D.

Krzysztof Landa, M.D. Additional Health Insurance Business Opportunities in the Polish Healthcare System. Total expenditure on health per capita (USD due to purchasing power parity ). Source: OECD Health Data 2006, (*) OECD Health Data 2008.

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Krzysztof Landa, M.D.

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  1. Krzysztof Landa, M.D. Additional Health Insurance Business Opportunities in the Polish Healthcare System WWW.WATCHHEALTHCARE.EU

  2. Total expenditure on health per capita (USD due to purchasing power parity) Source: OECD Health Data 2006, (*) OECD Health Data 2008

  3. Total expenditures on healh (private and public) per capita (2007, USD due to PPP) Source: OECD Health Data 2009

  4. Basic Benefit Package • This insurance-budgetary model of healthcare funding is regulated by the law on Basic Benefit Package (BBP). • The most important changes in regulations were introduced in second half of 2009 – law on BBP. • It means that this new law is not mature and there is still a lot of imperfection, divergence, ambiguity what requires constant improvement. WWW.WATCHHEALTHCARE.EU

  5. Drugs - Reimbursement List – A, B, C, D Poland Drugs - Reimbursement List Ambulatory Care Secondary and Tertiary Care TherapeuticProgramms HiglySpecializedProcedures HiglySpecializedProcedures Chemotherapyregimenscatalogue Hospitalcatalogue Dentistrycare Dentistrycatalouge PreventionProgramms Primary Care Primary Care PreventionProgramms Vaccinationcatalouge Serbia

  6. Hospital treatment There are three ways of finansing: • DRG system • Therapeutic programs • Services contracted separately • Historical budget • Limits on health services WWW.WATCHHEALTHCARE.EU

  7. What does a decision-maker want to know? • Is this technology of proven efficacy(health benefit and its safety profile)? • What is the strength of intervention in comparison to optional ones? (which is the most efficacious option and what are the differences) • Which is the most cost-effective option and what are the differences? • Is coverage of the intervention possible with respect to available resources? What changes should we expect if the technology gets a privileged market position?

  8. The most important requirements of the EU Transparency Directive (89/105/EEC from December, 21st, 1988) • Supervision of the court over decisions concerning reimbursement and pricing – i.e. a possibility to appeal from the DECISION • Supervision of the court is possible only if appellations to the court are considered according to transparent criteria ensuring high reproducibility! “Each decision on exclusion of a certain category of medicinal products from the national health insurance system must embrase justification based on objective and verifiable criteria and must be published in an appropriate publication.” • The course of decision and appellation – decisions within 90 days following submission of the application (in case of a large number of applications additional 60 days –the applicant must be informed) and within another 90 days following appellation

  9. Main advantages of the new lawon drug reimbursement in Poland • Economic Committee • Doubled Transparency Committee • Transparent reimbursement criteria • RSS (risk sharing schemes, patient access schemes) WWW.WATCHHEALTHCARE.EU

  10. Evidence based coverage decision-making – general process

  11. REIMBURSEMENT GOES FIRST IN UTYLITARIAN APPROACH New price or risk sharing Pricing Agency Negotiations Rejection Initial price by manufacturer in dossier and HTA report

  12. B 1/ willingness to cover C A Switzerland Cost per QUALY / cost per LYG UK Rwanda Hungary Cambodia Serbia

  13. Total expenditure on health in Poland [bn, 2007-2011] Public expenditure Private expenditure Total expenditure Source: ppt Jakub Gierczyński 2010 WWW.WATCHHEALTHCARE.EU

  14. Private expenditure on health care • Fees for medical examination • Fees for drugs • Additional health insurance (lisence fees) • Medical subscriptions (co-payment) • Bribes to get better or quicker access or any access at all WWW.WATCHHEALTHCARE.EU

  15. Private health expenditure In 2009 - 28 bn PLN per year 30% of total medical market in Poland WWW.WATCHHEALTHCARE.EU

  16. Out of pocket payments Apart of mandatory health premium Poles spend 30 bn for treatment Including 15 bnPLN for drugs its two times more than in 2007 WWW.WATCHHEALTHCARE.EU

  17. Supplementary insurance in Poland attain less than PLN 2.5 billion per year, while the complementary insurance market may reach 15 - 30 billion PLN per year Additional Public Supplying Substitutional Insuring Supplementary (alternative) Complementary Protective Allows for leaving the public system Benefits are granted faster, outside the queue, in a higher standard Benefits which are not covered by public insurance or co-payment Financeddirectlyfromtaxes, depending on income Financedfromcontributions, depending on risks Dotations, donations, indirect taxes and other Source: Classification based on a presentation by Xenia Kruszewska, 2010

  18. The DIRECTIVE OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL The Directive on the application of patients' rights in cross-border healthcare WWW.WATCHHEALTHCARE.EU

  19. Council adopts its position on patient's rights in cross-border healthcare The key provisions As a general rule, patients will be allowed to receive healthcare in another member stateand be reimbursed up to the level of reimbursement applicable for the same or similartreatment in their national health system if the patients are entitled to this treatment in their country of affiliation. WWW.WATCHHEALTHCARE.EU

  20. The key provisions In case of overriding reasons of general interest (such as the risk of seriouslyundermining the financial balance of a social security system) a member state ofaffiliation may limit the application of the rules on reimbursement for cross-borderhealthcare; member states may manage the outgoing flows of patients also by asking aprior authorisation for certain healthcare (those which involve overnight hospitalaccommodation, require a highly specialised and cost-intensive medical infrastructureor which raise concerns with regard to the quality or safety of the care) or via theapplication of the "gate-keeping principle", for example by the attending physician. WWW.WATCHHEALTHCARE.EU

  21. A cost of an exemplary health service WWW.WATCHHEALTHCARE.EU

  22. Pricing – the most importantregulatory mechanism of HI „Partially guaranteed” = partiallycovered BP (theoretically 1-99% co-paymentor a HI trully 20-80% copaymentoraHI) 100% out of pocketpaymentsoraHI ( „not guaranteed”) >120% BBP regulation by pricing

  23. „THE MOONS”: Deimos and Phobos Fundsfromthe primary contribution (health premium), tax FIELD B BASIC BENEFIT PACKAGE FIELD A expensive cheap A + B = ACTUAL NEGATIVE BP WWW.WATCHHEALTHCARE.EU

  24. Quality of healthcarein Poland „On a national level, there are some countries where citizens are consistently negativeabout the available healthcare. They feel harm from hospital- or non-hospital care islikely, feel at risk of experiencing adverse events and rate the quality of their nationalhealthcare poorly and worse than other Member States. These countries are Greece,Bulgaria, Hungary, Latvia, Lithuania and Poland”. Report: Patient safety and quality of healthcare, TNS Opinion & Social, European Comission , April 2010 WWW.WATCHHEALTHCARE.EU

  25. Quality of healthcare in Poland Report: Patient safety and quality of healthcare, TNS Opinion & Social, European Comission , April 2010 WWW.WATCHHEALTHCARE.EU

  26. HIGHER demand than supply –> QUEUES/ state control

  27. HIGHER demand than supply -> corruption and bribery

  28. HIGHER demand than supply -> PRIVILEGE (using connections)

  29. THE BBP CAN BE PUMPED UP TOO MUCH BUT THE BUDGET IS NOT MADE of RABBER MONEY Form PUBLIC HEALTH PREMIUM BBP The greater the discrepancy, the more severe pathologies in health care Removal of the causes of the disease, eliminates the symptoms

  30. „THE MOONS”: Deimos and phobos Organized patients $ FIELD B FIELD A They suffer in silence – they are not organized expensive cheap AS SEEN BY THE PATIENT WWW.WATCHHEALTHCARE.EU

  31. Access limitations to health care benefits and medical procedures in field A are mainly caused by: Watiting lits Limits / limiting the size of contract concluded with the payer (NHF) → increasing queues and patient selection Lowered (incorrect) price estimations = benefits are not cost-effective for clinic → patient selection stage character of treatment (GP → specialist → diagnostic test → therapy → control visit) Red tape Narrowed/ limited inclusion criteria, e.g. For therapeutic programs Copayment Lack of procedure standard WWW.WATCHHEALTHCARE.EU

  32. How the financial resorces from health premium and BBP can be balanced? • Icrease health premium or/and higher co-payment • Remove from BBP expensive and not cost-effective health services • Enforce additive health insurance (complementary and suplementary insurance) www.korektorzdrowia.pl

  33. Co-payment „Trifles”: 3 pln to a visit 10 pln to hospital addmission HIGH POLITICAL RISK BUT NO CURE FOR THE SYSTEM Deductibles (Udział własny) High co-payments WWW.WATCHHEALTHCARE.EU

  34. The project on „100 conferences” „Innovativehealthtechnologies in …(specificmedical field)…. – assessment of accessibility in Poland” • Presentation of therapeutic and diagnosticinnovationsremining out of BBP in Poland • Cooperation with NationalConsultants and Associations of SpecialistsE.g. oncology: chemiotherapy (15-16.04.2011), vaccination (May), hematooncology (June) • Participants: MDs, Health Insurance, patients’ organizations, media – debates with MoH, NHF, AOTM (AHTAPol) - freeparticipation / www.korektorzdrowia.plorwww.watchhealthcare.eu WWW.WATCHHEALTHCARE.EU

  35. SOCIAL AWARENESS CAMPAIGN "INNOVATIONS IN ONCOLOGICAL PHARMACOTHERAPY- HOPES FOR PATIENTS, SOLUTIONS FOR THE SYSTEM" 15-16.04.2011 PARTNERS: • Polish Oncology Union (PUO)www.puo.pl • Watch Health Care Foundation (WHC)www.krektorzdrowia.pl • Business Centre Club (BCC)www.bcc.org.pl • GREEN PR Agencywww.greenpr.pl WWW.WATCHHEALTHCARE.EU

  36. 11.00-11.15 Przedstawienie Komitetu Naukowego kampanii oraz uczestników debaty – moderator spotkania, red. Krzysztof Michalski11.15-11.30 Otwarcie debaty przez Minister Zdrowia, Ewę Kopacz11.30-11.45 Wystąpienie Prezesa Honorowego PUO, prof. Marka Belki11.45-12.00 Wystąpienie Szefa Zespołu Doradców Strategicznych Prezesa Rady Ministrów dr Michała Boniego 12.00-12.15 Wystąpienie Podsekretarza Stanu Ministerstwa Zdrowia, dr Andrzeja Witolda Włodarczyka12.15-12.30 Wystąpienie przedstawiciela NFZ12.30-12.40 Wystąpienie Konsultanta Krajowego w Dziedzinie Onkologii Klinicznej, prof. Macieja Krzakowskiego12.40-12.50 Wystąpienie Prezesa Fundacji WHC, dr. Krzysztofa Łandy12.50-13.00 Wystąpienie Prezesa PUO dr. Janusza Medera, 13.00-13.10 Wystąpienie Prezesa AOTM dr Wojciecha Matusewicza13.10-13.20 Wystąpienie przedstawiciela BCC, Wojciecha Bociańskiego13.20-13.35 Podsumowanie wystąpień i zaproszenie do dyskusji, dr Krzysztof Łanda13.35-14.35 Dyskusja z udziałem: pracowników naukowych, etyków, prawników, przedstawicieli branży ubezpieczeniowej, organizacji biznesowych, pacjentów i dziennikarzy.14.35-15.35 Poczęstunek, czas na rozmowy nieformalne15.35 Transfer uczestników seminarium do hotelu Fort Piontek w Jabłonnie19.00 Uroczysta kolacja w Pałacu PAN w Jabłonnie pod Warszawą Program – day 1 WWW.WATCHHEALTHCARE.EU

  37. 10.00-10.30 Powitanie uczestników i przedstawienie założeń kampanii społeczno-edukacyjnej „Liczymy się z naszym zdrowiem” w kontekście innowacyjnych rozwiązań diagnostyczno-terapeutycznych dla onkologii, prof. Tadeusz Pieńkowski (PTBRP), dr Krzysztof Łanda (WHC) i dr Janusz Meder (PUO) 10.30-10.45 Wykład inaugurujący sesje medyczne, prof. Wiesław Jędrzejczak Konsultant Krajowy w Dziedzinie Hematologii10.45-11.15 Przerwa kawowa11.15-14.30 Sesje sponsorowane14.30-14.50 Podsumowanie przedstawionych prezentacji, prof. Wiesław Jędrzejczak14.50-15.00 Zamknięcie seminarium, dr Krzysztof Łanda, dr Janusz Meder (PUO)15.00 Lunch16.00 Transfer na Dworzec Centralny w Warszawie Program – day 2 WWW.WATCHHEALTHCARE.EU

  38. Partially guaranteed benefits WWW.WATCHHEALTHCARE.EU

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  44. WWW.WATCHHEALTHCARE.EU

  45. Partners of the Foundation www.korektorzdrowia.pl

  46. Supporting Institutions WWW.WATCHHEALTHCARE.EU

  47. THANK YOU! Landa@korektorzdrowia.pl WWW.WATCHHEALTHCARE.EU

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