The Ministry of Health wants to transfer some more uncomplicated procedures from hospitals to outpatient specialist care (OSC) facilities. This will allow hospitals to be unburdened and bring benefits to the patients, who will not have to be hospitalised.
The Ministry of Health has moved some procedures from hospitals to OSC facilities through changing basket regulations and describing some minor procedures as services that do not have to be performed as a part of the stay in a hospital.
A change in the appraisal of services
Optimal OSC financing is important for NFZ, as it is one of the main branches of the healthcare system.
NFZ, in turn, has changed the appraisal methods for services which can be provided both in a hospital and in OSC facilities. Earlier some procedures were appraised as more expensive when performed in a hospital than in an outpatient clinic. Now it is the other way round.
The changes were intended to create a situation in which examining patients in surgeries is more profitable for doctors than sending them to hospitals when it is not necessary.
The difference in prices for the same procedure performed in a hospital and in an outpatient clinic is meant to cover the overhead costs connected with the patient's stay in a hospital.
There will be more procedures in doctors' surgeries after the changes
The appraisal of such procedures was carried out by the Fund at the end of 2012. NFZ's analyses concerning 258 procedures after changes in financing proved that in the first six months of 2013 the share of procedures performed in OSC facilities significantly increased. The biggest increase in procedures performed in OSC facilities was noticed in the fields of urology and laryngology.
In the first six months of 2012, 1 107 020 minor procedures were carried out in outpatient clinics and in 2013 the number grew to as many as 1 334 708. At the same time the number of procedures performed as part of hospital treatment fell from 545 404 in the first six months of 2012 to 514 749 in the first six months of 2013.
This caused a decrease in the costs of the procedures performed within hospital treatment from PLN 1.231 billion to PLN 1.129 billion.
The procedures that, from 2013, can be performed in OSC facilities include cystoscopy and multiple prostate biopsy, among others, and from 2014 colonoscopy and mammotome biopsy.
More procedures, less prescriptions
The Fund has announced more changes. The aim is to create the situation in which the number of visits during which doctors perform procedures is greater than the visits during which doctors simply write out prescriptions.
In order to encourage service providers to increase the number of small procedures in OSC, the Fund, during contracting services for 2014, devoted some financial resources for the implementation of surgery procedures in outpatient facilities.
Ministry of Health and NFZ: these solutions are beneficial for patients
The advocates of performing a higher number of procedures in OSC facilities think that it is beneficial for the patient as he/she gets better access to procedures, does not stay long in a healthcare facility and is not exposed to infections connected to the stay in a hospital.
Both the Ministry of Health and NFZ stress that in the process of qualifying the patient for a procedure it is the doctor who, taking into account patient's general condition and the possible risk of complications, decides if the procedure should be performed in a hospital or in an OSC facility.
We might expect that, with the changes in financing, the number of cases of unnecessary stays in hospitals will be reduced. It concerns the cases in which the procedure is performed as a part of hospitalisation because NFZ appraised the cost of such a procedure as higher when performed in a hospital.