Stick and carrot in primary care. The National Health Fund pays for results, but will take money for inaction

The incentive allowance is intended to mobilize primary health care clinics to increase the number of patients using coordinated care – the regulation of the President of the National Health Fund on this matter has entered into force.

The National Health Fund has signed almost three thousand contracts for the implementation of coordinated care in primary health care clinics (POZ), the National Health Fund Headquarters announced on Tuesday. That's about 49 percent. all primary health care contracts.

The National Health Fund gives raises to active clinics

At the same time, data from the National Health Fund show that as many as 62 percent primary care clinics that offer coordinated care treat less than 5% of patients. their patients. Therefore, in order to mobilize primary health care facilities to provide coordinated care to a larger number of patients, the National Health Fund has introduced a special incentive supplement (from January 1).

Its amount depends on the percentage of patients included in coordinated care:

• 3 thousand PLN for coordinated care from 5 to 10 percent. adult patients;
• 5 thousand PLN for coordinated care from 10 to 20 percent. adult patients;
• 9 thousand PLN for providing coordinated care above 20%. adult patients.

The incentive allowance is monthly, but will be paid quarterly – informed the National Health Fund Headquarters.

Penalties for lack of treatment in coordinated care

Also from January, if the primary care provider treats in coordinated care, at least 5%. their patients, the capitation rate for the coordinator's tasks increases to almost PLN 12, i.e. by 50%. – informed the National Health Fund Headquarters.

The changes also apply to the lump sum payment for the coordinator's tasks. Currently, it amounts to approximately 7.7 thousand. PLN per month for primary carethat start coordinated care and have up to five thousand patients enrolled. “If there are more patients, the capitation rate for the coordinator's tasks increases by an additional 25 percent,” informed the National Health Fund Headquarters.

From January 1, the allowance in the form of a lump sum for the coordinator's tasks will be paid only for six months after the POZ signs the agreement to introduce coordinated care. From 2023, it was paid to every POZ every month, regardless of the length of time in coordinated care. The National Health Fund headquarters noted that the supplement was from the beginning of a temporary nature: initially it was valid for one year (2023), but then it was extended (until December 31, 2025) to strengthen the development of coordinated care.

The Fund decided to introduce penalties for primary health care facilities that provide coordinated care but do not provide any services to patients or provide only few services. The NFZ headquarters noted that the facilities nevertheless collected a lump sum of approximately PLN 7.7 thousand for the coordinator's tasks. PLN per month.

After the change, if the primary health care facility does not provide coordinated care services for patients for three consecutive months, it will not receive: a higher capitation rate for coordinator's tasks, a lump sum for coordinator's tasks, an incentive allowance for patients covered by coordinated care (PLN 3, 5 or 9,000).

What is coordinated care?

The NFZ headquarters emphasized that the changes were developed jointly by the National Health Fund and representatives of the primary health care community.

Coordinated care applies to patients with diseases in the field of cardiology, diabetes, lung diseases, endocrinology and kidney diseases. As part of this care, the primary care physician provides comprehensive advice and establishes an individual treatment plan, and may order a wider range of diagnostic tests. The coordinator takes care of, among others: for better communication between doctor and patient, informing the patient in detail about the next stages of treatment.

From 2021, the tasks performed by the coordinator in primary health care facilities (POZ) are financed in the form of the so-called capitation rate settled on an annual basis. It is payable for each patient over 24 years of age who is enrolled in a primary care facility and does not receive coordinated care. When a primary care facility is in coordinated care, the capitation rate for the coordinator's tasks is calculated for a wider group of patients, i.e. for each adult patient (18+). (PAP)

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