Representatives of patients and hospitals interviewed by PAP believe that the effect of the new rules on financing tests and treatment in clinics will be delays in diagnosis, including for people with oncology. The National Health Fund wants to change the rules for paying for services above the limit.
The National Health Fund intends to pay 40%, not 100%. for services in outpatient specialist care (AOS) provided beyond the contract. Earlier, in March, the National Health Fund had already proposed such settlement rules for colonoscopy, gastroscopy, computed tomography and magnetic resonance imaging. The new rules do not apply to benefits for the so-called fast diagnostic path for oncology patients (DILO card) and treatment of children.
Dorota Korycińska, president of the Polish Oncology Federation, told PAP that she is afraid of a dramatic extension of queues to specialists. She pointed out that the change in the rules for financing diagnostic tests and outpatient specialist care (AOS), contrary to what the Fund argues, will also affect cancer patients.
– A patient who suspects that he may have cancer does not have a DILO card issued yet. If this patient does not have the test done on time, assuming that cancer is developing in his body, a late diagnosis will lead to further development or spread of the cancer – said Korycińska.
According to her, patients will pay for the new settlement rules with their health, and treatment costs will increase in the long term.
– Advanced disease means expensive treatment. Today's apparent savings will result in future costs. In the health care system, there is no forward-looking thinking, only term thinking. This is putting out fires, not a strategy, added Korycińska.
The president of the Polish Association of District Hospital Employers (OZPSP), Waldemar Malinowski, told PAP that the announced changes to the rules for financing specialist care will result in an actual limitation of these services for patients.
– The President of the National Health Fund, presenting the assumptions of the project, said that the National Health Fund does not limit these benefits, but will pay for all overpayments from 2026 in 2027 with a degressive rate of 40%. This is not even enough to cover labor costs. For this reason, healthcare providers will drastically limit the admission of patients only to the limit contracted by the National Health Fund – he added.
He emphasized that the announcement of the National Health Fund caused great anxiety among patients and healthcare providers. He said that doubts concern how the presented project relates to the National Oncology Strategy, the National Oncology Network or the National Cardiology Network, as well as how the pyramid of services is to be reversed while limiting them to the scope of specialized medical care or cost-intensive diagnostics.
– Currently, hospitals are investing in equipment, also for cardiology clinics within the National Cardiology Network, from the money of the National Reconstruction Plan, which would diagnose patients more effectively – he said.
He added that there are also concerns that the patient will have to go to the emergency room or to the hospital for hospitalization in order to perform cost-intensive diagnostic tests.
According to Malinowski, the president of the National Health Fund, Jakub Szulc, announced on Monday during a meeting of the tripartite team that the solution for AOS will be “twin” to the regulation on cost-intensive diagnostics.
Deputy Minister of Health Tomasz Maciejewski, asked on Wednesday about the risk of limiting the availability of specialist doctors after the implementation of new settlement rules, said that the Ministry of Health is working on adjustments to the AOS benefit package, which will enable comprehensive diagnostics of the patient already during the first visit.
– We prepare a package in every respect so that during the first visit the patient can be ordered the maximum number of tests to be able to make a diagnosis – said the Deputy Minister of Health.
According to him, this will reduce the number of subsequent visits to specialist clinics. He announced that he would present the solution around mid-year.
The Fund's headquarters does not provide any comments until the draft order of the President of the National Health Fund is published.
In March, the National Health Fund presented data showing that the value of services in outpatient specialist care (AOS) increased by 117% from 2021 to 2025, and at the same time the number of services increased slightly above 20%. During this time, the value of all health care benefits adjusted for inflation increased by 55%.
In 2026, changing the rules for settling cost-intensive tests, i.e. colonoscopy, gastroscopy, computed tomography and magnetic resonance imaging, is expected to bring savings of approximately PLN 800 million.
Limits on access to specialist doctors were abolished in July 2021 under the United Right government. (PAP)
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