The National Health Fund introduces new rules for primary health care clinics. Bonuses and penalties for coordinated care
The National Health Fund announced that currently almost half of primary health care clinics in Poland (approx. 49%) operate under coordinated care. However, according to the Fund's data, as many as 62 percent less than five percent of them receive treatment in this form. their patients.
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To increase this percentage, From January 1, incentive bonuses were introduced for facilities that provide coordinated care to a larger number of patients.
The amount of the supplement depends on the number of patients included in the program. Clinics that provided care to 5 to 10 percent. adult patients will receive three thousand PLN per month. Branches with interest from 10 to 20 percent. they can count on five thousand. PLN, and those that exceed the 20% threshold. — for nine thousand zloty. The allowance will be paid quarterly.
New financing rules and lump sums for primary care clinics in Poland
From January, the rules for paying a lump sum for coordinator's tasks were also changed. So far, each primary care facility, regardless of the number of patients in coordinated care, received a lump sum of approx. PLN 7.7 thousand. PLN per month. Currently, this lump sum will only be available for six months from signing the agreement to introduce coordinated care. The National Health Fund headquarters would like to remind you that the lump sum payment was of a temporary nature from the beginning – it was initially valid for a year and later extended until the end of 2025.
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Additionally, for facilities that will provide coordinated care, at least five percent. patients, the capitation rate for coordinator tasks will increase by 50%, reaching almost PLN 12 per patient. In the case of a larger number of patients, the capitation rate will increase by an additional 25%.
Penalties for failure to provide benefits
The National Health Fund also decided to introduce sanctions for facilities that formally participate in coordinated care but do not provide services to patients. As noted by the National Health Fund Headquarters, some clinics charged a lump sum of PLN 7.7 thousand. PLN per month, without providing any services as part of coordinated care.
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According to the new rules, if the facility does not provide services in this area for three consecutive months, it will lose the right to incentive bonuses, a higher capitation rate and a lump sum for the coordinator's tasks.
Comprehensive care for patients with chronic diseases
Coordinated care covers patients with cardiac, diabetic, pulmonological, endocrine and nephrological diseases. As part of this form of treatment, a primary care physician provides comprehensive advice, establishes an individual treatment plan and may order a wider range of diagnostic tests. A key role is played by the coordinator, who takes care of communication between the patient and the doctor and provides detailed information about the next stages of therapy.
The coordinators' tasks are financed from 2021 under the so-called capitation rate, which was previously payable for each patient over 24 years of age. In coordinated care, this rate covers all adult patients enrolled in a given primary care facility.
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The changes, as emphasized by the National Health Fund, were developed in cooperation with representatives of the primary health care community. Their goal is to develop coordinated care and increase the number of patients using this form of treatment.
