Merging NFZ with ZUS – V HTA Symposium in Krakow

HTA Real World Data

V HTA Symposium in Krakow – Session Recap III

Arcana Institute hosted the V HTA Symposium in Krakow on 29th-30th May 2017, which provided an in-depth view of the many important topics taking place in Poland in the realm of systematic changes in healthcare related to the development of clinical registries and planned introduction of amendments to reimbursement regulation concerning rare diseases and medical devices.


Speaker’s Panel: Dr Małgorzata Gałązka-Sobotka, Mec. Michal Czarnuch, Dr Igor Radziewicz Winnicki, Artur Fałek, Dr Andrzej Śliwczyński

Moderator: Mateusz Nikodem

Merging of NFZ with ZUS

The idea of combining Poland’s National Health Fund (NFZ) with the Social Insurance Institution (ZUS) stems from concerns in underfunding and deepening imbalances in the system. With the state of the current system in question, there is concern of how to address future challenges, which include an ageing population and increasing healthcare costs.

Some benefits of joining NFZ and ZUS include the possibility for optimal financial resource utilization, improved coordination of health and sickness insurance, and greater efficiency managing sickness and financial benefits. In order to move forward with proposed changes, the following conditions must be met:

  • Maintain health contributions at the current level
  • Increase spending on healthcare (budget target) – development of a mixed system
  • Integration of data from health and social services
  • Health information infrastructure strengthening
  • Suitably long vacatio legis

A possible outcome of merging NFZ with ZUS is that the interplay of the two agencies will offer improved management, which in turn will encourage medical providers to consider medical technologies that allow for citizens to return into the workforce more quickly.

The most important legal changes in healthcare in Poland in 2017

The Big Amendment on Reimbursement (DNUR) introduces the following: “Reimbursement Development Mode,” changes to calculations in the pay-back mechanism, possibility of initiating ex officio proceedings to change the reimbursement decision, a category for drug access to a “full range of indications and allocations” and an egalitarian approach to ultra-rare diseases.

A ‘medical devices’ amendment to the Reimbursement Law to introduce a reimbursement system for medical devices analogous to medicinal products.

Draft amendment to the law on benefits, together with the Small Amendment on Reimbursement – to introduce emergency access to drug technology and changes to the duration of issuing a reimbursement decision.

Draft law on primary health care – the main goal is to structure primary health care regulation and increase its role within the healthcare system, which may result in an increasing role of the Primary Care Physician within the system.

Draft law on quality in healthcare and the safety of patients – introduces new responsibilities to healthcare providers involved in internal quality assurance and safety, and establishes an Agency responsible for providing and monitoring quality in healthcare at a central level.

The “Pharmacies for pharmacists” regulation – allows for a pharmacy to be run only by a pharmacist and introduces demographic and geographic limitations associated with the location of a potential pharmacy. This law does not apply to pharmacies opened before 25 June 2017.

The Centre for Health Information Systems (CSIOZ) announced that the amendment to the Act on the information system in health care is aimed at clarifying the definition of Electronic Medical Records and to specify obligatory practices of the Polish National Implementation (PIK).

Hospital Network. The most important legal changes in the context of the hospital network include:

  • Six levels of benefits were identified in the hospital network. Providers from each province will qualify for one of the benefits.
  • Eligibility of a facility into the network will guarantee that the NFZ will conclude an agreement with them without having to participate in the competition proceedings.
  • 1st October 2017 is the first day that the “Hospital Network” act comes into force.
  • Financing of health benefits will be in the form of a lump sum, subject to benefits financed on a separate basis. For the network, it is necessary to allocate approximately 91% of resources, from which hospital care is currently funded.
  • Enrollment into the network will take place every 4 years.

Inclusion criteria into the hospital network leads to the exclusion of many specialized and private medical entities. Furthermore, discretion will be applied to a hospital that does not meet all inclusion criteria of the hospital network.

Merging NFZ with ZUS – V HTA Symposium in Krakow