Session Summary from VI HTA Symposium (11-12 June 2018)
DAY II, SESSION I:
A modern hospital
The panellists: Wojciech Szefke, Paweł Grzesiowski, Agnieszka Pachciarz, Waldemar Stylo, Krzysztof Łanda, Dariusz Dudek
The moderator: Mateusz Nikodem
The following topics were among those discussed during this session: aspects of modern solutions aiming at improving the way Polish hospitals operate as well as ensuring that hospitalised patients receive effective and safe healthcare.
These solutions include telemedical devices and systems, from products used to monitor the patient’s health condition remotely through systems and devices which enable conducting a teleconsultation, to IT systems for healthcare entities. An intense development of telemedicine provides hospitals with a chance to optimise their costs as well as health benefits. However, lack of comprehensive legal regulations regarding both the telemedical services and the long-term policy between: the Agency for Health Technology Assessment and Tariff System (AOTMiT), the Ministry of Health and the National Health Fund (NFZ) makes the successful implementation of telemedical solutions in Poland very difficult. Low awareness of both the general society and the medical personnel also limits the development of telemedical services. Another problem consists in incompatibility of the IT solutions offered by different entities on the market and high costs of adjusting the existing solutions to the system. As part of a comprehensive approach to the development of telemedicine in Poland, the following actions should be undertaken: supplementing the existing legal system, defining and adding new groups of healthcare services to the guaranteed benefits basket, appointing a National Consultant in the field of telemedicine, creating an incubator for telemedical solutions, standardising computerised systems and implementing central purchases for healthcare entities. One of the development paths of telemedicine could also consist in financing under additional health insurances.
New technologies contribute also to ensuring the safety of hospitalised patients. This is particularly important in the light of adverse events which have lately been observed in epidemiology. They include infections of drug resistant strains of bacteria (including Clostridium difficile or bacteria of the Enterobacteriaceae family) commonly found in hospitals. The risk of contracting such nosocomial infections is higher among older people and patients suffering from chronic diseases, therefore exactly those groups who constitute the increasing number of hospitalised patients. The risk of infection in a hospitalised patient grows several times in the event of insufficient decontamination of the room, in which a micro-organism carrier had previously been treated. In addition to the logistic activities consisting in isolation and dividing the hospitalised patients into cohorts, monitoring epidemiological situations, education of the medical personnel or introducing guidelines regarding the security of medical procedures, progress in ensuring the epidemiological safety of the hospitalised patient is not possible without implementation of new technologies. They include, among others,: active monitoring systems ensuring correct cleaning and disinfection (UV indicators, ATP test), contactless cleaning techniques and decontamination (steam cleaners, fumigation, i.e. with hydrogen peroxide, UV radiation), antimicrobial surfaces, textiles and dressings, active air cleaning systems (biocidal filters functioning in the presence of a patient), quick tests diagnosing infection in the healthcare unit, electronic systems of monitoring and early detection of biological hazards. Due to a wide range of modern solutions and their high costs, they are selected in compliance with individual needs of the medical facilities, once an in-depth profitability analysis has been conducted.
A system of basic provision of inpatient healthcare services (hospital network) has been established for the purposes of improving the organisation of healthcare services provided in Polish hospitals and facilitating patients’ access to specialised treatment in hospitals. During the VI HTA Symposium in Cracow, the participants presented an evaluation of the functioning of the hospital network from two different perspectives: the public payer and healthcare provider. Several months after the implementation of the network of hospitals, the public payer acknowledges the benefits of the new system, including lack of competition proceedings, financial stability (a guaranteed contract with the National Health Fund), rewarding quality (accreditation certificates for diagnostic and microbiological laboratories operating within the structure of a hospital), an additional adjustment of the lump sum amount for the planning period (Dl indicator). According to a representative of the Fund, potential advantages may in the future also consist in focusing on units ensuring patients with comprehensive care, increased importance of the director of the hospital (whose function has become more of a manager) and prevention of over-hospitalisation. The disadvantages mentioned include a risk related to limits of the planned admissions (due to discontinuation of the surplus performance settlement), high costs of hospitalisation as well as a small number of beds available in the Anaesthetics and Critical Care Department (OAiIT) financed in the form of a lump sum. According to a representative of the public payer, another potential threat can consist in limited access to services resulting from reduced performance of some services as part of a lump sum.
The healthcare providers’ assessment of the functioning of a hospital network was less optimistic. Great expectations of healthcare providers relating to the implementation of the hospital network (i.a. plans to develop network hospitals for the purpose of maximising the use of their resources, a chance to ensure complementarity of the activities of mutually complementary hospitals within the network). Th functioning of the hospital network, as evaluated by a district hospital director, leads to a deterioration of the financial result of the hospital (insufficient financial resources in the case of a surplus performance exceeding the lump sum), prevention of restructuring development of the facility as well as limited options for management of the hospital. Healthcare providers also draw attention to the fact that establishing the hospital network has caused a change in the structure of secondary care services which is beneficial for the payer, without affecting the service quality, yet at the same time, it means a considerable burden on the medical personnel of highly specialised departments and as a result, its outflow towards internal medicine or primary health care, whereas in the long-term – vacancies in medical specialisations.
Summing up the issue of the hospital network, the need for changes reported from the healthcare providers’ perspective must be stressed, however, in the opinion of a National Health Fund representative, due to the short time of functioning of the hospital network, such conclusions are premature.
An essential aspect of the operations and financial interest of hospitals was raised during the Symposium, namely equipping hospitals with drugs and medical devices. Reimbursement and tender procedures have also been compared. The reimbursement procedure is characterised by i.a.: the option of co-payment, better transparency, the possibility to carry out negotiations and apply risk sharing schemes or a reimbursement development mode. A tender procedure does not offer such benefits. The highest efficiency of a tender is achieved in case of generics (choosing the cheapest drug/medical device from among nearly identical technologies), whereas the lowest efficiency with regard to monopolistic drugs or devices (in such cases a tender procedure makes no sense, since the MAH, who does not compete with others, does not intend to win the procedure by lowering the price).