Announcement of the President – recommendation on the change of the method or level of healthcare service financing

Announcement of the President of the Agency for Health Technology Assessment and Tariff System dated 13 July 2022 on the Recommendation no. 65/2022 of the President of the Agency for Health Technology Assessment and Tariff System on the change of the method or level of healthcare service financing dated 13 July 2022.

Publication in Public Information Bulletin (BIP)

The President of the Agency recommends the following variants of an increase in the level of healthcare services financing:

1. to include the minimum salary growth implemented by means of the Act of 26 May 2022 on amendment of the Act on the method for determining the minimum base salary for certain employees of healthcare entities and certain other acts (Polish Journal of Laws of 2022, item 1352), or

2. to include the minimum salary growth implemented by the Act of 26 May 2022 on amendment of the Act on the method for determining the minimum basic salary for certain employees of healthcare entities and certain other acts (Polish Journal of Laws of 2022, item 1352), salary growth for employees of healthcare entities employed under contracts other than an employment contract associated with the inflation rate forecast for the years 2022–2023, the simulation of the reduction in differences between service providers in the individual service ranges in terms of payment unit values used in contracts concluded by the National Health Fund and the separate solutions for the service areas identified as requiring urgent intervention in terms of increasing the level of financing.

Grounds for the recommendation

In light of an extraordinary increase in the healthcare service provision costs, the President of the Agency received an order from the Minister of Health to issue a recommendation on the change of method or level of financing for these services. The order execution process included:

1. an analysis of the following changes:

– associated with the salary growth for employees of healthcare entities employed under contracts other than an employment contract;

– associated with the inflation rate forecast for the years 2022–2023;

– including the simulation of the reduction in differences between service providers in the individual service ranges in terms of payment unit values used in contracts concludes by the National Health Fund;

– including separate solutions for the service areas identified as requiring urgent intervention in terms of increasing the level of financing.

2. an analysis of the following:

– cost data collected from service providers;

– methods for including in the healthcare service financing system changes in the costs of provision of these services, including, but not limited to those related with the minimum base salary growth set forth in the Act of 8 June 2017 on the method for determining the minimum base salary for certain employees of healthcare entities (Polish Journal of Laws of 2021, item 1801 and of 2022, item 1352);

– financial consequences for the healthcare system, including for the entities obliged to finance healthcare services from public funds.

In the first variant, it is recommended to increase the payment unit prices used in contracts with service providers which result from the minimum salary growth in the individual range groups according to the growth rate for the individual groups provided in the table below.

Table 1. Increase in the level of healthcare service financing in variant 1.

Group	Group name	Mean increase in point price value due to salary growth in PLN	NHF contract value growth rate for lump sum payment units
1.	Primary Care – fee-for-service (FFS) consultations	0.05
2.	Night and Holiday Healthcare		19.27%
3.	Secondary Outpatient Care – consultations	0.20
4.	Secondary Outpatient Care – diagnostics Cost-consuming Outpatient Diagnostic Services – imaging	0.15
5.	Secondary Outpatient Care – diagnostics Cost-consuming Outpatient Diagnostic Services – endoscopic imaging	0.19
6.	Hospital Care	0.23
7.	Hospital Care – procedure ranges – elective hospitalization	0.14
8.	Hospital Care – procedure ranges – one-day treatment	0.09
9.	Hospital Care – procedure ranges – expensive devices	0.09	8.09%
12.	Emergency Department/Emergency Room
13.	Hospital Care – drug administration and diagnostics chemotherapy/drug programs	0.18
14.	Hospital Care – radiotherapy	0.15
15.	Psychiatry – inpatient adult psychiatry	3.32
16.	Psychiatry – inpatient pediatric psychiatry	3.41
17.	Psychiatry – outpatient and community adult psychiatry	1.53
18.	Psychiatry – outpatient and community pediatric psychiatry	1.50	14.20%
19.	Psychiatry – forensic psychiatry	4.18
20.	Rehabilitation – inpatient rehabilitation	0.26
21.	Rehabilitation – outpatient and day rehabilitation	0.19
22.	Rehabilitation – in-home physiotherapy	0.10
23.	Rehabilitation – treatment of comatose patients	0.16
24.	Dentistry	0.18
25.	Dentistry – prosthodontics and orthodontics	0.25
26.	Nursing and Caregiving Services – long-term care – Residential Medical Care Facility	6.68
27.	Nursing and Caregiving Services – long-term care – home nursing care	7.67
28.	Nursing and Caregiving Services – long-term care – home ventilation support	2.90
29.	Palliative and Hospice Care – hospice care	10.04
30.	Prophylaxis – prophylaxis	1.51
31.	Ambulances and sanitary transport		10.55%
34.	Pilot programs	0.16	14.09%
35.	Mental Health Center pilot program	2.29	18.18%
36.	Separately Contracted Services – other home services	0.13
37.	Sanatorium: hospital	20.21
38.	Sanatorium: health resort	16.25
39.	Outpatient sanatorium	8.70
40.	Other – predominantly Separately Contracted Services	0.21
41.	Dialysis therapy	0.16
42.	Coordinated Pregnancy Care	0.19
43.	Primary Care – lump sums		4.80%
44.	Psychiatry – emergency room		21.19%
45.	Dentistry – lump sums		18.31%
46.	Comprehensive Secondary Outpatient Care		16.50%
47.	Psychiatry adult day care	1.96
48.	Psychiatry forensic: increased security level	5.58
49.	Dentistry special (anesthesia and HIV)	0.54
50.	Mother’s diet	2.75
51.	Hospital Care – pediatrics	0.22
52.	Hospital Care – other than lump sum	0.19

The adoption of this variant will be associated with an increase in the payer’s expenditure by PLN 12,910 million within 12 months from the date of entry into force of the Act on salaries, which means a 15.6% increase in the NHF contract value (excluding the sum of factors referred to in § 16 of the General Terms and Conditions of contracts for the provision of healthcare services, drugs used under drug programs and active substances used in chemotherapy).

In the second variant, it is recommended to establish for each range group a payment unit price value at a level of at least the 6th decile of the payment unit price distribution as the minimum value reflecting the level of provision costs of services with a guaranteed certain degree of quality, taking into account the minimum salary, and then to increase the payment unit price obtained in this manner according to the table below. The ranges in which the payment unit is a lump sum are only subject to increases according to the table below.

Table 2. Increase in the level of healthcare service financing in variant 2.

Group name	Group	6th decile value	Point value increase amount in the range group over the 6th decile in PLN	Lump sum change once all factors have been applied
1	2	3	5	6
Primary Care – fee-for-service (FFS) consultations	1	1.05	0.07
Night and Holiday Healthcare	2	lump sum		23.61%
Secondary Outpatient Care – consultations	3	1.28	0.26
Secondary Outpatient Care – diagnostics Cost-consuming Outpatient Diagnostic Services – imaging	4	1.14	0.20
Secondary Outpatient Care – diagnostics Cost-consuming Outpatient Diagnostic Services – endoscopic imaging	5	1.17	0.25
Hospital Care	6	as per table 3	as per table 3
Hospital Care – procedure ranges – elective hospitalization	7	1.09	0.21
Hospital Care – procedure ranges – one-day treatment	8	1.04	0.17
Hospital Care – procedure ranges – expensive devices	9	1.17	0.11	9.57%
Emergency Department/Emergency Room	12	lump sum		21.29%
Hospital Care – drug administration and diagnostics chemotherapy/drug programs	13	1.14	0.21
Hospital Care – radiotherapy	14	1.12	0.17
Psychiatry – inpatient adult psychiatry	15	15.31	4.29
Psychiatry – inpatient pediatric psychiatry	16	16.36	3.88
Psychiatry – outpatient and community adult psychiatry	17	9.41	2.29
Psychiatry – outpatient and community pediatric psychiatry	18	10.78	2.08	18.77%
Psychiatry – forensic psychiatry	19	17.19	5.14
Rehabilitation – inpatient rehabilitation	20	1.56	0.33
Rehabilitation – outpatient and day rehabilitation	21	1.18	0.25
Rehabilitation – in-home physiotherapy	22	1.06	0.17
Rehabilitation – treatment of comatose patients	23	1.95	0.46
Dentistry	24	1.17	0.26
Dentistry – prosthodontics and orthodontics	25	1.31	0.34
Nursing and Caregiving Services – long-term care – Residential Medical Care Facility	26	35.53	9.16
Nursing and Caregiving Services – long-term care – home nursing care	27	34.99	7.14
Nursing and Caregiving Services – long-term care – home ventilation support	28	32.07	6.34
Palliative and Hospice Care – hospice care	29	63.47	13.49
Prophylaxis – prophylaxis	30	10.34	2.20
Ambulances and sanitary transport	31	lump sum		13.10%
Pilot programs	34	1.02	0.18	15.88%
Mental Health Center pilot program	35	10.41	2.65	20.19%
Separately Contracted Services – other home services	36	1.17	0.24
Sanatorium: hospital	37	157	25.08
Sanatorium: health resort	38	113	18.58
Outpatient sanatorium	39	41	10.39
Other – predominantly Separately Contracted Services	40	1.17	0.28
Dialysis therapy	41	1.13	0.19
Coordinated Pregnancy Care	42	1.2	0.24
Primary Care – lump sums	43	lump sum		6.26%
Psychiatry – emergency room	44	lump sum		23.79%
Dentistry – lump sums	45	lump sum		24.06%
Comprehensive Secondary Outpatient Care	46	lump sum		19.12%
Psychiatry adult day care	47	10.09	2.72
Psychiatry forensic: increased security level	48	22.38	6.94
Dentistry special (anesthesia and HIV)	49	4.73	0.82
Mother’s diet	50	20.53	3.13
Hospital Care – pediatrics	51	as per table 3	as per table 3
Hospital Care – other than lump sum	52	as per table 3	as per table 3

The adoption of the second variant is associated with adopting the final payment unit prices for selected range groups and ranges, with values indicated in the table below.

Table 3. Payment unit price in healthcare service ranges

Range group	Payment unit price
6 – Hospital Care	1.59
51 – Hospital Care – pediatrics	1.59
52 – Hospital Care – other than lump sum, including:
Neonatology	1.59
Comprehensive Oncological Care – comprehensive oncological care	1.59

52 – Hospital Care – other than lump sum, including:
Oncology	1.44
Deliveries	1.44
Transplantations	1.44
Tertiary care	1.44
Epidermolysis bullosa	1.44
Other	1.44

52 – Hospital Care – other than lump sum, including:
Cataract	1.34
Infarctions	1.34
Coordinated Specialist Care–infarction	1.34

The adoption of this variant will be associated with an increase in the payer expenditure by PLN 18,540 million within 12 months from the date of entry into force of the Act on salaries, which means 22.4% of the NHF contract value (excluding the sum of factors referred to in § 16 of the General Terms and Conditions of contracts for the provision of healthcare services, drugs used under drug programs and active substances used in chemotherapy).

At the same time, the following issues must be taken into consideration:

• The new payment unit prices should be a result of the inclusion of correction factor values in the payment unit value, establishing the boundary cut-off point at the level of the 6th decile in the payment unit price distribution, as well as the percentage or amount increase that includes the salary growth for employees of healthcare entities and the inflation rate increase. For range groups where the payment unit is a lump sum, only the percentage increase mechanism was applied.

• Due to the fact that some service providers had high correction factor values relative to the values of contracts concluded with the NHF, whenever the value of these factors exceeded 25% of contract value (excluding drugs under drug programs and active substances in chemotherapy, and the correction factor values), the excess over 25% was not included in the payment unit price increase and should be settled. If this requires changes in the relevant laws, such changes should be implemented.

• Following the implementation of valuation changes, an analysis of the entities’ financial situation, including salary amounts, arrears, current liabilities, financial liquidity, is recommended.

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