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Poland’s reimbursement system limits choices in ophthalmology
One ophthalmologist says he does not expect significant changes after the country is admitted to the European Union.
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Yearly limits on the number of procedures that can be performed and low government reimbursement rates are causing many ophthalmic practices in Poland to operate in deficits, according to one Polish ophthalmologist.
There are no private insurance groups in Poland, said Marek E. Prost, MD. Most ophthalmic procedures are paid for by the country’s National Health Service. However, the government’s reimbursement rates — $400 to $500 for cataract surgery, for example — are not sufficient for many ophthalmology departments to recover the costs of providing their services, he said.
Dr. Prost is chairman of the eye department at the Polish Air Forces Institute of Aviation Medicine. He is also an ophthalmologist at the Center for Pediatric Ophthalmology in Warsaw, which he noted is a private practice that has no reimbursement arrangements with the National Health Service.
“The main problem is limitations on the number of procedures that can be performed each year. It causes a long waiting time in eye practices,” he said.
Dr. Prost told Ocular Surgery News about the problems caused by these restrictions. If the limit on the number of procedures that can be reimbursed is reached, the National Health Service mandates that necessary surgeries must still be performed. However, the costs of these additional procedures are not always reimbursed, or it may take years of negotiations before a practice is reimbursed for them, he said.
Low reimbursement rates also prevent practices from updating equipment, he said. “The rates of reimbursement are low in Poland and quite often do not cover the costs of procedures. It is causing more and more eye departments to have financial problems,” Dr. Prost said.
In January of this year, Dr. Prost said, the National Health Service began reimbursing for foldable IOLs for cataract surgery. But this still leaves the surgeon with a poor choice, he said.
“The eye surgeon has to decide whether to perform more operations with cheaper IOLs or fewer operations with foldables,” Dr. Prost said. “The total amount of money the surgeon gets in a year is the same regardless of the technique used and the costs of surgery. However, it is now better because you have the choice and you can choose your own policy for your practice.”
He said the prices of foldable IOLs are going down in Poland and are now in the range of US$100 to US$120.
He noted that in private practices, which can charge $600 to $800 for cataract surgery, surgeons usually implant foldable lenses.
Changes expected
Before this year, the National Health Service did not differentiate its reimbursement rates based on where surgery is performed. Cataract surgeries and other ophthalmic surgical procedures are usually performed in hospitals, and patients stay for 3 days, Dr. Prost said.
However, this was set to change as of January of this year, when the National Health Service was to begin reimbursing for only the cost of the procedure itself, not for hospital stays.
“More than 90% of cataract surgeries are now performed in hospitals. It may be that the situation will change in the next year,” he said.
Also in January, reimbursement rates were expected to be differentiated depending on the technology used in a procedure. Dr. Prost said that private practices were already differentiating rates, but in these cases, the procedures are often paid for by individual patients.
European Union admission
Although Poland was to be admitted to the European Union on May 1, 2004, Dr. Prost said he did not expect the admission to significantly affect ophthalmology in his country.
“After admission, it will be more easy for patients to seek advice abroad, as there are usually patients with advanced stages of serious diseases who are looking for second or third opinions. But I think that language problems and higher costs of medical services abroad will decrease this,” he said.
He said the situation should improve for ophthalmology practices that have contracts with the National Health Service because the country should adopt EU standards for medical service. However, this may not greatly affect the situation, Dr. Prost said.
“Maybe there will be more foreign investment in health services in the future. However, it is difficult to say how it will change the situation in our health service,” he said.
For Your Information:
- Marek E. Prost, MD, can be reached at ul Pazinskiego 3d/6, Warsaw 04743, Poland; +48-22-61-33-164; fax: +48-22-81-52-754; e-mail: mprost@wiml.waw.pl.