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The hospital network, which came into force in 2017, eliminated a significant part of private providers from the pool of entities offering services under contracts with the National Health Fund (NFZ). Now, the Health Ministry wants to introduce legal changes that will make contracting of services by the NFZ almost entirely dependent on having a positive opinion on the advisability of investment (OCI). This may practically close the way to investing in new non-public hospitals.
No OCI, no chances for the NFZ contract
The planned changes are contained in the draft act amending the act on healthcare services financed from public funds and the act on medical activity. As the Chancellery of the Prime Minister states in its justification, at present the spectrum of medical entities covered by the need to have an assessment of the advisability of investments is too narrow. Dependence of obtaining a contract with the NFZ on having a positive OCI is, in accordance with the assumptions, to result in public support only for those projects that meet the existing and projected health needs in a given area.
According to the current solutions, the opinion within the Instrument for the Assessment of Investment Applications in the Health Sector must be obtained only by an entity applying for investment financing from public or EU funds. The lack of such an opinion, for example in the case of private hospitals, means fewer contracting points, but does not close the way to concluding a contract with the NFZ. If the planned solutions come into force, the entity without OCI must take into account the fact that it will not have a chance to receive a contract with the NFZ.
OCI required for investments from PLN 2m
Another important aspect of the planned changes is the introduction of investment value thresholds for which it will be necessary to obtain OCI. Currently, there are too many applications for OCI for low cost estimate. Therefore, it is planned to introduce a threshold of PLN 2m. Such investments will have to obtain the consent of the voivode or the minister of health.
However, in the case of investments exceeding PLN 50m (which is not a high threshold when looking at hospitals’ investment plans), the consent will have to be given by the newly established Investment Application Assessment Committee (KOWI). It will be composed of representatives of the Chancellery of the Prime Minister, the President of the NFZ and ministers of health, regional development and finance. The need to create such a body is justified by the difficulty of assessing the submitted applications, which results from their complexity and diverse specificity.
Private hospitals will not feel any change?
As stated in the explanatory memorandum to the bill, the aim of the planned solutions is to eliminate oversupply of medical services. This is to avoid “chaotic and short-sighted development of the medical services market”. On the one hand, such changes are therefore positive, as obtaining a positive assessment from the Commission will practically guarantee obtaining a contract with the NFZ. On the other hand, however, this is another regulation, after the network of hospitals, which aims to limit new investments in the hospital segment.
According to Dr Jerzy Gryglewicz from the Lazarski University, quoted by Rynek Zdrowia, the changes will affect primarily non-public hospitals run by local government units (JST). In his opinion, such hospitals are often established to meet the ambitions of local government officials, but the number of beds is too large. Thus, cities with several thousand inhabitants have huge hospitals and often hospitalise healthy people in order to perform their contracts with the NFZ.
In the case of private operators, the situation should not change significantly. In view of the existence of a hospital network, there are no competitions and contracts are already annexed. There are several dozen private hospitals operating in the hospital network, the rest must compete in competitions or focus their activities on commercial patients.