According to the analysis of NFZ data conducted by Jarosław Kozera, an expert in health care management, one of the main assumptions of the reform called hospital network, i.e. increasing access to ambulatory specialist care (AOS), has not been fulfilled. The new system also does not include a procedure whereby more complicated cases were to be delivered to hospitals at a higher level in the network.
Managers in hospital network do not direct services to ambulatory specialist care
The allocation of the total budget to the hospital was supposed to motivate the management to manage the financial resources more effectively. Some of the procedures were to be directed from hospital care to cheaper ambulatory specialist care. However, the National Health Fund data (Q1-Q3 2018 compared to Q1-Q3 2017) show that after the introduction of the network, hospitals provide more minor services (including diagnostics) in the hospitalisation mode. Therefore, it is the opposite of what was assumed in the reform. At the same time, it was observed that in the hospitals belonging to the network certain services (small procedures of the upper part of the reproductive system, removal of the cataract not complicated with the implantation of a lens, medium and endoscopic procedures of the gastrointestinal tract) were performed in the form of inpatient 24-hour treatment. Meanwhile, in hospitals outside the network, the same services were performed mostly in cheaper indirect forms, i.e. daily forms. According to the aforementioned analysis, performing all the services outside the network would allow to perform additional 5 thousand cataracts, 7 thousand colonoscopies and 4 thousand small surgeries of the upper part of the reproductive system within the same funds.
Hospital network did not change the structure of services
Moreover, in the national level hospitals (university hospitals, institutes, departmental hospitals) the share of services classified as specialist, large and complex services decreased from 28.7% to 28.0%. Transfer from another hospital accounted for only 0.6% of all admissions. In Q1-3/2010, in comparison to Q1-3/2010, this percentage was identical. With respect to the levels of hospitals in the network, there were no significant changes in the migration of patients from lower to higher levels.
In general, the data on the structure of the benefits provided do not show any changes during the analysed period. None of the ranges showed a change of more than 1.0%. The biggest change occurred in cardiology, share of which increased from 8.6% to 9.6%.
The study was prepared on the basis of 15.9 million patient records, nearly 178 million procedure records for 2017-2018 and over 10 million records obtained from the “NFZ Contracts” application for 2019-2017. The conclusions of the analysis were presented at the conference “Hospital & Healthcare Management 2019”.