How much does care in palliative care wards cost in Poland?

Abstract

IntroductionThe main task of palliative care units is to provide a dignified life for people with advanced progressive chronic disease through appropriate symptom management, communication between medical specialists and the patient and his family, as well as the coordination of care. Many palliative care units struggle with low incomes from the National Health Fund (NHF), which causes serious economic problems. The aim of the study was to estimate of direct and administrative costs of care and the actual cost per patient per day in selected palliative care units and comparison of the results to the valuation of the NHF.Material and methodsThe study of the costs of hospitalization of 175 patients was conducted prospectively in five palliative care units (PCUs). The costs directly associated with care were recorded on the specially prepared forms in each unit and also personnel and administrative costs provided by the accounting departments.ResultsThe total costs of analyzed units amounted to 209 002 EUR (898 712 PLN), while the payment for palliative care services from the NHF amounted to 126 010 EUR (541 844 PLN), which accounted for only 60% of the costs incurred by the units. The average cost per person per day of hospitalization, calculated according to the actual duration of hospitalization in the unit, was 83 EUR (357 PLN), and the average payment from the NHF was 52.8 EUR (227 PLN). Underpayment per person per day was approximately 29.2 EUR (125 PLN).ConclusionsThe study showed a significant difference between the actual cost of palliative care units and the level of refund from the NHF. Based on the analysis of costs, the application has been submitted to the NHF to change the reimbursement amount of palliative care services in 2013.

An appraisal of the situation of the palliative care in Poland in 2016

“…Sytuacja ta utrzymuje się od lat i wynika ze znacznego niedofinansowania opieki stacjonarnej. Zgodnie z naszymi szacunkami nakłady na stacjonarną opiekę paliatywną powinny zostać podwyższone o ok. 30% [9].…”

The appraisal of the situation of the palliative care in Poland in 2017

“…Choć świadczenia z zakresu opieki paliatywnej i hospicyjnej są świadczeniami gwarantowanymi, to jednak przez wiele lat środki przeznaczane na ich realizacje były niewystarczające. Problem niedostatecznego finan-sowania opieki paliatywnej poruszany był w wielu naszych wcześniejszych publikacjach [2][3][4].…”

“…Nakłady na domową opiekę paliatywną dla dzieci (w zł/mieszkańca) wynoszący ponad 30%, poprawiły sytuację finansową jednostek opieki paliatywnej. Zwiększenie nakładów na opiekę paliatywną o co najmniej 30% było zgodne z naszymi wcześniejszymi wyliczeniami [2,7]. Niepokojący jest jednak brak zastosowania w niektórych województwach zalecanej taryfy oraz ograniczenia w nakładach, które można było zaobserwować w innych województwach, tzn.…”

“…Taki podział środków finansowych należy uznać za słuszny, gdyż zgodnie z naszymi wcześniejszymi wyliczeniami opieka stacjonarna była najbardziej niedofinansowana. Niskie finansowanie było przez wiele lat barierą rozwoju tej formy opieki, gdyż opieka stacjonarna jest najbardziej kosztochłonna [2,3,7].…”

An analysis of the costs of treating aged patients in a large clinical hospital in Poland under the pressure of recent demographic trends

“…Unfortunately, for many years in Poland, financial assets have been assigned to medical services providers merely on the basis of crude and arbitrary estimates of local populations' health needs, not taking into account the specific requirements of many groups of patients, including the elderly [22]. Notoriously, there have been frequent reports of system-based significant underpayments (sometimes as high as 40-46% of the actual costs incurred by the medical service providers) on the part of the main state-run health insurance fund (Narodowy Fundusz Zdrowia -NFZ) in the case of services affecting elderly patients and others, such as palliative care [23,24]; however, specialized units dealing with the specific needs of elderly patients, such as geriatric and palliative care units, tend to be more cost effective than regular hospital wards, which mostly provide acute medical care [25] and are unable to provide all the full-length rehabilitation and prophylactic exercise programs that can be highly beneficial for elderly patients [26]. Introducing exercise programs for chosen groups of hospitalized older patients, especially those who require assistance or supervision on admission, can improve the health outcomes and discharge functional ability while at the same time lowering the total treatment costs by shortening the LOS and limiting complications, although the responses of individual patients may vary considerably on a case-to-case basis [27].…”