Though all eyes may be on the looming healthcare reforms in the United States under the new Trump administration, a fairly new government in Poland has quietly been undertaking an upheaval of the healthcare system that American lawmakers could not even imagine. The v Prawo i Sprawiedliwość (PiS; Law and Justice) party came into power in October 2015 with a number of healthcare-related promises, with a populist platform that included specific policies like creating a special reimbursement list of drugs that will be fully reimbursed for seniors over the age of 75. In addition to specific policy measures, the party also promised overarching reform of the healthcare system.
The vision is to take Poland from a so-called “Bismarck” healthcare system – which mandates nearly-universal government-provided healthcare coverage through compulsory employee and employer contributions – to a so-called “Beveridge” system. The Beveridge system, such as the British National Health Service (NHS), is a universal health coverage model that is funded by government revenues.
After the government swiftly introduced the special seniors’ reimbursement list, those who were skeptical about the government’s willingness to undertake such a drastic reform of the Polish healthcare system quickly changed their minds. Indeed, in July 2016, the Polish government announced that the new system would come into effect as of January 2018.
As a result, 2017 will be a year of considerable transition in Poland. Drug and medical device manufacturers will face a unique set of challenges this year as they – and the government itself – navigate changes working towards the new system. The major changes for healthcare will come in five areas: the management and financing of healthcare; the organization of hospital treatment; increased spending on healthcare; primary healthcare; and public health.
Some key changes that will occur include:
- The abolishment of the NFZ
The main part of the healthcare reform is the abolishment of the Narodowy Fundusz Zdrowia (NFZ; National Health Fund), Poland’s public fund responsible for paying for healthcare services and for reimbursement of medicines, which it does via money received from mandatory health insurance contributions. Recent polls suggest a majority of Poles are not happy with how the NFZ is working, so it is likely a winning issue. The fund, which should officially cease to exist on January 1, 2018, will not be replaced, as healthcare will be funded through government revenue. Overall, the remit of the NFZ will be transferred to the state and regional actors will be replaced by provincial health offices subordinate to the Ministry of Health. It is unclear whether this will have a direct impact on patients, but it could certainly affect manufacturers through knock-on effects on drug pricing and reimbursement.
- Public hospital networks
The PiS party has been extremely critical of its predecessor government’s efforts to privatize hospitals, and is set on rolling back measures that saw 16% of Polish hospitals privatized. The major concern is about publicly-funded hospital focusing on making profits. The bill creating network hospitals introduces a new model of contracting and accounting services used in hospitals, in order to ensure the continuity and stability of funding, but also to optimize the number of specialist branches and improve outpatient and inpatient coordination. The law, which will likely come into force in October 2017, will also stop hospital privatization and will stop publicly-funded hospitals from being profit-focused. It will change the relationships manufacturers and distributers have with hospitals directly, as their procurement systems and appetite for discounts will change as well.
- True universal access
Under the current healthcare system, some Polish citizens – such as those on short-term contracts with no health benefits – do not receive health coverage, despite the Polish constitution guaranteeing universal health coverage to all citizens. A transition to an NHS-style system will extend coverage to an estimated additional 2 million people. This will be a huge boon for manufacturers in one sense, but will create a lot of uncertainty as the healthcare budget must so many new patients accessing an already-overburdened system.
Overall, the biggest challenges have proven to be the lack of detail surrounding the major reforms and the funding sources. The changes to the system, and the plans to increase health expenditure by 25% by 2020, will be funded by additional taxes on bank assets, taxes on supermarkets and through savings found in dismantling the NFZ bureaucracy. The 2016 budget did see a 3.8% healthcare spending increase, and the 2017 budget saw a further 4.8% jump, so the government has been making good on its promises so far. However, the future remains opaque, as details on many aspects of such a drastic reform have not been outlined in considerable – or any depth at all. However, despite the challenging times for drug and medical device manufacturers, there are also opportunities to be found as the government focuses on improving healthcare access for Polish citizens.
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This blog is part of a series of posts from DRG’s global market access team examining challenges facing pharmaceutical firms in different countries in 2017. See our other blogs as they are added here (https://decisionresourcesgroup.com/tag/2017challenges/).