Introduction. Until 2011, the costs of drug reimbursement in Poland were constantly on the rise. In 2012, the Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices (“the Act”), came into force. Its aim, among other things, was to limit the amount of prescribed reimbursable drugs. The resulting changes were not only, due to by mechanisms provided in the Act, but also indirectly related to secondary events and circumstances probably not foreseen by the legislators. Aiming at the objectives set in the Act, the National Health Fund (NFZ) has imposed on doctors new contracts, which among other things, defined financial penalties for the prescription of drugs not within administrative limits. Disagreement between the physicians’ and the NFZ has arisen about what should be the priority: medical standards based on scientific evidence and the welfare of the patients, or administrative regulations. Some doctors did not sign the new refund scheme contracts imposing the new rules. To verify whether the legislative changes actually resulted in an overall reduction of availability of reimbursed drugs to patients, it seemed necessary to refer to actual expenditure data of reimbursed drugs. Aim. The aim of this study was to investigate the effect of the Reimbursement Act on the prescription of reimbursed drugs by allergologists, dermatologists-venereologists and psychiatrists. Material and methods. Data between Q12010 - Q1 2014 was analysed regarding the drug reimbursement. Data was obtained from the four departments of the NFZ in Lower Silesia, Lesser Poland, Swietokrzyskie and the West Pomeranian voivodeships. Doctors from three specialities were chosen: allergologists, dermatologists-venereologists and psychiatrists representing For further analysis 10 drugs used: acitretin, house dust and pollen allergy vaccines, cyclosporine, cetirizine, fluticasone, lamotrigine, methoxsalen, risperidone and sertraline. Results. Total reimbursement expenditure in the examined period fell in all provinces and for all of the specialisations. The number of patients to whom reimbursed drugs were prescribed decreased. Patient contribution in the Lesser Poland region has decreased and reimbursement expenditure on drugs has increased: house dust and pollen allergy vaccines, acitretin, fluticasone, risperidone and sertraline. The percentage of patient subsidies for cetirizine and methoxsalen decreased - in overall, the total reimbursement expenditure for the NFZ decreased. Expenses of the patients and the total reimbursement expenditure increased for cyclosporine and lamotrigine. Conclusions. The results show a diverse, sometimes conflicting effect of the reimbursement Act on the prescription and reimbursement of selected groups of drugs. For certain drugs, patients have to pay more while for others they pay less than they did prior to the Reimbursement Act coming into force.
Jun 28, 2017
Jun 14, 2017
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Sobczak,A. Czechowska,D. Dmowski,M.
Dziełak,D. Włodarczyk,J. Karaś,J. Czach,K. Sierakowski,M.