Changes in primary care clinics: Introduction of an allowance for chronically ill patients

July 1 this year new regulations regarding the conditions for concluding and implementing contracts for the provision of health care services, such as primary health care (POZ), entered into force. These changes, introduced by order of the president of the National Health Fund (NFZ), are aimed at improving the financing of treatment of chronic diseases within primary health care. One of the main novelties is the quota allowance, which replaced the previous correction factor of 3.2 in field groups.

These changes result from consultations conducted with experts and are aimed at strengthening activities related to the provision of health care services to chronically ill patients. They mainly concern the treatment of diseases such as diabetes, heart disease and lung disease.

The new regulations define domain groups for specific diseases. The "Diabetology" field group includes, among others, various forms of diabetes, while the "Cardiology" field group includes hypertensive disease, ischemic heart disease and other heart diseases. Additionally, the field groups "Endocrinology" and "Pulmonology" include thyroid diseases and chronic diseases of the lower respiratory tract.

According to the ordinance, after each reporting period (every month), primary care physicians will receive an allowance depending on the number of field groups to which the patient belongs.
The amount of the supplement is as follows: – 1 field group: PLN 17,
– 2 field groups: PLN 28.33,
– 3 field groups: PLN 36.83,
– 4 field groups: PLN 42.50.

Due to the introduction of the quota allowance, primary care physicians have a new obligation to provide patients with advice related to their reported chronic diseases at least once every 6 months. It is worth noting that the value of the supplement depends on the number of field groups, and not on the number of disease entities. For example, a patient suffering from diabetes, hypertension and atrial fibrillation may be billed as two field groups, i.e. diabetes and cardiology. However, diabetes, hypertension and chronic obstructive pulmonary disease (COPD) classify the patient into three groups: diabetology, cardiology and pulmonology.

However, it should be remembered that providing a patient with AOS (outpatient specialist care) services due to a given disease from a specific field group results in the suspension of sickness allowance in this group for another year, counted from the date of providing the AOS service. Other allowances are settled according to a specific table.

These changes are aimed at improving the financing and provision of health care services in primary care clinics. The allowance for chronically ill patients is intended to increase the motivation of doctors to provide comprehensive care and regularly monitor the health of patients. Thanks to this, patients with chronic diseases will have easier access to appropriate treatment and will be able to use the full range of medical services within primary care.

The introduction of a quota allowance is an important step in improving the health care system in Poland. However, this requires cooperation and commitment of both doctors and patients. Regular check-ups and advice on chronic conditions will be crucial to the effectiveness of these changes. Thanks to such initiatives, the health care system becomes more accessible, effective and focused on the needs of patients.