Wydatki powszechnego ubezpieczenia zdrowotnego w Polsce na refundację leków w latach 2004-2012

Health insurance expenditures on drug refunds in 2004-2012Drug expenditures in each country account for a large share in total health expenditures. Hence experts, media and societies are becoming very interested in the drug policy in their country, where one of the important components is reimbursement/refund policy. Good governance in the drug sector means not only taking up allocation, redistribution and stabilization tasks that belong to the government, but also taking into consideration differences in interests of different stakeholders on the drug market. If it is disregarded, even ideal theoretical solutions will not work in market reality. This article presents and comments basic facts on development of universal health insurance expenditures on drug refund in the last 13 years in Poland, especially in 2012 after implementation of the new bill on refund policy. This law led to a dramatic decrease in drug refund cost share in total expenditures of the National Health Fund (Narodowy Fundusz Zdrowia, NFZ) from 15% in 2011 to 11.2% in 2012. Still the share of drug refund has already had a decreasing tendency in NFZ expenditures starting from 2005. Available data contradict suspicions that savings on drug refunds in NFZ has led to an increase in patients’ health expenditures on prescription drugs. Costs of substitutive full-price drugs (equivalents for refunded ones) bought by Polish patients in 2012 increased only by 650 mln PLN, while NFZ’s refund expenditures decreased by almost 2 billion PLN, and patients’ copayment in the case of refunded drugs dropped by one billion PLN. However, drug consumption was reduced. Conducted analysis also showed a systematic, and positive for patients, growth in the share of almost fully refunded drugs – drugs with low fixed copayments (from 49% in 2004 to almost 65% in 2012) and lower 30% patients’ copayment in NFZ refunds. Which in fact is in contradiction with the common opinion that NFZ is running a policy of shifting more drug costs on patients. What is concerning are regional discrepancies (between regional – voievodship branches) in refund expenditures per insured person (the difference between the highest and lowest is 49 PLN – 28%).