Devastating report on Polish National Health Fund
The Polish National Health Fund has been facing criticism on various fronts.
Following a nationwide audit of Poland’s National Health Fund (NFZ) branches, the Polish Supreme Audit Office (NIK) issued a devastating report on March 19, pointing out the lack of effectiveness, due diligence and transparency in contracting healthcare providers by NFZ.
“Contracts with the NFZ are being signed at the last minute, based on unclear and opaque rules, and with mistakes,” the report stated. “Members of the verification committees are forced to verify hundreds of proposals and conduct site visits to hundreds of providers in very short periods of time.
“In extreme cases, one committee member had more than 100 proposals (tens of pages each) assigned to him. In the Malopolskie region, the committee was forced to conduct more than five thousand negotiations over a period of two to three weeks, frequently during night hours.”
The audits were carried out in six NFZ branches, at its headquarters, at the Health Ministry and in several tens of clinics scattered around Poland.
One major issue that NIK detected, and deemed a result of work overload, were mistakes in assessing the capability of a participant to fulfill tender requirements.
One such serious mistake was committed by the NFZ branch in Lodz, which erroneously awarded a contract for hospital treatment to an outpatient clinic. Likewise, two separate offers submitted for the same tender indicated that the participants were using the same equipment (with the same serial numbers) or that the two participants were employing the same doctors, both full-time. These mistakes should have been caught by the committee members, but were not.
NIK also criticized the way NFZ conducted negotiations with service providers. NIK deemed unjust the fact that the vast majority of the negotiations involved NFZ imposing terms and conditions, and the provider simply accepting them for fear that NFZ would not grant them any contract at all.
Last but not least, negotiations were conducted too hastily. An extreme case being the Malopolskie branch committee that was forced to conduct more than five thousand negotiation talks over a period of two to three weeks, frequently continuing late into the night.
NIK also highlighted situations that suggested a high risk of corruption, for instance instances where committees negotiated the price of an offer down before granting the contract to a participant, only to then suddenly renegotiate the terms by either increasing the price, lowering the requirements or changing the terms altogether in an annexed agreement.
The NIK report came very shortly after the Polish competition regulator, the UOKiK, imposed a PLN 361,000 fine on NFZ in January 2014 for excluding small and new market players from its ultrasonography and tomography scan tenders. UOKiK criticized one of the requirements, which demanded that participants provide evidence of conducting a minimum of 5 thousand ultrasonography and 2.5 thousand tomography scans. The fine is open to appeal.
