INTRODUCTION STRESZCZENIE. Jakub Gierczyƒski, Ma gorzata Ga àzka-sobotka, Miros aw J. Wysocki, Jerzy Gryglewicz

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1 Indictors on ntionl helth fund expenditures... INDICATORS ON NATIONAL HEALTH FUND EXPENDITURES FOR MEDICAL SERVICES IN 2012, IN SELECTED DISEASES, IN TERMS OF THE NATIONAL AND REGIONAL LEVEL, WITH PARTICULAR CONSIDERATION OF THE LODZKIE PROVINCE Wskêniki dotyczàce nk dów Nrodowego Funduszu Zdrowi n Êwidczeni zdrowotne w 2012 roku, w zkresie wybrnych jednostek chorobowych, w uj ciu ogólnopolskim i regionlnym, ze szczególnym uwzgl dnieniem województw ódzkiego Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz STRESZCZENIE W rtykule omówiono nk dy p tnik publicznego Nrodowego Funduszu Zdrowi (NFZ) n Êwidczeni zdrowotne w 2012 roku. Skupiono si n trzech istotnych epidemiologicznie i spo ecznie jednostkch chorobowych: niewydolnoêci sc, cukrzycy i przewlek ej obturcyjnej chorobie p uc (POChP). Nk dy przedstwiono w uj ciu ogólnopolskim i regionlnym, ze szczególnym uwzgl dnieniem województw ódzkiego. Przeprowdzono nliz w zkresie tzw. wskênik wydtków p cpit, który obrzuje iloêç Êrodków przeznczonych przez oddzi wojewódzki NFZ w rmch finnsowni kontrktów w zkresie okreêlonej jednostki chorobowej, n jednego ubezpieczonego w dnym województwie. W wyniku nlizy porównwczej stwidzono, i w województwie ódzkim poziom nk dów NFZ n Êwidczeni zdrowotne orz wskêniki p cpit w zkresie trzech wybrnych jednostek chorobowych osiàgn y poziom powy ej Êredniej krjowej. Szczególnie w przypdku cukrzycy poziom finnsowni publicznego by dl województw ódzkiego njwy szy w Polsce. Autorzy wskzujà oprcownà metodologi, jko jeden z sugownych wskêników do oceny i porównywni poziomu finnsowni Êwidczeƒ zdrowotnych w zkresie jednostek chorobowych pomi dzy województwmi wpolsce. S ow kluczowe: p tnik publiczny, Nrodowy Fundusz Zdrowi (NFZ), Êwidczeni zdrowotne, niewydolnoêç sc, cukrzyc, przewlek obturcyjn chorob p uc, zchorowlnoêç, umilnoêç, leczenie szpitlne, specjlistyczn opiek mbultoryjn, rehbilitcj medyczn, wskênik p cpit, Êwidczeniodwcy Keywords: public py, Ntionl Helth Fund (NHF), helth benefits, crdic insufficiency, dibetes, chronic obstructive pulmonry disese (COPD), morbidity, mortlity, hospitliztion, specilist out-ptient cre, medicl rehbilittion, p cpit indictor, provids INTRODUCTION Around 2 million people in Polnd re ffected by ischemic hert disese, dibetes nd chronic obstructive pulmonry disese. Helth problems relted to these diseses occur in t lest 6 million people, i.e. 16% of the popultion. The epidemiologicl distribution of these diseses in not even. With regrds to the Lodzkie Province its inhbitnts re more likely to be ffected by crdiovsculr diseses nd dibetes thn inhbitnts of ny oth provinces. While mking genl nlysis of public finncing of tretment of these diseses we should nlyse how the Ntionl Helth Fund distributes Journl of Helth Policy, Insurnce nd Mngement Polityk Zdrowotn 7

2 Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz finncil resves in prticulr provinces, wht is the totl incurred cost nd wht is the vlue of the p cpit indictor. Results of the nlysis might be source of informtion for people responsible for distributing finncil resves nd llow for the most optiml lloction of money in ord to stisfy regionl helth needs. Below the is n nlysis of dt received from the Ntionl Helth Fund on the wy of finncing helth svices, on the exmple of crdic insufficiency, dibetes nd chronic obstructive pulmonry disese. The uthors conducted the nlysis on the ntionl nd regionl levels, with prticulr considtion given to the Lodzkie Province. STUDY AIM The im of the study ws to nlyze nd compre public expenditures incurred by the Ntionl Helth Fund in 2012 on helth svices to tret selected diseses, on the ntionl nd regionl levels, with prticulr considtion given to the Lodzkie Province. METHOD AND MATERIAL OF THE STUDY The uthors presented expenditures of public py, i.e. the Ntionl Helth Fund on helth svices incurred in The dt received from the fund 1 we nlysed on the ntionl nd regionl levels, with prticulr considtion given to the Lodzkie Province. The dt gthed by the Ntionl Helth Fund refred to finncing contrcts signed with helth svice provids with respect to hospitliztion, specilist outptient cre nd medicl rehbilittion for three socilly nd epidemiologiclly importnt diseses: crdic insufficiency, dibetes nd chronic obstructive pulmonry disese. For the purpose of the nlysis the uthors used the p cpit indictor, which is identified with the mount of finncil resources llocted to one insured pson in prticulr province nd for one disese by regionl brnch of the Ntionl Helth Fund, within finnced contrcts for helth svices 2. With the ppliction of the indictor it ws possible to compre provinces in tms of finncing the three mentioned diseses. Expenditures incurred by public py the Ntionl Helth Fund on treting crdic insufficiency, nlysed on the ntionl nd regionl levels, with prticulr considtion given to the Lodzkie Province. About 2 million people in Polnd re ffected by ischemic hert disese. This disese, including myocrdil infrction contributed to 45,800 deths in Polnd in 2010 (26% of deths due to crdiovsculr resons) [Wojtynik, Goryƒski, Mosklewicz, 2012]. It should be pointed out tht inhbitnts of the Lodzkie Province re thretened with crdiovsculr diseses more thn ny oth inhbitnts. This obsvtion refs to the whole piod ft the yer According to The Guide to Helth Protection Sttistics of the Lodzkie Province [The Guide to Helth Protection Sttistics of the Lodzkie Province, Regionl Centre of Public Helth in Lodz, 2013] bout 92,000 people suff from ischemic hert disese nd bove 2,500 people die due to this disord evy yer. In 2012 the Ntionl Helth Fund llocted the mount of 672,233,105 PLN to the tretment of crdic insufficiency. The contrcted svices included: hospitliztion, specilist outptient cre nd medicl rehbilittion. The gretest mount of money ws spent on the tretment of crdic insufficiency in the Msovin Province (116,909,015 PLN); the lest money ws spent in the Westn Pomnin Province (20,914,882 PLN). The Lodzkie Province took the sixth position on the list of ll provinces. He, the expenditures we equl to 44,014,409 PLN. The tble nd the chrt below present this fct. 1 Dne Nrodowego Funduszu Zdrowi dotyczàce finnsowni kontrktów zwinych ze Êwidczeniodwcmi w zkresie lecznictw szpitlnego, mbultoryjnej opieki specjlistycznej i rehbilitcji leczniczej dl niewydolnoêci sc, cukrzycy i przewlek ej obturcyjnej choroby p uc (POChP) z 2012 rok, NHF, zrski Univsity, Wrsw XV/V

3 Indictors on ntionl helth fund expenditures... Tble 1. Totl cost of the tretment of crdic insufficiency incurred by the Ntionl Helth Fund in 2012 (vlue in PLN) Source. The uthors own study on the bse of dt received from the Ntionl Helth Fund M s ov i G Si re le t si Po Le ss l nd Po l nd Lu bl in Lo Lo dz w kie Su Sil Ku bc esi y r vi p Po thi m Po ni Sw m ie to ni kr zy sk ie O po W Pod le r l m sk i -M ie W es t P su om ri n i Lu bu sz Chrt 1. Totl cost of the tretment of crdic insufficiency in prticulr provinces in 2012 (vlue in PLN) Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund Journl of Helth Policy, Insurnce nd Mngement Polityk Zdrowotn 9

4 Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz The highest p cpit indictor (which is identified with the mount of finncil resources llocted to one insured pson in prticulr province nd for one disese by regionl brnch of the Ntionl Helth Fund, within finnced contrcts for helth svices) for 2012 ws obsved in the Opole Province (24.24 PLN), whes the lowest indictor ws in the Westn Pomnin Province (12.06 PLN). In the Lodzkie Province the indictor ws PLN, which put the province on the seventh position in Polnd. The vlue of the p cpit indictor for Polnd ws PLN. The tble nd the chrt below illustrte this obsvtion. Tble 2. Cost of the tretment of crdic insufficiency incurred by the Ntionl Helth Fund in 2012, in totl nd p cpit, by province (vlue in PLN) Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund nd the Centrl Sttisticl Office 3 Popultion. Size nd structure in tritoril cross-section. Size on 30 June 2013, Centrl Sttisticl Office, 2013, XV/V

5 Indictors on ntionl helth fund expenditures... Chrt 2. Cost of the tretment of crdic insufficiency incurred by the Ntionl Helth Fund in 2012, p cpit, by province (vlue in PLN) Opole Swietokrzyskie Msovi Lublin Podlskie Silesi Subcrpthi Lodzkie POLAND Lubusz Kuyvi-Pomni Wrmi-Msuri Low Silesi Gret Polnd Less Polnd Pomni West Pomni Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund nd the Centrl Sttisticl Office Expenditures incurred by public py the Ntionl Helth Fund on treting dibetes, nlysed on the ntionl nd regionl levels, with prticulr considtion given to the Lodzkie Province. More thn 2 million people in Polnd suff from dibetes. Mortlity due to type 2 dibetes ws 15 p 100,000 nd of tht numb 4,000 people died due to dibetes complictions. The highest morbidity ws obsved in the Lodzkie region (5.55%) [Niebiesk Ksi g Cukrzycy, 2013]. According to The Guide to Helth Protection Sttistics of the Lodzkie Province bove 101,000 people suff from dibetes [The Guide to Helth Protection Sttistics of the Lodz Province, 2013]. In 2012 the Ntionl Helth Fund incurred expenditures on treting dibetes for sum of 338,148,698 PLN. The gretest mount of money ws spent in the Msovin Province (48,707,346 PLN) nd the lest money in the Opole Province (7,635,322 PLN). The Lodzkie Province took the third position in Polnd (28,314,606 PLN). Tble 3 nd Chrt 3 illustrte this fct. Tble 3. Totl cost of the tretment of dibetes incurred by the Ntionl Helth Fund in 2012, by province (vlue in PLN) Journl of Helth Policy, Insurnce nd Mngement Polityk Zdrowotn 11

6 Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund Chrt 3. Totl cost of the tretment of dibetes incurred by the Ntionl Helth Fund in 2012, by province (vlue in PLN) Msovi Silesi Lodzkie Less Polnd Gret Polnd Low Silesi Lublin Subcrpthi Pomni West Kuyvi-Pomni Podlskie Swietokrzyskie Wrmi-Msuri Lubusz Opole Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund The highest p cpit indictor ws noted in the Lodzkie Province (11.25 PLN) nd the lowest in the Wrmin-Msurin Province (6.77 PLN). The p cpit indictor for Polnd ws 8.78 PLN. Tble 4 nd Chrt 4 below show this obsvtion XV/V

7 Indictors on ntionl helth fund expenditures... Tble 4. Cost of the tretment of dibetes incurred by the Ntionl Helth Fund in 2012, in totl nd p cpit, by province (vlue in PLN) Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund 4 Wojewódzkie Centrum Zdrowi Publicznego w odzi, Informtor Sttystyczny Ochrony Zdrowi Województw ódzkiego, Lodz 2013, Journl of Helth Policy, Insurnce nd Mngement Polityk Zdrowotn 13

8 Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz Chrt 4. Cost of the tretment of dibetes incurred by the Ntionl Helth Fund in 2012, p cpit, by province (vlue in PLN) Lodzkie Podlskie Silesi Lubusz West Pomni Msovi Swietokrzyskie Lublin POLAND Subcrpthi Less Polnd Gret Polnd Low Silesi Opole Kuyvi-Pomni Pomni Wrmi-Msuri Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund nd the Centrl Sttisticl Office Expenditures incurred by public py the Ntionl Helth Fund on treting chronic obstructive pulmonry disese, nlysed on the ntionl nd regionl levels, with prticulr considtion given to the Lodzkie Province. About 2 million people re ffected by chronic obstructive pulmonry disese. In 2010 respirtory diseses contributed to 19,333 deths. Of tht numb chronic obstructive pulmonry disese cused 7,161 deths [Wojtynik, Goryƒski, Mosklewicz, 2013]. According to The Guide to Helth Protection Sttistics of the Lodzkie Province bove 32,000 people in Lodzkie suff from chronic obstructive pulmonry disese [The Guide to Helth Protection Sttistics of the Lodzkie Province, 2013]. In 2012 the Ntionl Helth Fund incurred expenditures on treting chronic obstructive pulmonry disese for sum of 164,421,665 PLN. The gretest mount of money ws spent in the Msovin Province (25,217,875 PLN) nd the lest money in the Lubusz Province (4,489,565 PLN). The Lodzkie Province took the third position in Polnd (11,336,123 PLN). Tble 5 nd Chrt 5 illustrte this fct. Tble 5. Totl cost of the tretment of chronic obstructive pulmonry disese incurred by the Ntionl Helth Fund in 2012, by province (vlue in PLN) XV/V

9 Indictors on ntionl helth fund expenditures... Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund Chrt 5. Totl cost of the tretment of chronic obstructive pulmonry disese incurred by the Ntionl Helth Fund in 2012, by province (vlue in PLN) Msovi Gret Polnd Silesi Less Polnd Lublin Lodzkie Low Silesi Kuyvi-Pomni Subcrpthi Pomni Swietokrzyskie Podlskie Wrmi-Msuri West Pomni Opole Lubusz Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund The highest p cpit indictor with regrds to expenditures incurred on the tretment of chronic obstructive pulmonry disese ws noted in the Podlsie Province (6.06 PLN) nd the lowest in the West Pomnin Province (2.91 PLN). The p cpit indictor for the Lodzkie Province ws 4.50 PLN nd put the province on the eighth position in Polnd. The p cpit indictor for Polnd ws 8.78 PLN. Tble 6 nd Chrt 6 below show this obsvtion. Journl of Helth Policy, Insurnce nd Mngement Polityk Zdrowotn 15

10 Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz Tble 6. Cost of the tretment of chronic obstructive pulmonry disese incurred by the Ntionl Helth Fund in 2012, in totl nd p cpit, by province (vlue in PLN) Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund nd the Centrl Sttisticl Office Po dl s Sw ki ie e to kr zy sk ie Lu bl in O po le M W s r ov m i i M G re s t uri Po l nd Lo dz ki e Lu bu sz P Le OL AN ss Ku D y Po vi Po ln d m Su ni bc r p Lo t hi w Si le si Si le si Po m W es n tp om i n i Chrt 6. Cost of the tretment of chronic obstructive pulmonry disese incurred by the Ntionl Helth Fund in 2012, p cpit, by province (vlue in PLN) Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund nd the Centrl Sttisticl Office 5 Wojewódzkie Centrum Zdrowi Publicznego w odzi, Informtor Sttystyczny Ochrony Zdrowi Województw ódzkiego, Lodz 2013, XV/V

11 Indictors on ntionl helth fund expenditures... SUMMARY AND CONCLUSIONS The uthors of the nlysis identified nd compred public expenditures incurred by the Ntionl Helth Fund on the tretment of crdic insufficiency, dibetes nd chronic obstructive pulmonry disese on the ntionl nd regionl levels in They lso conducted n nlysis of the so clled p cpit indictor, which is identified with the mount of finncil resources llocted to one insured pson in prticulr province nd for one disese by regionl brnch of the Ntionl Helth Fund. While prepring the rnking presenting costs of treting three selected diseses the uthors clculted the totl costs nd the p cpit indictor. With regrds to expenditures incurred on the tretment of crdic insufficiency the Lodzkie Province took the sixth nd eighth positions. As for dibetes, the position ws the first nd third nd with regrds to chronic obstructive pulmonry disese it ws the sixth nd eighth. The tble below presents these obsvtions. Considing the epidemiologicl sitution for dibetes it cn be concluded tht the region ws grnted sufficient mount of finncil resources. With regrds to expenditures incurred on the tretment of crdic insufficiency the Lodzkie Province is not sufficiently finnced lthough the region took the middle position in the rnking. A similr obsvtion ws mde for chronic obstructive pulmonry disese. Tble 7. Position of the Lodzkie Province in the rnking of expenditures incurred in totl nd p cpit, on the tretment of crdic insufficiency, dibetes nd chronic obstructive pulmonry disese in 2012 Source: The uthors own study on the bse of dt received from the Ntionl Helth Fund nd the Centrl Sttisticl Office Journl of Helth Policy, Insurnce nd Mngement Polityk Zdrowotn 17

12 Jkub Giczyƒski, M gorzt G àzk-sobotk, Miros w J. Wysocki, Jzy Gryglewicz LITERATURE 1. Wojtynik B., Goryƒski P. i Mosklewicz B., Sytucj zdrowotn ludnoêci polski i jej uwrunkowni, Nrodowy Instytut Zdrowi Publicznego-Pƒstwowy Zk d Higieny, Wrsw Dne Nrodowego Funduszu Zdrowi dotyczàce finnsowni kontrktów zwinych ze Êwidczeniodwcmi w zkresie lecznictw szpitlnego, mbultoryjnej opieki specjlistycznej i rehbilitcji leczniczej dl niewydolnoêci sc, cukrzycy i przewlek ej obturcyjnej choroby p uc (POChP) z 2012 rok, Centrl NFZ, zrski Univsity, Wrsw Informtor Sttystyczny Ochrony Zdrowi Województw ódzkiego, Wojewódzkie Centrum Zdrowi Publicznego w odzi, Lodz LudnoÊç. Stn i struktur w przekroju tytorilnym. Accessed on 30 VI 2013 r., GUS, Niebiesk Ksi g Cukrzycy, Wrsw, 21 Novemb XV/V