Komentarz w sprawie sposobu kontraktowania w Polsce świadczeń zdrowotnych w dziedzinie anestezjologii i intensywnej terapii przez Narodowy Fundusz Zdrowia w 2006 roku

*Krzysztof Kusza

Summary
Medical services provided by intensive therapy units (ITU) in Poland are cost accounted by the National Health Fund on the basis of modyfied TISS- 28 scale. In its original form the scale allows for fairly credible assesment of ITU services provided for the patients treated in these units in compliance with specified criteria. Unfortunately, the scale was a subject to every year, unilateral Fund´s modifications and exclusions which have distanced its contents from the original version. This year, some more changes of selected medical procedures have been carried out.
In this process the number of scale positions, certain standard procedures, were found insignificant and unnecessary for ITU patients. This sociotechnical practice certainly results in significant underestimating of ITU´s costs and threatens succesful realization of the therapeutic procedures. There is a real risk that ITU medical interventions will be provided only when the patient´s condition deteriorates. Moreover, the changes in the current system of ITU cost accounting may result in incapacitating provision of refundable medical services in a majority of intensive therapy units in Poland.
Because of this reasons it seems to be obligatory for the President of the National Health Fund to give a statement on the issues concerning the range of medical services and the metods to improve the way of contracting intensive therapy procedures.

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