Access to innovative therapies in Poland has improved significantly in recent years. The prognosis for patients with serious illnesses has improved, and they live much longer. This is very good news. But it is also information that prompts discussion about the model of care for such patients, who remain in the system and in medicine programmes for many years. What direction should this discussion take?
In Poland innovative medicines are made available to patients in the form of therapeutic programmes. This form of access, designed by the Ministry of Health (MZ), is relatively unknown in Europe and has very strict criteria for including and excluding patients. Most innovative medicines for severe, incurable oncological and neurological diseases or various rare diseases are made available in the form of drug programmes. This allows the Ministry of Health and the National Health Fund (NFZ) to closely monitor who receives treatment, whether the funds, often substantial, are spent effectively, and whether they bring the best possible benefits to patients. This is good. Medicine programmes also guarantee patients very regular examinations and check-ups, which ensures proper monitoring of the efficiency of therapy and allows for the optimal use of financial resources. Over the last few years, the Ministry of Health has been consistently expanding access to innovative therapies, and has made numerous decisions that are beneficial to patients. This has led to a very large increase in the number of people who benefit from medicine programmes. Year on year, it amounts to 15 per cent: in 2024 more than 288,000 patients benefited from them, and it is estimated that this year the number is to exceed 300,000.
What does this mean?
Medicines provided under drug programmes are often made available in hospitals. This places a very heavy burden on these facilities. We are talking about 300,000 people who often have to visit the hospital multiple times. Depending on the drug programme, this can mean anywhere from a few to more than a dozen visits. On average a patient must visit the hospital six times a year. It is also a time and financial burden for the patient, who often has to travel long distances to the hospital. On the one hand, it is good that the patient is treated in referral centres with good specialists. This is important when qualifying for a medicine programme. On the other hand, however, when the patient is stable and has been undergoing treatment for a year, two or three years, it is possible to find a solution that makes their life easier. In many cases, innovative medicines are so low-impact that these people can continue to work, lead a normal family life and function in society. If they have to commute, as is currently the case, this means 6 to 12 days a year taken off work just to continue treatment. In the case of professionally active people, this means that they use more than half of their leave to receive treatment.
What can be done to make life easier for patients on the one hand, and to relieve the burden on the healthcare system on the other?
We observe what is happening around the world and we know what good practices exist in other countries. Based on this experience, together with Polish experts and the SGH think tank, we have developed a model that allows patients to continue their treatment close to their place of residence. We have named this project Flexcare, which means a flexible form of medical care. We do not say that treatment close to the place of residence should be mandatory. It would only be offered to those patients who want it and whose health condition, as assessed by a doctor, allows it, of course with the possibility to return to hospital if the patient requires it. We want to tailor the system to the health needs of every single patient.
What are the conclusions of the Flexcare report? What tools and good examples from abroad can be used?
In most European Union countries, solutions are now in place to make it easier for patients to receive treatment close to the place they live. These range from radical solutions, in which a team of doctors and nurses visits the patient and administers medication at home, to those in which the patient goes to the nearest pharmacy and collects the medication or has it administered intravenously by a pharmacist. There are also intermediate models, in which we retain full control and highly specialised care, but not at the level of a reference centre, only in our case, a district hospital or outpatient specialist care clinic, where there are treatment rooms and medication can be administered safely, in a fully controlled manner and monitored by a physician under the supervision of a reference centre.
The report proposes this model as a first step towards making care more flexible, so that patients can travel to a district hospital to receive their medication. Poland has almost 700 public hospitals, including over 300 district hospitals. This means that patients usually live no more than 20 km from such a hospital. This is much closer than a reference centre.
