There is only one key theme describing market access for medical technologies in Poland:
- Reimbursement: payment via the DRG-adjusted budget and fee-for-service (add-on reimbursement, unbundled payment categories) mechanisms
There is no separate funding (approval by the payer) aspect, as the coverage decision is made in parallel with the creation of the procedure code. Furthermore, there are no stand-alone health technology assessment activities in Poland, as HTA is an integral part of reimbursement decision-making.
Poland has one of the most complicated reimbursement systems in Europe. Various payment mechanisms are implemented.
Hospitals that are part of the National Hospital Network (63% of all Polish hospitals in 2022) are reimbursed via the following payment mechanisms:
- A budget adjusted for activity based on DRGs is used to finance the majority of (routine) hospital services
- Certain services are financed separately, outside of the budget, using the DRG case-by-case payment or fee-for-service (add-on reimbursement) mechanism
In addition, certain highly specialized services/devices are paid for directly by the Ministry of Health (unbundled payment categories).
Hospitals that are not part of the National Hospital Network participate in tenders for contracts with the National Health Fund and are typically paid via DRG on a case-by-case basis.
Poland uses the Polish DRG system, which was historically adopted from the English HRG system. DRGs are determined by the combination of a procedure code (ICD-9-PL) and a diagnosis code (ICD-10-PL). The procedure coding nomenclature and the DRG system are released by the National Health Fund, although the DRG system is maintained by the Agency for Health Technology Assessment and Tariff System (AOTMiT).
Specifics for IVD tests
There is no specific reimbursement framework for in-vitro diagnostic tests. Most IVD tests are funded using a global budget principle as part of the funding of the labs.
A limited number of expensive IVD tests are reimbursed on a fee-for-service basis using add-on payment categories in the DRG system.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, and policy considerations)
MTRC has experience with more than 43 projects in Poland
Get in touch
Contact us to discuss your needs and learn about our services