In the last 10 years, expenses on cancer treatment in Poland have tripled, but at the same time the queues to cancer clinics have lengthened. Perhaps the cause of problems with access to treatment is not the lack of funds, but the poor organization of the he alth care system … The situation is aggravated by the rapid increase in cancer incidence. What are our chances as patients in the face of cancer and what can improve them?
Cancer treatmentis not always about choosing the best method for the patient. Whatcancer treatmentwill be administered is determined by the procedures established by officials. Meanwhile, everyone who falls ill with a malignant neoplasm wants to be treated quickly, effectively and in a way that as little as possible disturbs his / her life. Unfortunately, patients' expectations do not match those of medical centers. The hospital is not accountable for the effects of therapy or the degree of patient satisfaction. The financial result of the facility is important. And even if the hospital director had a dovish heart, he must count money first. The hospital must work according to the rules devised by NFZ officials.
Cancer treatment: official absurdities
Following these procedures significantly extends the access time to diagnosis and treatment. And in the case of cancer, lengthening the time between suspicion of cancer, diagnosis, and start of treatment works to your disadvantage. This is because cancer is a disease in which the body's cells quickly become killer and destroy the host. The cancer becomes bigger and more aggressive.
The treatment that is convenient for the patient in no way matches the billing system that is in force in Poland. If a patient who is in hospital or comes to the outpatient clinic, during one visit, several necessary tests or treatments (medical procedures) are performed, the fund will pay for only one of them. In fact, it is a hidden form of limiting access to medical services and the reason for the formation of ever longer queues. Each visit of a patient in a hospital or clinic is settled by the National He alth Fund as a separate entity.
The procedure related to the treatment process cannot also be accounted for more often than every 2 weeks. Nonsense! If the treatment cycle requires the administration of 6 chemotherapy, the hospital should be charged for the entire treatment cycle, because one administration of chemotherapy does nothing. Inin practice, the National He alth Fund will pay for the third or fourth application, and not for the previous and next ones.
ImportantWhere cancer hits most
In men, these are the lungs, accounting for about 1/5 of cancer incidence. In second place is prostate cancer (13%), followed by colorectal cancer (12%) and bladder cancer (7%). The top ten also includes cancers of the stomach, kidneys, larynx, leukemias and lymphomas.
In women, breast cancer predominates (1/5 incidence of cancer), followed by colorectal cancer (10%) and lung cancer (9 percent). Next are cancers of the uterine body (7%), ovary (5%), cervix, kidney, stomach and thyroid.
Most cases (70% in men and 60% in women) occur after the age of 60. Cancer risk increases with age, peaking in the eighth decade of life.
(data from the National Cancer Registry)
Hospital treatment, although the most expensive, pays off for someone
The current billing system favors cancer treatment in hospital, even though it is much more expensive than outpatient treatment and there is not always a need for hospitalization. And because many medical procedures are too low-priced, hospitals are looking for ways not to lose money in treating patients. When the patient is lying down, the hospital earns money. Therefore, the percentage of unnecessary hospitalizations in Poland may reach even 25%.
It is not about removing all oncological beds, because there are patients who need them. However, many can be treated well on an outpatient basis. Poland is currently in a situation in which other European countries were many years ago, when hospitals not only treated the sick, but also performed various care functions. However, in developed countries it was recognized that it is possible to organize cheaper and equally good medical care on an outpatient basis. create day care units, pay by the National He alth Fund for the stay of patients in cheaper guesthouses than hospitals, reimburse travel costs for treatment.
Difficult access to diagnostic tests
In our country, there is talk of the need for early diagnostics, but it practically does not exist, because you have to wait months for an appointment with doctors of various speci alties. Primary care physicians should be able to issue referrals for preventive examinations for cancer diagnosis.
They are put into the role of a whipping boy, accusing them of lack of oncological vigilance. However, it is forgotten that their powers are very muchlimited. They cannot refer you for a PSA or mammogram. If several million men would like to go for a referral to a urologist, some people will not have enough life to wait for a visit.
Women are encouraged to undergo screening tests, invitations are sent home. However, when something is "wrong", they have to wait many weeks for further diagnostics.
The Polish Cancer Patient Coalition has calculated that in many cases it takes about six months for a patient suspected of cancer to be hospitalized. In some provinces it takes even longer. This is because in Poland there is no so-called the path that a person suspected of having cancer must walk within a given time frame. This problem has long been solved in the world.
Recommendations have been developed which stipulate that both for the diagnosis and the initiation of treatment a deadline should be specified. Individual activities may not last "longer than". Within this framework, 90 percent must fit. sick.
Too sparse branch network
According to experts, the number of centers dealing with the treatment of neoplastic diseases is insufficient (32 in Poland), which translates into the quality of services, long queues waiting for treatment to start, delayed diagnostics.
Currently, it happens that a visit to the doctor's office lasts 20 minutes, and it takes a few hours to get there. The largest number of establishments (8) is in Mazowieckie voivodship, 5 in Pomorskie, Łódzkie and Śląskie voivodships 3 each, Lubelskie, Podkarpackie and Małopolskie 2 each. In the others, there is only one oncology center.
(data from the Polish Union of Oncology)
Scientists convince, but officials know theirs
We introduce modern therapies much later than in other European countries. Research on cancer drugs is ongoing. Not only are new drugs appearing, but also new uses for known drugs are found. A good example is herceptin, which until recently was used only in the case of breast cancer, and today it can also be administered to patients with gastric cancer.
New therapeutic indications are introduced reluctantly and with a long delay. The NHF accounts for activities, not the effectiveness of treatment. It's not about someone getting better, it's about cutting back on expenses. But there is also another problem. The insistence of the National He alth Fund on the old records of therapeutic programs puts doctors at a moral crossroads. They know that they should treat the sick person differently, but they cannot because the hospital will not be paid for it. The stubbornness of the officials is admirable here, but it is a pity that it works against sick people. The argument of knowledge and progress in medicine at the National He alth Fund is notworks.
There will be more sick people
The World He alth Organization warns that in 2025 the number of cancer cases will increase from 14 million to 19 million annually, in 2030 - to 22 million, and in 2035 - up to 24 million. Forecasts contained in the World Cancer Report 2014 of the International Agency for Research on Cancer (IARC) indicate that one of the causes of the soaring incidence is the aging of populations. The following are smoking, excessive sugar consumption and obesity. But obesity will cause cancer more than smoking in a few years' time.
Lepsi lose in the race for a treatment contract
The he alth care market is home to state and private hospitals, including oncology hospitals. According to the law, all economic entities have equal access to public money intended for the treatment of he alth-paying citizens. There are many private entities on the market that obtain contracts with the National He alth Fund. There is no reason why oncology should be an exception. Especially when local governments have problems building new centers. Therefore, if someone decides to put their own resources for this purpose, they should have equal rights. But it doesn't work that way. Private institutions today have problems with survival, because the system of allocating funds is unfavorable for them, despite the fact that they provide services at a high level. Unfortunately, the payer, when awarding contracts, does not take into account the benefits to patients and the results of treatment.
Oncological care in Poland is dispersed and on a very different level.
There are oncological behemoths where the patient and his problems are only a fragment of the statistics hospital. There are small, private clinics that provide comprehensive services. The academic clinics that not only treat the sick, but also train medical staff are also failing.
Prevention and a look into the future
The fight against cancer goes far beyond the scope of oncology itself. Oncology is only a part of medicine. In order to win against cancer, it is necessary to involve agendas that influence education and employment. We still hear about the harmful effects of smoking, but Poland is one of the largest cigarette producers, and Polish farmers, like farmers across the EU, receive subsidies to grow tobacco. There is talk of a he althy lifestyle, and unfounded exemptions from gymnastics lessons are tolerated. Eating he althy foods is encouraged, but there is no fiscal policy that is favorable to producers. If economic interests are in conflict with the promotion of a he althy lifestyle and with anti-cancer prophylaxis, then nothing will improve. And even worse, because the number of cases of malignant neoplasms continuesgrows. Last year, there were 160 thousand. new cases. The most common ones were lung cancer (24,000) and breast cancer (18,000). Forecasts show that in the coming years, doctors will have to deal with the growing number of patients with breast cancer, colorectal cancer and prostate cancer, because the number of patients in these cancers is rapidly increasing. Treatment options are constantly increasing. Will the current system stand it? Certainly not. Polish oncology lacks long-term actions, and cancer is a chronic disease, because even in extreme situations, treatment takes many months.
ImportantNot only genes
Genes are only responsible for 10 percent. cases of illness. Genetic disorders cause cancer, but they can be caused by environmental factors, lifestyle factors, especially smoking, alcohol abuse and overeating. Meanwhile, greater consumption of fruit and vegetables, greater physical activity reduces the risk of cancer by as much as 1/3. The protective effect is also reducing the number of infections (mainly due to the popularization of vaccinations), weight control, moderate sunbathing and eliminating air pollution.
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