Da Vinci surgeries covered by the National Health Fund?

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Da Vinci surgeries covered by the National Health Fund?

Although surgeries performed using medical robots are not formally included in the basket of guaranteed services, some hospitals have found a way to (co-)finance such services using National Health Fund (NFZ) funds. All of this is done legally.

A positive opinion from AOTMiT in 2017

As Rynek Zdrowia points out, as early as 2017, the Agency for Health Technology Assessment and Tariff System (AOTMiT) issued a positive opinion regarding reimbursement for surgeries performed using medical robots for three indications. These indications were colorectal cancer, prostate cancer, and endometrial cancer. As a result, the Ministry of Health prepared a draft regulation to include surgeries for these indications in the basket of guaranteed services. However, the draft was put on hold during the public consultation phase, mainly due to a negative opinion from the national consultant.

Hospitals perform da Vinci surgeries under the National Health Fund

It turns out, however, that despite the lack of a specific regulation, it is possible to have da Vinci robot surgeries covered by the National Health Fund (NFZ). According to a spokesperson for AOTMiT quoted by Rynek Zdrowia, hospitals are not required to report to the NFZ the exact name of the technology or equipment used for the procedure. If the costs of a given procedure fall within the JGP algorithm, it will be reimbursed by the NFZ.

For example, the Wielkopolska Oncology Center reimburses a portion of da Vinci surgeries in this way. The health insurance fund pays for the procedure, but the facility must cover the remainder—at least 50 percent.

It’s also worth noting that the high cost of da Vinci procedures is somewhat of a “vicious cycle.” Experience with this technique and the number of surgeries performed annually could help reduce the cost of these procedures. However, due to the lack of reimbursement, too few procedures are performed for this to be possible.

The grants also fund robotic surgery

Other facilities benefit from various research grants, which also provide funding for da Vinci surgeries. This is the case at the Nicolaus Copernicus Municipal Specialized Hospital in Toruń. The hospital participates in a program run by the National Center for Research and Development focused on the prevention and treatment of lifestyle-related diseases. This allows it to perform bladder cancer surgeries while simultaneously conducting research. However, the program ends on October 31.

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