Cancer care in Poland: Activity and spending analysis as a forerunner to oncology reform

• Cancer spending in Poland represents 6% of total healthcare spending.
• In cancer care only 8% of spending is on ambulatory care.
• In cancer care only 39% of admissions are day cases.
• Excessive inpatient hospitalisation in accounts for 23% of total cancer spending.

AimsTo analyse the current expenditure on cancer services in Poland and the pattern of spending and to estimate the number of patients with cancer who use public healthcare services.Materials and methodsWe analysed all healthcare services funded by National Health Fund (NHF) in Poland, collected in central database, together with each individual social security number (PESEL). From the database we selected all healthcare services whose primary diagnosis for a given service indicated cancer i.e. it was contained within C00-D09, D37-48 or Z51 (with a corresponding C or D) of ICD-10 classification. For comparison of hospital inpatient activity we analysed aggregate data from England (NHS Hospital Episode Statistics) and Australia (AIHW).ResultsCancer spending in Poland was PLN 6.3 billion in 2011 and PLN 6.6 billion in 2012, accounting for 6% of total healthcare spending and 10.4% of NHF operating budget. Within the current system only 8% of spending is on ambulatory care and only 39% of admissions are day cases. Excessive inpatient hospitalisation in chemotherapy, radiotherapy and for diagnosis accounts for PLN 1.4 billion or 23% of total cancer spending. Poland has more inpatient bed days (5.3 million vs. 3.2 million for England), even though it has half the reported cancer incidence.ConclusionsHealth providers’ behaviour is economically rational and driven by the current modalities of healthcare service financing in Poland. It will be shown that the share of healthcare spending for cancer care is about the same as in other countries however the structure of spending is different. At the same time it is a huge window of opportunity to restructure the financing mechanism for oncology in Poland. At the end of article we present how the planned reform of oncological care in Poland will change the economical incentives for providers and the expected results of it.