Table of Contents

5  EXECUTIVE SUMMARY
5  Healthcare expenditure
5  Healthcare system issues
5  Pricing
6  Reimbursement
8  HEALTHCARE EXPENDITURE
8  Poland’s healthcare expenditure is substantially below that of developed markets, but above
the BRIC average
9  The government accounts for more than two thirds of total healthcare expenditure
14 Bibliography
15 HEALTH INSURANCE SYSTEM
15 The Polish healthcare system has undergone a series of reorganizations that have led to
increased decentralization
17 Public health insurance provides coverage to 98% of the Polish people
20 Private health insurance coverage is minimal in Poland
21 Primary care physicians act as gatekeepers and referrals are mandatory for patients to access
specialists as well as hospital care
25 Bibliography
27 PRICING AND REIMBURSEMENT OVERVIEW
27 Pricing and reimbursement tools
29 Key bodies influencing pricing and reimbursement
29 The pricing and reimbursement processes are connected in Poland and are overseen by the
same bodies
32 Bibliography
35 PRICING IN POLAND
35 Pharmaceutical pricing in Poland uses external reference pricing as a guide; however, the final
price is decided based on negotiations
36 Wholesaler and retailer margins for reimbursed medicines are set by law
37 Bibliography
39 REIMBURSEMENT IN POLAND
39 Reimbursement process involves reference pricing and pharmacoeconomic assessments
39 Introduction of new Reimbursement Act in 2012 has shrunk NFZ spending on reimbursed
drugs
44 Patient co-payment levels for prescription medicines vary depending on the type of medicine
46 The JPG system is used for the reimbursement of hospital services in Poland
49 Drug programs enable access to high-cost therapies
50 Poland is a highly genericized market
52 Bibliography

LIST OF FIGURES

8 Figure 1: GDP per capita vs total expenditure on healthcare (as percentage of GDP), 2006–11
9 Figure 2: Sources of healthcare expenditure in Poland compared with other analyzed markets,
2011
15 Figure 3: Overview of the Polish healthcare system
18 Figure 4: Funding of healthcare services in Poland
22 Figure 5: Number of hospitals in Poland, 2004–09
22 Figure 6: Hospitals by type and number of beds, 2011
23 Figure 7: Provision of healthcare services – flowchart
29 Figure 8: Key bodies influencing the pricing and reimbursement of drugs in Poland
30 Figure 9: Pricing and reimbursement process for drugs in Poland
40 Figure 10: The new Reimbursement Act – measures and impact, 2012
41 Figure 11: NFZ spending and patient co-payments for reimbursed pharmaceuticals in Poland,
2010–12
42 Figure 12: Payback decision process
45 Figure 13: Pharmaceutical spend by type in Poland, 2006–12
47 Figure 14: Calculation of hospital payments using JPGs in Poland
48 Figure 15: Hospital market sales in Poland, 2007–12
49 Figure 16: NFZ spending on drug programs and chemotherapy, 2008–12
51 Figure 17: Market share trends for generics usage in Poland, 2008 and 2011

LIST OF TABLES

11 Table 1: Healthcare expenditure indicators, 2007–12
16 Table 2: Key healthcare reforms/policy initiatives implemented in Poland for the provision of
healthcare services
21 Table 3: Key resources in the Polish healthcare sector, 2007–11
27 Table 4: Pricing and reimbursement tools in Poland, 2012
36 Table 5: Pharmacy margins in Poland
44 Table 6: Reimbursement of pharmaceuticals in Poland