Currently in Poland, there are approximately 10-12 thousand patients who are using ventilators at home, and the queue for such services is continuously growing. Considering the epidemic of chronic obstructive pulmonary disease, the demand will grow in the coming years. However, access to mechanical ventilation has been gradually restricted. In 2023 alone, the number of patients using ventilators at home, who were not covered by the National Health Fund (NFZ), exceeded 2,000 individuals. “A patient who is deprived of such care regularly returns to the hospital several times a year, generating costs that would have been sufficient for home care for several years,” emphasises Dr. Robert Suchanke, an Anaesthesiologist and President of the National Union of Mechanical Ventilation Providers.
“Patients with chronic respiratory insufficiency have had the possibility of using a ventilator at home since 2003. This service, mechanical ventilation, was developed based on the model of France, Germany, and other developed countries and was subsequently funded by the NFZ. Currently, there are about 12,000 such patients in Poland”, says Dr. Suchanke.
Mechanical ventilation, or assisted respiration using a ventilator, is generally done in the patient’s home. In Poland, this service is used by around 10-12 thousand people, many of whom have severe respiratory diseases. A significant proportion of these patients are older adults. However, it is estimated that the queue is much longer, with 50-60 thousand people awaiting treatment. Additionally, the number of patients mechanically ventilated in Poland has been continuously increasing for over 20 years, but it still lags significantly behind the European average. By comparison, in Germany, the number of patients treated for chronic respiratory insufficiency reaches 80,000. In France, it’s 74,000, in Italy 60,000, and in Spain over 40,000.
“Such patients are divided into two groups, those ventilated invasively and non-invasively [the latter group makes up 70-80 percent],” says Dr. Suchanke.
It is estimated that in Poland, chronic obstructive pulmonary disease (COPD) affects around 2 million people, and this number is increasing. Some of these patients will need a ventilator.
“COPD is a civilisation disease, and it is currently rampant in our country. It is already the third leading cause of death in Poland. It is estimated that between 2 and 3 million people are affected by this disease,” says Dr. Suchanke. The disease is caused by the two main etiological factors: smoking and air pollution, both of which are prevalent in Poland. “We used to have a very high percentage of smokers. Now we also have a large group of young people who smoke. As for air pollution, everyone knows that we lead in global statistics.”
Despite the growing need for mechanical ventilation, the access to this service is continuously limited in Poland. Just in 2023 alone, the number of patients on ventilators at home who were not covered by the NFZ exceeded 2,000 individuals.
“We currently have over 2,000 unfinanced patients. And we are maintaining care for these patients because otherwise, these patients could potentially not survive. Besides, a patient who is deprived of such care regularly returns to the hospital several times a year. And each time, they may fail to make it to the hospital. This cannot continue. This service cannot be limited”, the expert emphasises.
The National Union of Mechanical Ventilation Providers brings together entities that provide services to patients in need of assisted respiration using a ventilator in non-hospital conditions. The Union has long emphasised that in the last few years, costs have skyrocketed due to increasing personnel wages (resulting from wage increases and growing staff shortages), equipment, transportation to patients’ homes, etc. As a result, the cost of the service is continually increasing. The NFZ does not keep up with the revaluation, and it does not seem to be willing to expand the number of the so-called person-days. As a result, some patients do not have a chance for home ventilator care. Anaesthesiologists, pulmonologists and patients themselves, seeing this alarming trend, have appealed for changes on multiple occasions.
“The ministry tells us that it is not a life-saving service. But this is like saying that eating and drinking are not necessary for life, as there are three basic components: air, water and food. When we take away a person’s air, it is difficult to say that they will live. So, it is certainly a life-saving service”, explains Dr. Suchanke.
Although every year admission limits are rapidly exhausted, service providers in the OZŚWM try to maintain continuity of care for patients. Some entities have not yet received the reimbursement for the full surplus for 2015-2021.
“We currently have several dozen lawsuits pending for previous years,” says the Head of the National Union of Mechanical Ventilation Providers.
According to the OZŚWM, the NFZ’s profit was PLN 7.24 billion for 2022. By contrast, the amount of unsettled benefits for patients on ventilators at home in the last eight years – from 2015 until now – amounts to approximately PLN 150 million. This is just slightly over 2.1 percent of the financial result of the NFZ in 2022.
“An important issue is also that this service is many times cheaper than a patient’s hospital stay,” Dr. Suchanke emphasises.
The stay of a patient connected to a respirator in the hospital is estimated at 1-3 thousand PLN per day. In the case of the intensive care unit, this daily cost already exceeds 10 thousand PLN. It is even more expensive when this same service is provided in, for example, nursing and treatment facilities. The cost is then estimated at 337.20 PLN per day. For a full month of stay in such a facility, the NFZ pays from about 10,000 to even 19,000 PLN for patients requiring mechanical ventilation. On the other hand, the same service provided at home is valued from 107 to 167 PLN per day, depending on the patient’s disease stage and ventilation method. This means that home treatment could be 10 to 25 times cheaper for the healthcare system than hospital or facility treatment. A tangible benefit of at-home mechanical ventilation is freeing up hospital beds, thus making space available for those who require hospitalisation.
“A patient deprived of such treatment returns to the hospital several times a year, generating costs that would suffice for several years of home care. Therefore, we do not understand why access to this service is limited, as this relatively small group of patients could generate such savings,” says the president of the OZŚWM.
Mechanical ventilation therapy at home is not only economically viable. Its advantage is also the psychophysical comfort of the patient, reducing the risk of geriatric complications, disturbances in consciousness, and a deterioration in functional status due to immobilisation. It also decreases the risk of thromboembolic complications and hospital pathogen infections, and consequently the risk of death. Experts emphasise that the lack of full financing of home mechanical ventilation services affects Poland’s mortality rate.
“Unfortunately, in Poland, we have a hospital-focused model. We even hear this from NFZ and Ministry of Health officials: ‘But what’s the problem, these patients are taken care of, they are in the hospital, nothing bad is happening to them’. As a result, home care in Poland is lacklustre. There are individual services, but there are no connections between them,” says Dr. Suchanke.
The OZŚWM and the medical community have been working on a complex care model for patients with chronic respiratory failure for two years, including telemedicine. The new model of service provision that emerged from this work was economically justified, responded to the growing shortage of medical staff, and introduced technologies that increase the effectiveness of treatment. However, the project developed by the AOTMiT in cooperation with medical communities, patient communities and service providers are still waiting for acceptance and implementation by the health ministry.
“We hope that this situation will change. Much depends on what we will find after this half of October, regardless of which side will be in power,” says the President of the National Union of Mechanical Ventilation Providers.
