Financial chaos surrounding mental health care. Dr. Balicki: it's a wasted year and a half
- The pilot of mental health centers has been extended until the end of 2025, but the National Health Fund has planned to finance it for only six months, which raises concerns among experts
- Dr Marek Balicki and Dr Jerzy Gryglewicz draw attention to the lack of an approved financial plan for the National Health Fund and the chaos in financing psychiatric care
- The Ministry of Health assures that it does not plan to reduce funds for CZP and announces the development of standards and systemic solutions by the end of the year
Dr. Balicki, former Minister of Health, psychiatrist and member of the Council for Mental Health at the Minister of Health told PAP that in many centres there was uncertainty until the end as to what would happen after June 30.
The pilot of community psychiatric care implemented in mental health centers was supposed to end then. In May, the Ministry of Health decided to extend the pilot until the end of the year - the Ministry of Health submitted a regulation on this matter for consultation.
Balicki pointed out that the draft financial plan of the National Health Fund for 2025 provides only half a year of financing for the pilot. He also recalled that the plan has not yet been approved by the Minister of Finance.
Dr Jerzy Gryglewicz, an expert from the Institute of Healthcare Management at Lazarski University in Warsaw, told PAP that the decision of the Ministry of Health to extend the pilot means that the National Health Fund must find money to finance it for an additional six months.
- We are in financial chaos, but the Ministry of Health's decision obliges the Fund to find additional money - he added.
According to the expert, the failure of the Minister of Finance to approve the financial plan for 2025 is not an obstacle.
On Monday, PAP asked the Ministry of Health and the National Health Fund about the sources of financing for the CZP pilot for an additional six months. The National Health Fund informed PAP that information on the financing of the pilot is in the assessment of the project's regulatory impact. The Ministry of Health did not respond to PAP's questions by the time the dispatch was sent.
In the assessment of the regulatory impact of the project extending the CZD pilot, it was emphasised that the resulting costs will be covered from the National Health Fund funds, without the need to increase them or to activate the reserve fund.
The Ministry of Health indicated item B2.21.1 in the National Health Fund financial plan for 2025, which assumes financing of pilot projects in mental health centres in the amount of PLN 1 billion 284 million 684 thousand.
According to Balicki, the National Health Fund has not yet provided clear information on the financing and functioning of psychiatry in 2025. He emphasized that the planned total amount of expenditure on psychiatry and the CZP pilot is lower than the National Health Fund's expenditure for these purposes in 2024. He assessed that adding money for the pilot in the second half of the year will not result in a noticeable change.
Data from the NFZ financial plans show that in 2025 they will be lower by PLN 330 million 32 thousand than in 2024. The unapproved NFZ plan for 2025 assumes expenditure on psychiatric care and addiction treatment in the amount of PLN 6 billion 191 million 562 thousand . Together with the costs of the CZP pilot planned in the document, this gives PLN 7 billion 476 million 246 thousand . In turn, the final NFZ financial plan for 2024 specified the costs of psychiatric care and addiction treatment at PLN 5 billion 728 million 925 thousand, and the cost of the CZP pilot at PLN 2 billion 077 million 353 thousand , which gives a total of PLN 7 billion 806 million 278 thousand .
Balicki noted that the Ministry of Health has not yet presented systemic solutions that will ensure the operation of the centres after the pilot project is completed.
"It's a wasted year and a half," he said.
He emphasized that the recommendations in this matter were prepared by the working group of the Mental Health Congress and the Agreement for the implementation of the National Mental Health Protection Program. Balicki noted that they take into account the experience from the pilot of mental health centers.
Minister Leszczyna said that the ministry is working on a plan for the CZP after the pilot is completed and wants to work out joint solutions with the community and representatives of the centers by the end of the year . She emphasized that the development of an organizational standard for mental health centers is nearing completion. She added that requirements for financing the centers will be specified. She pointed out that the Supreme Audit Office has revealed irregularities in the spending of public funds in some public health centers.
The pilot of mental health centers began in 2018. It is based on the concept of community psychiatry, i.e. moving away from hospital treatment, which is intended for patients in acute conditions. CZPs focus on care organized close to the patient in smaller medical care centers, preventing mental crises, and when they do occur - quickly restoring balance.
The results of the NIK audit published in November last year revealed numerous irregularities in the operation of mental health centers in the Wielkopolska province and in the supervision by the National Health Fund . These included, among others, settlement errors, staff shortages, and the use of direct coercion measures without the required procedures.
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