The complexity of the process of service purchase planning by the National Health Fund

Abstract

Planning of health service purchase from public funds is a complicated management process, influenced by numerous legal, economic and political limitations. The task of the National Health Fund is to guarantee the fulfilment of health needs of all entitled individuals.
The key stage of the process is the prognosis of the entitled clients’ health needs. This calls for a precise definition of the concept of “health needs”, identification, classification and measurement of the needs. However, the perspective of meeting the needs collides with the perspective of maintaining the resources of service providers. It is the latter that have instruments, ability and interest to impose their perspective on the payer. This translates into the form the plan of healthcare service purchase.
The key factors influencing the process of service purchase planning by the National Health Fund as a public payer were analyzed:

1. Predicting selected populations’ health needs, including their identification, measurement and the quality of source data.
2. Political necessity to bring together the needs of the patient by the payer (health needs) and the needs of the service provider (preservation of resources, infrastructure).
3. Limited and insufficient public means available for the services.