Magdalena A. Mrożek-Gąsiorowska

 The National Health Fund finances rehabilitation services contracted in two scopes, therapeutic rehabilitation and health resort treatment. The aim of the study is to assess the impact of the Covid-19 pandemic on the realization of rehabilitation services financed by the National Health Fund in Poland in 2020 compared to the previous years (2016-2019). The paper also discusses the implementation of successive regulations regarding rehabilitation during Covid-19 pandemic in Poland in 2020. Based on the analysis, it was shown that the number of patients who benefited from rehabilitation services in Poland financed by the National Health Fund decreased by 17% in the case of services in the field of therapeutic rehabilitation in 2020 compared to 2019 (the largest decrease, amounting to 80%, was observed in the case of pulmonary rehabilitation provided in the conditions of a day center or ward) and by 50% in the case of health resort treatment services.

The current challenge for healthcare systems is to assess the clinical and economic value of non-drug technologies. Attempts have been made to use Health Technology Assessment, a standard method used in many countries to assess and make decisions regarding the reimbursement of medicines. The use of health technology assessment for non-drug technology can be a challenge because of the lower availability of high-quality scientific evidence in comparison with drugs. In several European countries attempts were made to develop guidelines for the clinical and economic evaluation of non-drug technologies; we presented specific guidelines prepared by British and French HTA agencies: NICE and HAS, respectively. In the case of Poland, the role of the Agency for Health Technology Assessment and Tariff System (AOTMiT) is to assess and appraise all medical technologies and services claiming public money funding; most of these assessments concern drug technologies. Only 103 of 1,550 orders (6.6%) issued by the Ministry of Health, from 1^st January 2012 to 1^st July 2018, were related to non-drug technologies. The health services assessed by the AOTMiT include different non-drug medical technologies, both specialized medical devices as well as surgical interventions or diagnostic procedures or screenings. Orders for non-drug technologies issued by the Ministry of Health vary in scope and type of assessment.

The medical rehabilitation system in Poland includes various rehabilitation services, financed by various institutions, including the NFZ, ZUS, KRUS, PFRON and local governments. The aim of the study is to identify the most important problems and limitations of this system, especially in the context of the COVID-19 pandemic. The most important issues to be solved and proposed reforms of the medical rehabilitation system in Poland presented in recent years were identified. The impact of the COVID-19 pandemic on this system, providing rehabilitation services and problems related to the im­plementation of further legal regulations in the first months of the pandemic were discussed. One of the most important recommended changes is the implementation of the comprehensive care model and the activities aimed at coordinating various elements and levels of rehabilitation.

Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. WHO, in “World Report on Disability”, defines rehabilitation as a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments. Lack of rehabilitation services creates a barrier to full inclusion and participation in all aspects of life.
The aim of this article was to present the nature of medical rehabilitation, in particular medical rehabilitation of elderly people. The basic definitions of medical rehabilitation and physiotherapy were also presented. The medical rehabilitation system in Poland, its organization and funding system was shown based on publications and statistical data of the Central Statistical Office (GUS) as well the access to medical rehabilitation services and selected medical procedures was assessed based on available data from National Health Fund (NFZ) and Ministry of Health (MZ).