Health insurance funds: residents will be able to choose joint endoprosthesis according to their needs and abilities

As of 1 May of this year, there are some important changes for patients who need joint endoprosthesis. Regulation, that people over 65 cannot be included into the waiting list for mechanical fixation hip joint endoprosthesis, is removed. Besides, patients, who wish to purchase endoprostheses at their own expense, are able to choose quality compliant devices from a range of options offered by the treatment institution.

Ensures quality and safety of joint endoprostheses

Joint endoprosthesis is one of the most effective ways of treating joint diseases that cause pain, restricted movement and disability. Joint endoprosthesis helps to restore the function of joints, to decrease pain and improve quality of life.

National Health Insurance Fund (NHIF) purchases about 11 thousand knee and hip endoprostheses per year. They are prescribed to those who are on the waiting list for these prostheses. NHIF centrally purchases only high-quality and safe joint endoprostheses from world-class manufacturers. Patients can be assured that implanted joint endoprosthesis will meet all quality and safety requirements and standards.

“Some residents want to buy a joint endoprosthesis, which is not reimbursed by the NHIF. For example, the number of these people reached 1.8 thousand last year. They bought a joint directly from a manufacturer or a supplier, but this procedure did not ensure compliance to quality requirements of the device. Therefore, joints will have to be bought for these patients by a treatment institution and not by patients themselves as of 1 May,” Lina Reinartienė, head of Centrally Procured Pharmaceuticals Division of the NHIF, explains.

The new procedure means that a patient will not have to look for a supplier of endoprostheses by himself/herself. He/she will be able to choose between the options offered by a treatment facility and pay only the difference between the price of the prosthesis, reimbursed by the NHIF, and the price of the chosen endoprosthesis.

In this way, if an institution providing services of joint endoprostheses wants to offer insured persons a different joint endoprosthesis from the one provided by the NHIF, it will first have to buy necessary joint endoprostheses. The NHIF will reimburse treatment institutions for costs incurred for purchasing joint endoprostheses. Currently, reimbursement is paid to a patient who has purchased an endoprosthesis at his own expense.

The new procedure will allow people to choose joint endoprostheses according to their needs and possibilities in the institution, where they want to undergo surgery. It will be much more comfortable to patients. In addition, the new procedure will ensure that all joint endoprostheses used in medical institutions will be of high quality and safe, as they will be purchased from reliable sources, after assessing quality compliance.

No more restrictions

As of 1 May, mechanical fixation hip joint endoprostheses will also be available for people over 65 years old, who were previously unable to get on the waiting list for compensated mechanical fixation hip joint endoprostheses.

The most suitable joint endoprosthesis, both in terms of the type of endoprosthesis and the method of its attachment to the bone, will be selected by an operating orthopaedic traumatologist before or during the operation, taking into account patient’s state of health, the condition of the bone, and any comorbidities. A compensated mechanical fixation hip joint endoprosthesis can be implanted regardless of age, if patient’s medical condition allows, but it is always recommended to consult a doctor, who will explain all the criteria for selecting an endoprosthesis and possible risk factors.

One queue for surgery

Last year, changes to the procedure for reimbursement of joint endoprostheses and its costs led to specification of a queuing procedure for endoprosthetic operations in medical institutions.

“The institution has a single queue for the reimbursed service, depending on the time of a patient’s referral, and does not depend on whether a patient wishes to purchase an endoprosthesis at his/her own expense or to be reimbursed by the NHIF. Therefore, funds used to purchase an endoprosthesis do not constitute a basis for obtaining a reimbursable inpatient service in a different procedure from the general procedure,” Lina Reinartienė, head of Centrally Procured Pharmaceuticals Division of the NHIF, says. 

The aim is to ensure that all people with and without financial possibilities to buy an endoprosthesis wait the same amount of time for an endoprosthetic operation.

Currently, reimbursement for an endoprosthesis, acquired with his/her own funds, is only paid when patients have reached the end of their waiting list for a free joint endoprosthesis. The amount of the reimbursement for a joint endoprosthesis, purchased at his/her own expense, corresponds to the minimum price of a standard joint endoprosthesis and its accessories purchased by the NHIF.

Last year, more than 6,000 hip joint endoprosthetic surgeries and about 4,000 knee joint endoprosthetic surgeries were performed in Lithuania. More than 12,000 people are currently waiting for joint endoprostheses.

(Freepik photo)

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