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1 hour 11 minutes ago
"DGP": the doctors want the government to refrain from introducing the obligation to only dismiss in electronic form. The reform must come into effect on December 1 st. Will it happen?
Gertruda Uścińska, President of the Social Insurance Institution: – I am not aware of any legislative work regarding the change of the date of universal enforcement of electronic redundancies. Today, it is even too late to start such work. The law is unequivocal: as of December 1, medical exemptions on paper will be replaced by electronic ones.
And if doctors threatened that after December 1, they would not write any referrals? Is this a form of pressure that could lead you to change your mind?
– I would not comment on the forms of pressure, because it is not my role. I would like to draw your attention to the fact that e-layoffs as a voluntary solution are effective as of January 1, 2016, almost three years. Seeing that the first two doctors had not gone through the new form of dismissal, we took the initiative in hand. We have taken a number of steps to meet the expectations of physicians to make it easier for them by sending them electronic redundancies. The breakthrough was the publication of a new free electronic signature, that is, a special ZUS certificate. It allows doctors to easily and, more importantly, quickly authorize layoffs. Our free certificate has nearly 90,000 doctors.
What happens if the number of layoffs after December 1 goes down considerably?
– I do not think that will happen, but we have different scenarios. The good of the insured is the most important for us, in this case the patient.
So, there is a plan B?
– Not only B. We have projects for more atypical situations.
What are they based on?
– Do not go over the facts. The fact that ZUS is prepared for various solutions does not mean that they will take place. I believe everything will work as planned and no emergency plan will be triggered.
And if not, then the ZUS inspectors are in the starting blocks?
– Do not exaggerate. It is not a question of scaring anyone with the ability to control. For our part, we have made every effort to ensure that doctors reliably switch to electronic redundancy. We acted and acted not by compulsion, but by encouragement and help. The best evidence is the fact that nearly 110,000 Doctors licensed to issue layoffs have a profile registered on the ZUS electronic services platform, which allows e-ZLA to be issued. I assure you that there are no controllers in the starting blocks, which does not mean that I will emphasize again that we are not prepared for various events.
You are convinced that doctors are ready to write electronic redundancies, but when you look at the numbers, you can see that there are areas where few doctors are still doing it.
– Only a year ago, only about 6.4%. Doctors have published electronic communiqués and that could have bothered them. Our actions, our continued cooperation with doctors and health facilities, the help and support provided by us, have been successful. Doctors have been gradually convinced of a new form of dismissal. Today, more than 56%. layoffs are electronic layoffs and most physicians can not imagine going back to paper forms.
But there are areas where it does not look good.
– In reality, there is a great regional diversity. In Koszalin, e-ZLA represents more than 75%. in Szczecin and Słupsk, but also in Warsaw, it is 60 to 70%. For example, in Rzeszów or Ostrów Wielkopolski, the electronic redundancy is less than 40%. more than 40% in Zielona Góra and Gorzów Wielkopolski.
What is the result of this diversity?
– Undoubtedly, there are fewer electronic dismissals in areas where physician associations and medical associations strongly oppose the introduction of the e-ZLA. We also see a much larger problem among family physicians, because, for example, in hospitals, the number of e-mail messages issued reaches 100%. Similarly, in non-public institutions.
Doctors also have arguments, such as slow Internet connections.
– In some cases, it is slow Internet connections, in others, the computer hardware is lacking. The arguments are different, but I would like to point out that the Ministry of Health has allocated 50 million zlotys to support primary health care facilities when purchasing computer equipment. There is no longer any argument regarding the creation of e-ZLA regarding special assistance centers because medical assistants have been set up. Today we have 1460 registered medical assistants.
This is not much, especially considering the total number of doctors.
– It was not so long ago, they were ten. The number of assistants is increasing very rapidly. Remember that these are just the first days since the creation of the medical assistant function.
Where are the assistants?
– In this case, there is no geographical dependence. For example, at the Otwock Hospital near Warsaw, we have up to 20 assistants. The director of the school could not imagine that he would not be allowed to leave his hospital. Let's wait with a more detailed evaluation of the positions of the assistants when the number of assistants stabilizes. For the moment, it will grow from day to day. For our part, we help assistants to become familiar with the principles of issuing electronic redundancies. We have already had several hundred such formations. To date, we also had close to 40,000 training for doctors.
Someone might say that is bragging.
– I assure you that there is nothing exaggerated here. Our statutory role was to prepare a computer system for the publication of e-ZLA. We went well beyond our responsibilities. It is important for us that electronic redundancies become popular in our country. We are now taking a step closer to the doctors. This Friday, our customer service rooms will be open until 6:00 pm. Extended working hours involve consulting in the field of e-layoffs. Our call center will also be longer. On weekdays we will receive phones from 6 to 10 pm and from 8 to 9 pm on weekends.
What do you think of the persistence of those who are not convinced? And what about a doctor so unconvinced?
– Our research shows that a large part of the doctors, who do not publish e-ZLA today, are waiting for Dec. 1 and say that from now on, they will start publishing e-mail releases. . And how to convince e-redundancies? Suffice it to say that the publication of an electronic version takes about 20 seconds and that the ZUS electronic system excludes any error. The advantage for the patient is the lack of obligation to provide layoffs to the employer. An advantage for the employer is the access to the exemption from the moment it is issued.
The lady talks about the benefits, and on the other side, we have a group of unconvinced and very resistant people. They see problems – bureaucratisation, obligation to transmit additional information …
– Is it rational to speak of bureaucratization in the case of electronification? Electronic redundancy is rather a departure from bureaucratization. When issuing an electronic release, the doctor enters only the patient's PESEL. Other data comes from the ZUS electronic system. Then select the code corresponding to the title of the illness, the period of incapacity to work and to sign. That's all.
But two years have passed and this unconvinced group is still not small. Is he diagnosed with age?
– We have more than 145 thousand doctors licensed to issue temporary work disability certificates, of which nearly 110,000 have a profile on the ZUS electronic services platform. Let's take into account that only 96.5 thousand. doctors have issued an exemption in the last 6 months. I do not think the approach of e-releases among doctors depends on their age. We have doctors aged 70 or 80 who are already exhibiting e-ZLA and, at the same time, doctors aged 35 and 40 who do not have e-ZLA.
But you do not hide that the purpose of this solution is to seal the system.
– The main goal is to make life easier for patients. Of course, one of the next goals is to seal the health benefits system. In 2017, the out-of-work expenses amounted to PLN 17 billion, of which PLZ 6.3 billion was paid by employers. The state budget subsidy for sickness benefits was PLN 8.1 billion. It is important in this context that at least 56%. layoffs are layoffs of up to 10 days, in other words, out of the control of ZUS and employers. Admittedly, the mere fact that the employer receives the dismissal of the worker in real time will act preventively and thus seal the system.
Are you going to check if such layoffs are brief?
– We control and control as much as the law allows. Electronic layoffs certainly offer more opportunities for employers, who will know what is happening to their employees on an ongoing basis.
What can be the benefits of sealing the system? If e-ZLA arrives, how much less will sick leave leave? We will also know how many were fictitious?
– You can answer this question at the end of December.
If you notice that after December 1 the number of layoffs has decreased, will sanctions be imposed on the doctors?
– Our rights to opt out of exemptions do not change. Our role is to take care of the letter of law. Please remember that the right to issue ZUS exemptions allocates to the doctor's request. There is no constraint here. If a doctor requests such a possibility, he accepts the obligations incumbent upon him in this respect, in particular: in the field of application of the exemption models in force.
And if doctors do not emit cyber-redundancies, because they will take this form of protest against change, will ZUS intervene?
– We will certainly analyze whether such an action is deliberate or rather accidental and what it implies. It may be enough to provide the doctor with training support. We are considering various options, but we will see what will happen in the first weeks of December.
A patient will come to the doctor, and he will give him a paper release. Then what?
– In case of emergency, the doctor can always issue a paper version of the system printing. Within three days, however, he must electronically.
And how will he not present?
– This will mean that the doctor will not make a decision according to the applicable law, that he decided to prosecute, asking for the right to issue exemptions. Then we will ask what actions to take. We will certainly act so that the insured do not suffer.
But what is the patient supposed to do in such a situation?
– First, it should require the issuance of a derogation in accordance with the applicable regulations, namely electronic. If this is not possible, the doctor must give the patient a release paper and then enter it into the system within three days.
But the insured will suffer no consequences?
– I assure you that the insured will not bear any consequence of the dysfunction of the doctor.
Dominika Sikora, Grzegorz Osiecki, Anna Ochremiak
November 27, 2018
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