CHANGES IN LEGAL REGULATION OF HEALTH CARE

(Act No. 138/2003 Coll., amending and supplementing the Act No. 277/1994 Coll. on Health Care, as amended and amending and supplementing certain other acts)

This act introduces changes into several fundamental regulations in the area of health care - Act on Health Care, Act on Medical Treatment Rules and Act on Health Insurance.

For the purpose of introducing fees for some provided services, services related to the provision of health care are separated from the health care. In the area of institutional care, these are in particular catering and lodging services, or administrative processing of patient's data, in case of ambulatory care also processing of patient's data, in case of pharmacy care these services are dispensation of medicaments or medical devices and administrative and statistical data processing for insurance companies. Such services also comprise transport services in the public health care.

The amended Medical Treatment Rules stipulate fixed fees for these services - SKK 50 per day for services in institutional care facilities (hospitals), SKK 20 for a visit to the doctor's surgery, or SKK 10 for dispensation of a medicament at the pharmacy. When transport service is used, SKK 2 per kilometre of a ride is paid. At the same time, the Act contains a considerable enumeration of exemptions from the duty to pay fees. The duty to pay fees shall not apply, save for a visit to the emergency service, to persons paying for the costs of health care in the full extent on their own.

Under the new regulation, health care is provided:

• free of charge based on mandatory health insurance,
• against partial reimbursement based on mandatory health insurance,
• based on contractual supplementary insurance, or
• against entire reimbursement.

Health care provided without indication on ground of other needs (e.g. for purposes of social security) is not reimbursed from health insurance and is paid for by the applicant or the entity for the benefit of which it was provided. The contractual supplementary insurance in the explicitly specified areas of health care is also possible.

Changes are also introduced into the categorisation of drugs and active substances - i.e. in classification into a list of drugs and active substances reimbursed from health insurance. The list stipulates a supplementary payment of a patient, which is pro rata decreased in the reduction of the total selling price of the drug. The classification of non-original drugs, so-called generic drugs containing an active substance that has been already classified before, is also simplified.

The amended Act on Health Insurance imposes on the insurance companies and health care facilities a duty to stipulate the maximum scope of medical performances, drugs, medical devices and dietary food reimbursed from health insurance in an agreement on provision of health care within a specified period of time. They are also obliged to agree on a procedure in case of excess in the agreed limits. However, an insurance company is obliged to reimburse the costs for inevitable and urgent health care also above the agreed limits.

This Act shall come into effect on 1 July 2003.

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