Decree No. 102 / 2024 Coll.
Order on how to measure the cost of health services for the purpose of reallocation of public health insurance premiums
Valid
Order
Effective from 26.04.2024
Text versions:
26.04.2024
25.04.2024
102
DECLARATION
of 17 April 2024
on how the cost of health services is to be measured for the purpose of reallocating public health insurance premiums
According to § 21f (d) of Act No. 592 / 1992 Coll., on Insurance for Public Health Insurance, as amended by Act No. 145 / 2017 Coll.:
Subject matter
This Decree regulates, for the purposes of redistribution, the method of pricing the costs of health services declared in 2023.
Method of pricing the cost of health services
For the purposes of redistribution, health insurance companies shall assess the costs of health services declared in 2023 in accordance with other public health insurance legislation, in accordance with Articles 3 to 9.
(1) The costs of emergency bed care shall be assessed in accordance with paragraphs 2 to 5.
(2) Cases of hospitalisation of patients that were completed in 2022 and for which no healthcare was reported before 2023 will be evaluated by the product of the basic rate of CZK 62 236 and the relative weights assigned to hospitalisation cases determined according to the Czech Statistical Office No.385 / 2021 Coll., on updating the Classification of hospitalized patients of CZK-DRG (hereinafter "CZ- DRG 2022 '). Patient hospitalisation cases will be compiled on the basis of the care reported in 2023. In the evaluation of patients hospitalisation cases according to the first sentence, the medicinal products listed in Annex 12 to Decree No 396 / 2021 Coll., establishing the values of the points, the amount of payments of the services paid and the regulatory restrictions for 2022, and the medicinal products not included in the calculation of relative weights under the CZ- DRG 2022 classification shall not be included; the medicinal products are assessed in accordance with Section 9.
(3) Cases of hospitalisation of patients which were completed in 2023 and for which no health care was reported before 2023 will be evaluated by the product of the basic rate of CZK 68460 and relative weights assigned to hospitalisation cases determined according to the Czech Statistical Office Communication No. 302 / 2022 Coll., on updating the Classification of hospitalized patients of CZK-DRG (hereinafter "CZ- DRG classification 2023"). Patient hospitalisation cases will be compiled on the basis of the care reported in 2023. In the evaluation of patients hospitalisation cases according to the first sentence, the medicinal products listed in Annex 12 to Decree No. 315 / 2022 Coll., establishing the values of the points, the amount of payments of the services paid and the regulatory restrictions for 2023, and medicinal products not included in the calculation of the relative weights under the CZ-DRG 2023 classification shall not be included; the medicinal products are assessed in accordance with Section 9.
(4) Cases of hospitalization of patients who were terminated in 2023, who were declared health care in 2022, but were not evaluated, and before 2022 no health care was reported, will be evaluated by the product of the basic rate of CZK 68460 and the relative weights assigned to hospital cases determined according to the CZ- DRG 2023. Patient hospitalisation cases will be compiled on the basis of care reported in 2022 and 2023. In the evaluation of patients hospitalisation cases according to the first sentence, the medicinal products listed in Annex 12 to Decree No 315 / 2022 Coll. and medicinal products not included under the CZ- DRG 2023 classification shall not be included in the calculation of relative weights; the medicinal products are assessed in accordance with Section 9.
(5) The hospitalisation cases of patients who received at least part of the health care before 2022 shall be evaluated by the product of a point value of CZK 1.58 and the number of points of performance with a point value ("performance ') set out in Decree No. 134 / 1998 Coll., which is published in the list of health performance with points, as amended, (" performance list'), for the relevant performance in the year in which the health services were provided, using only the part of the care of the patient's hospitalisation case declared in 2023.
(6) The care declared in 2023, provided in the context of hospitalisation of patients, which cannot be compiled on the basis of the care declared in 2023 under the nomenclature CZ- DRG 2022 or the nomenclature CZ- DRG 2023 and for which no healthcare was declared before 2023, is not considered to be declared in 2023 for the purposes of this decree.
The costs of extramural care relating to cases of hospitalisation of patients assessed under § 3 (2) - (4) or (6) are included in the valuation under § 3 and are no longer valued. The costs of extramural care relating to patients' hospitalisation cases assessed in accordance with § 3 (5) shall be assessed in accordance with § 7 to 9. Extramural care means extramural care according to Annex 1 to Decree No 396 / 2021 Coll. and Annex 1 to Decree No 315 / 2022 Coll.
The cost of health services provided by special bed care providers and subsequent and long-term bed care providers, with the exception of the cost of health services of follow-up intensive care, follow-up ventilation care, follow-up comprehensive intensive rehabilitation care and long-term intensive nursing care, shall be valued in accordance with the Annex to this Decree.
The cost of health services included in the capitalisation payment for providers in the field of general medical practice and providers in the field of practical medicine for children and young people shall be valued at the amount of the basic capitalisation rate for the converted number of insured persons according to Annex 2, Part A, point 1 to Decree No. 315 / 2022 Coll. in the amount of CZK 53 per insured person and month. The cost of health services included in the aggregated remuneration for dental care providers is valued at CZK 20 per registered insured person and month.
The cost of health services, the amount of which is set out in Decree No. 315 / 2022 Coll. in Czech crowns and the awards of which are not subject to § 3 to 6, is valued at the amount set out in Decree No. 315 / 2022 Coll.
The cost of health services not covered by Sections 3 to 7 shall be evaluated by the product of the value of the point referred to in Section 10 and the number of performance points determined in accordance with the list of performance effective in the year in which the health services were provided, if they can be assessed in this manner.
The cost of health services not subject to the evaluation of paragraphs 3 to 8 shall be valued at the amount of remuneration applied for the services provided.
The valuation according to § 8 applies to:
a) outpatient care declared in expertise 603 and 604 according to the performance list value of a point of CZK 1.16,
b) haemodialysis care value of a point of CZK 1.17,
(c) health services declared by the health rescue service provider value of a point of CZK 1.39; the value of the point 1.38 CZK shall be used for the evaluation of health services provided by patient transport providers;
d) health services declared in the medical emergency service value of a point of CZK 1.12,
e) special outpatient care value of a point of CZK 1.28,
(f) health services declared by providers in the field of general practical medicine and practical medicine for children and adolescents, including the performance of transport of health workers declared by these professionals, value of the point of CZK 1.26,
g) outpatient care in expertise 809 and 810 according to the list of performances including magnetic resonance, computer tomography and denzitometry value of point of CZK 1.09,
h) outpatient care in expertise 222, 403, 801, 802, 807, 812 to 819 and 823 according to the performance list, except for cervical screening performance, the value of a point of CZK 0,84,
(i) outpatient care in the 911, 914, 916, 921, 925 and 926 expertise according to the performance list, including the performance of the transport of health workers declared by these experts, value of the point of CZK 1,15,
j) outpatient care in expertise 902 and 917 according to the list of performances, including the performance of transport of health workers declared by these professionals, value of the point of 0.88 CZK,
k) health services declared by the health transport service provider value point of CZK 1.33,
l) health services of follow-up intensive care, follow-up ventilation care, follow-up complex intensive rehabilitation and long-term intensive nursing care declared by the providers of subsequent and long-term bed care value of a point of 1.46 CZK for treatment day 00015, 1.43 CZK for treatment day 00017, 1.41 CZK for treatment day 00020 and 1.18 CZK for treatment day 00033 and treatment day 00035,
m) outpatient care not mentioned in points (a) to (l) value of the point of CZK 1.10.
Repeal
Decree No. 119 / 2023 Coll., on the method of measuring the cost of health services for the purpose of the redistribution of public health insurance premiums, is hereby repealed.
Efficacy
This Decree shall take effect on the day following that of its publication.
Minister for Health:
Prof. MUDr. Válek, CSc., MBA, EBIR, v. r.
Minister of Finance:
Ing. Stanjura v. r.
Annex
Valuation of the cost of health services declared by special bed care providers and subsequent and long-term bed care, except for the cost of health services of follow-up intensive care, follow-up ventilation care, follow-up comprehensive rehabilitation treatment and long-term intensive nursing care
The cost of health services declared by special bed care providers and subsequent and long-term bed care, with the exception of the cost of health services of follow-up intensive care, follow-up ventilation care, follow-up comprehensive rehabilitation care and long-term intensive nursing care, shall be evaluated according to the type of day and patient category according to the performance list as follows:
| Ošetřovací den | Pro kategorii pacienta 1 podle seznamu výkonů | Pro kategorii pacienta 2 podle seznamu výkonů | Pro kategorii pacienta 3 podle seznamu výkonů | Pro kategorii pacienta 4 podle seznamu výkonů | Pro kategorii pacienta 5 podle seznamu výkonů |
|---|---|---|---|---|---|
| 00005 | 1 962,52 | 2 122,93 | 2 370,85 | 2 563,74 | 2 866,29 |
| 00021 | 2 831,10 | 3 049,97 | 3 329,06 | 3 554,72 | 3 581,42 |
| 00022 | 2 304,47 | 2 477,07 | 3 370,69 | 3 623,25 | 3 855,50 |
| 00023 | 2 209,19 | 2 594,75 | 2 850,23 | 3 064,16 | 3 489,36 |
| 00024 | 2 340,73 | 2 535,92 | 2 783,53 | 2 972,37 | 3 158,49 |
| 00025 | 6 324,42 | 6 672,31 | 7 125,69 | 7 285,01 | 7 456,60 |
| 00026 | 3 673,15 | 4 105,69 | 4 458,98 | 4 706,30 | 5 040,58 |
| 00027 | 2 569,32 | 2 861,58 | 3 661,37 | 3 937,77 | 4 051,04 |
| 00028 | 2 845,81 | 2 980,45 | 3 250,54 | 3 597,44 | 3 845,91 |
| 00029 | 2 509,27 | 2 678,19 | 2 901,11 | 3 173,08 | 3 429,00 |
| 00030 | 2 386,84 | 2 507,16 | 2 695,70 | 2 819,42 | 2 943,13 |
| 00031 | 639,50 | - | - | - | - |
| 00032 | 639,50 | - | - | - | - |
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Regulation Information
| Citation | Decree No. 102 / 2024 Coll., on the method of measuring the cost of health services for the purpose of reallocation of public health insurance premiums |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 25.04.2024 |
|---|---|
| Effective from | 26.04.2024 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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