Decree No. 119 / 2023 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 30.04.2023
Text versions:
30.04.2023
28.04.2023
119
DECLARATION
of 25 April 2023
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 for measuring the costs of health services reported in 2022.
Method of pricing the cost of health services
For the purpose of redistribution, health insurance companies shall measure the costs of health services declared in 2022 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, which were completed in 2021 and in which no healthcare was reported before 2022, will be evaluated by the product of the basic rate of CZK 57 297 and the relative weights assigned to hospitalisation cases determined according to the Czech Statistical Office communication No. 385 / 2020 Coll., on updating the Classification of hospitalised patients of CZK-DRG (hereinafter "CZ- DRG Classification 2021"). Patient hospitalisation cases will be compiled on the basis of the care reported in 2022. In the evaluation of patients hospitalisation cases according to the first sentence, the medicinal products listed in Annex 12 to Decree No. 428 / 2020 Coll., on the determination of the value of the points, the amount of payments of the services paid and the regulatory restrictions for 2021 shall not be included; the medicinal products are assessed in accordance with Section 9.
(3) Cases of hospitalisation of patients, which were completed in 2022 and for which no healthcare was reported before 2022, will be evaluated by the product of a basic rate of CZK 62 236 and 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 referred to as "CZ- DRG 2022"). Patient hospitalisation cases will be compiled on the basis of the care reported in 2022. 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., on the determination of the value of the points, the amount of payments of the services paid and the regulatory restrictions for 2022 shall not be included; the medicinal products are assessed in accordance with Section 9.
(4) Inpatient hospitalisation cases where at least part of the health care has been declared before 2022 shall be evaluated by the product of a point value of CZK 1.56 and the number of points of performance with a point value (hereinafter referred to as "performance ') laid down in Decree No. 134 / 1998 Coll., which is issued a list of health performance with points, as amended (hereinafter referred to as" 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 2022 for the evaluation.
(5) The care declared in 2022, provided in the context of hospitalisation of patients, which cannot be compiled on the basis of the care declared in 2022 under the CZ- DRG 2021 or the CZ- DRG 2022 classification and for which no healthcare was declared before 2022, is not considered to be declared in 2022 for the purposes of this Decree.
The costs of extramural care relating to cases of hospitalisation of patients assessed under § 3 (2), (3) or (5) 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 (4) shall be assessed in accordance with § 7 to 9. Extramural care means extramural care according to Annex 1 to Decree No. 428 / 2020 Coll. and Annex 1 to Decree No. 396 / 2021 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. 396 / 2021 Coll., on determining the values of the point, the amount of remuneration for the services paid and the regulatory restrictions for 2022, at CZK 51 for the calculated insured person and month. The cost of health services included in the aggregated remuneration for dental care providers is valued at CZK 16 per registered insured person and month.
The cost of health services, the amount of which is set in the Order No. 396 / 2021 Coll. in Czech crowns and the awards of which are not covered by § 3 to 6, is valued at the amount set out in the Order No. 396 / 2021 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 1.13,
b) hemodialysis care value of a point of CZK 1.04,
(c) health services declared by the health rescue service provider value of a point of CZK 1.31; the same value of the point shall also be used for the evaluation of health services provided by patient transport providers of emergency care;
d) health services declared in the medical emergency service value of a point of CZK 1.05,
e) special outpatient care value of a point of CZK 1.23,
(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 1.20,
g) outpatient care in expertise 809 and 810 according to the list of performances including magnetic resonance, computer tomography and denzitometry value of the point of 1.03 CZK,
h) outpatient care in expertise 222, 403, 801, 802, 807, 812 to 819 and 823 according to the performance list except for cervical screening, the value of the point of 0,78 CZK,
i) outpatient care in the 911, 914, 916, 921, 925 and 926 expertise according to the performance list, including the performance of transport of health workers declared by these specialists, value of the point of CZK 1.09,
j) outpatient care in expertise 902 and 917 according to the performance list, including the performance of the transport of health workers declared by these professionals, the value of the point of CZK 0.85,
k) health services declared by the health transport service provider value point of CZK 1.23,
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 1.34 CZK for treatment day 00015, 1.31 CZK for treatment day 00017, 1.30 CZK for treatment day 00020 and 1.09 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 1.08.
Repeal
Decree No. 98 / 2022 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 30 April 2023.
Minister for Health:
Prof. MUDr. Válek, CSc., MBA, EBIR, v. r.
Minister of Finance:
Ing. Stanjura v. r.
Annex to Decree No 119 / 2023 Coll.
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 | 1 784,11 | 1 929,93 | 2 155,31 | 2 330,67 | 2 605,72 |
| 00021 | 2 505,40 | 2 699,09 | 2 946,07 | 3 145,77 | 3 255,84 |
| 00022 | 2 094,97 | 2 251,88 | 3 064,26 | 3 293,86 | 3 505,00 |
| 00023 | 2 008,35 | 2 358,86 | 2 591,12 | 2 785,60 | 3 172,15 |
| 00024 | 2 127,93 | 2 305,38 | 2 530,48 | 2 702,15 | 2 871,36 |
| 00025 | 5 749,48 | 6 065,74 | 6 477,90 | 6 622,73 | 6 778,73 |
| 00026 | 3 250,58 | 3 633,35 | 3 946,00 | 4 164,86 | 4 582,35 |
| 00027 | 2 335,75 | 2 601,43 | 3 328,51 | 3 579,80 | 3 682,77 |
| 00028 | 2 587,10 | 2 709,50 | 2 955,04 | 3 270,40 | 3 496,28 |
| 00029 | 2 281,16 | 2 434,72 | 2 637,38 | 2 884,62 | 3 117,27 |
| 00030 | 2 169,86 | 2 279,23 | 2 450,64 | 2 563,11 | 2 675,57 |
| 00031 | 592,13 | - | - | - | - |
| 00032 | 592,13 | - | - | - | - |
Sign in for notes, favorites and notifications
Regulation Information
| Citation | Decree No. 119 / 2023 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 | 28.04.2023 |
|---|---|
| Effective from | 30.04.2023 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
Comments 0