Decree of the Ministry of Health No. 211 / 2001 Coll.
Decree of the Ministry of Health determining the amount of health care payments paid from public health insurance including regulatory restrictions for the 2nd half of 2001
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Effective from 01.07.2001
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01.07.2001
27.06.2001
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211
DECLARATION
Ministry of Health
of 15 June 2001
determining the amount of health care payments payable on public health insurance including regulatory restrictions for the 2nd half of 2001
According to § 17 (11) (b) of Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended by Act No. 459 / 2000 Coll., hereinafter referred to as "the Act":
This decree provides
(a) the amount of the public health insurance contributions, including the regulatory restrictions for the 2nd half of 2001 for health care in hospital institutions, including professional medical institutions, the treatment of long-term sick and health care establishments reporting on treatment day No 00005 under the Decree issuing a list of health performance with points (1) (hereinafter referred to as "the list of performance");
(b) the amount of compensation for the provision of emergency medical care in non-contractual medical establishments.
(1) Health care provided in health care institutions, except in professional medical institutions, long-term sick hospitals and in healthcare institutions reporting on the treatment day No 00005 according to the performance list (hereinafter referred to as "bed facilities"), is paid in the 2nd half of 2001 under the contractual arrangement between the health insurance company and the bed establishment
(a) a flat rate;
(b) according to the list of performances; or
(c) on a proposal of a sleeper, agreed by a method of payment combined with a diagnosis payment.
(2) A method of payment other than that referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1 (a) or (b), and the bed establishment and the health insurance undertaking have agreed on such a method of payment on the basis of a proposal from the bed establishment.
(3) The procedure for calculating the flat rate, the amount and the conditions for reimbursement referred to in paragraph 1 (a) and (b) is set out in Annex 1 to this Order.
(4) The price of the point of payment for health care referred to in paragraph 1 (b) set for the first half of 2001 remains valid for the second half of 2001.2)
(5) The amount of the remuneration referred to in point (c) of paragraph 1 shall be agreed in a contract between the health insurance undertaking and the bed establishment, the amount of the payment for the provision of emergency bed care being fixed at a flat rate and the other health care paid.
(6) If the bed establishment and the health insurance undertaking agree an amendment to the contract or agree a new contract containing new medical performance provided by the bed establishment or agree a new structure of the healthcare provided, the health insurance undertaking shall include these elements in the total amount of the payments for the second half of 2001.
(7) If, in the second half of 2001, the income from the collection of insurance premiums per insured person is higher than that provided for in the approved health insurance scheme for 2001, the health insurance company shall increase the total amount of remuneration set out in Annex 1 to this Order by as much as it increased the collection of premiums per insured person by as much as the amount specified in the health insurance plan. The increase thus calculated shall be multiplied by 0,9. This increase shall be paid by the sickness insurance company to the hospital until 31 May 2002.
(8) Where the flat-rate payment referred to in paragraph 1 (a) is made, the health insurance undertaking shall pay, in addition to the flat-rate payment in the second half of 2001, a separate remuneration:
(a) for cardioverters and also for pacemakers, including electrodes, provided in the case of reimplantation (performances No 55217 and 55219 included in the performance list), which were provided in the second half of 2001;
(b) for neuromodulation stimulators that were provided in the 2-semester 2001 treatment of epilepsy and Parkinson's disease;
(c) for neuromodulatory stimulators and intrathecal pumps provided for the treatment of chronic pain conditions in the 2nd half of 2001 in the bed facilities listed in Annex 3 to this Decree [peripheral nerve stimulation (PNS), spinal cord stimulation or back root stimulation (SCS), deep brain and cortical stimulation, under the stimulators of the anterior corners of spinal cord (SARS) in transverse spinal lesions]; the sleeper establishments listed in Annex 3 to this Decree may apply in total to health insurance companies in the Czech Republic a maximum of 30 programmable prostheses,
(d) for in vitro fertilisation treatment provided in the 2nd half of 2001 by sleeper establishments carrying out standard sterilisation treatment using the extra-body fertilisation method;
(e) for the medical performance of haemodialysis No 18051, 18052, 18510, 18513, 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590 according to the list of performance provided in the second half of 2001, the price of the point for the reimbursement of those performance laid down for the first half of 2001 remains valid for the second half of 2001; 3) for health performance No 18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590, respectively, the overhead costs shall be fixed at 4 points per minute;
(f) for the specifically charged medicinal products for the treatment of haemophilia listed in Annex 4 to this Decree, provided in bed facilities in the second half of 2001;
(g) for the specifically charged HIV / AIDS medicinal products (antiretroviral medicinal products and medicinal products for the comprehensive treatment of opportunistic infections) provided at the 2nd half of 2001 in the bedding facilities listed in Annex 5 to this Decree; antiretroviral medicinal products and medicinal products for the comprehensive treatment of opportunistic infections are listed in Annex 6 to this Decree,
(h) for the specifically charged Cerezyme medicinal product, for the treatment of Morbus Gaucher disease, provided only by the Children's and Adolescent Medicine Clinic of the General Faculty Hospital Prague in the 2nd half of 2001,
(i) for the treatment and intensive care days No 00051, 00052, 00053, 00055, 00057, 00058, 00061, 00065, 00068 provided for in the treatment of extensive burns in the second half of 2001, in the bedding facilities listed in Annex 7 to this Decree, the price of the point of reimbursement for these performance periods determined for the first half of 2001 remains valid for the second half of 2001.4)
(j) for specifically charged medicinal products provided in the 2nd half of 2001 for the treatment of cystic fibrosis in the bedding establishments listed in Annex 8 thereto; the list of medicinal products specifically charged is set out in Annex 9 to this Regulation,
(k) for the specifically charged medicinal products provided in the 2nd half of 2001 for oncologically ill children treated at the centres of pediatric oncology of the bed facilities listed in Annex 10 to this Decree; the list of medicinal products specifically charged is set out in Annex 11 to this Regulation.
(1) Health care provided in professional medical institutions is paid in the 2nd half of 2001 according to the contractual agreement between the health insurance company and the professional medical institution
(a) a flat rate; or
(b) in the combined manner referred to in Annex 2 (B).
(2) A method of payment other than those referred to in paragraph 1 may be used where the total amount of payment is higher than the payment provided for in paragraph 1 (a) or (b) and the professional medical institution and the health insurance undertaking have agreed, on a proposal from the medical professional institution, on such a method of payment.
(3) The procedure for calculating the flat rate and reimbursement in the combined manner, the amount and the conditions for reimbursement referred to in paragraph 1 (a) and (b) are set out in Annex 2 to this Decree.
(4) The price of the point of payment for health care referred to in paragraph 1 (b), as laid down for the first half of 2001, remains valid for the second half of 2001.5)
(5) If the medical professional institution and the health insurance undertaking agree an amendment to the contract or agree a new contract containing new medical performance, provided by the medical professional institution or agree a new structure for the healthcare provided, the health insurance undertaking shall include this in the total amount of remuneration for the second half of 2001.
(1) Health care provided in long-term hospitals is paid in the 2nd half of 2001 according to the contractual agreement between the health insurance company and the healthcare establishment according to the list of performance.
(2) A different method of payment than that provided for in paragraph 1 may be possible if the total amount of remuneration is higher than the payment provided for in paragraph 1 and the treatment facility of the long-term sick and health insurance undertaking has agreed on such a method of reimbursement on the basis of a proposal from the treatment facility of the long-term sick.
(3) The price of the point of payment for health care referred to in paragraph 1, set for the first half of 2001, remains valid for the second half of 2001.6)
(4) The value of the overhead agreed in the contract with the health insurance company, assigned to the point value of the treatment date No 00024 included in the performance list, shall be increased by 60 points compared to the 2nd half of 2000.
(5) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 10 compared to the 2nd half of 2000.
(1) Health care provided in health care establishments reporting on treatment day No 00005, listed in the performance list, shall be paid in accordance with the contractual arrangement between the health insurance undertaking and the healthcare establishment in accordance with the performance list in the second half of 2001.
(2) A method of payment other than those referred to in paragraph 1 may be used where the total amount of remuneration is higher than the payment provided for in paragraph 1 and the health care institution and the health insurance undertaking have agreed, on a proposal from the health care establishment, on such a method of payment.
(3) The price of the point for reimbursement of health care referred to in paragraph 1, set for the first half of 2001, remains valid for the second half of 2001.7)
(4) The value of the overhead agreed in the contract with the health insurance company, assigned to the point value of the treatment day No 00005 included in the performance list, shall be increased by 60 points compared to the 2nd half of 2000.
(5) The flat-rate amount to be paid for medicinal products under Section 17 (12) of the Act is increased by CZK 10 compared to the 2nd half of 2000.
(1) Reimbursement of urgent health care, unless a contract is concluded between a healthcare establishment and a health insurance company, is carried out in the second half of 2001 for the health performance provided as follows:
(a) dental outpatient care shall be paid at the rates applicable to dental care provided by dental practitioners in the 2nd half of 2001;
(b) other healthcare is paid according to the performance list and the health insurance company may apply regulatory mechanisms on the basis of the Act (8) similar to those for contractual health establishments.
(2) The price of the point for reimbursement of health care referred to in paragraph 1 (b), established for the first half of 2001, remains valid for the second half of 2001.9)
This Decree shall take effect on 1 July 2001.
Minister:
Prof. MUDr. Fisher, CSc.
Příloha č. 1
Annex No. 1 to Decree No. 211 / 2001 Coll.
Procedure for calculating the flat rate, the amount and the conditions for reimbursement referred to in Article 2 (1) (a) and (b)
(A) Procedure for determining the flat rate payment:
1. The reimbursement of health care provided by bed facilities shall include:
(a) the payment of emergency bed care recorded in hospitalisation accounts, including the relevant performance of the complement (hereinafter referred to as "hospitalisation payment");
(b) the payment of outpatient care recorded in outpatient accounts, including the relevant performance of the complement ("outpatient payment");
(c) reimbursement of the performance of health transport (hereinafter referred to as "transport payment"),
(d) the reimbursement of other health care performance, where provided by the bed establishment, of complements for other healthcare establishments or, where appropriate, other contracted performances ("other remuneration").
If one of these types of healthcare does not provide bed facilities, it is not part of the remuneration.
2. Procedure for establishing the flat rate for the first half of 2001:
The flat rate shall be calculated for the different types of healthcare referred to in points (1) (a) to (d) of the performance volume for the second half of 2000 which have been declared by the bedding establishment and recognised by the health insurance undertaking from 1 July 2000 to 31 May 2001 as follows:
The total volume of performance (points and separately charged medicinal products and separately charged material) is divided by the number of unique treated insured persons who have received health care in a bed establishment. A special insured person means one insured person, regardless of the number of times the number of times the bed establishment has shown health care on that insured person within a specified period of time. The performance and unique treatment of the insured person shall be calculated separately for each type of remuneration referred to in points 1 (a) to (d).
The flat rate shall include:
(a) the number of points per special insured person,
b) flat rate for separately charged medicinal products and separately charged material, on 1 special treated insured person, in CZK.
2.1. Flat rate hospitalisation
PHB
where:
PHB = number of points per unique treated insured person for the 2nd half of 2000
BH = the number of points for all medical performance provided in hospitalisation, including points per patient category, for the 2nd half of 2000 of the bed facility in question, which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001, except for points:
(a) for medical performance paid in the second half of 2001 in excess of the flat rate of hospitalisation or included in another flat rate;
(b) for recognised and recognised health performance provided in the course of hospitalisation in experts no longer contracted for the second half of 2001.
PHZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 to hospitalised insured persons per unique treated insured person.
ZH = remuneration for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 to hospitalised insured persons who have been declared by the bed establishment and recognised by the health insurance company between 1 July 2000 and 31 May 2001, except for separately charged material and specifically charged medicinal products:
(a) paid in the second half of 2001 in excess of the flat rate of hospitalisation or included in another flat rate;
(b) provided during hospitalisation in experts who are no longer contracted for the second half of 2001.
UH = number of unique treated insured persons who were hospitalised in the 2nd half of 2000 and who received the health benefits provided to them by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001.
2.2. Outpatient flat rate
PAB
where:
PAB = number of points per unique treated insured person for the 2nd half of 2000.
BA = number of points for all medical performance provided in ambulances, for the 2nd half of 2000, which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001, except for points:
(a) for the medical performance paid in the 2nd half of 2001 in excess of the flat rate outpatient or included in another flat rate;
(b) for recognised and recognised health performance provided in ambulances in expert matters no longer contracted for the second half of 2001.
PAZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 in ambulances treated to insured persons on 1 unique treated insured person.
ZA = reimbursement for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 in ambulances treated to insured persons who have been declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001, except for separately charged material and specifically charged medicinal products:
(a) paid during the second half of 2001 in excess of the flat rate outpatient or included in another flat rate;
(b) provided in ambulances in experts who are no longer contracted for the second half of 2001.
UA = number of unique treated insured persons who were treated in ambulances in the 2nd half of 2000 and who were provided with health benefits that were declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001.
2.3. Flat rate for health transport
PDB = INDIVIDUD PDZ = INDIVIDUAL
where:
PDB = number of points per unique treated insured person for the 2nd half of 2000
BD = the number of points for all medical performance provided for health transport in the 2nd half of 2000 of the bed establishment in question, which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001, except for points:
(a) for medical performance paid in the second half of 2001 in excess of the flat rate for health transport or included in another flat rate;
(b) for declared and recognised health performance in health transport which are no longer contracted for the second half of 2001.
PDZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 for medical transport transported and, where applicable, treated insured persons to 1 special treated insured person.
ZD = reimbursement for the specifically charged medicinal products and the separately charged material provided in the 2nd half of 2000 for the transport of medical goods transported and, where applicable, treated insured persons who have been declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001, except for the material separately charged and the medicinal products separately charged:
(a) paid during the second half of 2001 in excess of the flat rate for health transport or covered by another flat rate;
(b) provided for in the performance of health transport operations no longer contracted for the second half of 2001.
UD = number of unique treated insured persons who were transported in health transport during the 2nd half of 2000 and, where appropriate, treated and the medical performance provided to them was declared by bed facilities and recognised by the health insurance company from 1 July 2000 to 31 May 2001.
2.4. Flat rate for other health performance
PJB
where:
PJB = number of points per unique treated insured person for the 2nd half of 2000
BJ = the number of points for all other medical performance provided in the second half of 2000 of the bed establishment in question, which have been declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001, except for points:
(a) for medical performance paid in the 2nd half of 2001 in excess of the flat rate for other medical performance or included in another flat rate;
(b) for recognised and recognised other medical performance provided by experts no longer contracted for the second half of 2001.
PJZ = flat rate for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 for other health benefits to insured persons on 1 special treated insured person.
ZJ = reimbursement for separately charged medicinal products and separately charged material provided in the 2nd half of 2000 for other health benefits to insured persons who have been declared by the bed establishment and recognised by the health insurance company between 1 July 2000 and 31 May 2001, except for the material separately charged and the medicinal products separately charged:
(a) paid in excess of the flat rate for other medical performance or included in another flat rate;
(b) provided for other health performance in expertise which are no longer contracted for the second half of 2001.
UJ = number of unique treated insured persons who received other health benefits in the 2nd half of 2000, which were declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001.
3. Calculation of flat rate remuneration per point
The calculation of the flat-rate remuneration for 1 point is based on the individual rate of remuneration for 1 point in the second half of 2000, which is adjusted for a differentiated increase in the remuneration in 3 bands (as referred to in point 3.2).
3.1 The individual amount of remuneration for 1 point (IVUB) for the 2nd half of 2000 represents the proportion of the total remuneration, excluding the medicinal products specifically charged and the material separately charged, to 1 point. It shall be determined according to the following formula:
IVUB2.pol.2000 = Z2.pol.2000
where:
REMUNERATION 2.pol.2000 = remuneration for all medical performance provided, including patient category, provided by the bed establishment in question in the second half of 2000, which was declared and recognised from 1 July 2000 until 31 May 2001; This remuneration shall not include the medical performance which is paid in excess of the flat rate in the 2nd half of 2001.
Z2.pol.2000 = remuneration for the medicinal products separately charged and the material separately charged, excluding the medicinal products separately charged and the material separately charged, paid in excess of the flat rate provided in the 2nd half of 2000, which were declared by the hospital and recognised by the health insurance company from 1 July 2000 to 31 May 2001.
BODY2.pol.2000 = the number of points for health performance and for the patient category provided by the bed establishment in question in the second half of 2000, which were declared by the bed establishment and recognised by the health insurance company from 1 July 2000 to 31 May 2001; These points do not include points for health performance which are paid in excess of the flat rate in the second half of 2001.
3.2 The flat-rate remuneration for 1 point (PUB) for the second half of 2001 is based on the individual amount of remuneration for 1 point recorded for the second half of 2000. The following shall be determined:
a) if the calculated IVUB is less than CZK 0.89, then the PUB for the 2nd half of 2001 is CZK 0.89,
b) if the calculated IVUB is equal to 0,89 CZK or less or equal to 0,99 CZK, add to this IVUB 0,01 CZK (PUB = IVUB + 0,01),
(c) if the calculated IVUB is equal to or greater than CZK 1, the calculated IVUB (PUB = IVUB) shall be used.
4. Calculation of total remuneration for healthcare provided
4.1 The flat-rate payment for the different types of healthcare referred to in points (1) (a) to (d) per single treated insured person shall be made by multiplying the number of points per unique treated insured person by the flat-rate payment per point (PUB) and by adding the amount of the flat-rate for the medicinal products separately charged and the materials separately charged per single treated insured person.
The calculation of the flat-rate remuneration per single insured person for each type of healthcare referred to in points 1 (a) to (d) for the second half of 2001 is as follows:
PHU = (PHB x PUB) + PHZ
PAU = (PAB x PUB) + PAZ
PDU = (PDB x PUB) + PDZ
PJU = (PJD x PUB) + PJZ
where:
PHU = flat-rate hospitalisation payment for 1 special insured person
PAU = flat-rate outpatient payment for 1 special insured person
PDU = flat-rate transport payment per special insured person
PJU = flat-rate other remuneration per special insured person
4.2. The remuneration for the different types of healthcare referred to in points 1 (a) to (d) shall be calculated by multiplying the flat-rate payment per single treated insured person by the number of individuals treated in the reporting period as follows:
HU = PHC x UHV
AU = PAC x UAV
DU = PDC x UDV
JU = PJC x UJV
where:
HU = hospitalisation remuneration
AU = outpatient remuneration
DU = transport payment
JU = other remuneration
UHV = number of hospitalised unique treated insured persons to whom health care has been provided reported in the 2nd half of 2001 and recognised by the health insurance company
UAV = number of unique treated insured persons to whom outpatient health care has been provided reported in the 2nd half of 2001 and recognised by the health insurance company
UDV = number of unique insured persons to whom health transport has been provided reported in the 2nd half of 2001 and recognised by the health insurance company
UJV = number of unique insured persons to whom other performance has been provided reported in the 2nd half of 2001 and recognised by the health insurance company
4.3 The total remuneration (CU) is the sum of each type of remuneration:
CU = HU + AU + DU + JU
The total remuneration is also part of the remuneration of the performance pursuant to § 2 (6) of this Decree.
5. Calculation of reimbursement in regulation of the prescription of medicinal products and medical devices:
In addition, regulatory mechanisms based on a comparison of the average remuneration for prescribed medicinal products and medical devices to 1 insured person between the 2nd half of 2000 and 2nd half of 2001 shall be applied to the calculation of the total remuneration of healthcare referred to in point 4.3. Medicinal products and medical devices authorised by a revision physician are excluded from the comparison.
5.1 Where the average remuneration for prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2001, excluding medicinal products and medical devices authorised by a revision doctor, exceeds 102% of the average reference remuneration for the prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2000, a reduction of 60% of the total excess calculated as the product of the treated number of insured persons during the period and the amount of the excess of the costs of the medicinal products and medical devices for 1 treated insured person shall be set at 102% of the average reference remuneration for the medicinal products and medical devices for 1 treated insured person.
5.2. If the average payment for the prescribed medicinal products, medical devices for 1 treated insured person in the 2nd half of 2001 does not reach 102% of the average reference remuneration, which consists of payment for the prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2000, except for medicinal products and medical devices approved by the revised doctor, the remuneration for the 2nd half of 2001 will be increased by 40% of the savings achieved. This saving shall be calculated as the product of the treated number of insured persons during the period and the amount of the underutilisation of the costs of medicinal products and medical devices per insured person, compared to 102% of the average reference remuneration for medicinal products and medical devices per insured person.
6. Provision of a monthly advance
The sickness insurance company shall provide a monthly advance of 106% of one sixth of the amount of the remuneration paid to the bed establishment in the second half of 2000.
B) When determining the remuneration according to the performance list
1. The method of payment referred to in Article 2 (1) (b) may be applied only to sleeper establishments where there is a significantly fluctuating amount of healthcare provided by public health insurance, where it is not possible to set a flat rate for the reference period due to a small number of insured persons of the relevant health insurance company and where on average the sleeper establishments do not charge one health insurance company more than CZK 300 000 per calendar quarter.
2. If the Contracting Parties agree, this option may also be chosen in case of higher billing volumes, but the condition of fluctuating health care provided must be fulfilled.
Příloha č. 2
Annex No 2 to Decree No 211 / 2001 Coll.
Procedure for calculating the flat rate and payment in a combined manner, the amount and conditions of the payment referred to in Article 3 (1) (a) and (b)
A) Procedure for determining the flat rate reimbursement for healthcare
The remuneration is 110% of the comparison amount. The comparative amount of remuneration shall be equal to the remuneration for the healthcare provided in the corresponding 2nd half of 2000, declared and recognised from 1 July 2000 to 31 May 2001, and shall not include the remuneration for the healthcare provided during the comparative period in cases where such treatment is no longer provided in the professional hospital or is otherwise paid.
1. The 110% payment shall be made only on condition that the number of treatment days declared in the second half of 2001 is at least 95% of the number of treatment days declared in the second half of 2000. In the event that the professional treatment institution accounts for less than 95% of the treatment days thus determined, the fixed flat rate for the second half of 2001 for bed care shall be reduced by a percentage by which the limit of the number of treatment days has not been met.
2. Calculation of reimbursement in regulation of the prescription of medicinal products and medical devices:
2.1 Where the average remuneration for the prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2001, excluding medicinal products and medical devices approved by a revision doctor, exceeds 102% of the average reference remuneration for the prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2000, a reduction of 60% of the total excess calculated as the product of the treated number of insured persons during the period and the amount of the excess of the costs of the medicinal products and medical devices for 1 treated insured person shall be set at 102% of the average reference remuneration for the medicinal products and medical devices for 1 treated insured person.
2.2 If the average payment for the prescribed medicinal products, medical devices for 1 treated insured person in the 2nd half of 2001 does not reach 102% of the average reference remuneration, which consists of payment for the prescribed medicinal products and medical devices for 1 treated insured person in the 2nd half of 2000, except for medicinal products and medical devices approved by the revised doctor, the remuneration for the 2nd half of 2001 will be increased by 40% of the savings achieved. This saving shall be calculated as the product of the treated number of insured persons during the period and the amount of the underutilisation of the costs of medicinal products and medical devices per insured person, compared to 102% of the average reference remuneration for medicinal products and medical devices per insured person.
(B) When determining the remuneration in a combined manner:
The combined method of payment shall be used for professional medical institutions which are only contracted in bed care for the medical performance of the type of treatment day or, where applicable, the performance to be reported as income and discharge tests according to the performance list.
1. The bed care will be paid for by payment for the treatment day and for the performance reported by income and discharge tests according to the list of performances.
2. Outpatient care, health transport and other health performance will be paid at a flat rate. The flat rate shall be calculated on the basis of the output volume for the 2nd half of 2000 declared by the medical institution and recognised by the health insurance undertaking from 1 July 2000 to 31 May 2001 as follows:
The total volume of health performance (points and separately charged medicinal products and separately charged material) shall be divided by the number of unique treated insured persons who have received health care at the medical institution. A single insured person shall mean a single insured person regardless of the number of times the professional medical institution has declared that insured person within the prescribed period of medical care. The benefits and unique treatment of insured persons are calculated separately for outpatient care, health transport and other health performance.
The flat rate shall include:
(a) the number of points per special insured person,
b) a flat rate for separately charged medicines and separately charged material per special treated insured person in CZK.
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Regulation Information
| Citation | Decree of the Ministry of Health No. 211 / 2001 Coll., determining the amount of health care payments paid from public health insurance including regulatory restrictions for the 2nd half of 2001 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 27.06.2001 |
|---|---|
| Effective from | 01.07.2001 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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