Decree No. 216 / 2020 Coll.
Ordinance on Adjustable Parameters for the Redistribution of Public Health Insurance Funds for 2021
Valid
Order
Effective from 30.04.2020
Text versions:
30.04.2020
29.04.2020
216
DECLARATION
of 27 April 2020
on the adjustable parameters for the reallocation of public health insurance funds for 2021
According to Section 21f (a) of Act No. 592 / 1992 Coll., on Insurance for Public Health Insurance, as amended by Act No. 145 / 2017 Coll.:
Adjustable redistribution parameters
Adjustable distribution parameters and their values are set out in Annex 1 to this Decree.
Content, structure and format of data transmitted
(1) The data for the calculation of the calculated redistribution parameters are those for:
(a) the anonymisation of the insured person in accordance with point 1 of Annex 2 to this Order;
(b) registered insured persons as referred to in point 2 of Annex 2 to this Order;
(c) the cost of health services valued in accordance with Decree No. 170 / 2020 Coll., on the method of measuring the cost of health services for the purpose of redistribution (hereinafter referred to as "cost data") according to point 3 of Annex 2 thereto; and
(d) the consumption of medicinal products as referred to in point 4 of Annex 2 to this Regulation.
(2) The requirements for the content, structure and format of the data referred to in paragraph 1 are set out in Annex 2 to this Decree.
(3) Health insurance companies shall send the data referred to in paragraph 1 to the Ministry of Health within the period laid down in Section 20c of the Act. Health insurance undertakings shall, when processing the data referred to in paragraph 1, use the anonymisation tables set out in Annex 2 to this Regulation which shall be provided to them by the administrator of the central register of insured persons no later than 2 months before the expiry of that period.
Efficacy
This Decision shall enter into force on 30 April 2020.
Minister for Health:
Mgr. et Mgr. Vojtěch, MHA, v. r.
Minister of Finance:
JUDr. Schiller, Ph.D., v. r.
Příloha č. 1
Annex No 1 to Decree No 216 / 2020 Coll.
Adjustable redistribution parameters and values
The adjustable parameters of the reallocation and their values pursuant to Section 20a (2) of the Act, used for the calculation of calculated redistribution parameters effective from 1 January 2021 to 31 December 2021, shall be determined as follows:
1. List of pharmaceutical cost groups in the format referred to in Section A (1) of Annex 2 to the Act
| Číslo | Kód | Název | Definiční skupiny léčiv | Vyřazovací pravidla |
|---|---|---|---|---|
| 1 | THY | Poruchy štítné žlázy | H03A, H03B | |
| 2 | PSY | Antipsychotika, Alzheimerova choroba, léčba závislostí | N05A mimo (N05AL03, N05AN01), N06DA, N06DX01, N07BB, N07BC51 | |
| 3 | DEP | Léčba antidepresivy | N06A mimo (N06AA09, N06AX21) | ne, pokud zároveň PSY |
| 4 | CHO | Hypercholesterolémie | C10 mimo (C10AC01, C10BX03) | ne, pokud zároveň DM1, DM2, DMH |
| 5 | DMH | Diabetes s hypertenzí | A10 a zároveň C02 mimo (C02KX, C02CA04), C03 mimo (C03CA01), C07, C08 mimo (C08CA06), C09 | ne, pokud zároveň DM1 |
| 6 | COP | Těžké astma, chronická obstrukční choroba plic | R03AC18, R03AK03, R03BB | |
| 7 | AST | Astma | R03 mimo (R03AC18, R03AK03, R03BB, R03CA02, R03BC01, R03CC02, R03CC13) | ne, pokud zároveň COP |
| 8 | DM2 | Diabetes typu II | A10 | ne, pokud zároveň DM1, DMH |
| 9 | EPI | Epilepsie | N03 mimo (N03AX12, N03AX16, N03AE01) | |
| 10 | CRO | Crohnova choroba, ulcerózní kolitida | A07EA06, A07EC02 | |
| 11 | KVS | Srdeční choroby | C01A, C01B, C01D, C01EB15, C01EB17, C03CA01 | |
| 12 | TNF | Revmatické choroby léčené inhibitory TNF | L04AA11, L04AA24, L04AB, L04AC | |
| 13 | REU | Revmatické choroby léčené jinak než inhibitory TNF | A07EC01, L01BA01, L04AA13, L04AX03, M01CB01, M01CC01, P01BA02 | ne, pokud zároveň TNF |
| 14 | PAR | Parkinsonova choroba | N04B | |
| 15 | DM1 | Diabetes typu I | A10A | |
| 16 | TRA | Transplantace | L04AA06, L04AA10, L04AA18, L04AC02, L04AD01, L04AD02, L04AX01 | ne, pokud zároveň CRO |
| 17 | CFP | Cystická fibróza a onemocnění exokrinní funkce pankreasu | J01GB01, J01XB01, R05CB13 | |
| 18 | CNS | Onemocnění mozku a míchy | L03AB07, L03AB08, L03AX13, L04AA23, M03BX01, M03BX02 | |
| 19 | ONK | Malignity | L01 mimo (L01BA01), L03AA, L03AC01, L04AX04 | |
| 20 | HIV | HIV, AIDS | J05AE, J05AF mimo (J05AF08, J05AF10, J05AF11), J05AG, J05AR, J05AX mimo (J05AX05) | |
| 21 | REN | Renální selhání | B03X, V03AE | |
| 22 | RAS | Léčba růstovým hormonem | H01AC01, H01AC03 | |
| 23 | HOR | Hormonální onkologická léčba | L02 | |
| 24 | NPP | Neuropatická bolest | N01BX04, N03AX12, N03AX16 |
2. A list of the combinations of the age group with the pharmaceutical-cost group and the two pharmaceutical-cost groups are not set out.
3. The value of the coefficient for the calculation of the hedging constant shall be set at 111.
4. The value of the limit of drug consumption for the inclusion of the insured person in the pharmaceutical cost group shall be 181.
Příloha č. 2
Annex No 2 to Decree No 216 / 2020 Coll.
Requirements for content, structure and format of data for the calculation of calculated redistribution parameters
1. Data on the anonymisation of the insured person
1.1 Entities
The administrator of the central register of insured persons shall establish, in accordance with points 1.2 to 1.5 of this Annex, tables containing information on the anonymisation of the insured person (hereinafter referred to as "the anonymisation table ').
1.2 Time period and range of data
The Anonymous Tables shall include records of all insured persons registered by the administrator of the central register of insured persons between 1 January 2018 and 31 December 2019 or part thereof as a public health insurance policy.
1.3 Structure Basic anonymization table
The data relating to individual insured persons as defined in point 1.2 of this Annex shall be reported as one entry of the table (data file row) in the following structure:
| Atribut | Typ | Popis |
|---|---|---|
| IDPoj | INT(10) | Anonymní identifikátor podle oddílu F přílohy č. 2 zákona |
| ČísloPojištěnce | CHAR(10) | Číslo pojištěnce přidělené zdravotní pojišťovnou |
The data format details and explanations are given in the description of the data interface in point 5 of this Annex.
1.4 Creating anonymisation tables for individual health insurance companies
The administrator of the central register of insured persons from the Basic Anonymisation Table shall establish 1 for each health insurance undertaking in the structure referred to in point 1.3 of this Annex. The Anonymisation Table for the health insurance undertaking shall contain data from the Basic Anonymisation Table on insured persons registered as insured persons of the health insurance undertaking concerned at least part of the period of time referred to in point 1.2 of this Annex.
1.5 Name of the transmitted file
The transferred files containing anonymisation tables for health insurance companies of the administrator of the central register of insured persons shall be called "Insurance Identification _ KZP.csv" where the code of the relevant health insurance undertaking shall be entered as KZP.
2. Data on registered insured persons
2.1 Entities
In accordance with points 2.2 to 2.5 of this Annex, the health insurance company shall establish a table containing details of its registered insured persons (hereinafter referred to as the registration table).
2.2. Time period
The registration table shall contain information on the insurance companies of a health insurance undertaking during the period from 1 January 2018 to 31 December 2019.
2.3 Data range
The registration table shall contain the information on the insured persons of the health insurance undertaking referred to in the anonymisation table referred to in point 1.1 of this Annex and identified by the health insurance undertaking during the period referred to in point 2.2 of this Annex or part thereof as its insured person.
2.4. Structure of the registration plate
In the registration table, each registration of the insured person in accordance with point 2.3 of this Annex shall correspond to one entry in the time period referred to in point 2.2 of this Annex or part thereof. An insurer is listed in the registration table several times if, during that period, he has ceased to be an insurer of a health insurance undertaking and then applied to that health insurance company again.
Data shall be entered in the registration table in the following structure:
| Atribut | Typ | Popis |
|---|---|---|
| IDPoj | INT (10) | Anonymní identifikátor podle oddílu F přílohy č. 2 zákona |
| Pojištěncem od | DATE | Datum začátku pojištění (registrace) |
| Pojištěncem do | DATE | Datum ukončení pojištění (registrace) |
| Rok narození | INT (4) | Rok narození |
| Měsíc narození | INT (2) | Měsíc narození |
| Pohlaví | CHAR (1) | Poslední dostupný údaj o pohlaví pojištěnce. Uvede se „M“ pro mužské pohlaví a „Z“ pro ženské. |
The data format details and explanations are given in the description of the data interface in point 5 of this Annex.
2.5. Name of the transmitted file
The transmitted file containing the registration table of the health insurance company shall be called "Insurance .csv."
3. Cost data
3.1 Entities
The health insurance undertaking shall establish, in accordance with points 3.2 to 3.5 of this Annex, a table containing cost data ("the cost table ').
3.2. Time period
The cost table shall show the cost data reported in calendar year 2019.
3.3 Data range
The cost table shall include information on all insured persons who were listed in the registration table and were insured persons of the health insurance undertaking concerned during the period referred to in point 3.2 of this Annex, even if the health insurance undertaking does not register any costs for those insured persons during that period.
3.4. Structure of the cost table
Each insured person shall have 1 record of the table (data file row) and the data shall be entered in the cost table in the following structure:
| Atribut | Typ | Popis |
|---|---|---|
| IDPoj | INT (10) | Anonymní identifikátor podle oddílu F přílohy č. 2 zákona |
| Náklady | INT | Náklady pojištěnce v období podle bodu 3.2 této přílohy oceněné podle vyhlášky č. 170/2020 Sb., o způsobu oceňování nákladů na zdravotní služby pro účely přerozdělování, zaokrouhlené na celé číslo podle matematických pravidel pro zaokrouhlování. |
The data format details and explanations are given in the description of the data interface in point 5 of this Annex.
3.5 Name of the transmitted file
The transmitted file containing the cost table will be called "Naklady.csv."
4. Information on the consumption of medicinal products
4.1 Entities
In accordance with points 4.2 to 4.5 of this Annex, the health insurance undertaking shall establish a table containing data on the consumption of medicinal products (hereinafter referred to as the "consumption table ').
4.2. Time period
The consumption table shall contain data for the period from 1 January 2018 to 31 December 2019.
4.3. Data range
The table of consumption contains data on all insured persons who were listed in the registration table.
The table of consumption includes data on all consumption of mass-produced medicinal products during the period referred to in point 4.2 of this Annex that have been prescribed and issued on the prescription and mass-produced medicinal products that have been consumed during the period referred to in point 4.2 of this Annex in the framework of the provision of health services and reported as specifically charged medicinal products.
The consumption table does not include data on the consumption of mass-produced medicinal products that have not been recognised by the health insurance company.
4.4. Structure of the consumption table
Each case of the issue or consumption of the medicinal product of each insured person shall be subject to one record of the consumption table (row of the dataset) and the data shall be entered in the consumption table in the following structure:
| Atribut | Typ | Popis |
|---|---|---|
| IDPoj | INT (10) | Anonymní identifikátor podle oddílu F přílohy č. 2 zákona |
| Kód HVLP | CHAR | Kód léčivého přípravku podle § 32 odst. 5 zákona o léčivech přidělený Státním ústavem pro kontrolu léčiv a zveřejněný jako součást seznamu registrovaných léčivých přípravků |
| Množství | DECIMAL | Počet vydaných nebo spotřebovaných balení léčivého přípravku, zaokrouhlený na dvě desetinná místa podle matematických pravidel pro zaokrouhlování |
| Datum poskytnutí léčivého přípravku | DATE | Datum vydání léčivého přípravku na recept či aplikace zvlášť účtovaného léčivého přípravku |
The data format details and explanations are given in the description of the data interface in point 5 of this Annex.
4.5 Name of the transmitted file
The transmitted file containing the table of consumption of the health insurance company shall be called "SpotrebaLeky.csv."
5. Description of the data interface
5.1 Data types
Description of data types:
CHAR - text string.
CHAR (n) - text string with maximum number of characters n.
Date - date in format YYYY-MM-DD, including introductory zeros.
INT - non-negative integer.
INT (n) - non-negative integer with a maximum number of digits n.
DECIMAL - decimal with a dot as a decimal symbol.
5.2 File Format
Each table is transmitted as a separate text file with the file ".csv." The file format is as follows:
Each record of the table is shown on one line in the text file.
Encoding file content: ASCII (characters with diacritics are not used).
Line separator: CR + LF.
The individual attributes of the line are separated by the symbol "ZV124;" (ascia code 124).
Values in table cells are not bounded by any text separators.
The table column names are not part of the file.
5.3 Data assembly for transmission
Files transmitted by health insurance companies are archived into a single file ".zip" entitled "KZP-RRR-MMD-Zip," where RRR-MM-DD is the date of creation of this file and the code of the health insurance company shall be entered as KZP.
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Regulation Information
| Citation | Decree No. 216 / 2020 Coll., on Adjustable Parameters for the Redistribution of Public Health Insurance Funds for 2021 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 29.04.2020 |
|---|---|
| Effective from | 30.04.2020 |
| Effective until | - |
| Status | Valid |
Legal Areas:
Civil law
Civil law substantive
The regulation text is for informational purposes only.
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