Decree No. 71 / 2018 Coll.
Ordinance on Adjustable Parameters for the Redistribution of Public Health Insurance Funds for 2019
Valid
Effective from 01.05.2018
71
DECLARATION
of 23 April 2018
on adjustable parameters for the allocation of public health insurance funds for 2019
The Ministry of Health and the Ministry of Finance provides pursuant to Section 21f (a) of Act No. 592 / 1992 Coll., on Insurance for Public Health Insurance, as amended by Act No. 145 / 2017 Coll., hereinafter referred to as "the Act ':
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 necessary for the calculation of the calculated redistribution parameters are data on:
(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. 64 / 2018 Coll., on how to value 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 use, when processing the data referred to in paragraph 1, anonymisation tables which shall be provided to them by the administrator of the central register of insured persons no later than 2 months before the deadline referred to in the first sentence.
Efficacy
This Decision shall enter into force on 1 May 2018.
Minister for Health:
Mgr. et Mgr. Vojtěch v. r.
Minister of Finance:
JUDr. Schiller, Ph.D., v. r.
Příloha č. 1
Annex No 1 to Decree No 71 / 2018 Coll.
Adjustable redistribution parameters
The adjustable redistribution parameters in accordance with Section 20a (2) of the Act used for the calculation of calculated redistribution parameters effective from 1 January 2019 to 31 December 2019 shall be 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 | GLA | Glaukom | S01E | |
| 2 | THY | Poruchy štítné žlázy | H03A, H03B | |
| 3 | PSY | Antipsychotika, Alzheimerova choroba, léčba závislostí | N05A mimo (N05AL03, N05AN01), N06DA, N06DX01, N07BB, N07BC51 | |
| 4 | DEP | Léčba antidepresivy | N06A mimo (N06AA09, N06AX21) | ne, pokud zároveň PSY |
| 5 | CHO | Hypercholesterolémie | C10 mimo (C10AC01, C10BX03) | ne, pokud zároveň DM1, DM2,DMH |
| 6 | DMH | Diabetes s hypertenzí | A10 a zároveň C02 mimo (C02KX, C02CA04), C03 mimo (C03CA01), C07, C08 mimo (C08CA06), C09 | |
| 7 | COP | Těžké astma, chronická obstrukční choroba plic | R03AC18, R03AK03, R03BB | |
| 8 | AST | Astma | R03 mimo (R03AC18, R03AK03, R03BB, R03CA02, R03BC01, R03CC02, R03CC13) | ne, pokud zároveň COP |
| 9 | DM2 | Diabetes typu II | A10 | ne, pokud zároveň DM1, DMH |
| 10 | EPI | Epilepsie | N03 mimo (N03AX12, N03AX16, N03AE01) | |
| 11 | CRO | Crohnova choroba, ulcerózní kolitida | A07EA06, A07EC02 | |
| 12 | KVS | Srdeční choroby | C01A, C01B, C01D, C01EB15, C01EB17, C03CA01 | |
| 13 | TNF | Revmatické choroby léčené inhibitory TNF | L04AA11, L04AA24, L04AB, L04AC | |
| 14 | REU | Revmatické choroby léčené jinak než inhibitory TNF | A07EC01, L01BA01, L04AA13, L04AX03, M01CB01, M01CC01, P01BA02 | ne, pokud zároveň TNF |
| 15 | PAR | Parkinsonova choroba | N04B | |
| 16 | DM1 | Diabetes typu I | A10A | ne, pokud zároveň DMH |
| 17 | TRA | Transplantace | L04AA06, L04AA10, L04AA18, L04AC02, L04AD01, L04AD02, L04AX01 | |
| 18 | CFP | Cystická fibróza a onemocnění exokrinní funkce pankreasu | J01GB01, J01XB01, R05CB13 | |
| 19 | CNS | Onemocnění mozku a míchy | L03AB07, L03AB08, L03AX13, L04AA23, M03BX01, M03BX02 | |
| 20 | ONK | Malignity | L01 mimo (L01BA01), L03AA, L03AC01, L04AX04 | |
| 21 | HIV | HIV, AIDS | J05AE, J05AF mimo (J05AF08, J05AF10, J05AF11), J05AG, J05AR, J05AX mimo (J05AX05) | |
| 22 | REN | Renální selhání | B03X, V03AE | |
| 23 | RAS | Léčba růstovým hormonem | H01AC01, H01AC03 | |
| 24 | HOR | Hormonální onkologická léčba | L02 | |
| 25 | 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 coefficient for the calculation of the hedging constant shall be 109.
4. The limits on the consumption of medicines for the inclusion of the insured person in the pharmaceutical cost group shall be 181.
Příloha č. 2
Annex No 2 to Decree No 71 / 2018 Coll.
Requirements for content, structure and format of data for the calculation of calculated redistribution parameters
1. Anonymous Tables
1.1 Entities
The administrator of the central register of insured persons shall establish, in accordance with points 1.2 to 1.5, a table 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 2016 and 31 December 2017 or part thereof as a public health insurance policy.
1.3 Structure Basic anonymization table
The data relating to the individual insured persons defined in point 1.2 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.
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 company in the structure referred to in point 1.3. 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 referred to in point 1.2.
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
The health insurance company shall establish, in accordance with points 2.2 to 2.5, 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 health insurance policy holders during the period from 1 January 2016 to 31 December 2017.
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 and identified by the health insurance undertaking during the period referred to in point 2.2 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 shall correspond to one entry in the period referred to in point 2.2 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.
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
According to points 3.2 to 3.5, the health insurance company shall establish a table containing cost data (hereinafter referred to as the "cost table ').
3.2. Time period
The cost table shall show the cost data reported in calendar year 2017.
3.3 Data range
The cost table shall include data on all insured persons who were listed in the registration table and who were insured by the health insurance undertaking concerned during the period referred to in point 3.2, 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 oceněné podle vyhlášky č. 64/2018 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.
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
The health insurance company shall establish, in accordance with points 4.2 to 4.5, a table containing data on the consumption of medicinal products (hereinafter referred to as the "consumption table ').
4.2. Time period
The consumption table contains data for the period from 1 January 2016 to 31 December 2017.
4.3. Data range
The table of consumption contains data on all insured persons who were listed in the registration table.
In the table of consumption, data on all consumption of mass-produced medicinal products during the period referred to in point 4.2 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 for the provision of health services and reported as specifically charged medicinal products are included.
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.
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. 71 / 2018 Coll., on Adjustable Parameters of the Redistribution of Public Health Insurance Funds for 2019 |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 27.04.2018 |
|---|---|
| Effective from | 01.05.2018 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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