Kancelář ZP

Czech legal acts dealing with entitlements of the insured and rights of patients

-          Act No. 48/1997 Coll., Public Health Insurance Act

-          Act No. 372/2011 Coll., Healthcare Services Act

-          Act No. 373/2011 Coll., Specific Healthcare Services Act

-          Act No. 374/2011 Coll., Emergency Medical Services Act

-          Act No. 258/2000 Coll., Public Health Protection Act

-          Ordinance of the Ministry of Health No. 98/2012 Coll., on medical documentation

-          Convention on Human Rights and Biomedicine (downloadable here)

All the legal acts in power can be accessed here.

Legal acts of the EU concerning the entitlements of the insured and rights of patients

-          Regulation (EC) No 883/2004 of the European Parliament and of the Council on the coordination of social security systems

-          Regulation (EC) No 987/2009 of the European Parliament and of the Council laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems

-          Directive No 24/2011 of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare

These European legal acts can be accessed here.

Czech legal acts governing the area of resolution of disputes:

-          Act No. 89/2012 Coll., Civil Code

-          Act No. 99/1963 Coll., Civil Procedure Code

-          Act No. 500/2004 Coll., Administrative Procedure Code

-          Act No. 150/2002 Coll., Administrative Justice Code

-          Act No. 372/2011 Coll., Healthcare Services Act

-          Act No. 220/1991 Coll., of the Czech National Council, on the Czech Medical Chamber, the Czech Dental Chamber and the Czech Pharmacists' Chamber

-          Act No. 549/1991 Coll., Court Fees Act

-          Act No. 40/2009 Coll., Criminal Code

-          Act No. 141/1961 Coll., Criminal Procedure Code

All the legal acts in power can be accessed here.

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A Brief Summary of the Czech Public Health Insurance System:

1. Who is insured?

The Czech public health insurance system is based on obligatory participation of insured persons . There is no possibility of voluntary participation. Every person is insured individually, there are no derived rights („family insurance“) in cases limited to the territory of Czech Republic.   

The following persons are obligatorily insured only according to the national law:

-          People with the permanent residence in the territory of the Czech Republic (automatically all the Czech citizens)

-          Employees of employers based in the territory of the Czech Republic

The following persons are also obligatorily insured on the basis of European social security coordination rules (EU Regulation 883/2004 and 987/09) and principle of equal treatment with Czech citizens:

- self-employed persons from other EU - countries, active in the territory of Czech Republic and covered by Czech social security legislation

- employees from other EU states, working on Czech territory for employer based in other EU- country, if they are covered by Czech social security legislation

- non-active family members of  migrant workers from other EU states insured in the Czech Republic

2. Who pays the contributions?

1. The employee and employer pay altogether 13.5% of the gross income of the employee. The employee pays 4.5% and the employer 9% of it. Overall amount of contribution is paid to the fund of employee by his/her employer.

2. Self-employed persons pay 13.5 % of 50% of their profit. The minimum contribution is 2393 CZK per month.

3. People without a taxable income (f.e. housewives) pay their contributions themselves. The monthly contribution is 2052 CZK.

4. The State pays the contributions for unemployed, pensioners, students, women on the maternity leave, women taking care of one child less than 7 years old or more children less than 15 years old, prisoners, soldiers and people receiving social security benefits.

The State pays the contributions for 58% of the population. The amount of state contribution is regulated by Czech government. Currently the State pays for the state insured persons 1767 CZK per month.

Every health insurance company collects the contributions directly from employers, employees, self-employed and people without a taxable income.

The State pays the contributions to the so called Redistribution Fund. The collected contributions are divided to the individual health insurance companies.

3. Health Insurance Structure:

The Czech health insurance system is administered by seven health insurance companies.

The biggest one, Všeobecná zdravotní pojišťovna /The General Health Insurance Company/, covers approx. 60% of the population. Its ability to pay is guaranteed by the State. Its activities are governed by a special law called Act on the General Health Insurance Company. The other health insurance companies are governed in their activities by the Act on Employee Insurance Companies.

Each insured person can change his/her health insurance company twice a year.

Health insurance companies are not allowed to make profit.

Although it was the original intention that health insurance companies should be competitive in their various services, they don’t have much space for their competition at present.

4. Healthcare Covered by Health Insurance

• preventive care
• diagnostic care
• ambulant and hospital care, including rehabilitation and care of chronic diseases
• dental care
• medicines and medical aids
• patient transport
• spa care

Only the basic material and treatment is paid in the case of a dental treatment.

Only a small part of healthcare is excluded from the health insurance, for example cosmetic surgery without any health reason.

Medical aids are paid from the health insurance fully or partially.

5. Contracts with Healthcare Providers

There are regular frame negotiations among the representatives of healthcare providers, health insurance companies, hospital associations, scientific organisations and patient associations. The so called framework contracts are the result of these negotiations.

The health insurance companies make their own contracts with particular healthcare providers based on these framework contracts. The conditions set in these individual contracts can be partly different.

A healthcare provider can make a contract with more or even with all of the health insurance companies.

Only a very small percentage of healthcare providers has no contract with any health insurance company.

Healthcare costs are paid to contracted provider directly by health insurance company (patient mostly doesn´t need to pay any part of the cost to provider).

6. Financial participation of the patient

Every insured person (or his/her legal representative) is obliged to pay the regulatory fee of CZK 90 for emergency care that was provided by the first aid medical service including first aid medical service provided by the dentists.

The legal act also specifies the exceptions from this rule, when the insured person does not have the obligation to pay the regulatory fees – resulting hospitalisation.

Financial limits on partially covered medicines

If the total amount of supplementary payments paid for partially covered medicines by the insured person (or his/her legal representative) exceeds 5.000 CZK per a calendar year, the health insurance company is obliged to pay the insured person (or his/her legal representative) back the exceeding amount no later than 60 days after the end of the calendar quarter in which the limit was exceeded.

The overall limit for children under the age of 18 and for pensioners 65-70 years old is 1.000 CZK per a calendar year. The limit for pensioners above 70 years of age is 500 CZK.

Only the supplementary payments for prescribed medicaments and nourishments fully or partially covered by the health insurance that were issued on the territory of the Czech Republic.

The healthcare provider has to issue a document confirming a payment of the regulation charge only upon a request of the insured person (or his/her legal representative).

7. Overall expenses of the health insurance system

The yearly expenses of the Czech health insurance system represent about 9 billion EUR (Overall healthcare expenses represent 10 billion EUR).

The average yearly expenses of health insurance funds are about 900 EUR per capita.

The financial participation of patients in overall costs of healthcare is about 17 % in average. It concerns medicaments and dental care above all.

Metodika provádění pravidelného očkování

Metodika provádění pravidelného očkování v roce 2018 upravuje způsob zajištění a proces provádění pravidelných povinných plošných očkování, včetně očkování určeného jen pro některé rizikové skupiny obyvatel – pojištěnců. Metodika je zpracována na základě jednání mezi zdravotními pojišťovnami a zástupci PL a PLDD. Je určena pro smluvní poskytovatele zdravotních služeb i zdravotní pojišťovny.

Příloha: Metodika provádění pravidelného očkování

Metodický postup k vykazování očkování

V metodickém postupu jsou zpracována platná znění § 30 zákona č. 48/1997 Sb., o veřejném zdravotním pojištění, vyhlášky č. 537/2006 Sb. o očkování proti infekčním nemocem, Sdělení MZ o antigenním složení očkovacích látek a další dokumenty týkající se distribuce očkovacích látek a provádění očkování. Metodický postup je zpracován ve spolupráci Svazu zdravotních pojišťoven, VZP a zástupců PZS.

Příloha: Metodický postup k vykazování očkování od 17. 12. 2020

Pacienti v riziku za všechny sledované organizace

Podíl pacientů s dekubitem na celkový počet pacientů

Rozdělení dekubitů podle stupňů

Po letech

Celkové od roku 2009

Výskyt pacientů s dekubitem na celkový počet pacientů dle oborů
(započtena pouze ta pracoviště, kde se vyskytl dekubit)

Historie

Přípravou a rozvojem ukazatelů kvality zdravotních služeb v ČR se v letech 2009 -2013 zabývalo již Národní referenční centrum, které je jedním z předchůdců Kanceláře zdravotního pojištění.

Slibně rozvíjející se proces byl bohužel z vnějších politicko-ekonomických důvodů v roce 2013 přerušen.

Přesto v jeho průběhu vznikla řada dokumentů a výstupů, na které může Kancelář ZP v mnoha ohledech navázat, včetně Katalogu ukazatelů kvality (naposledy revidovaného v roce 2012).   

Vzhledem k velkému významu přípravy a měření ukazatelů pro zdravotní pojištění a zdravotní pojišťovny došlo na začátku roku 2019 rozhodnutím Rady Kanceláře (složené ze statutárních zástupců ZP) k obnovení prací. KZP tak byla pověřena dlouhodobou agendou přípravy, rozvoje, měření a sledování ukazatelů kvality zdravotních služeb v oblasti zdravotního pojištění. 

Katalog ukazatelů NRC 2012

Současný stav agendy

Kancelář zdravotního pojištění připravuje Katalog ukazatelů kvality zdravotních služeb pro rok 2020 z nemocniční i ambulantní oblasti.

V průběhu roku 2019 byla v rámci Kanceláře připravena a projednána základní metodika, byl vytvořen tým odborníků ZP, pověřených řešením této problematiky řediteli zdravotních pojišťoven, byly vytvořeny expertní panely složené ze zástupců plátců i klinických odborníků k projednání ukazatelů v jednotlivých oblastech, byly revidována řada dříve zpracovaných objemových ukazatelů a zahájena příprava ukazatelů v dalších, dříve nezpracovaných oblastech, včetně ukazatelů výsledkových. Již zpracované ukazatele jsou dostupné zdravotním pojišťovnám na portálu statistik KZP.

V současnosti probíhá druhá fáze řešení, v jejímž rámci je ve spolupráci s MZ a ZP řešena klíčová otázka dalšího dlouhodobého a systémového využití ukazatelů a dalších výstupů. Pro tento účel bylo připraveno zpřístupnění výstupů dotčeným poskytovatelům (s anonymizací výsledků ostatních PZS). Souběžně je diskutováno využití ukazatelů pro oblast horizontálních strategií (prevence, struktura, akreditace apod.), smluvní politiku zdravotních pojišťoven, nebo zavádění nových služeb do úhrad a vykazování.

Kancelář ZP spolupracuje na přípravě ukazatelů s řadou odborných společností, kterým patří za jejich úsilí o transparentnost a zvýšení kvality poskytovaných služeb veliký dík! Zároveň vyzýváme zástupce dalších odborných společností, kteří by měli o spolupráci zájem, aby se nás nezdráhali kontaktovat. Kancelář je členem pracovní skupiny pro kvalitu, vedené p. ministrem zdravotnictví. Jemu a jeho spolupracovníkům proto též patří velký dík za podporu a spolupráci. 

Metodika přípravy, rozvoje a revize ukazatelů

On 29.1.2020, the European Parliament approved the Agreement on the withdrawal of the United Kingdom of Great Britain and Northern Ireland from the European Union. In the area of ​​social security and hence health insurance, this means that the current European rules - Regulations on the coordination of social security systems Nos 883/2004 and 987/2009, will continue to apply after 31 January 2020. These rules enshrine, inter alia, the principle of single insurance, govern the use of the European Health Insurance Card and the provision of the necessary care based on it, the use of forms S1, E106, E109 and E121 for taking healthcare in full extent in the State of residence, or the provision of planned healthcare (S2 or E112 forms) or determination of applicable legislation (A1 form). These rules will apply for a transitional period - until the end of 2020. Thereafter, they will only apply to situations that arose before the end of 2020. The exact course of action after 2020 will also depend on whether and how the future EU-UK relations will be adapted.

Prague, 30.1.2020

JUDr. Ladislav Švec, director

According to current information, the United Kingdom is to leave the European Union on 31.1.2020. Given the variability of the situation, it is still uncertain how exactly Brexit will happen. There are still three scenarios for health insurance, each affecting health insurance and the provision of health services to Czech insured persons in the UK and UK insured persons in the Czech Republic in a different way. The information will change over time, so please check the current situation.

Read more: Brexit