Česky
What do you see as the biggest problem with the current health care reimbursement system?
The unnecessary complexity and unpredictability of the method and amount of reimbursement (annual validity), the permanent fixation of historical injustices that affect benchmarks, the total amount of reimbursement, regulatory mechanisms, etc.
Paradoxically, the facility in question is worse off because the reimbursement does not rise in line with client interest. There is still talk of payment going to the patient, but we remain in the grip of flat-rate reimbursement methods. The provider has no idea whether they will get paid if they provide care to multiple clients (if at all, if in full, and at the appropriate value of the costs incurred). There is also the problem of financial risk that is knowingly transferred to the provider. The provider should be providing the quality of care that is needed, but should also be entitled to proper reimbursement. It should not be constantly looking for solutions to fit within financial limits and ceilings on who gets treatment and who does not, especially when everyone is entitled to it.
Would you be in favour of repealing the reimbursement decree, why yes, why no? What is the alternative?
Yes and no. The decree ceases to fulfil its role, instead of being an entitlement minimum and an insurance policy it becomes a mantra and a maximum that cannot be gone beyond. Insurance companies cease to have contractual reimbursement discretion with more room to take into account local specifics and the needs of providing care to a particular locality.
It is set up for facilities with steady production, dealing with averages rather than pointing the direction and finding a way to account for increased client interest or specifics in care delivery.
Abolishing it would allow for negotiations with insurers on reimbursement terms that could reflect local specificities and take account of increased client interest or respond more flexibly to changes. On the other hand, there is a concern about uncontrolled payer behaviour, where, as part of a "stronger" contractual party, insurers could push for reductions in reimbursement at which it would no longer be possible to provide health services, and there is a risk of monopolies and cartel agreements. Presumably, the laws regarding the obligations of insurers and insureds would need to be modified.
What pitfalls or threats do you see in the upcoming reimbursement decree for 2018?
Probably, unfortunately, all the problematic things from the previous decree will remain (see above), payment will still not follow the patient, historically created inequalities will remain fixed, the average provider will be the best off, the specifics in providing care will not be taken into account, different point values across segments will persist, as opposed to straightening the system and rationalizing the list of procedures, etc.
What is your view on the union's proposal to introduce pay scales everywhere in the health sector, including private facilities?
Efforts in the sense of "everything for everyone" are perhaps outdated. They impede contractual freedom and deny individual autonomy and the function of competition and the market.
What should be the first thing to change in the health sector in the next government that emerges from the autumn elections?
There is more. They should straighten out the premium payments, especially for the state insured and the self-employed (minimums), which are very low in relation to employee contributions, for example. This should bring some additional much needed funding into the system. Allowing the insured to pay for part of their care (medicines, supplies, intervention by another method, etc.) over and above the care covered by their insurance.
Allowing the insured to decide for themselves where they receive their care, thus becoming the financial carrier for the provider. The insured person should be allowed to pay the difference between the amount of care guaranteed by the insurer and the provider's contracted price, should the latter be higher. At the same time, this would make the insurance relationship between the insured and his health insurer functional, shifting the responsibility for his behaviour to the insured, not to the provider. The provider would not bear the risk of not being reimbursed for care properly provided.
