487/2000 Sb.
REGULATION OF THE GOVERNMENT
of 18 July 2003. December 2000,
fixing the value of the item and the amount of reimbursement of health care covered by the
public health insurance for 1. half-year 2001
The Government decrees referred to in § 17 paragraph. 5 of Act No. 48/1997 Coll., on public
health insurance and amending and supplementing certain related
laws, as amended by Act No. 2/1998 Coll. (hereinafter the "Act"):
§ 1
This regulation lays down the values of the point and the amount of reimbursement of health care paid for by
from public health insurance. half of 2001 for health care
in health care, including specialist medical
institutes for long-term patients, hospitals and medical facilities
returning under the list of health interventions
with point values, ^ 1) (hereinafter referred to as "the Ordinance"), the length of the day no. 00005
and the amount of the remuneration for the provision of emergency care in non-
medical facilities.
§ 2
(1) the Medical care provided in the medical facilities of the constitutional
care, with the exception of health care in specialised therapeutic institutes,
Sanatorium for long-term patients and in medical devices
returning the day care Decree No. 00005 (hereinafter referred to as "bed
device "), at 1. half of 2001 under contractual arrangements between pays
health insurance and in-patient facilities
and) flat-rate,
(b) according to the list of health performance) listed in the notice, or
(c) the design of the device socket) on the combined payment with the payment for the
the diagnosis.
(2) Inpatient facilities and health insurance company may agree on a different
the method of payment, than is provided for in paragraph 1, where the total amount of the remuneration
will be higher than the remuneration provided for in paragraph 1 (b). and) or (b)).
(3) the procedure for the calculation of flat rates, the amount of the value of the point and the conditions for reimbursement
referred to in paragraph 1 (b). and (b))) shall be established in annex 1 to this
of the regulation.
(4) the amount of remuneration referred to in paragraph 1 (b). (c)) shall negotiate in the contract between the
health insurance and the amount of fasility, payment
the provision of acute care will be provided with payment for the diagnosis and
other health care will be covered by a flat rate.
(5) If an inpatient facility and health insurance company will agree to supplement
contract, or out a new contract, containing new health performances
provided by the device, or will agree a new structure
Healthcare, health insurance is bound to these
in fact, the total amount of payments for 1. half of 2001 include.
(6) If, in the 1. half of 2001 income from a selection of premium
one insured higher than the approved plan provides a disability insurance
health insurance for the year 2001, will increase the health insurance company
the value of the point set out in annex 1 to this regulation, no so much per mile,
how much per mile increased premiums on the insured's choice of one over
the amount referred to in the health insurance plan. This increase in pay
health insurance lůžkovému devices to 30. November 2001.
(7) beyond the standard rates referred to in paragraph 1 (b). and health)
the insurance company will provide in the 1. half of 2001 cover
and for kardiovertry and later) for cardiac pacemakers, including electrodes,
provided in the case of reimplantací (performances no 55217 and 55219 referred to in
the Decree), which were provided in the 1. half of 2001,
(b)) for the neuromodulační enhancers that have been provided in the 1. half of the
2001 in the treatment of epilepsy and Parkinson's disease,
(c)) for neuromodulační promoters and intrathekální pumps, provided by
treatment of chronic painful conditions. half of 2001 in the bed
the establishments listed in the annex 3 to this Regulation [peripheral
nerve stimulation (PNS), stimulation of the spinal cord or the rear roots
(CCT), deep brain stimulation, and korová for the promoters of the front corners
Spinal (SARS) with transversálních lesions of spinal]; inpatient facilities
referred to in annex 3 to this Regulation may apply to the sum of the
health insurance companies in the Czech Republic up to 30 programmable
prostheses,
(d)) for the treatment of in vitro fertilization, which was granted in the 1. half of the
2001 sleeper devices implementing the standard treatment of sterility
her method of fertilization,
(e)) for the health centre performance no 18051, 18052, 18510, 18513,
18521, 18522, 18530, 18550, 18560, 18570, and 18590 18580 list
health procedures referred to in the Decree, which was provided in the 1.
half of 2001, in the amount of CZK 1 per point, with no performances for health.
18521, 18522, 18530, 18550, 18560, 18570, 18580 and 18590, referred to in
the Decree, provides for overhead costs in the amount of 4 points per minute,
(f)) for a particularly charged to medicinal products intended to treat hemophilia,
listed in annex 4 to this regulation, provided in the 1. half-year 2001
in the inpatient facilities,
(g)) of a particularly charged to medicinal products intended to treat HIV/AIDS
(antiretroviral medicinal products and medicinal products intended to treat
opportunistic infections), provided in the 1. half of 2001 in the bed
equipment listed in annex 5 to this regulation,
(h)), the medicinal product particularly charged Cerezyme, to treat disease
Morbus Gaucher, provided only the clinic of child and adolescent
Medicine of the General faculty hospital in Prague 1. half of 2001,
I) for health performance intensive care no 00651 00652,.,,, 00653 00656
00657 00658, 00661,, according to the list, 00665 00668 health performance
referred to in the Decree, granted in treating extensive burns at 1.
half of 2001, in the amount of CZK 1 per point in the bed of the establishments listed in the
Annex 6 to this regulation, as follows:
1. in adults
1.1 when Burns over 40% of the surface of the body,
1.2 when Burns over 10% of the surface of the body, while inhalation
popáleninovém trauma,
1.3 when Burns, electric shock,
2. for the children
2.1. from 2 to 5 years of age, when burns in the range above 10% of the surface of the body,
children from 6 to 10 years while Burns in the range of 15% of the surface of the body and the
children from 11 years of age in the range of burns over 40% of the surface of the body,
2.2 when inhalation popáleninovém trauma or burns electric
shock,
(j)) of a particularly charged given in medicinal products 1. half-year 2001
in the treatment of cystic fibrosis in in-patient establishments listed in annex No.
7 to this regulation; the list of medicinal products is charged separately
given in annex 8 to this regulation,
separately charged to) for medicinal products granted in 1. half of 2001 for
selected risk groups oncologically ill children treated at the
workplaces Pediatric Oncology inpatient establishments listed in the annex.
9 to this regulation; the list of medicinal products is charged separately
contained in annex 10 to this regulation.
§ 3
(1) the health care provided by specialised therapeutic institutes in 1.
half of 2001 according to the contractual arrangements between the paid by the health insurance company
and professional medical Institute
and) flat-rate, or
(b)) combined.
(2) the procedure for calculating the flat-rate remuneration and combined way, above
remuneration, the amount of the value of the point and the conditions for reimbursement referred to in paragraph 1 (b). and) and
(b)) shall be established in annex 2 to this regulation.
(3) if the professional therapeutic Institute and the health insurance company will negotiate a supplement
to the contract, or out a new contract, containing new health
performances, provided by professional medical Institute, or negotiating a new
the structure provided by the health care, health insurance company is required to
These facts in the total amount of payments for 1. half of 2001 include.
§ 4
(1) the health care provided in hospitals for long-term patients in the 1.
half of 2001 according to the contractual arrangements between the paid by the health insurance company
and medical facilities, according to the list of medical procedures referred to in
the Decree.
(2) the remuneration referred to in paragraph 1 shall be the value of the item in the amount of CZK 1.
(3) the value of the direction set out in the Decree, assigned to the point value
ošetřovacího of the day no. 00024 referred to in the Decree, is increased by 60 points
compared to the 1. half of the year 2000.
(4) the flat-rate amount shall be reimbursed medicinal products pursuant to § 17 paragraph.
6 of the Act, shall be increased by $ 10, compared to 1. half of the year 2000.
§ 5
(1) the health care provided in health facilities
returning the length of the day no. 00005 referred to in the decree in the 1.
half of 2001 according to the contractual arrangements between the paid by the health insurance company
and medical facilities, according to the list of medical procedures referred to in
the Decree.
(2) the remuneration referred to in paragraph 1 shall be the value of the item in the amount of CZK 1.
(3) the value of the direction set out in the Decree, assigned to the point value
ošetřovacího of the day no. 00005 referred to in the Decree, is increased by 60 points
compared to the 1. half of the year 2000.
(4) the flat-rate amount shall be reimbursed medicinal products pursuant to § 17 paragraph.
6 of the Act, shall be increased by $ 10, compared to 1. half of the year 2000.
§ 6
Reimbursement of emergency health care, if there is no contract between the
medical facilities and health insurance company, is in the 1. half-year 2001
performed by health performance as follows:
and) dental out-patient care are reimbursed according to the rates in force for
health care provided by dentists in the 1. half year 2001, ^ 2)
(b)) other health care are reimbursed by the health performance
referred to in the decree and the point value is determined in the amount of Czk 0.82;
the health insurance company may, on the basis of the law ^ 3) exercise regulatory
as with mechanisms of health care facilities.
section 7 of the
In cases where the number of points used for payment reported on the basis of
the list of medical procedures referred to in the Decree, valid until 30 June.
in June 2000, and at the same time point rating of these health interventions
different according to the list of medical procedures in force from 1 January. July 2000,
be translated at the point of performance evaluation of health 1. half of 2000 on
value according to the list of medical procedures in force from 1 January. July 2000.
§ 8
This Regulation shall enter into force on 1 January 2005. January 1, 2001.
The President of the Government:
Ing. Zeman in r.
Minister of health:
Prof. MUDr. Fisher, PhD. in r.
Annex 1
The calculation of remuneration, flat-rate, above the value of the point and the conditions
the remuneration pursuant to § 2 (2). 1 (a). and (b)))
And)
Procedure for determining the flat-rate remuneration:
1.
Reimbursement of healthcare provided by sleeper devices includes:
and acute care) remuneration reported on hospitalizačních accounts
including relevant performance complement (hereinafter referred to as the "hospital
remuneration "),
(b)) reimbursement of out-patient ambulatory care reporting on accounts, including
the relevant performance of the complement (hereinafter referred to as "ambulatory payment"),
(c) the reimbursement of transport performance), health (hereinafter referred to as "the remuneration of transport"),
(d) remuneration of other outputs) of health care, if the bed equipment
provides performance complement for other medical devices, where appropriate,
other contracted performances (hereinafter referred to as "other remuneration").
If any of these kinds of health care inpatient facilities
does not, then it is not part of the remuneration.
2.
Procedure for determining the flat-rate for 1. half of 2001:
The flat rate is calculated for each type of health care referred to in
point 1 (a). and (d))) of the amount of performance 1. half of the year 2000, which were
fasility reported and health insurance company recognized by 1. January
2000 to 30. November 2000, as follows:
The total volume of performances (and especially the points charged to medicinal products and
posted material) is divided by the number of unique treated policyholders,
who have been in inpatient facilities provided health care. Unique
the policyholder, which means a beneficiary, regardless,
How many times the bed on this device showed the insured person in specified
period of health care. Performances and unique treatment of insured persons are
be calculated separately for each type of remuneration referred to in paragraph 1 (b). and (d)).)
The flat rate includes:
and the number of points per 1) unique treated insured persons,
b) flat rate for a particularly charged medicinal products and separately billed
material on 1 unique treated policyholders, in CZK.
2.1 the lump-sum rate of inpatient
sum sum BH ZH
PHB =-------PHZ =-------
sum of the sum of the UH UH
where:
PHB = number of points per 1 insured persons treated for unique
1. half-year 2000
BH = the number of points for each hospitalization, including the points for
the category of the patient, for 1. half of the year 2000 of the bed
the devices, which were reported by the device
and health insurance company recognized by 1. January 2000 to
November 30, 2000, in addition to the points:
and health performances) paid in excess of the flat-rate
hospital or included in another flat-rate,
declared and recognized health performances provided when the
hospitalization in the fields of medicine, that are no longer for the
1. half 2001 contracted,
(b)) for the declared and recognised health performances provided when the
hospitalization in the fields of medicine, that are no longer for the
1. half 2001 contracted.
PHZ = flat rate for a particularly charged to medicinal products
and posted the material provided in the 1. half of the
2000, in addition to the insured hospitalized separately
posted in medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered above and beyond
flat rate includes or included in other
a flat rate, which have been reported by device
and health insurance company recognized by 1. January 2000 to
November 30, 2000 on 1 unique treated
the insured person.
ZH = remuneration for medicinal products and specially charged separately
posted material provided in 1. half-year 2000
hospitalized insured, in addition to the extra charged
medicinal products, and particularly of the posted material, which
are in the 1. half of 2001 paid in excess of the flat-rate
hospital or included in another flat rate,
that have been reported and health equipment Center
insurance recognised from 1. January 2000 to 30. November
2000.
UH = the number of unique treated policyholders who were
in the 1. half of 2000 provided them hospitalized and
health performance were fasility reported
and health insurance company recognized by 1. January 2000 to
November 30, 2000.
2.2 the flat rate for outpatient
sum sum for BA
PAB =-------PAZ =-------
the sum of the sum of the UA UA
where:
PAB = number of points per 1 insured persons treated for unique
1. half of the year 2000.
BA = number of points for all of the health performance
in the dispensaries, for 1. half of 2000 that were patient
the device reported and health insurance company recognized by
1 January 2000 to 30. November 2000, in addition to the points:
and health performances) paid in excess of the flat-rate
outpatient or included in another flat-rate,
(b)) for the declared and recognised health performances provided
in the dispensaries in the fields of medicine, that are no longer for the
1. half 2001 contracted.
PAZ = flat rate for a particularly charged to medicinal products
and posted the material provided in the 1. half of the
2000 in ambulances treated the insured, in addition to the particularly
posted in medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered over
beyond the standard rate for outpatient or included in other
a flat rate, which have been reported by device
and health insurance company recognized by 1. January 2000 to
November 30, 2000 on 1 unique treated
the insured person.
A = remuneration for medicinal products and specially charged separately
posted material provided in 1. half-year 2000
in ambulances treated the insured, in addition to the particularly
posted in medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered over
beyond the standard rate for outpatient or included in other
a flat rate, which have been reported by device
and health insurance company recognized by 1. January 2000 to
November 30, 2000.
UA = the number of unique treated policyholders who were
in the 1. half of 2000 in ambulances treated and jim
provided by the health services which have been patient
the device reported and health insurance company recognized by
1 January 2000 to 30. November 2000.
2.3 the flat rate for medical transport
the sum of the BD sum ZD
PDB =-------PDZ =------
sum sum UD UD
where:
PDB = number of points per 1 insured persons treated for unique
1. half-year 2000
BD = number of points for all of the health performance
medical transport in the 1. half of the year 2000 of the bed
the devices, which were reported by the device
and health insurance company recognized by 1. January 2000 to
November 30, 2000, in addition to the points:
and health performances) paid in excess of the flat-rate
for medical transport or included in another flat-rate
rates,
(b)) for the declared and recognised health performances provided when the
medical transport in the fields of medicine, which are no longer
for the 1. half of 2001 contracted.
PDZ = flat rate for a particularly charged to medicinal products
and posted the material provided in the 1. half of the
2000 in the medical transport insurance policy holders, in addition to the treated
separately charged of medicinal products and
the posted material, which are in the 1. half-year 2001
paid in excess of the flat-rate shipping for health
or included in another flat rate, which have been
fasility reported and health insurance company
recognised from 1. January 2000 to 30. November 2000 on
1 unique treated policyholders.
ZD = remuneration for medicinal products and specially charged separately
posted material provided in 1. half-year 2000
medical transport of the insured, in addition to the specially treated
posted in medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered over
framework of a flat rate for health or shipping included
in another flat rate, which were fasility
reported and health insurance company recognized by 1. January
2000 to 30. November 2000.
UD = the number of unique treated policyholders who were
in the 1. half of 2000 in the medical transport, transported,
where appropriate, treated and health performances
were reported and health equipment Center
insurance recognised from 1. January 2000 to 30. November
2000.
2.4 the flat rate for other health performances
sum sum REV. BJ
PJB =-------PJZ =-------
sum sum UJ UJ
where:
PJB = number of points per 1 insured persons treated for unique
1. half-year 2000
BJ = number of points for all other health performances
in the 1. half of the year 2000, the socket device, which were
fasility reported and health insurance company
recognised from 1. January 2000 to 30. November 2000, in addition to
points:
and health performances) paid in excess of the flat-rate
for other medical performance or included in other
flat-rate,
(b)) for the declared and recognised by other medical performance provided
in the fields of medicine, that are no longer for 1. half of the
2001 contracted.
PJZ = flat rate for a particularly charged to medicinal products
and posted the material provided in the 1. half of the
2000 when other medical procedures, which
the insured, in addition to specially charged to medicinal products
and especially of the posted material, which are in the 1. half of the
2001 paid in excess of the flat-rate tariffs for other health
performance or included in another flat rate, which have been
fasility reported and health insurance company
recognised from 1. January 2000 to 30. November 2000 on
1 unique treated policyholders.
ZJ = remuneration for medicinal products and specially charged separately
posted material provided in 1. half-year 2000
other health insurance policy holders, which, in addition to performance
separately charged to medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered above and beyond
flat rates for other health performance or included
in another flat rate, which were fasility
reported and health insurance company recognized by 1. January
2000 to 30. November 2000.
UJ = the number of unique treated policyholders, which were
in the 1. half of 2000 provided other health services
that have been reported and health equipment Center
insurance recognised from 1. January 2000 to 30. November
2000.
3.
The determination of the amount of the flat-rate payment for 1 point
For the 1. half of 2001 the amount of flat-rate payments for the 1 point for
specific inpatient facilities. This is based on the amount of individual payments for 1
in point 1. half of the year 2000, which modifies a differentiated increase of the remuneration
in 3 zones (described in section 3.2).
3.1 the individual amount of remuneration for the 1 point (IVCB). half-year 2000
represents the proportion of the total remuneration without separately charged
medicinal products and especially the posted material on 1 point.
It is determined by the following formula:
the sum of PAYMENT-from
1.2000 2000 1.
IVCB = -----------------------------------
1. the sum of 2000 POINTS.
1.2000
where:
REMUNERATION 1.2000 = remuneration for all health
the performances, including the categories of the patient,
provided by the in-patient facilities
in the 1. half of the year 2000, that have been reported
and recognised from 1. January 2000 to
November 30, 2000, to the remuneration
not health services
are in the 1. half of 2001 covered above and beyond
flat rate.
1.2000 = remuneration separately charged medicinal
preparations and posted the material,
In addition to specially charged to medicinal
products and especially the posted material,
paid in excess of the flat-rate,
provided by the in 1. half of the year 2000, which
were reported by device
and health insurance company recognized by
1 January 2000 to 30. November 2000.
POINTS 1.2000 = number of points in the health, transport
performances and for the category of patient provided
the fasility in 1. half of the
2000 fasility
reported and health insurance accepted
from the 1. January 2000 to 30. November 2000.
3.2 the lump-sum payment for 1 point for 1. half of 2001 (VCB) consists of
individual amount of remuneration for 1 point, recorded a 1. half of the year 2000.
Shall be determined as follows:
and if the calculated IVCB) is less than $ 0.89 then VCB for 1.
half of 2001 is $, 0.89
(b)) if the calculated IVCB is equal to 0.89 Eur or less than or equal to 0.99
CZK, added to this price 0.01 Kč (VCB = IVCB + 0.01)
(c)) if the calculated IVCB is equal to or higher than CZK 1, the
the calculated price (VCB = IVCB).
The flat-rate payment for 1 item must be increased in cases referred to in § 2
paragraph. 6 of this government regulation.
4.
The calculation of the total remuneration for provided health care
4.1 the lump-sum payment for different types of health care referred to in section 1
(a). and (d))) up to 1 unique treated the insured person is made up of
by multiplying the number of points on 1 unique treated the insured a lump
remuneration for 1 point and by adding the volume of flat rates for a particularly charged
medicinal products and separately charged materials paid on 1 unique
treated policyholders.
The calculation of the lump-sum payment to the insured for 1 unique treated
different types of health care referred to in point 1 (a). and (d))) up to 1.
half of 2001 is the following:
PHC = (PHB * VCB) + PHZ
PAC = (PAB * VCB) + PAZ
PDC = (PDB * VCB) + PDZ
PJC = (PJD * VCB) + PJZ
where:
PHC = lump sum payment to the hospital 1 unique
treated insured persons
PAC = standard outpatient reimbursement on 1 unique treated
the insured's
PDC = flat-rate remuneration of transport on 1 unique treated
the insured's
PJC = flat-rate reimbursement on the other 1 unique treated
the insured's
4.2 payment for different types of health care referred to in section 1
(a). and (d))) will be calculated so that the flat-rate payment on
1 the insured multiplied by the number of unique treated unique
the treated policyholders in the reporting period, as follows:
HU = PHC TO UHV
AU = PAC OF UAV
DU = PDC * UDV
JU = OF THE UJV PJC
where:
HU = hospital reimbursement
AU = outpatient reimbursement
DU = transportation reimbursement
JU = other remuneration
UHV = the number of inpatients treated with the unique
insured persons who have been granted medical care,
reported at 1. half of 2001 and recognised health
the insurance company
UAV = the number of unique treated policyholders who have been
outpatient health care, reported
in the 1. half of 2001 and recognised health insurance
UDV = the number of unique treated policyholders who have been
health right provided, reported in 1. half of the
2001 and recognised health insurance
UJV = the number of unique treated policyholders, which other
the performances given, reported in 1. half of 2001 and recognised
health insurance company
4.3 the total remuneration (CU) is the sum of the individual types of payments:
CU = HU + AU + DU + JU
Part of the total remuneration are on payment procedures under section 2
paragraph. 5 of this government regulation.
5.
Calculation of the remuneration in regulating the prescription of medicinal products and
medical devices:
In the calculation of the total health care payments according to section 4.3 on
apply regulatory mechanisms, which are based on a comparison of average
the reimbursement of prescribed medicines and medical devices to 1
treated policyholders between 1. half of 2000 and 1. half of 2001. From
the comparison excludes medicinal products and medical devices
revision approved by the doctor.
5.1 in the event that the average payment for prescribed medicines and
medical devices to 1 in 1. insured persons treated, or in the 2.
quarter of 2001, in addition to medicinal products and medical devices
approved review physician exceeds 102% of the average of the reference
remuneration, which is made up of remuneration for the prescribed medicines and
medical devices on the 1-in-1 the insured person treated. half of the year 2000,
the reduction shall be fixed in the amount of 60% of the total, which exceeded
calculated as the product of the number of insured persons treated in the period and the amount of
exceeding the cost of medicinal products and medical devices to 1
treated insured persons compared to 102% of the average of the reference remuneration for medicinal
products and medical devices to 1 treated policyholders.
5.2 If the average payment for prescribed medicines, medical
resources on 1 the insured person in the treated 1. half of 2001 has reached 102
% of the average of the reference remuneration, which is made up of remuneration for prescribed
medicinal products and medical devices to 1 the insured person treated in
1. half of the year 2000, in addition to medicinal products and medical devices
the review will be approved by a physician, payment for the 1. half of 2001 increased
about 40% of savings. This saving is calculated as the product of the treated
the number of insured persons in the period and amount of the costs to the Betterment of the medicinal
products and medical devices to 1 the insured compared to treated
102% of the average of the reference remuneration for medicinal products and medical
resources on 1 the insured person treated.
6.
Monthly backup will provide a health insurance company in the amount of lůžkovému equipment
106% one sixth volume of payment that have been this lůžkovému device
paid in 1. half of the year 2000.
(B))
When determining the remuneration referred to in the list of medical procedures referred to in
the Decree
1.
Point value is determined in the amount of Czk 0.89.
2.
Method of payment according to § 2 (2). 1 (a). (b)) may be applied only for the bed
the device, which is significantly fluctuating volume provided by the health care
paid from public health insurance, where it is not possible to establish
flat rate over the reference period because of the small number of treated
competent health insurance policyholders and where inpatient facilities in
average of one health insurance company charged more than 300 000 CZK
the calendar quarter.
3.
If the Contracting Parties agree, this variant can choose
the case of the higher volume of the Bill, however, must be met
within the volume of the provided health care.
Annex 2
Procedure for calculating the flat-rate remuneration and combined way, above
remuneration, the amount of the value of the point and the conditions for reimbursement under section 3 (3). 1 (a). and)
and (b))
And)
Procedure for determining the flat-rate payments for health care
Remuneration is 110% of the volume of the comparison of remuneration. Matching the volume of payment
is equal to the payment for health care provided in the appropriate 1.
half of the year 2000, declared and recognised from 1. January 2000 to 30. November
2000, and the comparison of the volume is not remuneration for
provided health care in the comparison period, in cases where this
the care is no longer in the treatment provided to the Institute, or is paid
otherwise.
1.
The condition of the above remuneration for provided health care is that the reported
the number of care days in the 1. half of 2001 must be at least 95% of the number of
care days reported in 1. half of the year 2000. In the event that the professional
therapeutic Institute reports less than 95% of care days provided for,
will be provided for the total lump-sum rate for 1. half of 2001 under the bed
care has been reduced by a percentage which was filled with a fixed limit to the number of
care days.
2.
Calculation of the remuneration in regulating the prescription of medicinal products and
medical devices:
2.1. In the case that the average payment for prescribed medicines and
medical devices to 1 in 1. insured persons treated, or in the 2.
quarter of 2001, in addition to medicinal products and medical devices
approved review physician exceeds 102% of the average of the reference
remuneration, which is made up of remuneration for the prescribed medicines and
medical devices on the 1-in-1 the insured person treated. half of the year 2000,
the reduction shall be fixed in the amount of 60% of the total, which exceeded
calculated as the product of the number of insured persons treated in the period and the amount of
exceeding the cost of medicinal products and medical devices to 1
treated insured persons compared to 102% of the average of the reference remuneration for medicinal
products and medical devices to 1 treated policyholders.
2.2 If the average payment for prescribed medicines, medical
resources on 1 the insured person in the treated 1. half of 2001 has reached 102
% of the average of the reference remuneration, which is made up of remuneration for prescribed
medicinal products and medical devices to 1 the insured person treated in
1. half of the year 2000, in addition to medicinal products and medical devices
the review will be approved by a physician, payment for the 1. half of 2001 increased
about 40% of savings. This saving is calculated as the product of the treated
the number of insured persons in the period and amount of the costs to the Betterment of the medicinal
products and medical devices to 1 the insured compared to treated
102% of the average of the reference remuneration for medicinal products and medical
resources on 1 the insured person treated.
(B))
When remuneration combined way:
1.
Inpatient care will be paid for by payment for day care and for performances,
which show the receipt and examinations referred to in the list of the layoff
health procedures referred to in the notice. Point value is CZK 1. This
method of payment shall apply only to specialized therapeutic institutes, which are
contracted health-care-only performances of the day.
2.
Outpatient care and medical transportation will be covered by a flat rate.
The flat rate is calculated from the volume of performance 1. half of the year 2000, which
Professional therapeutic Institute have been reported and recognized health insurance
from the 1. January 2000 to 30. November 2000, as follows:
The total volume of health performance (especially the healing post points
preparations and posted material) is divided by the number of unique
insured persons who have been treated in the specialized treatment of the Institute granted
health care. Unique products treated with the policyholder shall mean one
beneficiary, regardless of how many times the professional therapeutic Institute reported on
of the insured person within a specified period of time health care. Performances and
the unique treatment of insured persons shall be calculated separately for outpatient care and
medical transport.
The flat rate includes:
and the number of points per 1) unique treated insured persons,
b) flat rate for a particularly charged medicinal products and
posted material on 1 unique treated insured persons
in CZK.
2.1 the lump-sum rate of outpatient
sum sum for BA
PAB =-------PAZ =-------
the sum of the sum of the UA UA
where:
PAB = number of points per 1 insured persons treated for unique
1. half-year 2000
BA = number of points for all of the health performance
in the dispensaries in the 1. half of 2000 the vocational
treatment of the Institute, which has been recognized and acknowledged by
1 January 2000 to 30. November 2000, in addition to the points:
and health performances) paid in excess of the flat-rate
outpatient or included in another flat-rate,
(b)) for the declared and recognised health performances provided
in the dispensaries in the fields of medicine, that are no longer for the
1. half 2001 contracted.
PAZ = flat rate for a particularly charged to medicinal products
and posted the material provided in the 1. half of the
2000 in ambulances treated the insured, in addition to the particularly
posted in medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered above and beyond
flat rate for outpatient or included in another flat-rate
the rate, which has been a professional therapeutic Institute reported
and health insurance company recognized by 1. January 2000 to
November 30, 2000 on 1 unique treated
the insured person.
A = remuneration for medicinal products and specially charged separately
posted material provided in ambulances treated
the insured, in addition to specially charged to medicinal products
and especially of the posted material, which are in the 1. half of the
2001 paid in excess of the standard rate for outpatient or
included in the other flat rate and were granted
in the 1. half of the year 2000 and that have been reported and recognized by
1 January 2000 to 30. November 2000.
UA = the number of unique treated policyholders who were
in the 1. half of 2000 in ambulances treated and health
the performances were recorded and recognised from 1. January 2000 to
November 30, 2000.
2.2 the flat rate for medical transport
the sum of the BD sum ZD
PDB =-------PDZ =------
sum sum UD UD
where:
PDB = number of points per 1 insured persons treated for unique
1. half-year 2000
BD = number of points for all of the health performance
medical transport in the 1. half of 2000 the vocational
treatment of the Institute, which has been recognized and acknowledged by
1 January 2000 to 30. November 2000, in addition to the points:
and health performances) paid in excess of the flat-rate
for medical transport or included in another flat-rate
rates,
(b)) for the declared and recognised health performances provided when the
medical transport in the fields of medicine, which are no longer
for the 1. half of 2001 contracted.
PDZ = flat rate for a particularly charged to medicinal products
and posted the material provided in the 1. half of the
2000 in the medical transport insurance policy holders, in addition to the treated
separately charged to medicinal products and especially the posted
the material, which are in the 1. half of 2001 covered above and beyond
flat rate for medical transport or included in other
a flat rate, which were qualified medical Institute
reported and health insurance company recognized by 1. January
2000 to 30. November 2000 to 1 unique treated
the insured person.
ZD = remuneration for medicinal products and specially charged separately
posted material provided in the medical transport
treated separately charged to the insured, except medicinal
products, and particularly of the posted material, which are
in the 1. half of 2001 paid in excess of the flat-rate tariffs for
medical transport or included in another flat rate
and were provided in the 1. half of 2000 and which were
recorded and recognised from 1. January 2000 to 30. November
2000.
UD = the number of unique treated policyholders who were
in the 1. half of 2000 in the medical transport, transported,
where appropriate, treated and health performances have been reported
and recognised from 1. January 2000 to 30. November 2000.
3.
The determination of the value of the point value of 1 point. half of 2001 (CB)
fixed in the amount of Czk 0.89.
4.
Calculation of the remuneration for health care
The flat-rate payment for outpatient care and health services on 1 unique
treated the insured person is made by multiplying the number of points on 1 of the unique
treated the insured's flat-rate remuneration for 1 point and by adding volume
a flat rate for a particularly charged medicinal products and separately charged
materials paid on 1 unique treated policyholders.
4.1 calculation of the lump-sum payment on 1 unique treated
the insured person for each of the types of health care for
1. half of the year 2001 is as follows:
PAC = (PAB * CB) + PAZ
PDC = (PDB * CB) + PDZ
where:
PAC = standard outpatient reimbursement on 1 unique treated
the insured's
PDC = flat-rate remuneration of transport on 1 unique treated
the insured's
4.2 payment for outpatient care and medical transport
calculated so that the flat-rate payment shall be multiplied by the number of
unique treated policyholders in the reporting period,
as follows:
AU = PAC OF UAV
DU = PDC * UDV
where:
AU = outpatient payment = payment DU transport
UAV = the number of unique treated policyholders who have been
outpatient health care, reported
in the 1. half of 2001 and recognised health insurance
UDV = the number of unique treated policyholders who have been
health right provided, reported in 1. half of the
2001 and recognised health insurance
4.3 the total remuneration (CU) is the sum of outpatient (AU)
and transportation reimbursement (DU):
CU = AU + DU
4.4 Further performances are part of the remuneration of health under section 3
paragraph. 3 of this government regulation.
5.
Calculation of the remuneration in regulating the prescription of medicinal products and
medical devices:
In the calculation of the total remuneration of health care referred to in section 4 shall apply
regulatory mechanisms that are based on a comparison of the average of the remuneration
at the prescribed medicinal products and medical devices to 1
treated policyholders between 1. half of 2000 and 1. half of 2001. From
the comparison excludes medicinal products and medical devices
revision approved by the doctor.
5.1 in the event that the average payment for prescribed medicines and
medical devices to 1 in 1. insured persons treated, or in the 2.
quarter of 2001, in addition to medicinal products and medical devices
approved review physician exceeds 102% of the average of the reference
remuneration, which is made up of remuneration for the prescribed medicines and
medical devices on the 1-in-1 the insured person treated. half of the year 2000,
the reduction shall be fixed in the amount of 60% of the total, which exceeded
calculated as the product of the number of insured persons treated in the period and the amount of
exceeding the cost of medicinal products and medical devices to 1
treated insured persons compared to 102% of the average of the reference remuneration for medicinal
products and medical devices to 1 treated policyholders.
5.2 If the average payment for prescribed medicines, medical
resources on 1 the insured person in the treated 1. half of 2001 has reached 102
% of the average of the reference remuneration, which is made up of remuneration for prescribed
medicinal products and medical devices to 1 the insured person treated in
1. half of the year 2000, in addition to medicinal products and medical devices
the review will be approved by a physician, payment for the 1. half of 2001 increased
about 40% of savings. This saving is calculated as the product of the treated
the number of insured persons in the period and amount of the costs to the Betterment of the medicinal
products and medical devices to 1 the insured compared to treated
102% of the average of the reference remuneration for medicinal products and medical
resources on 1 the insured person treated.
Annex 3
A list of bed establishments-center for the treatment of chronic pain
States
+--+--------+---------------------------------+----------+
| # | IDN | The name of the registered equipment | Head Office |
+--+--------+---------------------------------+----------+
|1. | 00023884 | Homolce Hospital | Prague 5 |
+--+--------+---------------------------------+----------+
|2. | 00064203 | Teaching hospital in motol | Prague 5 |
+--+--------+---------------------------------+----------+
|3. | 61,383,082 | Central military hospital Prague | Prague 6 |
+--+--------+---------------------------------+----------+
|4. | 00159816 | The University Hospital. Anna | Brno |
+--+--------+---------------------------------+----------+
| 5. | 65,269,705 | Faculty hospital Brno | Brno |
+--+--------+---------------------------------+----------+
| 6 | 00098892 | Faculty hospital Olomouc | Olomouc 5 |
+--+--------+---------------------------------+----------+
Annex 4
List of proprietary medicinal products for the treatment of hemophilia,
which are covered in the form of medicinal products, particularly those posted above
beyond the flat rate
+---+-------------------------------------+---------------------+
|č. | Code Name | The add-on name |
+---+-------------------------------------+---------------------+
' |1 '. BEBULIN TIM 4 03051 | | inj sic 1x600ut + sol |
+---+-------------------------------------+---------------------+
|2. 03052 BEBULIN TIM 4 | | inj sic 1 x 1.2 ku + sol |
+---+-------------------------------------+---------------------+
| 3. 08607 BEBULIN TIM 4 | | inj sic 1x200ut + sol |
+---+-------------------------------------+---------------------+
| 4. | 1000UT | BERIATE 44999 P inj sic 1ku + 10 ml |
+---+-------------------------------------+---------------------+
| 5. | 1000UT | BERIATE P 45000 inj sic 1ku + 10 ml |
+---+-------------------------------------+---------------------+
| 6. | 250UT | BERIATE 45001 P inj sic 250ut + 2.5 ml |
+---+-------------------------------------+---------------------+
| 7. | 250UT | BERIATE 45002 P inj sic 250ut + 2.5 ml |
+---+-------------------------------------+---------------------+
| 8. | 500UT | BERIATE 45003 P inj sic 500ut + 5 ml |
+---+-------------------------------------+---------------------+
| 9. | 500UT | BERIATE 45004 P inj sic 500ut + 5 ml |
+---+-------------------------------------+---------------------+
| 10 | 59486 MONOCLATE-P | inj sic 1x250ut |
+---+-------------------------------------+---------------------+
| 11. | 59487 MONOCLATE-P | inj sic 1x500ut |
+---+-------------------------------------+---------------------+
12. | 59488 MONOCLATE-P | inj sic 1x1000ut |
+---+-------------------------------------+---------------------+
| 13. | 60379 HAEMOCTIN SDH 250 | 1x250ut + inj sic sol |
+---+-------------------------------------+---------------------+
| 14 | 60380 HAEMOCTIN SDH 500 | 1x500ut + inj sic sol |
+---+-------------------------------------+---------------------+
| 15 | 60381 HAEMOCTIN SDH 1000 | 1x1ku inj sic + solv. |
+---+-------------------------------------+---------------------+
| 16 | 75079 IMMUNINE 600I. E. | + 5 ml inj sic 1x600ut |
+---+-------------------------------------+---------------------+
| 17 | 75080 IMMUNINE 120I. E. | + inj sic 1.2 to 10 ml |
+---+-------------------------------------+---------------------+
| 18. | 83452 KOATE HP 250I. U. | + 5 ml lyo inj 1x250ut |
+---+-------------------------------------+---------------------+
| 19 | 83453 KOATE HP 500I. U. | + 5 ml lyo inj 1x500ut |
+---+-------------------------------------+---------------------+
| 20. | 83454 KOATE HP 1000I. U. | + 1000ut lyo inj 10 ml |
+---+-------------------------------------+---------------------+
| 21 | FACTOR IX 83781 P CENTEON 300UT | 300ut + 10 inj sic |
+---+-------------------------------------+---------------------+
| 22. | 83782 FACTOR IX P CENTEON 600UT | + 20 ml inj sic 600ut |
+---+-------------------------------------+---------------------+
| 23. | 83783 FACTOR IX P CENTEON 1200UT | inj sic 1.2 to + 30 ml |
+---+-------------------------------------+---------------------+
| 24 | 83785 HAEMATE P inj sic | 1x250ut |
+---+-------------------------------------+---------------------+
| 25 | 83786 HAEMATE P | 1x500ut inj sic |
+---+-------------------------------------+---------------------+
| 26. | HAEMATE inj 83787 P | 1x1ku sic |
+---+-------------------------------------+---------------------+
| 27. | 85676 FEIBA TIM 4 inj sic 1x500ut + sol |
+---+-------------------------------------+---------------------+
| 28. | 85677 FEIBA TIM 4 inj 1x1ku sic + solv. |
+---+-------------------------------------+---------------------+
| 29 | 87238 FANHDI 250 IU | inj sic 1x250ut + sol |
+---+-------------------------------------+---------------------+
| 30. | 87239 FANHDI 500 IU | inj sic 1x500ut + sol |
+---+-------------------------------------+---------------------+
| 31. | 87240 FANHDI 1000 IU | inj sic 1x1ku + sol |
+---+-------------------------------------+---------------------+
| 32. | 88335 HAEMATE P | inj sic 1x250ut |
+---+-------------------------------------+---------------------+
| 33. | 88336 HAEMATE P | inj sic 1x500ut |
+---+-------------------------------------+---------------------+
|. | 88337 HAEMATE P | inj sic 1x1ku |
+---+-------------------------------------+---------------------+
|. | 88800 PORCINE FACTOR VIII: C (HYATE: C) inj 20 ml/400-700ut |
+---+-------------------------------------+---------------------+
| 36. | 89027 IMMUNATE STIM PLUS 250 | inj sic 1x250ut + sol |
+---+-------------------------------------+---------------------+
|. | 89028 IMMUNATE STIM PLUS 500 | inj sic 1x500ut + sol |
+---+-------------------------------------+---------------------+
| 38 | 89029 IMMUNATE STIM PLUS 1000 | inj sic 1x1ku + solv. |
+---+-------------------------------------+---------------------+
|. | 89825 NOVOSEVEN 1.2 MG (= 60KU) inj sic 1 x 1.2 mg + sol |
+---+-------------------------------------+---------------------+
| 40. | 89826 NOVOSEVEN 2.4 MG (= 120KU) inj sic 1 x 2.4 mg + sol |
+---+-------------------------------------+---------------------+
|. | 91689 KRYOBULIN TIM 3 | + inj 1x1ku sic 40 ml |
+---+-------------------------------------+---------------------+
|. | 91690 KRYOBULIN TIM 3 | + inj 500ut sic 20 ml |
+---+-------------------------------------+---------------------+
|. | 91691 KRYOBULIN TIM 3 | + inj 250ut sic 10 ml |
+---+-------------------------------------+---------------------+
|. | 92641 NOVOSEVEN 4.8 MG (= 240KU) inj sic 1 x 4.8 mg + sol |
+---+-------------------------------------+---------------------+
|. | 97407, 250 I.U. | 1x250ut inj sic |
+---+-------------------------------------+---------------------+
|. | 97408, 500 I.U. | 1x500ut inj sic |
+---+-------------------------------------+---------------------+
Annex 5
The list of selected inpatient facility-center for the treatment of HIV/AIDS
+--+--------+------------------------+------------------------------------+
| # | IDN | The name of the registered equipment | Head Office | The workplace |
+--+--------+------------------------+----------------+-------------------+
|1. | 65,269,705 | Faculty hospital Brno | Brno-Bohunice | clinic infectious |
| | | | | diseases |
+--+--------+------------------------+----------------+-------------------+
|2. | 00179906 | University Hospital | Hradec Králové | infectious clinic |
+--+--------+------------------------+----------------+-------------------+
|3. | 00843989 | University Hospital | Ostrava-Poruba | clinic for treatment |
| | | first | infectious diseases ' | |
| | | | | & AIDS |
+--+--------+------------------------+----------------+-------------------+
|4. | 00669806 | University Hospital | Pilsen | AIDS Center |
| | | | infectious diseases clinic | |
+--+--------+------------------------+----------------+-------------------+
| 5. | 00064211 | University Hospital On | Prague 8 | AIDS Center |
| | | The NA bulovce hospital | infectious diseases clinic | |
+--+--------+------------------------+----------------+-------------------+
| 6 | 00673544 | Masaryk hospital | Ústí nad Labem | Department of portable |
| | | first | | diseases |
+--+--------+------------------------+----------------+-------------------+
| 7 | 00072711 | Hospital České Budějovice Czech | | infectious Department |
| | | České Budějovice | | Hospital |
+--+--------+------------------------+----------------+-------------------+
Annex 6
List of in-patient medical facilities-center for the treatment of burns
+--+--------+------------------------+----------------+--------------------+
| # | IDN | The name of the registered equipment | Head Office | The workplace |
+--+--------+------------------------+----------------+--------------------+
|1. | 00064173 | University Hospital | Prague 10 | Department of burns |
| | | Královské Vinohrady | | medicine |
+--+--------+------------------------+----------------+--------------------+
|2. | 00843989 | University Hospital | Ostrava-Poruba | Burns |
| | | first | | Center |
+--+--------+------------------------+----------------+--------------------+
|3. | 65,269,705 | Faculty hospital Brno | Brno | Center (clinic) |
| | | | | Burns and |
| | | | | Reconstructive |
| | | | | surgery |
+--+--------+------------------------+----------------+--------------------+
Annex 7
List of in-patient medical facilities-center for treatment of cystic
Fibrosis
+--+--------+-------------------------+--------------+--------------------+
| # | IDN | The name of the registered equipment | Head Office | The workplace |
+--+--------+-------------------------+--------------+--------------------+
|1. | 00064203 | University Hospital | Prague 5 | 2. The children's clinic |
| | | in motol | | THORN |
+--+--------+-------------------------+--------------+--------------------+
|2. | 65,269,705 | Faculty hospital Brno | Brno | Infectious diseases clinic of the DFN |
+--+--------+-------------------------+--------------+--------------------+
|3. | 00179906 | Faculty hospital Hradec | Hradec Králové | The children's clinic |
| | | Kings | | |
+--+--------+-------------------------+--------------+--------------------+
|4. | 00669806 | Faculty hospital Pilsen | Pilsen | The children's clinic |
+--+--------+-------------------------+--------------+--------------------+
| 5. | 00098892 | University Hospital | Olomouc | The children's clinic |
| | | Olomouc | and THORN clinic | |
+--+--------+-------------------------+--------------+--------------------+
Annex 8
The list of medicinal products for the treatment of cystic fibrosis, that are
paid in excess of the flat-rate
+---+-------------------------+------------------+
|č. | Kód | The name |
+---+-------------------------+------------------+
| Parenteral antibiotics: |
+---+-------------------------+------------------+
' |1 '. | 83736, 90485 | Netromycine |
+---+-------------------------+------------------+
|2. |, 03952, 11785 03951 | Amikin |
+---+-------------------------+------------------+
| 3. | 76353, 76354, 76355 | Fortum |
+---+-------------------------+------------------+
| 4. | 83487 | Meronem |
+---+-------------------------+------------------+
| 5. |, 84783 84784 | Tazocin |
+---+-------------------------+------------------+
| 6. |, 91560 91559, 96040 | Ciprobay, Ciprinol |
+---+-------------------------+------------------+
| 7. | 61178 | Colimycine |
+---+-------------------------+------------------+
| Pancreatic substitution: |
+---+-------------------------+------------------+
| 8. | 68989 | Kreon 25 000 |
+---+-------------------------+------------------+
| 9. | 44015 | Kreon 10000 |
+---+-------------------------+------------------+
| 10 | 97756 | Panzytrat 20 000 |
+---+-------------------------+------------------+
| Nutritional preparations: |
+---+-------------------------+------------------+
| 11. | 75588 | Paediasure |
+---+-------------------------+------------------+
12. | 75153 | Fantomalt |
+---+-------------------------+------------------+
| DNáza: |
+---+-------------------------+------------------+
| 13. | 77521 | Pulmozyn |
+---+-------------------------+------------------+
Annex 9
List of inpatient health care facility-workplaces for the treatment
oncologically ill children
+--+--------+---------------------------+-------+-------------------------+
| # | IDN | The name of the registered equipment | Head Office | The workplace |
+--+--------+---------------------------+-------+-------------------------+
|1. | 00064203 | Teaching hospital in motol | Prague 5 | Department of children's Oncology |
+--+--------+---------------------------+-------+-------------------------+
|2. | 65,269,705 | Faculty hospital Brno | Brno | Department of children's Oncology |
+--+--------+---------------------------+-------+-------------------------+
Annex 10
The list of medicinal products for the treatment of oncologically ill children, which
are paid in excess of the flat-rate
1. Erythropoietin
2. Interferon alpha,
3. the Interleukin 2,
4. Amifostin,
5. the Lipo-somatic Amphotericin B.
1) Decree No. 134/1998 Coll. issuing the list of health interventions
with point values, as amended by Decree No. 55/2000 Coll., Decree No.
135/2000 Coll. and Decree No 449/2000 Sb.
2) Journal of MZ amount No 13/2000.
§ 40 paragraph 3). 2 of Act No. 48/1997 Coll., on public health insurance
and amending and supplementing certain related laws, as amended by
amended.
