The Act regulates public health insurance, the scope and conditions under which medical services are covered, the method of determining prices and reimbursement of medicinal products by health insurance, and the method of determining the payment of medical devices prescribed on a voucher paid from health insurance.
Key Elements of the Framework:
- Foundational Acts and Objectives:
- The Act on Public Health Insurance (No. 48/1997 Coll.) establishes the core framework for providing health insurance to citizens, defining the services covered and the responsibilities of insurers and insured individuals.
- The Act on the General Health Insurance Company (No. 551/1991 Coll.) and the Act on Sectoral and Corporate Insurance Companies (No. 280/1992 Coll.) delineate the structure and roles of insurance providers.
- Healthcare Service Reimbursement:
- A series of government regulations and decrees, such as No. 134/1998 Coll., No. 187/2000 Coll., and their annual updates, provide a detailed methodology for determining the point values of services and reimbursement amounts for healthcare providers. This ensures standardization and fairness in compensating healthcare services.
- Specialized Healthcare Provisions:
- Decrees like No. 59/1997 Coll. focus on specialized healthcare for children, while others, such as No. 2/2015 Coll., address spa and rehabilitation care. These measures ensure specific population groups receive tailored services.
- Regulation of Insurance Funds:
- Decree No. 418/2003 Coll. provides a comprehensive framework for managing public health insurance funds, including their income, expenditures, and conditions for their use. It aims to maintain financial sustainability while adhering to national health policies.
- Access and Equity:
- The Government Regulation No. 307/2012 Coll. ensures the local and temporal availability of health services, addressing disparities in access to care across regions.
- Framework Contracts and Professional Criteria:
- Decrees like No. 618/2006 Coll. establish framework contracts to define the responsibilities and rights of healthcare providers and insurance companies, while No. 2/2015 Coll. sets professional standards for specific healthcare services.
The full available legislation Act can be seen here.
