The Ministry of Health sends the long-awaited legislation to the preliminary observation procedure, which will optimise the use of health benefits so that the patient is primarily the beneficiary. At the same time, the amendment to the Health Insurance Act will make the financing of the health system more effective and will clarify the current mechanism for reimbursement of health care. In 2021, public health insurance paid more than EUR 5.6 billion, almost EUR 400 million more than the previous year. It is all the more important that insured persons' finances are used with maximum effectiveness, with the benefit of the patient first and foremost, said Vladimír Lengvarský, Minister for Health. By amending the Health Insurance Act, the Resort regulates the current system for handling health levies. The new legislation will define the so-called optimal profit-loss for insurance companies - if the insurance company exceeds the optimal profit-loss, the rest can be used exclusively to provide health care for insured persons.
The optimal management result itself retains the incentive element for insurance companies. It will take into account, for example, the contractualness of healthcare providers and the fulfilment of other obligations of insurance companies towards their clients or the State. At the same time, it will create a transparent and predictable margin for a reasonable profit to companies active in public health insurance, complements Vladimir Lengvarsky. The amendment also contains another key change required by application practice. It brings greater transparency to the mechanism for the recognition and reimbursement of health performances. Insurance companies will publish new revision rules on their website and make changes to them only once per calendar year. If enforcement is not recognised, the insurance undertaking must justify its decision to the healthcare provider. Last but not least, the new legislation also responds to regular stimuli concerning so-called fraudulent insurance and also ensures access to healthcare for all participants in the public health insurance system.
The Ministry of Health prepared the legislative change for several months. Its wording was continuously attended by the Health Care Supervisory Authority, representatives of healthcare providers and other stakeholders. The Health Department expects an amendment to the Act to be introduced to the Government's negotiations in September this year following the conclusion of the comments.