The Health Department wants to reduce uncertainties between health insurance companies and healthcare providers

In July the Ministry of Health presented rules for the efficient use of health levies. The new legislation also pays attention to setting revision rules. The current absence of their settings complicates the work of doctors, hospitals, baths and other health care providers. The health department wants to bring greater predictability and stability to the financial relations between health insurance companies and health establishments. One step is to establish the basic conditions for the functioning of the system of so-called revision rules. Through the review rules, health insurance companies control the activities of hospitals, doctors, pharmacies and other reporting facilities for healthcare provided. The rules are determined by each health insurance undertaking itself and may be introduced or amended without having a clear legal obligation for its partners to draw attention to their introduction or change. It is precisely this setting, according to the opinions of healthcare providers, that unnecessarily complicates the situation for doctors, baths or medical institutions.

Healthcare providers often do not have the staffing capacity to constantly check possible changes to the health insurance review rules for each reporting to each insured person. In practice, they only learn about the change after they provide health care, but they refuse to pay for it. This unnecessarily increases the administrative burden and brings confusion to the system. The Ministry of Health therefore proposes a number of measures to change the status quo. In particular, health insurance undertakings will be required to publish the rules on review activities and to be able to amend their review rules only once a year with effect from 1 January of the following year, with a view to their partners being clearly informed of the change. In the event that the health insurance undertaking fails to recognise the health care provider's declared performance, it must duly justify its decision and, in particular, inform the healthcare provider of the correct way of reporting health care performance.