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Lecturer(s)
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Course content
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Lecture Topics: 1. Introduction to the public health insurance system, valid legislation 2. Subjects of public health insurance 3. Center of Interstate Payments 4. The network of health service providers 5. Activities of health insurance companies 6. Authorization to provide health services 7. Methodology for transmission and reporting 8. List of medical procedures 9. Health service providers 10. Payment of paid services from public health insurance 11. Revision and control activities of health insurance companies Seminar Topics: 1. Explanation of basic concepts of public health insurance 2. Basic overview of legal norms 3. Rights and obligations of insured persons, providers, health insurance companies 4. The system of providing health services in the EU 5. Availability of health care services depending on the expertise of providers 6. Organization and activity of "VZP" (Všeobecná zdravotní pojišťovna) and employee health insurance companies 7. Conditions for establishing a contractual relationship with a health insurance company 8. Overview and content of basic types of documents, data interface 9. Content and composition of medical procedures, method of determination of point value 10. Method of reporting of health performance, storing of medical documentation 11. Types of reimbursement of health services in individual segments
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Learning activities and teaching methods
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unspecified
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Learning outcomes
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The aim of the course is to acquaint students with the system of public health insurance in the Czech Republic. Teaching is based on the currently valid legislation of the Czech Republic and the European Union. The lectures will be conceived both on a theoretical basis, in which the basic principles of the activities of individual subjects of public health insurance will be explained, as well as on practical examples from practice. The main focus will be on the specific activities of health service providers in relation to health insurance companies.
Expertise: The student is well oriented in the currently valid legislation related to public health insurance - laws and decrees of the Ministry of Health of the Czech Republic. Professional skills: The student understands the basic contractual documents of health insurance companies - Contract, Appendix No. 2, reimbursement supplements. Student is well informed about the settlement of the final payment and settlement reports.
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Prerequisites
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unspecified
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Assessment methods and criteria
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unspecified
80% attendance in lessons, seminar work of selected topic, written test
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Recommended literature
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Metodika pro pořizování a předávání dokladů v platné verzi.
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Vyhláška č. 134/1998 Sb., kterou se vydává seznam zdravotních výkonů s bodovými hodnotami, ve znění pozdějších předpisů.
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Vyhláška č. 273/2015 Sb., o stanovení hodnot bodu, výše úhrad hrazených služeb a regulačních omezení pro rok 2016.
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Zákon č. 372/2011 Sb., o zdravotních službách a podmínkách jejich poskytování.
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Zákon č. 48/1997 Sb., o veřejném zdravotním pojištění a o změně a doplnění některých souvisejících zákonů.
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Zákon č. 551/1991 Sb., o Všeobecné zdravotní pojišťovně České republiky.
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Zákon č. 96/2004 Sb., o podmínkách získávání a uznávání způsobilosti k výkonu nelékařských zdravotnických povolání a k výkonu činnosti souvisejících s poskytováním zdravotní péče a o změně některých souvisejících zákonů (zákon o nelékařských zdravotnických povoláních).
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