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Lecturer(s)
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Course content
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Lecture Topics: 1. Legal framework of health services - provider, payer, regulator, insured 2. Contract on the provision and payment of health services - scope and structure 3. List of medical procedures with point values 4. Performance sheets 5. International classification of diseases 10th revision 6. Methodology for acquisition and transfer of VZP CR (General Health insurance company of the Czech republic) documents 7. Health Service Billing Process 8. Overview of payment systems according to provisioning segments 9. System of outpatient care reimbursement 10. System of reimbursement of after-care 11. System of acute inpatient care 12. Casemix systems 13. History and development of the classification system in the Czech Republic 14. Basic concepts in DRG 15. Current IR DRG and its Restart (IHIS) 16. Availability, quality and effectiveness of health services 17. Benchmarking of production data 18. Controlling as a tool for the company's long-term success 19. Financial controlling 20. Activity based management, activity based costing 21. Clinical controlling 22. Health service provider production management 23. Business intelligence 24. Management reporting Seminar Topics: 1. Health services - forms, structure, authorization 2. The process of reporting health care provided in a health care facility 3.Primary Classification - List of Medical Procedures, ICD 10 4.Current Reimbursement Order of the Ministry of Health of the Czech Republic 5. Payments and estimated acute inpatient care 6. DRG in practice 1 - Coding methodology, RV assignment to case, case building 7. DRG in practice 2 - statistics, analysis, benchmarking 8. Usage of ABC - cost of product 9. Reimbursement and estimated items of outpatient care 10. Reporting of health services by providers of after-care and PZSS 11. Controlling - planning of health services 12. Strategic controlling
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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 subject acquaints students with the current reimbursement system, including legislative boundaries and historical contexts. Students will be acquainted with controlling, as a result-oriented method of business management.
Expertise: The student is able to describe and explain the principles of reporting health services. Student knows current problems and possibilities of their solution. Professional skills: The student is able to define problems of payments in health care, knows and respects economic, political and medical influences.
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Prerequisites
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unspecified
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Assessment methods and criteria
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unspecified
Credit test, oral exam, 80% attendance
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Recommended literature
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Mezinárodní klasifikace nemocí 10. Revize.
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Novela vyhl. č.134/1998 Sb., kterou se vydává seznam zdravotních výkonů.
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OECD: Health at a Glance: Europe 2016. ISBN 978-92-64-26558-5.
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OECD: Health at a Glance 2017. ISBN 978-92-64-28039-7.
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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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BOROVSKÝ, J. Ekonomika zdravotnických zařízení. ČVUT v Praze 2012.
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KOŽENÝ P., NĚMEC J., KÁRNÍKOVÁ J., LOMÍČEK M. Klasifikační systém DRG. ISBN 978-80-247-2701-1.
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MACH J., BURIÁNEK A., ZÁLESKÁ D., MLYNÁŘOVÁ D., KVAPILOVÁ I., MÁCA M., VALÁŠEK D. Univerzita medicínského práva. ISBN 978-80-247-5113-9.
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NĚMEC J. Principy zdravotního pojištění. ISBN 978-80-247-2628-1.
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ŠEDO, J. DRG v praxi. Galén 2013. ISBN: 9788072629817.
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