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Reimbursement mapping: CZECH REPUBLIC. 2011. Content. Key Economic Indicators Healthcare Overview Reimbursement Systems Market Access Funding Mechanisms HTA Decision makers, Acronyms and Links Austerity Measures 2011. Key Economic Indicators Czech Republic. Healthcare system overview.
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Content • Key Economic Indicators • Healthcare Overview • Reimbursement Systems • Market Access • Funding Mechanisms • HTA • Decision makers, Acronyms and Links • Austerity Measures 2011
Healthcare system overview • Czech Republic reformed its health care system in 2003. • The ownership and management of health establishments was transferred to the 14 regions (kraj), which have autonomous powers. • The State still has the power to set the level of medical coverage and it continues to influence hospital operations by defining the mechanisms for their remuneration. • The regions have obtained powers over the employment and planning of care.
Reimbursement system • The process, to create a committee within the Public Health Insurance Company VZP, to approve the reimbursement prices, is still under way.The largest sickness fund (60% of the insured population) administers a reimbursement list. • Preconditions for inclusion are: CE mark and Registration with the MoH. • For the new devices – endorsement by the doctors’ specialist society. • For me-too devices, price level must be below the currently listed products. • The process to create a new DRG code is obscure for now. • The level of what proportion of the global budget gets calculated through the DRG key remains unclear.
Market Access • Distribution channels for medical devices in community care settings can be pharmacies or similar shops specialized in medical devices and aids.The patient redeems a product prescribed by a physician and the cost of the product is covered up to a nationally set limit. • The costs above are paid by the patient as co-payment. • In Czech Republic direct sales to the patient do not exist • Medical devices are sold in hospital settings through tenders (e.g. organized locally or by hospitals), with increasing spread of e-auctions • There isn’t a centralized procurement system. • Lowest price criterion is relevant either within or without e-auction but there is no standardization.
Funding Mechanisms • For primary care, out-patient clinics, ambulatory care, out-patient recovery centers and home care, patients receive prescription and they redeem the device in pharmacy or in medical device outlets. Co-payment may be collected as funding is limited for pieces and/or for total sum per month. • The limit for patient co-payment is 2.500 CZK. The co-payment is for prescription medicines, a doctor visit (30 CZK) and hospital stay (60 CZK per day). • In case of inpatients rehabilitation/recovery centers, patients receive devices used in-house for free. • For community care there is a product list but if the product has an added value, there is a higher reimbursement price, with no co-payment. • In hospital care, as a precondition for use, the inclusion in the reimbursement list (same as for ambulatory devices) is expected. • All devices are covered within the global budget. In hospital settings the general sickness fund administers the medical devices list while on the side of the hospitals the clinicians in accordance with the procurement department / hospital management are involved in this process.
HTA • No HTA agencies exist in the Czech Republic • iHETA non-profit organization developing and promoting HTA in the Czech Republic. Collaborating with EUnetHTA, INATHA. The main barrier for using developed international methodologies is luck of qualified experts and non existing study programs in this field. The collaboration in international networks is very limited as well.
Austerity measures 1/2 In CZ, an austerity package is focused on a public deficit of 4,6%: • 10% average pay cuts for public-sector employees; • Reduced sick pay, with employers providing wage compensation for longer; • Benefits for very low-income families with children are abolished; • The conditions for entitlement to parental benefit will be changed with the benefit reduced in certain cases. The birth allowance will be means tested; • Carer's allowance will be sharply reduced; • Unemployment benefit will be reduced for workers who terminate their contract without a serious reason; • The state housing allowance will be reduced and subject to a tax; • Regional transfers have been cut by nearly 20%.
Austerity measures 2/2 Tender / procurement mechanisms • Electronic auctions for medical devices (by hospitals) or electronic auctions by sickness funds to establish reimbursement levels for devices – both occurring ad-hoc over the year and to continue in 2011. Price referencing (domestic and cross-border) • Domestic price referencing by sickness funds – price referencing to establish level of reimbursement levels for medical devices for a group of devices with perceived similar action / effect in treating a diagnosis. Other • Ambulatory care is subject to various limits of volume of care, prescription etc. Once example for all: General practitioners will be penalized (financially) if they prescribe more than the average prescription level in their region. The relevant period is one quarter. However, the average prescription level for Q1 2011 will not be known until June 2011 (!). Thus, the measure will be applied retroactively. At the same time the average level will be strongly influenced by the threat of this measure, therefore lowering the prescription level up front.
