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BODKA ZA DISKUSIOU UNIVERSITATIS DISPUTATIONES 2014: Pacient a zdravotné poistenie


 | 12.11.2014 | komentárov: 290

Na Právnickej fakulte UPJŠ v Košiciach sa 5. novembra 2014 uskutočnila prvá diskusia projektu UNIVERSITATIS DISPUTATIONES 2014 realizovaného v Košiciach. Pozvaní hostia diskutovali na tému Pacient a zdravotné poistenie. UD 2014 je projekt univerzitných dišpút, ktorú už tretí rok organizuje Komora pre medicínske právo – MEDIUS. Tento ročník sme opäť zrealizovali v spolupráci s odbornými partnermi, ktorými sú Právnická fakulta UPJŠ a Lekárska fakulta UPJŠ. Nad projektom už tretí rok prevzal záštitu primátor mesta Košice – MUDr. Richard Raši, PhD., MPH. Projekt sa podarilo zorganizovať aj vďaka finančnej podpore GlaxoSmithKline (GSK) a spoločnosti Medtronic.

Obrazok

Prvá „dišputa“  bola venovaná debate o vzťahu pacienta a poskytovateľa v systéme s verejným zdravotným poistením  z pohľad bioetika, právnika zdravotníckeho zariadenia a právnika – advokáta.  V diskusii vystúpili prof. ThDr. Ing. Inocent – Mária V. Szaniszló, PhD., OP z Inštitútu aplikovanej etiky prof. Alexandra Spesza pri Teologickej fakulte Katolíckej univerzity v Ružomberku so sídlom v Košiciach, JUDr. Dušan Podolský – právnik Nemocnice Košice – Šaca a.s.,  1. súkromná nemocnica a JUDr. Ivan Humeník, PhD. – advokát z h&h PARTNERS, advokátska kancelária, a.s.

Po zahájení diskusie každý z hostí prezentoval svoj príspevok k téme zdravotného poistenia. prof. Szaniszló sa zameral na definovanie pojmu choroby a zdravia. Zdôraznil, že choroba je prirodzenou súčasťou našich životov, nejde o externú resp. absurdnú životnú situáciu. Pripomenul vývoj systému poskytovania zdravotnej starostlivosti, ktorý vychádzal z chápania starostlivosti ako prejavu služby blížnemu, charity (v kresťanskom ponímaní). Vplyvom kresťanstva sa z medicíny stala intelektuálna činnosť. K uhrádzaniu starostlivosti ale uviedol, že „zaplatiť ju niekto musí“ prirovnaním k aktuálne diskutovanej otázke zavedenej vlakovej dopravy pre študentov a dôchodcov zadarmo. Možným riešením by mohla byť tzv. dvojrýchlostná medicína, akú majú inde v zahraničí. V takomto systéme si pacient buď na základe úhrady zo súkromného poistenia dopraje lepšiu starostlivosť alebo mu bude v rámci siete verejného zdravotného poistenia poskytnutý nižší štandard starostlivosti.

Druhým rečníkom bol JUDr. Dušan Podolský. Vo svojom príspevku venoval pozornosť vzniku systému verejného zdravotného poistenia, ktorý sa označuje aj ako bismarckovský systém a kombinuje princíp solidarity s trhovým princípom. Tento systém je financovaný z najväčšej časti z odvodov, ďalej iných verejných zdrojov a napokon zo súkromných zdrojov, pričom ale hospodárenie v súkromnom sektore je často krát transparentnejšie ako hospodárenie vo verejnom sektore.  Ako by mal byť určený nárok pacienta vyplývajúci z verejného zdravotného poistenia? Kde by mala končiť bezplatnosť?

Osobitne ďalej vyzdvihol dva problémy, snahu poisťovní stanoviť poskytovateľom novú povinnosť v rámci poučenia pacienta, a to informovanie pacienta o nedoplatku na poistnom a jeho vymáhanie tj. kým pacient neuhradí nedoplatok – nebude sa mu poskytovať zdravotná starostlivosť hradená z verejného zdravotného poistenia. Tiež vidí ako problémové poskytovanie neodkladnej zdravotnej starostlivosti, ktorá je uhrádzaná z verejného zdravotného poistenia, nakoľko to, či ide o prípad neodkladnej starostlivosti určuje poskytovateľ ad hoc a za týmto účelom musí vykonať isté výkony.

Napokon sa zameral na problém limitov, ktoré si zdravotná poisťovňa a poskytovateľ musia zmluvne dohodnúť. Tento „defekt“ obmedzuje poskytovanie zdravotnej starostlivosti pacientovi, je znevýhodňujúci pre poskytovateľov (napr. v porovnaní s ČR) a spôsobuje dlhšie čakacie doby.

Posledným rečníkom bol JUDr. Ivan Humeník, PhD. Ten poukázal na vývoj vzťahu medzi lekárom a pacientom, ktorý bol najprv bez vstupu tretej strany – zdravotnej poisťovne. Zdravotná starostlivosť mala ale vždy špecifický charakter, pričom nepanovali jednotné názory nato, či by sa za jej poskytnutie mala vyberať odmena alebo nie. A napriek tomu, že dnes sa presadzujú trhové modely aj do vzťahu lekára a pacienta, aspekt služby/starostlivosti/pomoci nie je možné z tohto vzťahu lekára a pacienta odstrániť.

Po otvorení diskusie sa ďalej debatovalo o nadlimitoch, funkciách Úradu pre dohľad nad zdravotnou starostlivosťou, motiváciách lekárov poskytovať zdravotnú starostlivosť, spoluúčasti pacientov.

Všetkým účastníkom a hosťom ďakujeme za účasť a z pozície organizátora sa tešíme, že sa nám opäť na pôde univerzity podarilo vytvoriť priestor pre vysoko odbornú, fundovanú a zároveň verejnosti prístupnú interdisciplinárnu diskusiu o téme, ktorá sa týka nás všetkých. 




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Самцы косатки, обитающие в Британской Колумбии, всю жизнь живут с мамой.
Герои украинского сериала о школьниках с трудом изъясняются по-украински.
Один из старейших музеев Амстердама находится в церкви на чердаке.
В 1941 году в московскую «Писательскую роту» пришли добровольцами бывший вор и следователь ЧК.


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