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Zmluva o poskytovaní a úhrade zdravotnej starostlivosti. I. časť


 | 28.8.2016 | komentárov: 310

Medzi základné povinnosti zdravotnej poisťovne vo vzťahu k poskytovateľom zdravotnej starostlivosti, patrí povinnosť uzatvárať Zmluvu o poskytovaní a úhrade zdravotnej starostlivosti s poskytovateľom zdravotnej starostlivosti. Na uzavretie zmluvy, zákon stanovuje prísne podmienky, ktoré majú svoj význam, nie len pre poisťovňu alebo poskytovateľa zdravotnej starostlivosti ale hlavne pre pacienta.

Obrazok

Právnu úpravu Zmluvy o poskytovaní a úhrade zdravotnej starostlivosti (ďalej len „zmluva“ alebo „zmluva o poskytovaní“) obsahuje zákon č. 581/2004 Z. z. o zdravotných poisťovniach, dohľade nad zdravotnou starostlivosťou a o zmene a doplnení niektorých
zákonov (ďalej len zákon č. 851/2004 Z. z.), ktorý upravuje, čo tvorí predmet zmluvy a stanovuje všetky náležitosti zmluvy, nevynímajúc postup a všeobecné podmienky pri uzatváraní zmluvy.
Podľa zákona č. 581/2004 Z. z., obsah, alebo ak chceme predmet zmluvy tvorí zabezpečovanie poskytovania zdravotnej starostlivosti, poistencom poisťovne, poistencom členských štátov Európskej únie ale aj bezdomovcom a cudzincom zo štátov, s ktorými má Slovenská republika uzatvorené dohody o poskytnutí zdravotnej starostlivosti, a to na mieste prevádzkovania zdravotníckeho zariadenia. Zmluva
zároveň upravuje úhradu za zdravotnú starostlivosť, lekárenskú starostlivosť alebo služby súvisiace s poskytovaním zdravotnej starostlivosti v rozsahu a za podmienok stanovených zákonom a zmluvou.
Za subjekty, ktoré zmluvu o poskytovaní uzatvárajú, môžeme označiť na jednej strane zdravotnú poisťovňu, a na strane druhej poskytovateľa zdravotnej starostlivosti.
Zákon ďalej stanovuje koho môžeme považovať za poskytovateľa spôsobilého uzavrieť zmluvu o poskytovaní. Takáto zmluva sa môže uzatvoriť:
 len s poskytovateľmi najmenej v rozsahu verejnej minimálnej siete poskytovateľov
 s každým poskytovateľom všeobecnej ambulantnej zdravotnej starostlivosti, ak má uzatvorenú dohodu o poskytovaní všeobecnej ambulantnej zdravotnej starostlivosti najmenej s jedným jej poistencom
 s každým poskytovateľom zdravotnej starostlivosti, ktorý má povolenie na prevádzkovanie ambulancie záchrannej zdravotnej služby
 s každým poskytovateľom lekárenskej starostlivosti
Medzi subjekty spôsobilé uzavrieť predmetnú zmluvu tak môžeme zaradiť rôznych štátnych, či neštátnych poskytovateľov laboratórnej diagnostiky, CT vyšetrení, magnetickej rezonancie, ale aj lekárne alebo očné optiky.
Zákon č. 581/2004 Z. z., ďalej stanovuje niekoľko podmienok za akých poisťovňa zmluvu s poskytovateľom uzatvára. Medzi všeobecné náležitosti, ktoré zákon vymedzuje patrí písomná forma. Zmluva musí byť zároveň uzavretá najmenej na 12 mesiacov, pokiaľ sa zmluvné strany nedohodnú na dlhšej dobe platnosti zmluvy. Zmluvu môže uzavrieť len poskytovateľ s platným povolením na poskytovanie zdravotnej starostlivosti, alebo rozhodnutím o povolení na prevádzkovanie zdravotníckeho zariadenia, licencie na výkon samostatnej zdravotníckej praxe.
Okrem všeobecných podmienok, ktoré musia byť pri uzatváraní zmluvy splnené, zdravotná poisťovňa na základe uvedeného zákona sama stanovuje kritéria na uzatváranie zmlúv s poskytovateľmi zdravotnej starostlivosti. Medzi základné predpoklady patrí personálne a materiálne zabezpečenie poskytovateľa. Tým sa má zaistiť poskytovanie zdravotnej starostlivosti osobami, ktoré spĺňajú podmienky na výkon zdravotníckeho povolania stanovené zákonom a vybavením najmenej na úrovni predpísaného minimálneho materiálno-technického vybavenia zdravotníckeho zariadenia. Zároveň sme toho názoru, že pri poskytovaní zdravotnej starostlivosti dôležitú úlohu zohráva aj cena za poskytované služby, keďže adekvátne ohodnotenie práce zdravotníckych pracovníkov môže zlepšiť prístup zdravotníckych pracovníkov k pacientom a skvalitniť tak zdravotnú starostlivosť.
Na základe uvedeného môžeme povedať, že hlavný cieľ uzavretia zmluvy spočíva v materiálnom zabezpečení poskytovateľa a v zaistení prvotriednej zdravotnej starostlivosti pre pacienta. Preto je dôležité aby poskytovateľ spĺňal všetky kritériá stanovené zdravotnou poisťovňou a aby poisťovňa dohliadala na to, aby sa zmluva uzavrela len s poskytovateľom, ktorý v predmetnej oblasti zabezpečí zdravotnú starostlivosť na čo najvyššej úrovni.
Všetky tieto podmienky majú svoj význam nie len pre poskytovateľa či poisťovňu, ale hlavne pre pacienta. Zároveň však nemožno vylúčiť uzavretie takej zmluvy, ktorá by podmienky nespĺňala a teda by bola v rozpore s platným právom. V prípadoch, kedy je tu istý predpoklad, že predmetná zmluva nenapĺňa všetky stanovené podmienky na jej uzavretie, je na orgánoch dozoru aby predmetnú zmluvu
skontrolovali a posúdil, či bola uzavretá v súlade so zákonom, a či boli splnené všetky náležitosti a podmienky uzavretia.
Kontrola, môže prebiehať v dvoch základných formách. Prvá forma predstavuje kontrolu vnútornú, vykonávanú orgánom ktorý je nadriadený kontrolovanému orgánu alebo ho priamo riadi. Medzi takéto kontrolné orgány môžeme zaradiť Vládu SR, ako najvyšší orgán výkonnej moci, Úrad vlády SR, Ministerstvo financií SR ako ústredný orgán pre finančnú kontrolu alebo Ministerstvo zdravotníctva SR,  v prípadoch kontroly v oblasti zdravotníctva. Kontrolná činnosť je zväčša vykonávaná vedúcim kontrolného orgánu alebo kontrolnými útvarmi, ktoré sú priamo podriadené vedúcemu kontrolného orgánu. Cieľom kontroly je zabezpečiť, aby bola činnosť, ktorá je predmetom kontroly v súlade s právnymi normami, a aby kontrolovaný subjekt, v našom prípade poisťovňa, efektívne a hospodárne využíval poskytnuté štátne zdroje.
Okrem vnútornej kontroly rozoznávame kontrolu vonkajšiu, pri ktorej  kontrolovaný subjekt nie je vo vzťahu podriadenosti k orgánu, ktorý ho kontroluje, ani ním nie je riadený. Pri tomto druhu kontroly činnosť štátnych kontrolných orgánov v podmienkach SR zastrešuje prevažne Najvyšší kontrolný úrad SR (ďalej len NKÚ). NKÚ je nezávislý štátny orgán, ktorého činnosť pozostáva z  kontroly hospodárenia s
rozpočtovými prostriedkami, so štátnym majetkom a majetkovými právami. Popri NKÚ môže kontrolu v oblasti verejného zdravotného poistenia vykonávať aj ďalší nezávislý štátny orgán, ktorým je Úrad pre dohľad nad zdravotnou starostlivosťou (ďalej len Úrad). Dohľad vykonávaný Úradom sa môže dotýkať rôznych činností zdravotnej poisťovni, najčastejšie však pôjde o kontrolu zákonnosti postupu zdravotnej poisťovne, či už vo vzťahu k poistencom alebo poskytovateľom zdravotnej starostlivosti.
Podobná kontrola je zo strany kontrolných orgánov nevyhnutnosť, ktorá môže veľakrát priniesť objektívne informácie o predmetnej činnosti subjektu a ozrejmiť skutočný stav veci, v dôsledku čoho môžu byť následne prijaté opatrenia pomocou ktorých sa má
zamedziť prípadnému protizákonnému konaniu.

V ďalšom pokračovaní článku sa budeme venovať problémom, ktoré v súvislosti s uzatváraním zmluvy vznikajú a priblížime niektoré otázky právnej praxe.




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