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Nemecko zrušilo poplatky u lekára s účinnosťou od nového roka


 | 4.2.2013 | komentárov: 378

Nemeckí poslanci dňa 9.11.2013 prijali Zákon o regulácii požiadaviek asistenčnej starostlivosti v stacionárnych, opatrovateľských a v rehabilitačných zariadeniach , v ktorom sa zrušili paušálne poplatky za návštevu u lekára tzv. „Praxisgebühr“.

Obrazok Tieto regulačné poplatky zaviedla v roku 2004 niekdajšia ľavicová vláda Gerharda Schrödera kvôli obmedzeniu zbytočných návštev praktických lekárov, zubárov a psychoterapeutov. Šlo o poplatok vo výške 10 eur, ktorý mal pokryť všetky návštevy v danom štvrťroku. Nezáležalo na tom, koľkokrát počas troch mesiacov lekára pacienti navštívili. V prípade, ak  boli poslaní k špecialistovi, neplatili nič.  Ak však pacienti navštívili iného lekára bez tohto odporúčania, museli  opäť zaplatiť „Praxisgebühr“. Poplatky vyberala sestra, ktorá ich ďalej posielala zdravotnej poisťovni, u ktorej bol pacient poistený. To znamená, tieto poplatly neboli určené lekárom, ale na podporu zdravotníctva. Treba však povedať, že tamojšia populácia ich vnímala predovšetkým ako zbytočnú byrokratickú záťaž a dôvod zhoršovania vzťahu medzi lekárom a pacientom.

Zavedenie poplatkov za zdravotnú starostlivosť sa stalo nepopulárnym  nielen v Nemecku ale aj v ďalších krajinách strednej Európy. Pokusy o podobné reformy skončili neúspešne napríklad v Maďarsku, kde po neutíchajúcich protestoch napokon občania v referende rozhodli o ich zrušení1. Rovnaký neúspech reformy v zdravotníctve možno zaznamenať aj v Česku. Regulačné poplatky tu boli presadzované niekdajšou vládou premiéra Topolánka, napokon boli českou snemovňou zrušené.2 Na Slovensku si zas možno zaspomínať na známu Zajacovu reformu a zavedenie dvadsaťkorunového poplatku za návštevu lekára.
   
Cieľ reformy
    
Základným cieľom pri zavedení týchto poplatkov v Nemecku bolo predovšetkým obmedziť nadbytočný dopyt po zdravotnej starostlivosti znížením počtu návštev u lekára a znížiť spotrebu liekov. Po zavedení finančnej spoluúčasti pacienta pri poskytovaní zdravotnej starostlivosti vo forme marginálnych nákladov je samozrejme dôležité, aby výška poplatku nebola stanovená tak vysoko, že by pacienta mohlo odradiť od návštevy lekára. Pri necitlivom stanovení by sa totiž mohlo stať, že pacient v komplikovanejšej fáze choroby lekára nenavštívi, čo cieľom týchto poplatkov samozrejme nie je. V Nemecku však mala táto reforma opačný efekt. Podľa štatistík navštívi každý Nemec lekára priemerne osemnásťkrát za rok, zatiaľ čo v iných krajinách je bežný zhruba polovičný počet návštev. No zavedením poplatku práve naopak vzrástla návštevnosť u lekárov, pretože niektorí pacienti sa po zaplatení kvartálneho poplatku zrejme cítili byť priamo vyzvaní k tomu, aby lekára navštívili čo najčastejšie.

Spoplatnené zdravotníctvo predmetom rozhodovania Spolkového sociálneho súdu


Spolkový sociálny súd (BSG) v roku 2009 prijal rozhodnutie, podľa ktorého sú poplatky v zdravotníctve v súlade so Základným zákonom SRN. Zaoberal sa sťažnosťou Erwina Finka, ktorý namietal porušenie jeho základných práv garantovaných ústavou Nemecka.3 Sťažovateľ sa cítil nespravodlivo diskriminovaný voči pacientom poisteným súkromnou zdravotnou poisťovňou, ktorí tieto poplatky platiť nemuseli. Spolkový súd sa priklonil k názoru, že platby za služby spojené s poskytovaním zdravotnej starostlivosti nemôžu natoľko zasiahnuť do sociálnej integrity človeka, že by to znamenalo zásah do jeho základných práv.  

Spokojní lekári aj pacienti
    
Prijatý nový zákon v novom roku si pochvaľujú ako pacienti, tak aj lekári, podľa ktorých sa odstráni hlavne nesplnený pôvodný účel a aj zbytočná byrokracia. Rozhodnutie kritizujú nemecké zdravotné poistovne, ktoré kvôli tomu prídu o zhruba dve milardy eur ročne.

AUTOR: Lucia Onderková
FOTO: http://www.rarediseaseblogs.net

ZDROJE:
http://www.sme.sk/c/3771482/madarsko-platby-uz-nie-su.html
http://www.sme.sk/c/4844027/ceska-snemovna-zrusila-zdravotnicke-poplatky.html
http://www.faz.net/aktuell/politik/bundessozialgericht-praxisgebuehr-verstoesst-nicht-gegen-grundgesetz-1815862.html



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