Návrh novely zákona o zdravotných poisťovniach | Medicínske právo
              

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Návrh novely zákona o zdravotných poisťovniach


 | 8.10.2013 | komentárov: 295

Do Národnej Rady SR (ďalej NRSR) bol podaný poslanecký návrh zákona, ktorým by sa mal zmeniť zákon č. 581/2004 Z. z. o zdravotných poisťovniach, dohľade nad zdravotnou starostlivosťou a o zmene a doplnení niektorých zákonov v znení neskorších predpisov (zákon o zdravotných poisťovniach).

Cieľom zákona je podľa dôvodovej správy zlepšenie definovania nároku poistenca v oblasti plánovanej zdravotnej starostlivosti a snaha sprehľadniť proces tvorby a vedenia zoznamov poistencov čakajúcich na plánovanú zdravotnú starostlivosť.
Navrhované sú tieto legislatívne zmeny:
1.    povinnosť zdravotných poisťovní viesť čakacie zoznamy na všetky chirurgické operačné  a plánované hospitalizácie, t.j. nielen pre 6 okruhov diagnóz,
2.    transparentné a flexibilné informovanie poistencov o ich poradí v zozname, o termíne plánovanej hospitalizácie, o možnostiach čerpania starostlivosti u iných poskytovateľov,
3.    povinnosť poskytovateľov bezodkladne po indikácii plánovanej starostlivosti nahlásiť poistenca zdravotnej poisťovni do čakacieho zoznamu,
4.    jednotný formulár pre zaradenie alebo vyradenie poistenca do/zo zoznamu na plánovanú zdravotnú starostlivosť,
5.    predĺženie lehoty, dokedy poskytovateľ musí informovať poistenca o termíne nástupu na plánovanú zdravotnú starostlivosť (z terajších 10 kalendárnych dní na 15 pracovných dní pred nástupom).
Touto úpravou by sa mala zvýšiť transparentnosť pri plánovaní a poskytovaní zdravotnej starostlivosti a tiež zodpovednosť zdravotnej poisťovne za zabezpečenie nároku poistencov. Upravuje tiež spôsoby a rozsah vedenia čakacích zoznamov, pravidlá zaraďovania do čakacích zoznamov resp. vyraďovania.
Novela vedie aj k lepšej a prísnejšej regulácii zisku zdravotných poisťovní a k efektívnejšiemu využitiu zdrojov verejného zdravotného poistenia v prospech poistencov.
V prípade, ak by zdravotná poisťovňa nebola schopná zabezpečiť poistencovi plánovanú ústavnú zdravotnú starostlivosť do 12 mesiacov od indikácie, poistenec môže zdravotnú starostlivosť čerpať aj u nezmluvného poskytovateľa resp. v členských krajinách EÚ s právom na plnú refundáciu nákladov zo strany zdravotnej poisťovne.
Čakacie zoznamy by sa mali viesť podľa jednotlivých zdravotných výkonov. Zdravotné poisťovne aj poskytovatelia zdravotnej starostlivosti by po zmene boli povinní zverejňovať zoznamy na svojich webových sídlach.
Návrh novely zákona bol predložený 26.9.2013, legislatívny proces je zatiaľ v štádiu výberu právnych poradcov.

Zdroj: http://www.nrsr.sk/web/Default.aspx?sid=zakony/zakon&MasterID=4655

Spracovala: Veronika Miková



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