{"id":3596,"date":"2015-02-28T10:31:59","date_gmt":"2015-02-28T10:31:59","guid":{"rendered":"http:\/\/obcanskymonitoring.cz\/?p=3596"},"modified":"2015-02-28T10:31:59","modified_gmt":"2015-02-28T10:31:59","slug":"smlouvy-pojistoven-s-poskytovali-zdravotnich-sluzeb-maji-byt-zverejnovany","status":"publish","type":"post","link":"https:\/\/obcanskymonitoring.cz\/?p=3596","title":{"rendered":"Smlouvy poji\u0161\u0165oven s poskytovali zdravotn\u00edch slu\u017eeb maj\u00ed b\u00fdt zve\u0159ej\u0148ov\u00e1ny"},"content":{"rendered":"
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Zaujala mne vl\u00e1dn\u00ed novela z\u00e1kona, kterou se m\u011bn\u00ed z\u00e1kon \u010d. 48\/1997 Sb., o ve\u0159ejn\u00e9m\u00a0zdravotn\u00edm poji\u0161t\u011bn\u00ed. Cel\u00fd text je mo\u017en\u00e9 si p\u0159e\u010d\u00edst zde<\/a>. \u00a0Cituji pas\u00e1\u017ee z d\u016fvodov\u00e9 zpr\u00e1vy, kter\u00e9 mne zaujaly. M\u00e9 koment\u00e1\u0159e jsou uvedeny tu\u010dn\u011b.<\/p>\n

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Smlouvy o poskytov\u00e1n\u00ed a \u00fahrad\u011b hrazen\u00fdch slu\u017eeb, by m\u011bly b\u00fdt zve\u0159ej\u0148ov\u00e1ny<\/strong><\/p>\n

”\u00a0Jako nedostate\u010dn\u00e1 se v sou\u010dasnosti jev\u00ed pr\u00e1vn\u00ed \u00faprava kontroly nakl\u00e1d\u00e1n\u00ed s finan\u010dn\u00edmi\u00a0prost\u0159edky syst\u00e9mu ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, zejm\u00e9na v oblasti smluvn\u00edch vztah\u016f mezi\u00a0zdravotn\u00edmi poji\u0161\u0165ovnami a poskytovateli zdravotn\u00edch slu\u017eeb. P\u0159\u00edjmy zdravotn\u00edch poji\u0161\u0165oven\u00a0jsou p\u0159itom tvo\u0159eny platbami od pl\u00e1tc\u016f pojistn\u00e9ho (poji\u0161t\u011bnci a zam\u011bstnavatel\u00e9) nebo od st\u00e1tu,\u00a0kter\u00fd hrad\u00ed pojistn\u00e9 za tzv. st\u00e1tn\u00ed poji\u0161t\u011bnce z prost\u0159edk\u016f st\u00e1tn\u00edho rozpo\u010dtu. Ve v\u0161ech\u00a0p\u0159\u00edpadech se jedn\u00e1 o ve\u0159ejn\u00e9 finan\u010dn\u00ed prost\u0159edky, jejich\u017e vyu\u017e\u00edv\u00e1n\u00ed m\u00e1 podl\u00e9hat podrobn\u00e9\u00a0kontrole jak ze strany org\u00e1n\u016f st\u00e1tn\u00ed spr\u00e1vy, tak ze strany ve\u0159ejnosti. Ve\u0159ejn\u00e1 kontrola by se\u00a0p\u0159itom m\u011bla realizovat prost\u0159ednictv\u00edm dohledu nad obsahem smluv o poskytov\u00e1n\u00ed a \u00fahrad\u011b\u00a0hrazen\u00fdch slu\u017eeb. To t\u00edm sp\u00ed\u0161e, \u017ee obsah smluv o poskytov\u00e1n\u00ed a \u00fahrad\u011b hrazen\u00fdch slu\u017eeb\u00a0m\u016f\u017ee b\u00fdt sjedn\u00e1n mimo parametry stanoven\u00e9 ka\u017edoro\u010dn\u011b vyhl\u00e1\u0161kou o stanoven\u00ed hodnot bodu,\u00a0v\u00fd\u0161e \u00fahrad hrazen\u00fdch slu\u017eeb a regula\u010dn\u00edch omezen\u00ed. M\u016f\u017ee tak doch\u00e1zet k individu\u00e1ln\u00edmu\u00a0zv\u00fdhod\u0148ov\u00e1n\u00ed jednotliv\u00fdch poskytovatel\u016f zdravotn\u00edch slu\u017eeb ze strany zdravotn\u00edch\u00a0poji\u0161\u0165oven, kter\u00e9 nakl\u00e1daj\u00ed s ve\u0159ejn\u00fdmi prost\u0159edky.”<\/p>\n

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V t\u011bchto smlouv\u00e1ch je ro\u010dn\u00ed pln\u011bn\u00ed p\u0159esahuj\u00edc\u00ed 200 miliard ro\u010dn\u011b<\/strong><\/p>\n

“Obsah smluv o poskytov\u00e1n\u00ed a \u00fahrad\u011b hrazen\u00fdch slu\u017eeb je v sou\u010dasnosti dostupn\u00fd pouze\u00a0na z\u00e1klad\u011b \u017e\u00e1dosti prost\u0159ednictv\u00edm z\u00e1kona \u010d. 106\/1999 Sb., o svobodn\u00e9m p\u0159\u00edstupu\u00a0k informac\u00edm, ve zn\u011bn\u00ed pozd\u011bj\u0161\u00edch p\u0159edpis\u016f, (d\u00e1le jen \u201ez\u00e1kon \u010d. 106\/1999 Sb.\u201c), a to\u00a0v souladu s rozsudkem Nejvy\u0161\u0161\u00edho spr\u00e1vn\u00edho soudu Sp. zn. 3 Ads 33\/2006. Takovou praxi\u00a0pova\u017euje p\u0159edkladatel za nedostate\u010dnou, p\u0159edev\u0161\u00edm s ohledem na velk\u00e9 mno\u017estv\u00ed smluv\u00a0uzav\u0159en\u00fdch mezi zdravotn\u00edmi poji\u0161\u0165ovnami a poskytovateli zdravotn\u00edch slu\u017eeb a rovn\u011b\u017e\u00a0na nekomplexnost st\u00e1vaj\u00edc\u00ed pr\u00e1vn\u00ed \u00fapravy ve vztahu k siln\u00e9 pot\u0159eb\u011b ve\u0159ejn\u00e9 kontroly. Je t\u0159eba\u00a0uv\u00e9st, \u017ee celkov\u00e9 v\u00fddaje syst\u00e9mu ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed (resp. z\u00e1kladn\u00edch fond\u016f\u00a0v\u0161ech zdravotn\u00edch poji\u0161\u0165oven) \u010dinily v roce 2013 cca 221,8 mld. K\u010d<\/strong>, a s ohledem na to, \u017ee se\u00a0tyto ve\u0159ejn\u00e9 finan\u010dn\u00ed prost\u0159edky pou\u017e\u00edvaj\u00ed zejm\u00e9na k \u00fahrad\u011b poskytovan\u00fdch hrazen\u00fdch slu\u017eeb\u00a0na z\u00e1klad\u011b individu\u00e1ln\u00edch smluv, je nezbytn\u00e9 zajistit jejich transparentnost prost\u0159ednictv\u00edm\u00a0ve\u0159ejn\u00e9 kontroly nad jejich obsahem.<\/p>\n

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Nejsou nyn\u00ed dostate\u010dn\u011b kontrolov\u00e1n konflikt z\u00e1jm\u016f<\/strong><\/p>\n

“Ze st\u00e1vaj\u00edc\u00ed pr\u00e1vn\u00ed \u00fapravy z\u00e1kona o VZP a z\u00e1kona o zam\u011bstnaneck\u00fdch poji\u0161\u0165ovn\u00e1ch nen\u00ed\u00a0zcela z\u0159ejm\u00e9, za jak\u00fdch podm\u00ednek doch\u00e1z\u00ed ke st\u0159etu z\u00e1jm\u016f u osob, kter\u00e9 vykon\u00e1vaj\u00ed funkci\u00a0\u0159editele nebo funkci \u010dlena n\u011bkter\u00e9ho org\u00e1nu zdravotn\u00ed poji\u0161\u0165ovny (spr\u00e1vn\u00ed a dozor\u010d\u00ed rady).\u00a0Z aplika\u010dn\u00ed praxe m\u00e1 p\u0159itom p\u0159edkladatel za potvrzen\u00e9, \u017ee v n\u011bkter\u00fdch p\u0159\u00edpadech doch\u00e1z\u00ed\u00a0u t\u011bchto osob k takov\u00e9mu st\u0159etu z\u00e1jm\u016f (pozn. nen\u00ed my\u0161leno ve smyslu z\u00e1kona\u00a0\u010d. 159\/2006 Sb., o st\u0159etu z\u00e1jm\u016f, ve zn\u011bn\u00ed pozd\u011bj\u0161\u00edch p\u0159edpis\u016f), kdy z\u00e1rove\u0148 vykon\u00e1vaj\u00ed\u00a0\u010dinnost nebo funkci, kter\u00e1 je s v\u00fd\u0161e \u00a0veden\u00fdm neslu\u010diteln\u00e1. Zejm\u00e9na se jedn\u00e1 o \u010dlenstv\u00ed\u00a0v org\u00e1nech pr\u00e1vnick\u00fdch osob (p\u0159\u00edpadn\u011b se m\u016f\u017ee jednat i o fyzick\u00e9 osoby jako podnikatele),\u00a0kter\u00e1 jsou ve smluvn\u00edm vztahu ke konkr\u00e9tn\u00ed zdravotn\u00ed poji\u0161\u0165ovn\u011b, a to bez ohledu na to,\u00a0zda se jedn\u00e1 p\u0159\u00edmo o poskytovatele zdravotn\u00edch slu\u017eeb nebo jin\u00e9 dodavatele zbo\u017e\u00ed a slu\u017eeb\u00a0(nap\u0159. dodavatel IT technologi\u00ed). Jednozna\u010dn\u011b \u017e\u00e1douc\u00ed je zamezit, aby se na rozhodov\u00e1n\u00ed\u00a0zdravotn\u00ed poji\u0161\u0165ovny pod\u00edlely osoby, kter\u00e9 by mohly rozhodov\u00e1n\u00ed zdravotn\u00ed poji\u0161\u0165ovny\u00a0ovlivnit ve sv\u016fj prosp\u011bch.\u00a0Tento probl\u00e9m identifikoval p\u0159edkladatel zejm\u00e9na u V\u0161eobecn\u00e9 zdravotn\u00ed poji\u0161\u0165ovny, kdy lze\u00a0nesoulad s podm\u00ednkami st\u00e1vaj\u00edc\u00ed pr\u00e1vn\u00ed \u00fapravy nal\u00e9zt u n\u011bkter\u00fdch \u010dlen\u016f org\u00e1n\u016f ji\u017e\u00a0nahl\u00e9dnut\u00edm do obchodn\u00edho rejst\u0159\u00edku. Z\u00e1rove\u0148 chyb\u00ed z\u00e1konn\u00e1 mo\u017enost Ministerstva\u00a0zdravotnictv\u00ed t\u011bmto p\u0159\u00edpad\u016fm \u00fa\u010dinn\u011b zabr\u00e1nit (nedostate\u010dn\u00e1 regula\u010dn\u00ed schopnost).<\/strong>\u00a0“<\/p>\n

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 1,126 total views Zaujala mne vl\u00e1dn\u00ed novela z\u00e1kona, kterou se m\u011bn\u00ed z\u00e1kon \u010d. 48\/1997 Sb., o ve\u0159ejn\u00e9m\u00a0zdravotn\u00edm poji\u0161t\u011bn\u00ed. Cel\u00fd text je mo\u017en\u00e9 si p\u0159e\u010d\u00edst zde. \u00a0Cituji pas\u00e1\u017ee z d\u016fvodov\u00e9 zpr\u00e1vy, kter\u00e9 mne zaujaly. M\u00e9 koment\u00e1\u0159e jsou uvedeny tu\u010dn\u011b.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":true,"template":"","format":"standard","meta":[],"categories":[7],"tags":[],"_links":{"self":[{"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=\/wp\/v2\/posts\/3596"}],"collection":[{"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3596"}],"version-history":[{"count":0,"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=\/wp\/v2\/posts\/3596\/revisions"}],"wp:attachment":[{"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/obcanskymonitoring.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}