Systems of Funding the Health Care Activities

In different health care activities funded by the compulsory health insurance, different systems of funding apply.

In the primary health care activity (general physician surgeries, paediatrician and school children surgeries), a combined system of capitation and fee for services is in effect. The same system has been introduced in primary gynaecology. In other areas of the primary level health care in its narrow sense, the fee for service system is applied. The health education and some of the preventive programmes are funded by the Institute in the form of fixed sums.

In the specialist dispensary activity, the fee for service system is mainly in effect. For individual specialist dispensary activities, standards are specified, to determine the annual planned number of visits per team. In the dialysis activity, the prices are set for 5 types of dialysis services. The Institute pays the dialysis services at uniform, agreed prices.

In the hospital specialist activity a reimbursement payment per diagnostic related groups (Australian type) is used, combined with the fee for service system for some high cost services and materials. Number of days are followed statistically. The same system is in effect for the "one day hospital" and the "daily hospital".

In the pharmacist activity, the fee for services system is in effect, while the medicaments on prescription and technical aids issued by the pharmacies are separately invoiced to ZZZS at their purchase prices. The Institute has contracts concluded with the suppliers of medical aids, providing, among other issues, also the prices of medical aids to be supplied on the account of compulsory health insurance.

In the health resort activity, the price of a non-medical daily charge is set, covering the services of residence and daily rations, and the value of a point of the health resort treatment.

In the area of the social care institutions and social habilitation institutions, the system of the average daily charge is in effect, according to the number of planned nursing types.

The operation of the emergency transport service is valuated with a planned budget for emergency transports and with price per kilometre for nonemergency transports, but last within planned number of kilometres. There is a separate price for transport service to dialyses and back.