FVP:UOGK050 Economics and Insurance System - Course Information

UOGK050 Economics and Insurance Systems

Extent and Intensity

0/4/0. 1 credit(s). Type of Completion: z (credit).

Teacher(s)

Ing. Karel Siebert (lecturer)

Guaranteed by

doc. Ing. Viera Jakušová, Ph.D., MPH.
Institute of Paramedical Health Studies – Faculty of Public Policies in Opava
Contact Person: Mgr. Veronika Slováček Hagenová

Prerequisites (in Czech)

FAKULTA(FVP) && TYP_STUDIA(B) && FORMA(K)

Course Enrolment Limitations

The course is only offered to the students of the study fields the course is directly associated with.

fields of study / plans the course is directly associated with

• General Nursing Studies (programme FVP, B5341-OSET)

Course objectives

The course is designed as a theoretical-practical unit with comprehensive issue of health service economy. The historical perspective of the achieved level of medicine, related to the development of the level of nursing care, is combined with possibilities of the given society in order to explain and to address continuous improvement of achieved level of care for health, achieved range of health care services and prevention of diseases and its economic saturation - funding. The course characterizes the principles of origination of health care systems in Europe and in the USA, which are based on principles of equality and solidarity in the European concept. It is focused on studies of organization and management of health care including prevention. A basic overview of valid legislation, other rules and regulations related to payment of health care provided in different segments in current conditions of the public health care system and health care insurance. The conditions for provision of partially and fully paid services and health care are explained. The course explains the importance and the consequences of transformation changes in the Czech Republic after 1989, related to the start of the amendment of health care legislation, the privatization process, to the development of professional organizations, health insurance companies and to the introduction of the compulsory health insurance. It defines the society-wide importance of three basic elements of the system - insured person, care provider and care payer. It explains the motives of increasing financial expenses on health care, the amount of GDP share spent on health care even outside the Czech Republic and the facts of health care funding. It explains the mechanism of funding and use of regulation mechanisms in individual segments of the care provided, including expensive care, involvement of the state in system organization, importance of health insurance companies, involvement of inspection medicine and inspection physicians in inspection of justifiability of payments and of the level of the quality provided.

Syllabus

• Contents orientation of lectures:
  The students will be familiarized with issues of value of health, with causes and socio-economic consequences of diseases and health disorders within context of historical development of organization of health and social services. The students will get grasp of funding of health care, of models of health care funding systems, of the importance of economics in health care, including as related to the demographic development.
  They will be able to explain the meaning of social equality and solidarity, they will be familiarized with the issue of public health insurance system and with fundamentals of valid legislation, they will be able to present the health care system indicators including their strengths and weaknesses. They will be familiarized with types of the care provided, including its need and consumption depending on population ageing, with methods of funding of the health care provided, with application of professional inspection carried out by health insurance companies through inspection physicians and health care workers qualified for inspection activities. They will be familiarized with methods and rules for reporting of interventions according to applicable rules. They will be familiarized with regulation mechanisms applied in health care funding, with types and calculations of payments in individual segments of the care provided, including the inspection of quality of the care provided and the importance of monitoring of the purposefulness of payments.
  They will be familiarized with the issue of drug policy (pharmacotherapy, pharmacoeconomics, the role of the State Institute for Drug Control and of the Drug Commission).
  Contents orientation of seminars and practical sessions:
  1. Medical documentation and general rules for reporting of medical interventions.
  2. Legislation related to reporting of medical interventions.
  3. Basic concepts used at reporting of medical interventions, intervention content, intervention point value.
  4. Medical intervention calculation, payment of indirect costs, minute overhead costs.
  5. Author qualification, intervention carriers, ZUM, ZULP, Nursing day (OD), Medical means (ZP).
  6. Wage index.
  7. Medical intervention value, importance of conciliation procedure.
  8. Fully and partially paid medical interventions.
  9. Keeping of records and documents for reporting of interventions in outpatient and inpatient care (clinical examinations, rules for reporting of nursing days, interventions reported together with nursing days).
  10. Patient categories and rules for their reporting.
  11. Transport and reimbursement of travel costs.
  12. Rules for reporting of interventions in qualification 001, general practical medicine.
  13. Rules for repoting of interventions in qualification 002, practical medicine for children and youth.
  14. Rules for reporting of interventions in qualification 911, general nurse.
  15. Rules for reporting of interventions in qualification 913, general nurse in social services.
  16. Rules for reporting of interventions in qualification 916, nutrition therapist.
  17. Rules for reporting of interventions in qualification 921, midwife.
  18. Rules for reporting of interventions in qualification 925, home health care nurse.
  19. Rules for universal interdisciplinary interventions 999.
  20. Reporting of therapeutic rehabilitation care and health care in

Literature

required literature
• METODIKA VZP 6.0 o předávání a zpracovávání účetních dokladů. info
• SOCIÁLNÍ ZABEZPEČENÍ. URL info
• ZDRAVOTNÍ POJIŠTĚNÍ, zdravotní péče. URL info
• JAKUSOVA, V. Manazment pre nelekarske studijne programy. Martin: Osveta, 2016. ISBN 978-80-8063-447-6. info
• DOLANSKÝ, H. Ekonomika zdravotnických a sociálních služeb. Distanční studijní opora a e-learningový kurz [online]. c2008, posl. akt. 2008 [cit. 2012-09-23]. Opava: Slezská univerzita v Opavě, 2012. URL info
• DOLANSKÝ, H. Ekonomika zdravotnických a sociálních služeb. Opava: Slezská univerzita, 2008. ISBN 978-80-7248-482-9. info
• KŘEPELKA, F. Evropské zdravotnické právo. Praha:LexisNexis, 2004. ISBN 80-8619-989-4. info

recommended literature
• DOLANSKÝ, H. Economics of Health and Social Services. Podpůrný studijní text v rozsahu studijní opory Slezská univerzita v Opavě, Fakulta veřejných politik, Institucionální program pro veřejné vysoké školy pro r. 2014. Název a číslo projektu: Podpora rozvoje zahraničních vztahů a spolupráce s FVP, č. 10/3 (projekt, učební pomůcka). info
• KOVANICOVÁ, D. Abeceda účetních znalostí pro každého. Praha: Polygon, 2009. ISBN 978-80-7273-156-5. info
• DOLANSKÝ, H. Veřejné zdravotnictví. Opava: Slezská univerzita, 2008. ISBN 978-80-7248-494-2. info
• KRÁL, B. A KOL. Manažerské účetnictví - 2. rozšířené vydání. Praha: Management Press, 2006. ISBN 80-7261-141-0. info
• ZLÁMAL, J., BELLOVÁ, J. Ekonomika zdravotnictví. Brno: NCO NZO, 2005. ISBN 80-7013-429-1. info
• SYNEK, M. a kol. Manažerská ekonomika. Praha: Grada, 2003. ISBN 80-247-0515-X. info
• DOLANSKÝ, H. Socioekonomické aspekty, ukazatele zdravotního stavu obyvatelstva a analýzy jako faktory, které mohou ovlivnit orientaci revizního lékaře zdravotní pojišťovny v problematice sekundární prevence. Revizní a posudkové lékařství-Listy revizního lékařství, č. 1, ročník VI. 2003. info
• PUSTELNÍK, K., JAROŠOVÁ, D. Úvod do studia zdravotnických systémů. Ostrava: ZSF OU Ostrava, 2003. ISBN 80-7042-346-3. info
• WAN, T. T. Analýza a vyhodnocování systémů zdravotní péče: Integrovaný přístup k manažerskému rozhodování. Olomouc: Univerzita Palackého, 1998. ISBN 80-7067-834-8. info

Language of instruction

Czech

Further comments (probably available only in Czech)

The course can also be completed outside the examination period.
Information on the extent and intensity of the course: Seminář 4 HOD/SEM.

Teacher's information

The contact instruction is implemented through the system of tutorials on selected topics. The combined part of the studies is implemented in the e-learning course environment at e-portal http://elearning.fvp.slu.cz/. The students have study supports including correspondence tasks available for instruction there. The course is concluded by a credit in written or oral form; within it, the student will demonstrate knowledge of basic and recommended reading and be able to discuss the processed correspondence tasks. The student will have opportunity to consult individually the topics studied, through individual or group tutorials or electronic mail.
Credit requirements: carry out a sociological research, pass the credit test.

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