{"id":29767,"date":"2017-12-09T18:03:45","date_gmt":"2017-12-09T17:03:45","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=29767"},"modified":"2017-12-09T18:04:35","modified_gmt":"2017-12-09T17:04:35","slug":"moznost-vyjimecne-uhrady-lecby-pro-tezce-nemocne-pacienty-otazky-a-odpovedi","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=29767","title":{"rendered":"Mo\u017enost v\u00fdjime\u010dn\u00e9 \u00fahrady l\u00e9\u010dby pro t\u011b\u017ece nemocn\u00e9 pacienty – ot\u00e1zky a odpov\u011bdi"},"content":{"rendered":"

V posledn\u00ed dob\u011b se m\u00e9dia st\u00e1le \u010dast\u011bji v\u011bnuj\u00ed p\u0159\u00edpad\u016fm, kdy l\u00e9ka\u0159i doporu\u010dili pacientovi s v\u00e1\u017enou chorobou l\u00e9\u010dbu, kterou v\u0161ak nen\u00ed mo\u017en\u00e9 podle platn\u00e9ho z\u00e1kona zaplatit z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed. Zve\u0159ej\u0148ujeme nej\u010dast\u011bji se vyskytuj\u00edc\u00ed dotazy a odpov\u011bdi na n\u011b.<\/strong><\/p>\n


\n1) Pro\u010d VZP odm\u00edt\u00e1 n\u011bkter\u00fdm klient\u016fm uhradit l\u00e9ky, kter\u00e9 by jim podle l\u00e9ka\u0159\u016f mohly pomoci?<\/strong><\/p>\n

Jak\u00e1 l\u00e9\u010dba a komu m\u016f\u017ee b\u00fdt hrazena z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, neur\u010duj\u00ed jednotliv\u00e9 zdravotn\u00ed poji\u0161\u0165ovny, ale platn\u00e1 legislativa.<\/p>\n

Ta upravuje jak p\u0159\u00edpady, kdy je \u00fahrada l\u00e9ku stanovena St\u00e1tn\u00edm \u00fastavem pro kontrolu l\u00e9\u010div (S\u00daKL), tak p\u0159\u00edpady, kdy \u00fahrada stanovena nen\u00ed.<\/p>\n

V p\u0159\u00edpad\u011b, \u017ee S\u00daKL stanovil \u00fahradu, VZP tyto l\u00e9ky standardn\u011b hrad\u00ed. I v p\u0159\u00edpad\u011b, \u017ee S\u00daKL \u00fahradu doposud nestanovil, m\u016f\u017ee poji\u0161\u0165ovna klientovi l\u00e9k zaplatit v nestandardn\u00edm v\u00fdjime\u010dn\u00e9m re\u017eimu (podle \u00a7 16 z\u00e1kona \u010d. 48\/1997 Sb.). Z\u00e1kon na takov\u00e9 mo\u017enosti pamatuje. Nicm\u00e9n\u011b jako jednozna\u010dnou podm\u00ednku tent\u00fd\u017e z\u00e1kon stanov\u00ed, \u017ee poji\u0161\u0165ovna m\u016f\u017ee l\u00e9k takto v\u00fdjime\u010dn\u011b uhradit jen tehdy, je-li to jedin\u00e1 mo\u017enost l\u00e9\u010dby (tento term\u00edn je v z\u00e1kon\u011b jako podm\u00ednka v\u00fdslovn\u011b uveden).<\/p>\n

Pokud jde tedy o l\u00e9k, pro kter\u00fd S\u00daKL zat\u00edm nestanovil \u00fahradu a u konkr\u00e9tn\u00edho pacienta nejde ani o jedinou mo\u017enost l\u00e9\u010dby, platn\u00e9 z\u00e1kony poji\u0161\u0165ovn\u011b neumo\u017e\u0148uj\u00ed p\u0159\u00edpravek uhradit.<\/p>\n

2) Nep\u0159ipadaj\u00ed v\u00e1m takov\u00e9 z\u00e1kony nesmysln\u00e9 a proti z\u00e1jmu klient\u016f?<\/strong><\/p>\n

VZP z\u00e1kony ani vyhl\u00e1\u0161ky, na\u0159\u00edzen\u00ed vl\u00e1dy a dal\u0161\u00ed legislativn\u00ed normy nenavrhuje, ani netvo\u0159\u00ed, naopak je povinna je respektovat (\u00dastava \u010cR nep\u0159isuzuje zdravotn\u00edm poji\u0161\u0165ovn\u00e1m z\u00e1konod\u00e1rnou iniciativu). Pokud je tedy kdokoliv toho n\u00e1zoru, \u017ee z\u00e1kon by m\u011bl v konkr\u00e9tn\u00edm bod\u011b vypadat jinak, nem\u016f\u017ee z toho vinit zdravotn\u00ed poji\u0161\u0165ovnu a stejn\u011b tak nem\u016f\u017ee cht\u00edt, aby zdravotn\u00ed poji\u0161\u0165ovna z\u00e1kon zm\u011bnila. Rovn\u011b\u017e nem\u016f\u017ee nikdo po\u017eadovat, aby zdravotn\u00ed poji\u0161\u0165ovna jednala protiz\u00e1konn\u011b.<\/p>\n

Je n\u00e1m moc l\u00edto, pokud se na\u0161i klienti dost\u00e1vaj\u00ed do obt\u00ed\u017en\u00fdch \u017eivotn\u00edch situac\u00ed, sna\u017e\u00edme se jim ze v\u0161ech sil pomoci a ka\u017ed\u00e9mu z nich tak\u00e9 zajist\u00edme nejlep\u0161\u00ed mo\u017enou l\u00e9\u010dbu, kterou v jeho konkr\u00e9tn\u00edm p\u0159\u00edpad\u011b z\u00e1kon umo\u017e\u0148uje z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed uhradit. Ale i my \u2013 stejn\u011b jako v\u0161ichni ostatn\u00ed \u2013 mus\u00edme respektovat platn\u00e9 z\u00e1kony.<\/p>\n

3) To ve VZP od stolu rozhodujete a zam\u00edt\u00e1te l\u00e9\u010dbu, kterou klient\u016fm doporu\u010dili profeso\u0159i a docenti na \u0161pi\u010dkov\u00fdch klinik\u00e1ch?<\/strong><\/p>\n

V \u017e\u00e1dn\u00e9m p\u0159\u00edpad\u011b. V\u011bt\u0161inu rozhodnut\u00ed, a zejm\u00e9na ta problematick\u00e1, nech\u00e1v\u00e1me posoudit \u0161pi\u010dkov\u00fdmi odborn\u00edky z dan\u00fdch obor\u016f, kte\u0159\u00ed rovn\u011b\u017e pracuj\u00ed na \u0161pi\u010dkov\u00fdch klinick\u00fdch pracovi\u0161t\u00edch a VZP je vyu\u017e\u00edv\u00e1 pouze na \u010d\u00e1ste\u010dn\u00fd \u00favazek jako revizn\u00ed l\u00e9ka\u0159e.<\/p>\n

Nav\u00edc \u0159adu p\u0159\u00edpad\u016f konzultujeme i p\u0159\u00edmo s odborn\u00fdmi l\u00e9ka\u0159sk\u00fdmi spole\u010dnostmi, co\u017e jsou nejvy\u0161\u0161\u00ed odborn\u00e9 autority v dan\u00e9m oboru v r\u00e1mci \u010cR.<\/p>\n

4) Jak je mo\u017en\u00e9, \u017ee jedna poji\u0161\u0165ovna odm\u00edtne l\u00e9k sv\u00e9mu klientovi zaplatit a jin\u00e1 poji\u0161\u0165ovna stejn\u00fd l\u00e9k sv\u00e9mu poji\u0161t\u011bnci uhrad\u00ed?<\/strong><\/p>\n

V\u017edy z\u00e1le\u017e\u00ed na zdravotn\u00edm stavu konkr\u00e9tn\u00edho pacienta. \u017d\u00e1dn\u00ed dva lid\u00e9 nejsou stejn\u00ed. I kdy\u017e maj\u00ed t\u0159eba stejnou diagn\u00f3zu, mohou m\u00edt ka\u017ed\u00fd jin\u00e9 p\u0159idru\u017een\u00e9 diagn\u00f3zy, ka\u017ed\u00fd jin\u00e9 komplikace, ka\u017ed\u00fd se mohl doposud l\u00e9\u010dit jinak a nemoc u n\u011bj m\u016f\u017ee b\u00fdt v jin\u00e9m stadiu. S nejv\u011bt\u0161\u00ed pravd\u011bpodobnost\u00ed by tak pacientovi, kter\u00e9mu byla v\u00fdjime\u010dn\u00e1 \u00fahrada jinak nehrazen\u00e9ho l\u00e9ku schv\u00e1lena jednou poji\u0161\u0165ovnou, stejn\u011b vyhov\u011bla i jin\u00e1 zdravotn\u00ed poji\u0161\u0165ovna. Prost\u011b proto, \u017ee jeho zdravotn\u00ed stav to vy\u017eaduje a konkr\u00e9tn\u011b u n\u011bj jde o jedinou mo\u017enost l\u00e9\u010dby. A naopak \u2013 klientovi, kter\u00e9mu jedna poji\u0161\u0165ovna b\u011b\u017en\u011b nehrazenou l\u00e9\u010dbu zaplatit odm\u00edtla, by ji odm\u00edtla zaplatit i ka\u017ed\u00e1 jin\u00e1 poji\u0161\u0165ovna, proto\u017ee v jeho p\u0159\u00edpad\u011b p\u0159ipadala v \u00favahu i jin\u00e1 mo\u017enost l\u00e9\u010dby.<\/p>\n

5) Co maj\u00ed d\u011blat lid\u00e9, kter\u00fdm VZP odm\u00edtne uhradit l\u00e9\u010dbu?<\/strong><\/p>\n

VZP nikomu neodm\u00edtne zaplatit l\u00e9\u010dbu. Pouze v p\u0159\u00edpadech, kdy konkr\u00e9tn\u00ed l\u00e9\u010dba nem\u016f\u017ee b\u00fdt v souladu se z\u00e1konem hrazena z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, zaplat\u00ed sv\u00fdm klient\u016fm jinou z \u0159ady mo\u017enost\u00ed l\u00e9\u010dby. P\u0159i\u010dem\u017e jde v\u017edy o l\u00e9\u010dbu pln\u011b odpov\u00eddaj\u00edc\u00ed odborn\u00fdm standard\u016fm, kter\u00e9 stanovily odborn\u00e9 l\u00e9ka\u0159sk\u00e9 spole\u010dnosti.<\/p>\n

6) Co maj\u00ed d\u011blat lid\u00e9, kte\u0159\u00ed cht\u011bj\u00ed od poji\u0161\u0165ovny uhradit l\u00e9\u010dbu, kter\u00e1 je pro n\u011b podle jejich l\u00e9ka\u0159e nejlep\u0161\u00ed, ale poji\u0161\u0165ovna ji uhradit odm\u00edt\u00e1?<\/strong><\/p>\n

Je velmi t\u011b\u017ek\u00e9 \u0159\u00edci, kter\u00e1 l\u00e9\u010dba je skute\u010dn\u011b ta nejlep\u0161\u00ed. Leckdy se st\u00e1v\u00e1, \u017ee vhodnost jednoho zp\u016fsobu l\u00e9\u010dby konzultujeme se dv\u011bma odborn\u00fdmi spole\u010dnosti a dostaneme od nich diametr\u00e1ln\u011b odli\u0161n\u00e1 stanoviska. Takto se nap\u0159\u00edklad \u010cesk\u00e1 onkologick\u00e1 spole\u010dnost a Spole\u010dnost radia\u010dn\u00ed onkologie, biologie a fyziky neshodnou, zda m\u00e1 b\u00fdt hrazena z ve\u0159ejn\u00e9ho poji\u0161t\u011bn\u00ed protonov\u00e1 l\u00e9\u010dba prostaty.<\/p>\n

Nav\u00edc jak u\u017e bylo uvedeno u p\u0159edchoz\u00edho dotazu \u2013 VZP nikomu neodm\u00edtne zaplatit l\u00e9\u010dbu. Pouze v p\u0159\u00edpadech, kdy konkr\u00e9tn\u00ed l\u00e9\u010dba nem\u016f\u017ee b\u00fdt v souladu se z\u00e1konem hrazena z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, zaplat\u00ed sv\u00fdm klient\u016fm jinou z \u0159ady mo\u017enost\u00ed l\u00e9\u010dby. P\u0159i\u010dem\u017e jde v\u017edy o l\u00e9\u010dbu pln\u011b odpov\u00eddaj\u00edc\u00ed odborn\u00fdm standard\u016fm, kter\u00e9 stanovily odborn\u00e9 l\u00e9ka\u0159sk\u00e9 spole\u010dnosti. 7) V m\u00e9di\u00edch vystupuj\u00ed n\u011bkte\u0159\u00ed pr\u00e1vn\u00edci, kte\u0159\u00ed tvrd\u00ed, \u017ee VZP posuzuje \u00a7 16 \u0161patn\u011b a v\u00fdklad by m\u011bl b\u00fdt jin\u00fd, p\u0159\u00edzniv\u011bj\u0161\u00ed pro klienty.<\/p>\n

\u0158\u00edk\u00e1 se, \u017ee kdy\u017e po\u017e\u00e1d\u00e1te dva pr\u00e1vn\u00edky o pr\u00e1vn\u00ed n\u00e1zor na jednu v\u011bc, dostanete od nich t\u0159i pr\u00e1vn\u00ed n\u00e1zory. Samoz\u0159ejm\u011b, \u017ee ka\u017ed\u00fd m\u00e1 pr\u00e1vo na sv\u016fj pr\u00e1vn\u00ed n\u00e1zor, nicm\u00e9n\u011b z hlediska pr\u00e1va m\u00e1 n\u00e1zor libovoln\u00e9ho pr\u00e1vn\u00edka vystupuj\u00edc\u00edho v m\u00e9di\u00edch zhruba stejnou v\u00e1hu, jako n\u00e1zor kohokoliv, kdo jde venku po ulici. Rozhodn\u011b nen\u00ed o nic kvalifikovan\u011bj\u0161\u00ed a v\u00fdznamn\u011bj\u0161\u00ed ne\u017e pr\u00e1vn\u00ed n\u00e1zor pr\u00e1vn\u00edk\u016f z VZP. Jedin\u00fd, kdo je kompetentn\u00ed k tomu z\u00e1vazn\u011b vykl\u00e1dat z\u00e1kony, je soud.<\/p>\n

8) Lid\u00e9 ale nemohou \u010dekat na soudn\u00ed rozhodnut\u00ed, kdy\u017e maj\u00ed v\u00e1\u017enou nemoc a m\u016f\u017ee u nich <\/strong>hrozit nebezpe\u010d\u00ed z prodlen\u00ed.<\/p>\n

Ka\u017ed\u00fd m\u00e1 mo\u017enost, pokud se rozhodne \u0159e\u0161it svou v\u011bc soudn\u011b, po\u017e\u00e1dat soud o vyd\u00e1n\u00ed p\u0159edb\u011b\u017en\u00e9ho opat\u0159en\u00ed, tzn. po\u017e\u00e1dat, aby soud prakticky obratem na\u0159\u00eddil VZP hradit l\u00e9\u010dbu. To pak m\u016f\u017ee b\u00fdt ot\u00e1zka n\u011bkolika dn\u00ed.<\/p>\n

9) Pro\u010d zam\u00edt\u00e1te tolik \u017e\u00e1dost\u00ed o modern\u00ed l\u00e9\u010dbu?<\/strong><\/p>\n

Jak u\u017e bylo \u0159e\u010deno, o tom, co lze a nelze hradit z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, nerozhoduj\u00ed poji\u0161\u0165ovny, ale platn\u00e1 legislativa.<\/p>\n

V lo\u0148sk\u00e9m roce l\u00e9ka\u0159i \u017e\u00e1dali VZP pro sv\u00e9 pacienty o nestandardn\u00ed v\u00fdjime\u010dnou \u00fahradu l\u00e9\u010dby ve v\u00edce ne\u017e 14 tis\u00edc\u00edch p\u0159\u00edpad\u016f. VZP schv\u00e1lila v\u00edce ne\u017e 90 % t\u011bchto \u201ev\u00fdjimek\u201c a na z\u00e1klad\u011b toho zaplatila klient\u016fm l\u00e9ky za v\u00edc ne\u017e 1 miliardu korun. Naprosto srovnateln\u00e9 procento \u017e\u00e1dost\u00ed zam\u00edtaj\u00ed i dal\u0161\u00ed zdravotn\u00ed poji\u0161\u0165ovny.<\/p>\n

10) P\u0159esto jste ale zhruba 1 400 klient\u016fm zam\u00edtli l\u00e9\u010dbu, kterou jim l\u00e9ka\u0159i doporu\u010dili. Jak to chcete do budoucna \u0159e\u0161it?<\/strong><\/p>\n

VZP minul\u00fd t\u00fdden na tiskov\u00e9 konferenci p\u0159edstavila n\u00e1vrh \u0159e\u0161en\u00ed. T\u00edm je podle na\u0161eho n\u00e1zoru princip \u201eplatby za v\u00fdsledek\u201c, n\u011bkdy naz\u00fdvan\u00fd t\u00e9\u017e \u201eprincip sd\u00edlen\u00ed rizik\u201c.<\/p>\n

Firma, kter\u00e1 si za p\u0159\u00ednosem sv\u00e9ho l\u00e9ku stoj\u00ed, nem\u00e1 d\u016fvod k obav\u00e1m a nem\u011bla by m\u00edt s t\u00edmto principem probl\u00e9m. Pokud si ale s\u00e1m v\u00fdrobce nen\u00ed jist\u00fd funk\u010dnost\u00ed sv\u00e9ho l\u00e9ku, odm\u00edt\u00e1 p\u0159istoupit na princip \u201e\u00fahrady za v\u00fdsledek\u201c a nav\u00edc nejde o jedinou mo\u017enost l\u00e9\u010dby, pak VZP nem\u016f\u017ee l\u00e9\u010dbu sv\u00e9voln\u011b schv\u00e1lit. Jedin\u00fd zaru\u010den\u00fd efekt by v takov\u00e9m p\u0159\u00edpad\u011b byl ten finan\u010dn\u00ed pro farmaceutick\u00fd pr\u016fmysl. A to by bylo v rozporu jak se st\u00e1vaj\u00edc\u00edm z\u00e1konem, tak s prostou logikou, ale i s principem solidarity, na kter\u00e9m je zdravotn\u00ed syst\u00e9m zalo\u017een. M\u00e1 j\u00edt o solidaritu s nemocn\u00fdmi, nikoliv s nadn\u00e1rodn\u00edmi farmaceutick\u00fdmi korporacemi, kter\u00e9 bez ohledu na pacienty \u0159e\u0161\u00ed hlavn\u011b sv\u00e9 zisky.<\/p>\n

VZP ji\u017e s n\u011bkolika v\u00fdrobci takovou dohodu uzav\u0159ela a jejich v\u00fdrobky hrad\u00ed. V\u0161e ale zat\u00edm z\u00e1le\u017e\u00ed na vst\u0159\u00edcnosti firem. Sou\u010dasn\u00e1 legislativa ned\u00e1v\u00e1 VZP mo\u017enost takov\u00fd postup \u00fa\u010dinn\u011b prosazovat. To by se dle na\u0161eho n\u00e1zoru m\u011blo zm\u011bnit.<\/p>\n

11) Pro\u010d nejsou modern\u00ed l\u00e9ky v \u010cR dostupn\u00e9 stejn\u011b jako v cizin\u011b?<\/strong><\/p>\n

Co se t\u00fd\u010de dostupnosti biologick\u00e9 l\u00e9\u010dby, je na tom \u010cR nejl\u00e9pe ze zem\u00ed st\u0159edn\u00ed a v\u00fdchodn\u00ed Evropy a p\u0159inejmen\u0161\u00edm stejn\u011b dob\u0159e jako z\u00e1padoevropsk\u00e9 zem\u011b se srovnateln\u00fdm HDP.<\/p>\n

V lo\u0148sk\u00e9m roce zaplatila VZP za biologickou l\u00e9\u010dbu 10 miliard korun. Tuto \u010d\u00e1stku spot\u0159ebovalo cca 30 tis\u00edc lid\u00ed. P\u0159ed p\u011bti lety to bylo n\u011bco p\u0159es 5 miliard a 20 tis\u00edc klient\u016f.<\/p>\n

Ka\u017ed\u00e9mu klientovi uhrad\u00ed VZP nejlep\u0161\u00ed mo\u017enou p\u00e9\u010di, kterou vy\u017eaduje jeho zdravotn\u00ed stav a jej\u00ed\u017e \u00fahradu umo\u017e\u0148uj\u00ed platn\u00e9 legislativn\u00ed mantinely.<\/p>\n

Mgr. Old\u0159ich Tich\u00fd<\/p>\n

vedouc\u00ed tiskov\u00e9ho odd\u011blen\u00ed a tiskov\u00fd mluv\u010d\u00ed <\/p>\n","protected":false},"excerpt":{"rendered":"

V posledn\u00ed dob\u011b se m\u00e9dia st\u00e1le \u010dast\u011bji v\u011bnuj\u00ed p\u0159\u00edpad\u016fm, kdy l\u00e9ka\u0159i doporu\u010dili pacientovi s v\u00e1\u017enou chorobou l\u00e9\u010dbu, kterou v\u0161ak nen\u00ed mo\u017en\u00e9 podle platn\u00e9ho z\u00e1kona zaplatit […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":15130,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-29767","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/29767","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29767"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/29767\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/15130"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29767"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29767"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29767"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}