{"id":30260,"date":"2018-03-11T22:55:51","date_gmt":"2018-03-11T21:55:51","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=30260"},"modified":"2018-03-11T22:55:51","modified_gmt":"2018-03-11T21:55:51","slug":"vzp-verdikt-soudu-o-uhrade-leku-muze-ohrozit-financovani-zdravotnictvi","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=30260","title":{"rendered":"VZP: Verdikt soudu o \u00fahrad\u011b l\u00e9ku m\u016f\u017ee ohrozit financov\u00e1n\u00ed zdravotnictv\u00ed"},"content":{"rendered":"

M\u011bstsk\u00fd soud v Praze, kter\u00fd v \u00fater\u00fd rozhodoval o sporu VZP s klientkou do\u017eaduj\u00edc\u00ed se proplacen\u00ed standardn\u011b nehrazen\u00e9ho l\u00e9ku, postupoval podle poji\u0161\u0165ovny VZP v rozporu s rozsudky v obdobn\u00fdch p\u0159\u00edpadech. Klientce toti\u017e p\u0159iznal \u00fahradu velmi drah\u00e9ho l\u00e9ku, kter\u00fd podle St\u00e1tn\u00edho \u00fastavu pro kontrolu l\u00e9\u010div pro jej\u00ed diagn\u00f3zu hrazen b\u00fdt nem\u00e1 a nen\u00ed v jej\u00edm p\u0159\u00edpad\u011b ani jedinou mo\u017enost\u00ed l\u00e9\u010dby. Soud tak fakticky rozhodl, \u017ee l\u00e9\u010dbu, kter\u00e1 m\u016f\u017ee vyj\u00edt odhadem a\u017e na 1,5 milionu korun ro\u010dn\u011b, m\u00e1 VZP uhradit jen proto, aby nemocn\u00e1 nemusela dr\u017eet dietu.<\/strong><\/p>\n

Z \u00fatern\u00edho soudn\u00edho verdiktu je podle VZP z\u0159ejm\u00e9, \u017ee pokud by se takov\u00e1 praxe roz\u0161\u00ed\u0159ila, m\u016f\u017ee to v\u00e1\u017en\u011b ohrozit ekonomickou stabilitu cel\u00e9ho zdravotn\u00edho syst\u00e9mu v \u010cesku. Jin\u00fdmi slovy \u2013 ve\u0161ker\u00e9 pen\u00edze, kter\u00e9 v\u0161ichni lid\u00e9 a st\u00e1t pos\u00edlaj\u00ed do syst\u00e9mu ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, by mohly brzy doj\u00edt a nebylo by za co l\u00e9\u010dit.<\/p>\n

Samotn\u00fd soudn\u00ed p\u0159\u00edpad se t\u00fdkal osmilet\u00e9 d\u00edvky, kterou l\u00e9ka\u0159i dlouhodob\u011b l\u00e9\u010d\u00ed s nezhoubnou formou fenylketonurie (jedna z poruch metabolismu). Podle odborn\u00fdch doporu\u010den\u00ed je prim\u00e1rn\u00edm zp\u016fsobem l\u00e9\u010dby dieta, kter\u00e1 je dosta\u010duj\u00edc\u00ed k eliminaci zdravotn\u00edch probl\u00e9m\u016f, kter\u00e9 jinak m\u016f\u017ee fenylketonurie vyvolat. Jedna z farmaceutick\u00fdch firem v\u0161ak d\u00edvku v jej\u00edch dvou letech za\u0159adila do klinick\u00e9 studie, v jej\u00edm\u017e r\u00e1mci na n\u00ed testovala nov\u00fd, zdarma pod\u00e1van\u00fd l\u00e9k. Loni firma studii ukon\u010dila a l\u00e9k d\u00edvce p\u0159estala dod\u00e1vat.<\/p>\n

Proto\u017ee podle St\u00e1tn\u00edho \u00fastavu pro kontrolu l\u00e9\u010div nem\u00e1 b\u00fdt uveden\u00fd p\u0159\u00edpravek pro d\u00edv\u010dinu diagn\u00f3zu hrazen ze zdravotn\u00edho poji\u0161t\u011bn\u00ed, m\u011bla by se klientka za\u010d\u00edt l\u00e9\u010dit dietou. Stejn\u011b jako v\u0161ichni ostatn\u00ed pacienti, kte\u0159\u00ed rovn\u011b\u017e trp\u00ed nezhoubnou formou t\u00e9\u017ee nemoci. L\u00e9k m\u00e1 b\u00fdt naopak hrazen pacient\u016fm se zhoubnou formou fenylketonurie, pro kter\u00e9 je skute\u010dn\u011b nezbytn\u00fd. T\u011bm ho tak\u00e9 VZP standardn\u011b propl\u00e1c\u00ed. D\u00edv\u010din\u00fdm rodi\u010d\u016fm se to ale nel\u00edbilo a dohnali cel\u00fd p\u0159\u00edpad a\u017e k soudu.<\/p>\n

Pr\u00e1vn\u00ed z\u00e1stupci klientky v \u017ealob\u011b argumentovali t\u00edm, \u017ee dodr\u017eov\u00e1n\u00ed diety je \u00fadajn\u011b p\u0159\u00edli\u0161 svazuj\u00edc\u00ed a omezuj\u00edc\u00ed v b\u011b\u017en\u00e9m \u017eivot\u011b (nap\u0159\u00edklad \u017ee by nemohla chodit se spolu\u017e\u00e1ky j\u00edst do \u0161koln\u00ed j\u00eddelny). To by podle nich mohlo klientce zp\u016fsobit psychickou \u00fajmu a vy\u010dlenit ji ze spole\u010dnosti. Takov\u00e9 tvrzen\u00ed se ale jev\u00ed jako \u00fa\u010delov\u00e9 a p\u0159ehnan\u00e9. Dietn\u00ed opat\u0159en\u00ed mus\u00ed dodr\u017eovat v\u0161ichni pacienti l\u00e9\u010den\u00ed se stejnou diagn\u00f3zou, stejn\u011b jako \u0159ada pacient\u016f s mnoha dal\u0161\u00edmi onemocn\u011bn\u00edmi. To ale nen\u00ed z\u00e1konn\u00fd d\u016fvod pro p\u0159izn\u00e1n\u00ed v\u00fdjime\u010dn\u00e9 \u00fahrady mimo\u0159\u00e1dn\u011b drah\u00e9ho l\u00e9ku, kter\u00fd v \u010cesku pro takovou diagn\u00f3zu b\u011b\u017en\u011b hrazen nen\u00ed.<\/p>\n

\u00dastavn\u00ed soud ji\u017e d\u0159\u00edve opakovan\u011b potvrdil, \u017ee nelze v\u0161em poji\u0161t\u011bnc\u016fm v\u017edy hradit nejlep\u0161\u00ed mo\u017enou l\u00e9\u010dbu a \u017ee je naopak legitimn\u00ed, pokud pr\u00e1vn\u00ed p\u0159edpisy stanov\u00ed ur\u010dit\u00e1 omezen\u00ed pro \u00fahradu. A to zejm\u00e9na s ohledem na objem finan\u010dn\u00edch prost\u0159edk\u016f, kter\u00fdmi zdravotn\u00ed poji\u0161\u0165ovny disponuj\u00ed. Bal\u00edk pen\u011bz z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed nen\u00ed a nem\u016f\u017ee b\u00fdt neomezen\u00fd. Aktu\u00e1ln\u00ed rozhodnut\u00ed M\u011bstsk\u00e9ho soudu v Praze v\u0161ak podle n\u00e1zoru VZP tato stanoviska \u00dastavn\u00edho soudu nerespektuje.<\/p>\n

D\u016fle\u017eit\u00e9 je rovn\u011b\u017e upozornit na to, \u017ee uveden\u00fd p\u0159\u00edpad je typickou uk\u00e1zkou pochybn\u00e9ho postupu n\u011bkter\u00fdch zahrani\u010dn\u00edch farmaceutick\u00fdch firem, kter\u00e9 vyu\u017e\u00edvaj\u00ed \u010desk\u00e9 pacienty k testov\u00e1n\u00ed sv\u00fdch l\u00e9k\u016f. Tyto firmy nejprve pacient\u016fm zdarma dod\u00e1vaj\u00ed p\u0159\u00edpravek, kter\u00fd je\u0161t\u011b nem\u00e1 v\u0161echny klinick\u00e9 studie, aby ho na nich vyzkou\u0161ely a n\u00e1sledn\u011b na n\u011bm mohly vyd\u011bl\u00e1vat. Kdy\u017e v\u0161ak u\u017e maj\u00ed dostatek dat a rozl\u00e9\u010den\u00e9 pacienty pro dal\u0161\u00ed testov\u00e1n\u00ed nepot\u0159ebuj\u00ed, zaujmou striktn\u011b obchodnick\u00fd p\u0159\u00edstup a odm\u00edtnou se d\u00e1le jakkoliv pod\u00edlet na jejich l\u00e9\u010db\u011b. V t\u00e9to souvislosti s popisovan\u00fdm p\u0159\u00edpadem stoj\u00ed za pozornost i fakt, \u017ee pr\u00e1vn\u00ed z\u00e1stupce osmilet\u00e9 klientky byl (p\u0159inejmen\u0161\u00edm d\u0159\u00edve) t\u00e9\u017e na v\u00fdplatn\u00ed p\u00e1sce jednoho z nadn\u00e1rodn\u00edch farmaceutick\u00fdch kolos\u016f.<\/p>\n

VZP doposud nem\u00e1 p\u00edsemn\u00e9 vyhotoven\u00ed rozsudku, a bylo by proto p\u0159ed\u010dasn\u00e9 p\u0159edj\u00edmat jej\u00ed dal\u0161\u00ed postup. Ji\u017e nyn\u00ed ale pova\u017euje za nutn\u00e9 upozornit na riziko, kter\u00e9 takov\u00e1to aplikace pr\u00e1va m\u016f\u017ee znamenat pro cel\u00fd zdravotn\u00ed syst\u00e9m \u010cesk\u00e9 republiky.<\/p>\n","protected":false},"excerpt":{"rendered":"

M\u011bstsk\u00fd soud v Praze, kter\u00fd v \u00fater\u00fd rozhodoval o sporu VZP s klientkou do\u017eaduj\u00edc\u00ed se proplacen\u00ed standardn\u011b nehrazen\u00e9ho l\u00e9ku, postupoval podle poji\u0161\u0165ovny VZP v rozporu […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14127,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-30260","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30260","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=30260"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30260\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14127"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30260"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30260"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30260"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}