magistrsko diplomsko delo
Kaja Pipan (Author), Grega Strban (Mentor)

Abstract

Čezmejno izvajanje zdravstvenih storitev obstaja že dlje časa, vendar je sprejetje Direktive 2011/24/EU o uveljavljanju pravic pacientov v čezmejnem zdravstvenem varstvu ponovno oživilo zanimanje za to temo, saj je poleg uredb o koordinaciji in izključno nacionalnih določb odprlo dodatno pravno pot do dostopa do čezmejnega zdravstvenega varstva. V magistrskem diplomskem delu sta predstavljeni dve možnosti v zvezi s čezmejnim zdravstvenim varstvom. Prva določa pogoje za vključitev mobilnih državljanov EU v posamezne nacionalne sisteme javnega zdravstvenega varstva preko socialnega zdravstvenega zavarovanja ali nacionalne zdravstvene službe. Druga pa je nenačrtovana in načrtovana čezmejna zdravstvena oskrba, ki ohranja pokritost v domačem javnem zdravstvenem sistemu. Ugotavljam, da razlikovanje med nenačrtovanim in načrtovanim čezmejnim zdravstvenim varstvom ni vedno jasno, ker se lahko namen pacienta, ki želi prejemati določene zdravstvene storitve, spremeni med potovanjem v drugo državo članico EU (v nadaljevanju: država članica). Nenačrtovano zdravstveno varstvo je v skladu z uredbami zagotovo najpogostejša oblika čezmejnega zdravstvenega varstva, vendar se kljub temu pojavljajo dileme glede pojmov začasnega bivanja zunaj pristojne države članice ter kaj se šteje za nepredvideno in potrebno zdravljenje in kakšen je obseg povračila stroškov za navedene zdravstvene storitve. Poleg tega Direktiva 2011/24 za določene primere nenačrtovanega zdravstvenega varstva zahteva predhodno dovoljenje pristojnega organa, kar povzroča povečano upravno obremenitev za nacionalne sisteme zdravstvenega varstva, ki iščejo najboljšo možno rešitev za pacienta. Vzporedna uporaba uredb, Direktive 2011/24 in čisto nacionalne zakonodaje lahko povzroči tudi pravne in praktične težave pri načrtovanem zdravstvenem varstvu, saj so upravni postopki za izdajo predhodne odobritve dolgotrajni. Nekatere države članice so tako vzpostavile sistem samodejne predhodne odobritve, če upravni postopki trajajo predolgo, pri čemer bi morali biti procesni roki strožji kot v splošnih upravnih postopkovnih pravilih. Praktične težave mobilnih pacientov se pojavljajo tudi, če isti čezmejni izvajalci zdravstvenega varstva hkrati ponujajo javno in zasebno zdravstveno varstvo. Oboje hkrati lahko namreč vodi v usmerjanje pacientov iz javne v zasebno zdravstveno dejavnost pri istem izvajalcu. Slednje praviloma zagotavljajo brez čakalnih seznamov, vendar z višjimi tarifami in neposrednim plačilom, zato je ponudnikom zdravstvenih storitev "lažje", če mobilne paciente zdravijo kot zasebne paciente. Vendar pa takšna obravnava mobilnih pacientov ni dovoljena. Pacient se mora sam odločiti, ali bo obravnavan kot javni ali zasebni pacient, o svobodni izbiri pa mora biti tudi pravilno obveščen. Posebej se osredotočim tudi na odprto vprašanje obrnjene diskriminacije nacionalnih pacientov v primerjavi z mobilnimi. Obrnjena diskriminacija nastane v primeru, ko ima posameznik zaradi gibanja med državami članicami več pravic, kot če ostane znotraj ene države. Primer take ureditve je slovenska zakonodaja. Predstavljeni sta možnosti za njeno odpravo tako na nacionalni ravni kot tudi na ravni EU.

Keywords

zdravstveno varstvo;čezmejno zdravstveno varstvo;javni izvajalci;zasebni izvajalci;mobilnost;obrnjena diskriminacija;Slovenija;Evropska unija;magistrske diplomske naloge;

Data

Language: Slovenian
Year of publishing:
Typology: 2.09 - Master's Thesis
Organization: UL PF - Faculty of Law
Publisher: [K. Pipan]
UDC: 614.2(1-87):34(043.2)
COBISS: 16107857 Link will open in a new window
Views: 1389
Downloads: 745
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Other data

Secondary language: English
Secondary title: Public or private providers of cross-border health service?
Secondary abstract: Although the cross-border provision of health services has existed for a long time, the adoption of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare has recently revived interest in this topic, because it has opened another legal path to access cross-border healthcare in addition to co-ordination regulations and purely national legal provisions. In the master’s thesis two possibilities are presented regarding cross-border healthcare. One is the inclusion of mobile EU citizens into the public healthcare systems through social health insurance or national health service. The other is unplanned and planned cross-border healthcare, which maintains coverage in the domestic public health system. I find that the distinction between unplanned and planned cross-border healthcare is not always clear, because the intention of a patient who wishes to receive certain medical services may change while such patient is visiting another EU Member State. Unplanned healthcare under the Regulations is certainly the most common application of cross-border healthcare, but nevertheless, dilemmas may occur as to the notions of temporary stay outside of the competent Member State, as to what can be considered as unforeseen and necessary healthcare, and as to the extent of reimbursement. In addition, in certain cases of unplanned healthcare, Directive 2011/24/EU requires prior authorization by the competent authority, which increases administrative burden for national healthcare systems seeking the best possible solution for the patient. A parallel application of Regulations, the Directive and purely national legislation may also lead to legal and practical problems in planned healthcare, because the administrative procedures for granting prior authorization are too long. Some Member States have established a system of automatic authorization applied if administrative procedures take too long, with procedural deadlines being more stringent than in general administrative procedural rules. Practical problems may occur for mobile patients if the same cross-border healthcare providers offer both public and private healthcare. At the same time, they can lead to directing patients from public to private healthcare with the same provider. They provide non-waiting lists, but with higher tariffs and direct payments. Therefore, it is "easier" for healthcare providers to treat mobile patients as private patients. Nevertheless, such steering of mobile patients is not allowed. The patient has to decide whether he/she would like to be treated as a public or private patient, and has to be properly informed of the possibility of his/her free choice. Particular emphasis is laid on the open question of reversed discrimination against national patients compared to mobile ones. Reversed discrimination occurs when an individual has more rights due to movement between EU Member States than he/she would have if he/she remained within a single country. An example of this arrangement is the Slovenian legislation. Two possibilities for elimination of such an arrangement are presented at both national and EU level.
Secondary keywords: health care;cross-border healthcare;health care providers;public healthcare providers;private healthcare providers;mobility;reverse discrimination;
Type (COBISS): Master's thesis/paper
Study programme: 0
Embargo end date (OpenAIRE): 1970-01-01
Thesis comment: Univ. v Ljubljani, Pravna fak.
Pages: 58 f.
ID: 10920794