diplomsko delo
Edita Beganović (Author), Janja Hojnik (Mentor)

Abstract

Z razvojem notranjega trga EU je bilo neizogibno, da se bodo razvile tudi pravice na področju zdravstvenih storitev v drugih državah članicah. Zdravstvo je sicer v domeni vsake članice, a kadar gre za prehajanje med državami članicami, ima EU pristojnost urejati takšna razmerja. Raziskave kažejo, da večina Evropejcev ne pozna pravic glede zdravljenja v tujini in povračila stroškov za zdravljenje. Ljudje se odločajo za čezmejno zdravljenje, če živijo na obmejnem področju ali kadar gre za visoko specializirano oskrbo, bližino družinskih članov, ki prebivajo v drugi državi članici, dostop do drugačnega načina zdravljenja, kot ga imajo v državi članici zdravstvenega zavarovanja ter zaradi kakovostnejše storitve. Zavarovana oseba se mora pozanimati, ali je za zdravljenje, ki ga želi opraviti v drugi državi članici, potrebna predhodna odobritev. Ta se lahko uveljavlja na podlagi Uredbe 883/2004 ali Direktive 2011/24/EU. Kadar se uveljavlja čezmejno zdravljenje na podlagi Uredbe 883/2004, je predhodna odobritev vedno pogoj za takšno zdravljenje. Odobri se, ko gre za storitve iz košarice pravic, hkrati pa so izčrpane vse možnosti zdravljenja, zdravljenje doma ni na voljo ali v primeru predolgih čakalnih dob. Stroški v višini dejanske vrednosti se povrnejo le v primeru predhodne odobritve in sicer jih plača nosilec socialnega zavarovanja neposredno izvajalcu storitve, zdravstvene storitve pa se lahko uveljavljajo samo pri izvajalcih v javni mreži. V primeru Direktive 2011/24/EU se predhodna odobritev uporablja le za določene storitve iz košarice pravic (bolnišnično zdravljenje, zahtevne in drage storitve, storitve z večjim tveganjem, vprašanje varnosti in kakovosti). Stroški se povrnejo za vse primere predhodne odobritve, a le v vrednosti zdravstvene storitve v državi nosilki zavarovanja. Zavarovanec prosto izbira med zdravstvenimi storitvami javnih in zasebnih izvajalcev, katerim tudi sam plača, nosilec socialnega zavarovanja pa mu nato vrne znesek, do katerega je upravičen na podlagi izračunov.

Keywords

čezmejno zdravljenje;predhodna odobritev;stroški;zdravstveno zavarovanje;država članica;Evropska unija.;

Data

Language: Slovenian
Year of publishing:
Typology: 2.11 - Undergraduate Thesis
Organization: UM PF - Faculty of Law
Publisher: [E. Beganović]
UDC: 339.923:61(043.3)
COBISS: 5801771 Link will open in a new window
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Downloads: 61
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Other data

Secondary language: English
Secondary title: Prior authorization of cross-border healthcare in another member state of European Union
Secondary abstract: With the development of the EU internal market it was a matter of time for the rights to healthcare in other Member States to be claimed. Healthcare is in the domain of each EU Member State, with the exception when it comes to transitions between Member States. In that case EU has competence of regulation. Surveys show that most Europeans do not know their rights in respect of medical treatment abroad and possibility of reimbursement for treatment. People opt for cross-border treatment, if they live close to border area, or when it comes to highly specialized care, proximity to family members residing in another Member State, access to a different method of treatment than they have it in the Member State of affiliation or for the reason of quality services. The insured person has to inquire whether the treatment he wishes to obtain in another Member State is subject to prior authorization. The latter can be obtained on the basis of Regulation 883/2004 or Directive 2011/24 / EU. If cross-border treatment is claimed on the basis of Regulation 883/2004, prior authorization is always a requirement for the treatment. It shall be granted when it comes to service from the health care basket and all treatment options in the domestic Member State are exhausted, treatment is not available in the domestic Member State or in case of excessively long waiting periods. Costs in the amount of the actual value are repaid only in case of approval of prior authorisation and are paid by the social security institution directly to service provider. It is mandatory for service provider to be the part of public system. In the case of Directive 2011/24 / EU prior authorization only applies to certain healthcare services (hospitalization, complicated and expensive services, with a higher risk, the issue of safety and quality). Costs for cases subjected to prior authorisation are reimbursed according to price of the same or comparable health service in the Member State of affiliation. The insured person is free to choose between public or private health service providers and has to cover the costs by himself to be refunded later but only in the amount as if the service was provided in the Member State of affiliation.
Secondary keywords: cross-border healthcare;prior authorization;costs;health insurance;Member State;European Union;
Type (COBISS): Bachelor thesis/paper
Thesis comment: Univ. v Mariboru, Pravna fak.
Pages: IV, 36 str.
ID: 11234286