magistrsko diplomsko delo
Sara Birsa (Author), Grega Strban (Mentor)

Abstract

Vsi si želimo biti zdravi, v primeru nastanka bolezni pa, da to oviro čim prej odpravimo. Da bo temu kar se da tako, skrbi država z vzpostavitvijo obveznega zdravstvenega zavarovanja. Zavzema se, da na ta način zavaruje javno zdravje in vsem zavarovanim osebam nudi ustrezne zdravstvene storitve, ko te potrebujejo, pa naj bo to znotraj ali zunaj domačih državnih mej. V praksi pa se v zvezi z učinkovitim zdravljenjem pojavljajo številni dvomi, sploh zaradi relativno dolgih čakalnih vrst, ki že tako slabo zdravstveno stanje posameznika, še dodatno poslabšajo. Ti iz različnih razlogov iščejo alternativne rešitve pri domačih zasebnih izvajalcih ali poiščejo čezmejne zdravstvene storitve pri tujih izvajalcih. Čeprav je bila možnost zdravljenja v tujini včasih omejena na nepričakovane situacije ali predstavljala rešitev, ko je bilo zdravljenje doma zaključeno, so evropske institucije predvidele potrebo po ureditvi načrtnega čezmejnega zdravljenja, ki široko odpira vrata možnosti izbire zavarovanca, v kateri državi in pri katerem izvajalcu zdravstvenih storitev bo deležen zdravstvene oskrbe. V magistrski nalogi je najprej kratko predstavljeno delovanje slovenskega sistema zdravstvenega zavarovanja, saj je ta temelj obsega pravic in povračil v zvezi z čezmejnim zdravljenjem. Nato so analizirane možnosti zdravljenja v državah, v katerih velja evropski pravni red kot tudi izven njih. Obseg pravic in načini kritja stroškov se glede na različne pravne vire precej razlikujejo, zato je pomembno, da zavarovana oseba ve katero pot izbrati. Predstavljena je tudi nacionalna zakonodaja, ki ureja čezmejno zdravljenje. Pomembno vprašanje v zvezi z čezmejnim zdravstvenim varstvom predstavljata (ne)upravičeno razlikovanje med domačimi pacienti, ki poiščejo storitve v tujini in tistimi, ki iz različnih razlogov ostajajo doma, z omejeno izbiro izvajalcev zdravstvenih storitev ter neenak položaj domačih in tujih zdravstvenih izvajalcev. V zadnjem delu je predstavljenih nekaj primerov sodne prakse socialnega sodišča, glede zgoraj omenjenega vprašanja morebitne diskriminacije domačih pacientov, ki se odločijo za iskanje storitev v tujini in tistih, ki to opravijo doma, odločitev o upravičenosti čezmejnega zdravljenja oziroma povrnitvi nastalih stroškov ter ostalih vprašanjih, ki se v samem postopkom pojavijo.

Keywords

čezmejno zdravljenje;pacienti;zdravljenje v tujini;zavarovanci;Direktiva 2011/24/EU;Uredba 883/2004;zasebni izvajalci zdravstvenih storitev;povračilo stroškov zdravstvenih storitev;magistrske diplomske naloge;

Data

Language: Slovenian
Year of publishing:
Typology: 2.09 - Master's Thesis
Organization: UL PF - Faculty of Law
Publisher: [Š. Remic]
UDC: 349:61(043.2)
COBISS: 17208401 Link will open in a new window
Views: 647
Downloads: 190
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Other data

Secondary language: English
Secondary title: ǂThe ǂright to cross-border medical treatment and medical treatment in Slovenia in the Social court case law.
Secondary abstract: As a society, we all want to be healthy, or in the event of illness, we want to recover as soon as possible. Because of this, the government established compulsory health insurance. This system ensures protection of public health and medical services when necessary for all policyholders whether in their home country or abroad. In the last few years, many flaws in the efficiency of the system could be noticed. More specifically, the long waiting lists which can often worsen the medical service seeker’s condition. As aforementioned, patients seek for additional help with domestic medical private providers and even foreign medical providers. Until recently, foreign treatment was restricted to unexpected situations or was a solution when individuals domestic treatment was completed. This was rectified as the European Institutions recognized the need for more closer regulation of cross-border medical treatments. Regulation of cross-border medical treatments gave policyholders a wider list of possibilities specifically stating its country and provider. The first part of my master’s thesis is an introduction to the Slovenian health insurance system, as it is the basis of rights and cost reimbursement regarding cross-border medical treatment. Furthermore, the thesis includes analysis of available possibilities of medical treatment services respective to countries under European Law and outside it. The extent of rights and types of cost reimbursements vary for each country; therefore, it is important for policyholders to understand their options. Domestic legislation that arranges cross-border medical treatment is also examined. In my master’s thesis I was interested in (un)justified differentiation between policyholders that find medical service in the foreign country and policyholders that decide to use domestic providers. A similar problem present unequal status of domestic and foreign medical health service providers. Finally, social court case-laws concerning the question of possible policyholder discrimination are introduced, as well as case-laws regarding court’s decision on the eligibility of the cross-border medical treatment, cost reimbursements and other questions arising in the decision-making process.
Secondary keywords: cross-border medical treatment;foreign medical service;patients;policyholders;Directive 2011/24/EU;Regulation 883/2004;private medical treatment providers;reimbursement of the health service cost;
Type (COBISS): Master's thesis/paper
Study programme: 0
Embargo end date (OpenAIRE): 1970-01-01
Thesis comment: Univ. v Ljubljani, Pravna fak.
Pages: 55 f.
ID: 11414404