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The Effect of the Introduction of Fee-For-Service on the Demand for Outpatient Care
Žílová, Pavlína ; Votápková, Jana (advisor) ; Pavloková, Kateřina (referee)
The thesis estimates the effect of the 2008 introduction of regulatory fees for outpatient visits by using 2009 health reform, abolition of co-payments for children, as a natural experiment. To estimate this effect we use micro-level data from EU-SILC survey and two different econometric models - Multinomial logit (MNL) and Zero-inflated negative binomial (ZINB). As co-payments for examination were abolished only for children, we use children as a treatment group and adult part of the population as a control group in difference-in-differences approach. We found an insignificant effect, i.e. introduction of user charges was ineffective in reducing number of doctor visits in Czech Republic. Another important result from this analysis is the significant role of the socio-economic characteristics, associated with the tendency of health-care utilization.
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The issues of the constitutionality of regulatory fees in health care
Svatoš, Jiří ; Suchánek, Radovan (advisor) ; Jirásková, Věra (referee)
Goal of this thesis was to assess the constitutionality of "regulatory fees" in healthcare, which were enacted in the Czech Republic in 2007. The first chapter goes through the two decisions of the Czech Constitutional Court concerning assessment of the constitutionality of regulatory fees and identifies five main areas to study: 1)General methodology of human rights interpretation and their collisions in the Czech constitutional system, 2)Genesis and interpretation of social rights. 3)Identification of a test to assess collision between social rights and public goods 4)Essence of the right to free healthcare 5)Empirical assessment of the regulatory fees impact Second chapter is an overview of the first area divided into two sections: traditional methods of interpretation in constitutional law and development of the proportionality principle based on an overview of the Czech and foreign jurisprudence and the previous decisions of the Czech Constitutional Court. Third chapter describes the genesis of the social rights as a specific area of human rights. Implication from both chapters are combined to create a universal proportionality test that includes specific intensity of review for social rights. Fourth chapter provides a case study that firstly identifies the essence of the right to free healthcare,...
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The Effect of the Introduction of Fee-For-Service on the Demand for Outpatient Care
Žílová, Pavlína ; Votápková, Jana (advisor) ; Pavloková, Kateřina (referee)
The thesis estimates the effect of the 2008 introduction of regulatory fees for outpatient visits by using 2009 health reform, abolition of co-payments for children, as a natural experiment. To estimate this effect we use micro-level data from EU-SILC survey and two different econometric models - Multinomial logit (MNL) and Zero-inflated negative binomial (ZINB). As co-payments for examination were abolished only for children, we use children as a treatment group and adult part of the population as a control group in difference-in-differences approach. We found an insignificant effect, i.e. introduction of user charges was ineffective in reducing number of doctor visits in Czech Republic. Another important result from this analysis is the significant role of the socio-economic characteristics, associated with the tendency of health-care utilization.
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Analysis of healthcare financing in the Czech republic with particular regard to assessment of reasons and impacts of introducing regulatory fees in the years 2008--2015
Matláková, Eliška ; Chmelová, Pavla (advisor) ; Lukášová, Tereza (referee)
The topic of this bachelor s thesis is healthcare financing in the Czech Republic. It predominantly focuses at the impact of regulatory fees introduced in 2008. The theoretical portion defines healthcare politics, its models as well as various ways of healthcare financing. The practical portion covers the issue that arose with the introduction of regulatory fees and especially aims at analyzing their impact at certain parameters of the healthcare market in the Czech Republic. The goal of this paper is to find out whether the aforementioned regulatory fees fulfilled their planned expectations, especially considering that the whole policy ended up being canceled seven years later. The analysis showed that its impacts were indeed positive and as predicted, which makes their cancellation questionable. This suggests that there must have been a different motive for the cancellation, because their effectiveness was demonstrable. The paper also contains a comparison to Slovakia, where regulatory fees were also introduced in the past and the development of their cancellation can be analogous in the Czech Republic. Analysis of certain parameters of the Slovakian healthcare market proved that the cancellation was not effective, because the observed parameters are slowly shifting back to their original values and the issue of healthcare overuse has also started reappearing.
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The impacts of regulatory fees in health care on public health insurance
PRAŽMOVÁ, Věra
The Public health insurance system in the Czech Republic was established more than 20 years ago. During this period, the public health insurance system has gone through many transformations. A lot of reform proposals have been submitted with the aim of keeping the increase of healthcare expenses under control but simultaneously not limiting the quality and the accessibility of healthcare. The introduction of the regulatory fees was a part of the healthcare reformation and its purpose was to reduce the demand for healthcare and thus regulate the consumption of health services. Secondarily, the regulatory fees should bring private funds into healthcare system. In the theoretical part of the research, the author describes healthcare systems of several European countries mainly from the point of view of cost sharing by patients. The funding of healthcare in the Czech Republic is then evaluated in more detail. The research characterises all the types of regulatory fees including all the legal changes they have undergone prior to their implementation. The author summarizes the amounts of funds received from the different types of fees which patients have paid since the introduction of regulatory fees in 2012 on the basis of data received from health insurance companies. In the practical part of the research, the author analyses and statistically processes data which were taken from one specific bureau of employee health insurance company. On the basis of this data, the author maps the development of average visits of healthcare institutions per patient in the chosen fields of ambulant care specializations. The author compares the number of average visits in 2007, which is the year before the introduction of regulatory fees, with the number of average visits after the regulations implementation that means during the 2008-2013 period. The aim was to discover whether the fees had any effect on the amount of healthcare services and whether they led to decrease in the number of patients´ visits (at the doctor). The development of the number of patients´ visits was studied in 22 different fields of ambulatory specialization in total. The collected results have been statistically processed using one sample, one-tailed T test. Furthermore, the influence of fees on the healthcare expenses was surveyed in the respective ambulatory fields. In the similar manner as with the patients´ visits, the author compares the average expenses per one patient before the introduction of regulatory fees in 2007 with the average value after the implementation of regulatory fees to the healthcare system. The research offers a comprehensive overview of these issues and can be used as a basic material for further research about regulatory fees and patient cost sharing in healthcare.
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Regulatory Fees Five Years after Establishing
ŠILLEROVÁ, Veronika
Regulatory fees were launched by the Act No. 261/2007 Coll. on stabilization of public budget. Many acts were amended through this Act including the Act No. 48/1997 Coll. on public health insurance. This amendment set the obligation for the person insured or their legal representative to pay regulatory fees to the medical facility providing health care ? a practitioner, a medical facility or a pharmacy. The aim of this thesis was to summarize legal adjustment considering regulatory fees and to map citizens´ opinions of both this issue and regulatory character of fees. The author´s goal was to ascertain whether citizen´s opinions have changed in past five years since their implementation. Whether citizens became accustomed to the fees and if they understood their purpose or they would rather abolish them. Theoretical part explains the terms relating to health care and insurance industry where the particular regulatory fees are explained in detail, such as their amount and the range of people involved. The attention is paid even to cases of the regulatory fee exemption. Theoretical part also deals with the safety limit which is directly concerned with regulatory fees as well as it is explained which fees belong to this limit. The next subsection is concerned with the basic rules of providing health care in member states of the European Union. The theoretical part concludes with the description of the individual changes and amendments which regulatory fees underwent during 2008-2013. The practical part was created by the means of quantity research which was conducted through the questioning method. The questioning survey of 331 respondents among the public of South Bohemia was implemented through online questionnaire and the tangible forms. Three following hypotheses are defined on the basis of the secondary sources: Hypothesis 1: Respondents do not agree with the fee increases for a hospital stay from 60,- CZK to 100,- CZK. Hypothesis 2: From all the launched regulatory fees only the emergency service fee affects the use of health care. Hypothesis 3: Patients agree with the prescription charges. The hypotheses H1 and H3 were confirmed whereas H2 were proved false on the basis of the questionnaires. It was proved that 90,- CZK treatment fee in emergency service is not for the majority of people so high so that it would prevent them from using emergency service and therefore negatively affected the use of health care. On the contrary, it follows from the confirmed hypothesis that the cancellation of 30,-CZK fee for prescription item and the replacement for fee prescription as a whole was correct. As patients are more willing to pay a fee for prescription rather than pay for every item. The outcome of hypothesis 1 was virtually unequivocal for most of respondents do not agree with the fee increase for a one day of hospital stay. Research outcomes show the fact that in comparison with previous years not only does the acceptance of citizens about regulatory fee system gets better but also does their acceptance of citizens and citizens? willingness to pay them. There is always a group of people who are not satisfied with the current adjustment of regulatory fees. It also seems improbable to eliminate fees to affect personal and family budget. The important goals of Czech public health and responsible bodies are to set regulatory fees in the way to accomplish their regulatory objective as well as make sure fees do not limit the ability of people who end up in socially or otherwise difficult situation to use health care. The thesis may work well as an information booklet for the wide public, as a study material for the students of Health and Social Studies or as a source for comparison with future researches.
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Regulation Fees in the Czech Health Care System
KYTLEROVÁ, Ivana
A large part of the work has been devoted to regulation fees as one of the health care systems regulating mechanisms. An essential place in the work is taken by elaboration of the topic of increase of costs for the health care systems functioning in the current world and the possibilities of their solution. The work also deals with an extensive and frequently discussed topic of justice in the physician-patient relationship. This topic has been processed in connection with historical circumstances and a philosophical dimension of perception of justice in health care. Further to this, ideas and ideological foundations of justice, which project into political ideologies, have been dealt with. Health care systems, the system of health insurance in the Czech Republic and its legal regulation have been briefly characterized. The aim of the work was to map an opinion of some ordinary citizens regarding perception of justice in the Czech health care and introduction of the regulation fees. Partial goals were to find out in what way political orientation reflects in the opinion on justice of the collected regulation fees and furthermore to map, in what way an amount of income of respondents influences an opinion that regulation fees represent an income for a health care facility. Two hypotheses were determined. Hypothesis no. 1: University graduates understand better the system of regulation fees. Hypothesis no. 2: More than 80% or respondents consider it unjust that regulation fees represent an income of a physician, health care facility, or pharmacy. A method of questioning was used for the processing, data collection was carried out by using a questionnaire technique. Statistical methods suitable for an analysis of categorical data were used for evaluation of information. 300 questionnaires were handed out, the return rate being 74%, the final research population consisted in 182 respondents from the city of Votice. Another employed processing method was the secondary data analysis. Results of the questionnaire research brought a number of intriguing facts relating to attitudes of the respondents as to the issue of justice and state of the Czech health care. Further to this, it has been confirmed that university educated respondents understand better the system of regulation fees. In more than 65%, respondents consider it unjust that the proceeds from the regulation fees collection represent income of a health care facility. One of the hypothesis was confirmed and the other was disproved. The acquired information can be used as a guideline for public discussion.
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Regulatory fees in healthcare from the perspective of the public
KOLLÁROVÁ, Iva
Part of the Czech healthcare system is public health insurance and health care is paid to beneficiaries from its funds. From 1.1.2008 a new system of regulatory fees and annual protective limit forms its part. Regulatory fees were introduced by Act No. 261/2007 Coll. about stabilizing public budgets, which amended many laws, in this case also the Act No. 48/1997 Coll., about public health insurance. The reason for their introduction should be reduction of inefficiency of health care and, consequently, reduction of health care costs, reduction of misuse of health services, as well as increase in revenues of medical facilities. Funds saved should be used to improve medical care, to treat sick people and to finance expensive medical services. The objective of my thesis was to make a survey of public opinion on the introduction of regulatory fees. In the theoretical part I briefly described basic concepts relating to public health service, health policy, insurance and in detail I mentioned functioning of regulatory fees and the annual protection limit. In the practical part I used quantitative research, method of interviewing, data collection was performed using the questionnaire technique and then also secondary analysis of data. For the research section one statistical sample was established {--} the public of South Bohemia. Based on available literature I stated 2 hypotheses, both of which were confirmed by the research. Research pointed at the diversity of views and perception of regulatory fees among citizens. Citizens´ awareness certainly also affects the issue of regulatory fees, and the awareness, as revealed in the survey, has been improving compared to previous years. Regulatory fees in health care in the Czech Republic have become a most discussed topic. But this step is only the first step, unfortunately still unpopular with many people, and it should lead to step-by-step implementation of planned changes in health care. I think that compared to previous years an increasing number of citizens understand the purpose of regulatory fees and they realize that modern medicine is very expensive and that from the current health insurance system it is not always possible to grant all care to everyone. In my opinion, the introduction of regulatory fees is a very important step for our health care, but it will be necessary to improve some legal details and gain greater public trust so that the purpose that these fees should have would be reached. The thesis could serve as an information brochure, study material, or respondents´ views and the research findings could be used in other studies for comparison.
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Regulatory Fees at Children's Department in Klatovy Hospital
GOLDSCHMIDOVÁ, Kateřina
Regulatory Fees at Children´s Department in Klatovy Hospital The bachelor thesis deals with effects and impacts after an introduction of regulatory fees in the health service. An aim of the thesis was to ascertain effects of the introduction of regulatory fees at Children´s Department in Klatovy Hospital. First I investigated how the fees influenced an exploitation of the hospital care, and then I investigated whether the fees influenced a possibility of parents to accompany their children during the hospitalization. In the theoretical part I deal with basic definitions of terms related to the issue of regulatory fees. These include concepts of a health, an illness, a health policy, health systems, a structure of the health system in the Czech Republic and a definition of the regulatory fees, their types, an importance of their introduction, a protection limit, effects of the introduction and a consumption of the health services after the introduction of the fees. In the practical part I attend to a description of objectives and hypotheses, a research methodology and an interpretation of results. The research part was realized by using a quantitative form of the research, I used a method of interviewing, a questionnaire technique. As an auxiliary method I chose a document analysis {--} secondary data analysis. The research sample consisted of the parents accompanying their children for an examination at an outpatient clinic and parents accompanying hospitalized children. The research results showed that regulatory fees do not influence the possibility of parents to accompany their children during the hospitalization and although parents say that in case of repeated hospitalizations the fees could influence this possibility, they continue to accompany their children during their hospitalization and on the contrary, there is an increasing number of the accompanying. The research also showed that at Children´s Department a use of First Aid Medical Service (Baby Call) decreased after the introduction of the fees and thus it was not further misused. On the contrary there was no decline in the number of hospitalized patients. I suppose that this bachelor thesis can be used for a better orientation in this new area of the health care charges and for an outline of real impacts which were brought into the health care in the first two years. Just because of the relatively short period of the existence of the fees, I would recommend to continue monitoring the impact of the charging and to follow any further changes in legislation.
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