scholarly journals PRAVILA EUROPSKE UNIJE O TRŽIŠNOM NATJECANJU I DRŽAVNIM POTPORAMA I DOPUNSKO ZDRAVSTVENO OSIGURANJE U REPUBLICI HRVATSKOJ: KRIVO SRASTANJE?

2021 ◽  
Vol 37 (2) ◽  
pp. 61-82
Author(s):  
Tomislav Sokol ◽  
Frane Staničić
Keyword(s):  
Health Insurance ◽  
Economic Activity ◽  
The Elderly ◽  
Risk Profile ◽  
Insurance Fund ◽  
Economic Interest ◽  
Privileged Position ◽  
Compulsory Health Insurance ◽  
Special Rules ◽  
General Economic Interest

Competition and state aid rules are not applicable to compulsory health insurance in the Republic of Croatia, since the latter does not constitute an economic activity as defined by EU law. On the other hand, complementary health insurance, as established in Croatia, constitutes an economic activity, due to the existence of real competition between undertakings. The illustrated situation with competition in complementary health insurance market allows for the statement that special rules applicable to Croatian Health Insurance Fund (HZZO) provide the latter with a privileged position when compared to its private competitors to whom these rules do not apply. Moreover, this privileged position is strengthened by the fact that HZZO, as a legal monopolist within the sphere of compulsory health insurance, utilizes respective infrastructure in the field of complementary health insurance, which enables it to reduce expenses to the detriment of its private competitors lacking such a privilege. A solution for the described situation could be for the state to establish a separate entity to provide complementary health insurance. This entity would have to provide open enrolment and community rating, regardless of age, sex or health of the insured persons. In order to prevent private competitors from jeopardising the exercise of service of general economic interest by taking over only the insured persons with a more favourable risk profile, a risk equalisation scheme would have to be set up. This would result in a transfer of funds from insurers with a favourable risk profile to those with an unfavourable risk profile on basis of objective and clear criteria, thereby making it possible for the latter to provide service to the higher-risk insured persons like the elderly and the ones with chronic illnesses. In this way, a balance between the necessity to provide a service of general economic interest to all insured persons, including those with a higher risk, and competition on the EU internal market, would be struck.

8. Competition, the State, and Public Undertakings: Article 106 TFEU

2019 ◽  
pp. 582-641
Author(s):  
Alison Jones ◽  
Brenda Sufrin ◽  
Niamh Dunne
Keyword(s):  
Direct Effect ◽  
Competition Law ◽  
Case Law ◽  
State Aid ◽  
The State ◽  
Economic Interest ◽  
Inequality Of Opportunity ◽  
Dominant Position ◽  
Privileged Position ◽  
General Economic Interest

This chapter examines how competition law applies to the actions of the State when it intervenes in the market through undertakings which it controls or owns or which it places in a privileged position. The discussion includes the principle of Union loyalty in Article 4(3) TEU; Article 106(1); Article 106(2); and the Commission’s supervisory and policing powers in Article 106(3). Article 106(1) is a prohibition addressed to Member States against enacting or maintaining in force any measure in relation to public undertakings or undertakings to which they have granted special or exclusive rights which are contrary to the Treaty rules. The chapter discusses what is meant by ‘public undertakings’ and ‘special or exclusive rights’ and examines in the light of the case law what measures are forbidden by Article 106(1), including those involving the cumulation of rights, the extension of a dominant position from one market to another, and the creation of situations of inequality of opportunity. Article 106(2) gives a limited derogation from Article 106(2) to undertakings entrusted with the operation of services of general economic interest (SGEIs). The chapter discusses the concept of ‘services of general economic interest’ and examines the cases in which the derogation has been applied or not applied, including the application of Article 106(2) to compensation for the provision of SGEIs which constitutes State aid. The chapter also considers Article 106(3) and the question of the direct effect of Article 106(1) and (2).

scholarly journals Bismarck’s Health Insurance and the Mortality Decline

2019 ◽  
Vol 18 (5) ◽  
pp. 2561-2607 ◽  
Author(s):  
Stefan Bauernschuster ◽  
Anastasia Driva ◽  
Erik Hornung
Keyword(s):  
Health Insurance ◽  
Fixed Effects ◽  
Natural Experiment ◽  
Social Health Insurance ◽  
Insurance Fund ◽  
Difference In Differences ◽  
German Empire ◽  
Compulsory Health Insurance ◽  
The Impact ◽  
Significant Mortality

Abstract We study the impact of social health insurance on mortality. Using the introduction of compulsory health insurance in the German Empire in 1884 as a natural experiment, we estimate difference-in-differences and regional fixed effects models exploiting variation in eligibility for insurance across occupations. Our findings suggest that Bismarck’s health insurance generated a significant mortality reduction. Despite the absence of antibiotics and most vaccines, we find the results to be largely driven by a decline of deaths from infectious diseases. Further evidence suggests that statutory access to well-trained doctors was an elementary channel. This finding may be explained by insurance fund physicians transmitting new knowledge on infectious disease prevention.

8. Competition, The State, and Public Undertakings

2016 ◽  
Author(s):  
Alison Jones ◽  
Brenda Sufrin
Keyword(s):  
Direct Effect ◽  
Competition Law ◽  
State Aid ◽  
The State ◽  
Economic Interest ◽  
Privileged Position ◽  
General Economic Interest ◽  
Academic Debate

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter examines how competition law applies to the actions of the State when it intervenes in the market through undertakings that it controls or owns or which it places in a privileged position. The discussions include the limits of competition law; Article 4 TEU; Article 106; the direct effect of Article 106(1) and (2); Article 106(3); and services of general economic interest and state aid.

scholarly journals Relevance of the health insurance databases to study potentially inappropriate prescriptions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Jardin ◽  
M C Banide ◽  
G Saba ◽  
E Burlot ◽  
F Jozancy ◽  
...  
Keyword(s):  
Health Insurance ◽  
Oral Anticoagulants ◽  
The Elderly ◽  
Administrative Databases ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Long Term Treatment ◽  
Inappropriate Prescriptions

Abstract Issue/problem Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events. Description of the problem In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area. Results Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017. Lessons These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices. Key messages A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.

scholarly journals Organization of medical and economic control of the volume and cost of medical care in the system of compulsory health insurance in 2021

2021 ◽  
Vol 9 (4) ◽  
pp. 647-656
Author(s):  
Elena V. Manukhina ◽  
◽  
Svetlana V. Yurina ◽  
◽  
◽  
...  
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Russian Federation ◽  
Insurance Fund ◽  
Federal Law ◽  
Medical Organization ◽  
Economic Control ◽  
The Subject ◽  
Compulsory Health Insurance ◽  
The Russian Federation

The article is devoted to the current problem of interaction in fulfilling the obligations of all participants of compulsory health insurance to pay for and provide medical care in accordance with the amendments made to Federal Law No. 326-FL of 29 November 2010 (as amended on 08 December 2020) «On Compulsory Health Insurance in the Russian Federation» and entered into force on January 1, 2021. The authors focus on the issue of granting of the territorial compulsory health insurance fund new powers to conduct medical and economic control and abolishing these powers from medical insurance organizations. According to the amendments, all volumes of medical care provided to the insured population of the subject of the Russian Federation, both on the territory of insurance and outside it, as well as medical care provided outside the territory of insurance, are the subject of medical and economic control by the territorial fund. Starting from 2021, the form of the contract for the provision and payment of medical care for compulsory health insurance, approved by Order of the Ministry of Health of the Russian Federation No. 1417n of 30 December 2020, has also changed. Unlike the previous form of contract concluded between an insurance medical organization and a medical organization, the current document provides for the participation of three parties in contractual relations: the territorial fund, insurance medical organizations, medical organizations. The agreement contains provisions providing for the obligation of the territorial fund to carry out medical and economic control of registers of accounts and accounts submitted by medical organizations to pay for medical care provided within the framework of the basic and territorial compulsory health insurance programs. The article presents the results of the control carried out with the analysis of the identified violations in the provision by medical organizations of the Ryazan region of invoices and registers of invoices for payment of medical care provided for January 2021, identifies problematic points in the information interaction between participants of compulsory insurance in the implementation of this function of the territorial fund.

scholarly journals VECTOR FOR THE DEVELOPMENT OF MEDICAL INSURANCE IN THE CONTEXT OF MODERN MEDICAL REFORM IN UKRAINE

2018 ◽  
pp. 148-156
Author(s):  
Olha KNEYSLER ◽  
Lesia SHUPA
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Insurance ◽  
Medical Services ◽  
Insurance Fund ◽  
Ministry Of Health ◽  
Insurance Medicine ◽  
Medical Reform ◽  
Compulsory Health Insurance

Introduction. The current practice of functioning of the medical sector shows the existence of problems that impede the introduction of compulsory health insurance in Ukraine, the effective development of its voluntary form. At the same time, the problems of development of medical insurance under the influence of crisis phenomena of the national economy are deepening. The purpose of the article is to develop recommendations for improving medical reform in Ukraine. Results. The most controversial moment in the reform of health care was the rejection of free medicine, the right to which is enshrined in the Constitution of Ukraine. However, budget medicine in Ukraine will still remain, however, in what volumes and at what stages of provision of medical services or medical care is not yet defined in the Ministry of Health of Ukraine. The negative trend of the contracted health model is the creation of an authorized body that will not only implement health policy but, in fact, formulate this policy: to define state guarantees, needs for medical services and to check the quality of these services. And this is a huge threat, because Ukrainian medicine will be in a worse situation than it is now. We believe that the policy-making function should remain under the Ministry of Health of Ukraine. The negative aspect of modern medical reform in Ukraine is the lack of requirements for the formation of medical treatment protocols. This can be explained by the fact that patients will continue to prescribe treatment that is untrue. Instead, for the health insurance, the insurance company would monitor costs and control the appointment of treatment for the patient, the price of medical services. In this context, we propose to adopt the Law of Ukraine “On Compulsory Health Insurance”, which stipulates and clearly defines the rights and obligations of the insurer, the insurer, the list of services, their price, a single register of insured persons, the formation of the Social Health Insurance Fund and a differentiated approach to categories of the population. Conclusions. The experience of developed countries of the world proves that achieving this goal is possible through the introduction of insurance medicine. Insurance medicine is a real alternative to budget financing, which is no longer capable of ensuring the constitutional right of citizens to receive unpaid health care. The development of health insurance is an objective need, which is dictated by the need to ensure that healthcare receives funds. At the moment, the study of the question of the necessity of introducing compulsory health insurance is probably very relevant to all. Successful market reforms in Ukraine are impossible without the formation of an effectively organized health insurance market that can guarantee the preservation and strengthening of human health, improving the quality of medical services and the level of human life.

NON-AGRICULTURAL ECONOMIC ACTIVITY IN THE SYSTEMS OF PUBLIC SOCIAL INSURANCE AND SOCIAL INSURANCE FOR FARMERS

2017 ◽  
Vol XIX (5) ◽  
pp. 204-209
Author(s):  
Zbigniew Wasąg
Keyword(s):  
Health Insurance ◽  
Old Age ◽  
Agricultural Economic ◽  
Economic Activity ◽  
Social Insurance ◽  
Insurance Fund ◽  
Pension Insurance ◽  
Sickness Insurance ◽  
The Public ◽  
Social Insurance Fund

The aim of the study was to compare conducting economic activity by people covered by social insurance and by social insurance for farmers in the years 2013-2017. The former included old-age pension insurance, disability and survivors’ insurance, sickness insurance, accident and health insurance as well as contributions for the Labour Fund. Social insurance for farmers was defined based on old-age and disability insurance, sickness insurance, accident insurance and maternity insurance. Monthly contributions for social insurance for persons conducting non-agricultural economic activity were three times higher in the public system of social insurance (ZUS, or National Social Insurance Institution). However, when health insurance and Labuor Fund contributions were included, they were five times higher than agricultural social insurance (KRUS, or Agricultural Social Insurance Fund). The share of social and health insurance in the income of persons commencing economic activity was more than twice higher than in the income of persons insured by KRUS.

scholarly journals Analysis of the Current Situation after the Introduction of Compulsory Social Health Insurance System іn Kazakhstan

2021 ◽  
Vol 1 (41) ◽  
pp. 82-92
Author(s):  
Azamat Umertayev ◽  
◽  
Gulnar Kurenkeyeva ◽  
◽  
Keyword(s):  
Health Insurance ◽  
Service Providers ◽  
Social Health Insurance ◽  
Social Health ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
Health Insurance System ◽  
Insurance System ◽  
Social Health Insurance System ◽  
Compulsory Health Insurance

The aim of the study: To assess the current state, the balance of functions and development trends of Social Health Insurance Fund NJSC. Methods. In order to study the level of awareness of the population about the implementation of the compulsory social health insurance system (CSHI), a mass survey was conducted twice during 2019 (in May and September) with a total sample of 2,150 respondents, including all regions of Kazakhstan. Also, within the framework of the study, such indicators of the activity of the Social Health Insurance Fund as the availability of funding for 2019-2020, the amount of funding by service providers, and coverage of the population were analyzed. Results. There is a positive trend in the compulsory health insurance system: awareness of the population is growing; the population positively assesses the changes in the provision of health services; there is a twofold increase in PHC visits; the share of private spending on health is twice the ceiling recommended by WHO; the level of coverage of the population with the compulsory health insurance system is quite high - 84%. However, about 3 million of the country's citizens remain uncovered. Conclusions. It is necessary to create a system for monitoring the effectiveness of the implementation of compulsory health insurance on the basis of information systems with the further adoption of managerial decisions both at the regional level and at the republican level. The introduction of mechanisms for proactive monitoring of the quality of medical care will protect the rights of patients, as well as improve feedback with them. Key words: Compulsory social health insurance, Medical services, Health care financing, Kazakhstan

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