Patients avoid complaining
Advisor of the Service Expertise and Control Department of VLK Nijolė Bijanskienė “Vakaro žinias” informed that patients also paid unreasonably when medical specialist consultations, inpatient services, nursing and supportive treatment services, transportation services, etc. were provided.
According to the interlocutor, it is noticeable that patients with complaints avoid contacting the health insurance funds, citing the fact that they will have to return to the same institution for treatment. According to the information of the State Health Insurance Fund, last year Territorial Health Insurance Funds (TLK) received 36 complaints from patients regarding additional payments in medical institutions. Vilnius TLK received the most complaints – 24. Klaipėda TLK – 7, Kaunas TLK – 2, Šiauliai TLK – 2, Panevėžys – only 1.
“After inspections, 24 complaints were confirmed and it was found that patients were illegally required to pay. The institutions were obliged to return 8,852 euros to the patients”, said N. Bijanskienė, adding that after receiving a patient’s complaint about paid services, the health insurance specialists carry out inspections. If it is determined that the patient paid for the service, but did not have to pay, the institution is obliged to return to the patient what he paid Patients are informed about the results of the examination and are advised to contact the institution for a refund.
You cannot offer paid services only
“TLK annually concludes contracts with both public and private health care institutions regarding the payment of specific health care services from PSDF funds. Not all private institutions sign contracts with TLK (a detailed list of institutions with which TLK has signed contracts and for which services is published on the website of the health insurance funds).
Treatment facilities that have signed contracts with ITC are paid for the services provided at the base prices approved by the Minister of Health. Therefore, the Compulsory Health Insurance Fund (PSDF) pays only for those services for which a contract has been concluded, and the patient cannot be required to pay for what the health insurance funds pay for the medical institution”, explained the adviser of the Service Expertise and Control Department of VLK .
According to N.Bijanskienė, both the treatment facility (on notice boards, website, etc.) and the attending physician must inform patients covered by compulsory health insurance (PSD) about the possibility of receiving services paid for by the sick funds. A medical institution that has concluded a contract with ITC for a specific service cannot offer only paid services, that is, it must first offer the patient a free service (paid from the PSDF without any additional charge).
“Legislation provides that the patient may be offered a service or additional services that are more expensive than those paid for by health insurance funds. If a paid or more expensive service is offered to the patient, he must be informed of the basis for the provision of the paid service or the differences and advantages of the more expensive service must be explained to him in detail and comprehensibly. The patient must confirm his decision and agreement to pay for the services with his signature. The patient has to pay to the institution’s cash desk. It cannot be required that the patient buy medicines or tools himself and bring them to the institution,” said the advisor of the Service Expertise and Control Department of the VLK.
Exception for urgent care
A certain annual amount of money is allocated to each medical institution with which TLK signs a contract, emphasizes N. Bijanskienė, to pay for those services. If the institution exceeds the allocated amount, it can continue to provide free services, as TLK later also pays for extra-contractual services provided by contractual partners.
The VLK representative drew attention to the fact that free, or more precisely, – paid for by health insurance funds with PSDF funds – health care services can only be provided to people insured by PSD. The exception applies only to necessary (urgent) medical assistance, which is provided free of charge without referral to all permanent residents of Lithuania, even non-insured PSD.
According to N. Bijanskienė, it is very important to know that the medical institution where the doctor who issues the referral works has concluded a contract with the ITC regarding the services required by the patient, that is, the specialist doctor must provide a service paid from PSDF funds to a person covered by compulsory insurance. If a specialist doctor provides a paid consultation to a patient – both in a private and public institution – he cannot prescribe referral services paid from PSDF funds. According to the currently valid procedure, institutions have the right to provide paid services, this is not prohibited for institutions.
First contact the administration
The advisor of the Service Expertise and Control Department of VLK emphasizes that if a patient believes that his rights have been violated in a health care institution, for example, he had to pay for services that are paid for with PSDF funds, he should first contact the institution’s administration. Patients have the right to apply to the state institutions that examine patient complaints when they are dissatisfied with the handling of complaints at the aforementioned institution.
“The health care institution must examine the situation and provide a written response within 20 working days from the date of receipt of the complaint at the institution. When applying to state institutions dealing with patient complaints, you must submit the complaint to the health care institution and copies of the institution’s response. If the medical institution does not provide an answer within 20 working days, the patient has the right to apply to other institutions for the examination of the complaint, but it is necessary to submit a copy of the complaint addressed to the medical institution”, said N. Bijanskienė.
Also, the advisor reminds that if the patient applies to a health care institution and does not receive an answer from it or the institution’s answer is not satisfactory, due to, in the patient’s opinion, violated rights related to PSD issues, it is possible to apply to VLK or TLK regarding the quality and availability of services – to the State Accreditation service for health care activities.
Former Minister of Health, MEP Juozas Olekas comments:
I think two things are needed. First of all, that the health insurance funds pay for the services, because not all services are paid according to their prices, according to the cost price. Some services make a certain loss, then hospitals start to do all sorts of trickery on how to raise funds, this is very important. To my knowledge, it was announced that 600 million euros left in reserve, so maybe those funds could be used. I recently visited, for example, the Klaipėda University Hospital and saw how they are facing certain economic difficulties there.
Secondly, there should be even clearer information about what services in hospitals, in general, in public or private medical institutions, are free of charge, that is, those services are paid for by the health insurance fund. So that people know and protect their rights.
I have excellent examples – there are a number of private dispensaries in the Sūduva region, the best of which provide free services to people. There is a choice for almost all services in Lithuania, if Kaunas is not suitable, you can apply to Vilnius and so on.
I think such a problem occurs not only in Lithuania, but also in other Western countries. I am talking about the new countries of the European Union.
Information
Briefly, what is guaranteed by compulsory health insurance:
* ambulance services;
* necessary (urgent) medical assistance;
* services of a family doctor (including examinations assigned to his competence and prescribed by a family doctor);
* primary mental health care services;
* primary dental health care services (there are certain conditions), dental prosthesis cost compensation (for people of certain groups);
* services of medical specialists;
* expensive tests and procedures;
* treatment in hospitals;
* nursing services;
* medical rehabilitation services;
* examination according to preventive programs (for people of a certain age);
* compensatory medicines and medical aids;
* reimbursement of the costs of emergency care services in European Union countries, cross-border health care provided in European countries (except the United Kingdom and Switzerland).
The patient has to pay when:
* the patient is not covered by compulsory health insurance;
* when the tests are chosen by the patient himself, if the doctor does not prescribe them during the consultation, the referral is not issued (the full actual price of the service has to be paid);
* when the patient chooses to consult a specialist doctor who works in a treatment facility that does not have a contract with the ITC, or when, without the necessary referral, wishes to receive a specialist doctor’s consultation or tests;
* if the patient wants to receive a scheduled service without a queue. Those who want to receive a specialist consultation without waiting in a queue (there are other patients who are also waiting for services paid for by the PSDF) can receive a paid consultation after paying for it (in cases where the patient needs essential medical assistance, services must be provided to patients on the day of application to the treatment facility);
* if the patient himself chooses, with the permission of the attending physician, more expensive services, materials, tests, medicines, medical aids, procedures. In this case, it is not necessary to pay the full price, but only the difference between the price paid by the health insurance fund and the price of the selected more expensive service, material, tests, medicine, medical aid or procedure. Payment must be made to the cash desk of the institution where a receipt or other payment document is issued;
* when providing a service included in the list of paid services.
Source – VLK
Tags: Treatment facilities pay piercings Respublika .lt
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