NHOC no longer has grounds to deny hospitals payment of the full amount of the performed medical activity.
This reminds BNR.
The Constitutional Court (SC) declared unconstitutional the provision of Art. 55 a, para. 2 of the Health Insurance Act (HAI), which limits the payment of medical services performed by hospitals to the values specified in their budgets. This means that after the publication of the SC's decision and its entry into force, the NHIF has no reason to deny hospitals payment of the full amount of the performed medical activity, and patients will not be returned due to exhaustion of the limits.
Arkady Sharkov, a health economist, shared on the air of "Our Day" important analysis and predictions about this decision. First, he emphasized the importance of the fact that this controversial article in the law is from 2019, which means that no such provision existed before that period.
The repeal of this article now opens the possibility for hospitals to bring claims against the National Health Insurance Fund (NHIF) and expect court decisions in their favor. Sharkov emphasizes that this process, however, can take years and create significant financial commitments for the NHIF.
Despite the difficulties in estimating exactly how much it will cost the NHIF, he explained that it will be about collecting funds that “will be under a billion”. However, he reassured the public that these costs will be spread over time and will not create a hole in the budget.
To compensate for possible financial deficits, Sharkov believes that the next National Framework Agreement may include new cost containment measures. He explained that these measures will probably be related to a "play with volumes and prices", aiming to compensate for potential losses from the payment of over-limit medical activity.