patient rights in the czech republic judr. ondrej dostal, ph.d., ll.m. center for health law 3th...
TRANSCRIPT
Patient Rights
in the
Czech Republic
JUDr. Ondrej Dostal, Ph.D., LL.M.Center for Health Law
3th Medical School, Charles University, Prague
Holubova.cz
Attorneys Specialized in Health Law, Prague
Features of Current System Czech Constitution, Art.31:
Citizens shall have the right, on the basis of public insurance, to free medical care and to medical aids under conditions provided for by law.
Compulsory insurance coverage, Act 48/1997 Coll.: Annual compulsory insurance premium set by law
avg. under 1000 USD/year/capita (cca 10 billion USD/yr, 7%HDP) Paid by employer/employees State budget pays for non-productive citizens (aged, students…)
Coverage: Almost all interventions covered (excl. explicit negative list) Medical aids covered typically up to 75% Drugs: system of 300 „reference groups“, at least one drug fully
covered
Bismarck (Potemkin) Model of Public Health Insurance in Czechia
PatientsInsured
Health Facilities
Health Insurance
Funds
Parliament legislation, MoH regulation
Fixed premium(<1000 USD/yr)Broad universal coverageNo co-payment
Early years: fee for service reimbursementRecently: „Historical budget limits“, capitation payments
High standard of due careInfo.consent, right to know alternatives
Almost no payment for covered services
Access to Quality Health Care
Very generous promises in insurance law In fact, problem to access expensive
treatments Physicians „motivated“ not to expend money Weak enforcement mechanisms
Internal review of insurance company: biased Court review: lengthy Other external review (arbitration): non-existent
Problems for cross-border care and insurance reimbursement
Patient Rights: Legal Basis
Council of Europe Biomedicine Convention Since October 2001 Directly enforceable Catalogue of rights
Informed consent Quality of medical intervention Privacy Access to information
National laws and directives NB: liberal rules on reproduction medicine –
many incoming patients
Informed consent
Condition of legality of intervention Missing consent, invalid consent = liability „No valid consent to medical error“
Disclosure requirements: Risks Alternatives Costs? Doctor experience?
Foreign patient JCI Accred.: Consent forms in more languages Interpreter found (not paid for) by provider
Informed consent - exceptions Patients unable to give consent
Minors Persons with mental disability
Permanent Temporary
Consent given by legal representative Exceptions: duty to follow best interest of the
represented person Cases of necessity, where consent cannot
be obtained Exception: Previously expressed wishes
Privacy protection
General duty of medical confidentiality Exceptions:
Patient consent Needs to be explicit, ideally written Needed also for communication w/relatives
Exceptions in specific laws Serious crimes reporting (murder, abuse of child) Access of medical and other professionals (limited to
the necessary level) Access of medical students (w/consent of patient)
Access to Medical Records
2007 laws: Right to access all health records Right to make copies Right to transfer these rights to other person Rights of relatives of deceased to access medical
records, if the deceased did not prohibit it Benefits:
Easier to resolve malpractice claims Problems:
„Retrospective“ - „úplně blbá“ example
!!LAWYER ALERT!! Follow the Emergency Plan!
Patient N., ischaemic heart disease, died 00:15, 9.4.2008Attached paper with instructions to the nurse: „Fill in the drinking regime observation!“„Dr. K....: Record application infusions from 24.03.!“
Conclusions
„Explosion of rights, absence of duties“ Need to balance rights and duties in upcoming legislation Need to provide motivation to efficient behavior in
solidarity-based system Lack of enforcement
„De iure“ vs. „de facto“ situation Need to improve legal knowledge between medical
workers, patients AND system administrators Need to establish fast and efficient procedures for
dispute resolution
Current regulation of cross border health care in CR
No domestic legal provision
EU regulation 1408/71 coordinating social security systems (directly applicable)
Urgent treatment – European Health Insurance Card
Planned medical treatment - main „legal regulation“ in the European Court of Justice (legally binding); not respected by the HIFs in pre-auth. decisions
New Directive on patient rights in cross border helath care´incorporating case law – to be discussed in the EP in April 2009
Holubova.cz Law [email protected]
Center for Health Law, 3.LF, Charles University [email protected]
Contact:
Thank you for your attention