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Title:PRAVICE ZAVAROVANIH OSEB DO MEDICINSKIH PRIPOMOČKOV IZ OBVEZNEGA ZDRAVSTVENEGA ZAVAROVANJA
Authors:ID Prodan, Danijela (Author)
ID Markovič Hribernik, Tanja (Mentor) More about this mentor... New window
Files:.pdf VS_Prodan_Danijela_2016.pdf (1,06 MB)
MD5: 2AF684297E079F66A245C96A19605A86
 
Language:Slovenian
Work type:Undergraduate thesis
Typology:2.11 - Undergraduate Thesis
Organization:EPF - Faculty of Business and Economics
Abstract:Vpliv demografskih sprememb ter druge socialne in ekonomske okoliščine spreminjajo potrebe prebivalstva po vse večjem obsegu zdravstvenih storitev, kar pa predstavlja velik izziv za ZZZS, ki z zbiranjem in razdeljevanjem finančnih sredstev iz blagajne javnega zdravstva zagotavlja pokritje zdravstvenih storitev. V teoretičnem delu smo spoznali splošne pojme, ki so potrebni za razumevanje delovanja sistema zdravstvenega zavarovanja v Sloveniji. Predstavili smo obvezno zdravstveno zavarovanje, katerega izvaja ZZZS, kot javni in neprofitni zavod. Predstavili smo obseg pravic in vrste pravic iz obveznega zdravstvenega zavarovanja zavarovanih oseb, ki so določene z Zakonom o ZZVZZ, ter postopek njihovega uveljavljenja, ki ga določajo Pravila OZZ. Predstavili smo tudi pomen dopolnilnega zdravstvenega zavarovanja in ponudnike prostovoljnega zavarovanja. Predvsem pa je namen diplomske naloge, podrobno predstaviti poznavalcu in nepoznavalcu področje medicinskih pripomočkov, ki so pravica zavarovanih oseb iz OZZ. V praktičnem delu smo analizirali pomet medicinskih pripomočkov v breme obveznega zdravstvenega zavarovanja. Primerjali smo podatke o stroških MP po skupinah pripomočkov na celotnem območju ZZZS in na območni enoti Koper. V zadnjem delu diplomske naloge smo namenili predstavitvi ukrepov ZZZS za obvladovanje stroškov na področju medicinskih pripomočkov iz obveznega zdravstvenega zavarovanja. ZZZS z obsežnimi dopolnitvami na področju delovanja informacijskega sistema, z vgrajenimi avtomatskimi kontrolami, izboljšuje nadzor nad predpisovanjem MP na naročilnico, da se le te izvajajo skladno s pravili za uresničevanje pravic iz obveznega zdravstvenega zavarovanja, ter še bolj točen obračun storitev in materialov. Dolgoročno tako Zavod za zdravstveno zavarovanje Slovenije omogoča večji vpliv na zniževanje odhodkov za medicinske pripomočke na letni ravni, ki se zagotavljajo v breme obveznega zdravstvenega zavarovanja.
Keywords:Zdravstveno zavarovanje, Obvezno zdravstveno zavarovanje, pravice zavarovancev do medicinskih pripomočkov, prostovoljno zdravstveno zavarovanje.
Place of publishing:Maribor
Publisher:[D. Prodan]
Year of publishing:2016
PID:20.500.12556/DKUM-57865 New window
UDC:368
COBISS.SI-ID:12418844 New window
NUK URN:URN:SI:UM:DK:POU1TFDX
Publication date in DKUM:03.08.2016
Views:1708
Downloads:223
Metadata:XML DC-XML DC-RDF
Categories:EPF
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Secondary language

Language:English
Title:THE RIGHTS OF INSURED PEOPLE FOR MEDICAL DEVICES, COVERED BY THE COMPULSORY HEALTH INSURANCE
Abstract:Demographic changes and other social and economic conditions have resulted in population’s growing needs for health care services, posing a great challenge for the Health Insurance Institute of Slovenia (ZZZS), which covers the health care services by collecting and allocating funds from the health care budget. In the theoretical part we presented general notions necessary for understanding how the Slovenian health insurance system works. We presented compulsory health insurance managed by ZZZS, which is a public and non-profit institute. We also detailed the scope and type of rights covered by the compulsory health insurance, which are specified in the Health Care and Health Insurance Act, and the procedure for exercising these rights, which is laid down in the Rules on Compulsory Health Insurance. We furthermore presented compulsory health insurance and its providers. However, the main purpose of this diploma thesis was to present in detail the medical devices covered by the compulsory health insurance in a manner understandable to experts and laymen. In the applied part of the thesis we analyzed the traffic of devices covered by the compulsory health insurance. We compared the data about cost of devices by category in the entire territory covered by ZZZS, and in the area covered by the Koper regional branch. The last part of the thesis presents the measures applied by ZZZS in order to control the cost of medical devices covered by the compulsory health insurance. ZZZS has introduced extensive changes in the operation of its information system, which has integrated automatic controls that improve the oversight of prescribed medical devices and issued purchase orders in order to ensure that everything is compliant with the rules on exercising rights covered by the compulsory health insurance, and provide a more exact account of services and materials. In the long term this will allow the Health Insurance Institute of Slovenia to have more influence on cutting the annual expenditure for medical devices that are covered by the compulsory health insurance.
Keywords:health insurance, compulsory health insurance, insured person’s rights to medical devices, complementary health insurance.


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