Oncologists request rules for the provision and reimbursement of treatment by health insurers

Press release for print (in the pdf format)

Prague, 31 May 2011

Health insurance companies are speaking publicly about the lack of financial resources. In addition, oncologists have not yet received any rules from the health insurance companies this year, according to which they should treat insureds, or in other words their patients. No patient has a contract with any doctor or healthcare facility; patients have contractual relationships with their health insurance companies. Healthcare insurers should therefore clearly specify what treatment should be paid for which patients and to what extent. Instead, healthcare insurers paid comprehensive cancer centres only the same amount as they did in the year 2009, reduced by 2 percent. However, cancer patients are now surviving longer thanks to modern treatment and the number of newly diagnosed patients is increasing. So, the existing financial possibilities offered by health insurance companies are insufficient for optimal treatment of all patients according to standards of care.

“The Czech Society for Oncology is aware of the lack of funds. However, it needs to receive clear rules from the health insurance companies for the treatment of cancer patients”, said Prof. Jiří Vorlíček, Chairman of the Czech Society for Oncology, ČLS JEP. “Fixed payment of costs irrespective of the need for care and irrespective of real needs on the part of the patients contradicts the solidarity principles as well as the equal access to treatment”, added Prof. Vorlíček. The Czech Society for Oncology (CSO) provided healthcare insurers with the document “Principles of cytostatic treatment of malignant cancer diseases” as well as with predictions of the numbers of patients with various diagnoses who will need cancer treatment this year, including the estimated need for care in the individual regions of the Czech Republic. The CSO received no response from the health insurance companies regarding these materials.

The CSO requests that health insurance companies prepare clear rules for the provision of care and communicate them to the public, as well as current and future patients. “People have the right to know what care, to how many patients, and to what extent and at what facilities the health insurers are willing to pay this year”, explained Prof. Vorlíček. “The absence of any rules not only makes everyday work more difficult for the doctors, but also prevents all of society from taking part in the required healthcare reforms – which means from increasing the involvement of patients in the entire treatment, adherence to solidarity principles, provision of care based on real needs, and equal access to care for everybody”, added Prof. Vorlíček.

The four-year election period of the current Committee of the Czech Society for Oncology, Czech Medical Association, J.E.P. is coming to an end; on 21 June, members of the newly elected committee will hold a secret ballot to elect a chairman and other officers of the organisation. The CSO had many successes during the last voting period from 2007 through 2011. The membership base has expanded substantially; at present the Society has almost 800 members. It successfully fulfilled the National Cancer Program, re-accredited 13 Complex Cancer Centres and Groups based on four basic competences evaluated through public tenders, the National Cancer Register was further developed, and a new information system was established enabling the prediction of the treatment burden for most cancer diagnoses. For the clinical oncology segment, therapeutic standards covering the entire pharmacotherapy were updated every year. In the area of financing cancer care in the Czech Republic, rational approaches to treatment were supported in accordance with the principles of contemporary pharmacoeconomic and ethical principles and approaches. The Committee of the CSO became an active participant in these proceedings and submitted proposals to resolve the situation of the reimbursement of cancer care, including estimates of necessary costs. There was Intensive cooperation with the Ministry of Health of the Czech Republic, Institute of Health Information and Statistics of the Czech Republic, Czech Medical Chamber, State Institute for Drug Control, health insurance companies, professional societies of the Czech Medical Association of JEP (such as societies of surgery, urology, gynaecology, gastroenterology, pneumology), and other institutions. The Committee also supported cancer screening programs, actively cooperated with many patient organisations and defended the interests of cancer patients in all situations. The Committee ensured direct and constant access of patients to information about prevention and treatment of diseases at the website of the CSO: www.linkos.cz, thus increasing their participation in the treatment. All of the activities above and goals achieved are in accordance with the required changes to the healthcare management and financing system, and thereby with the program declaration of the current government. If the cooperation from the health insurance companies in the foregoing activities was more generous, the benefits for the entire Society would be more visible.

Detailed information on the activities of the Czech Society for Oncology is available at www.linkos.cz.

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