Area: Zdravstvo
Competent authority: MZ
EZU URL: .nan
Initiative ID: 909
Initiative accepted and completed: '2020-05-28'
Initiative classified in EZU: .nan
Initiative forwarded in response: '2018-06-12'
Initiative published: '2018-06-12'
Initiative submitted: '2018-06-04'
Response from the competent authority: "The answers were prepared by the Ministry\
  \ of Health, the National Institute of Public Health of the Republic of Slovenia\
  \ (hereinafter: NIJZ), the Health Insurance Institute of Slovenia (hereinafter:\
  \ ZZZS).Problems encountered by the family doctor in relation to eHealth.\r\nThe\
  \ NIJZ explains that they and the team they have available to manage the eHealth\
  \ solution are doing their best to ensure that there is no disruption in the operation\
  \ of the solution. The eHealth system currently includes 20 services and solutions,\
  \ all of which are used at national level. The system is extremely complex, both\
  \ at the system infrastructure level and at the content level. eHealth involves\
  \ a large number of stakeholders with its services and solutions, including healthcare\
  \ providers and their employees, patients, software houses, system infrastructure\
  \ maintainers, etc. Their requirements, wishes and needs are coordinated and met\
  \ as far as possible.\r\nActivities are also currently underway to recruit additional\
  \ eHealth staff at the NIJZ, which will in the long term improve the possibility\
  \ to provide quality support for the stable functioning of eHealth.Relieving family\
  \ doctors of unnecessary administration and short-term sick leave are managed in\
  \ agreement with the employer.\r\nIn this respect, we would like to clarify that\
  \ the determination of incapacity for work and other reasons for temporary absence\
  \ from work for up to 30 days is a statutory competence of the chosen personal physician\
  \ (Article 80(3) of the Health Care and Health Insurance Act (Official Gazette of\
  \ the Republic of Slovenia, No. 72/06 - Official consolidated text, 114/06 - ZUTPG,\
  \ 91/07, 76/08, 62/10 - ZUPJS, 87/11, 40/12 - ZUJF, 21/13 - ZUTD-A, 91/13, 99/13\
  \ - ZUPJS-C, 99/13 - ZSVarPre-C, 111/13 - ZMEPIZ-1, 95/14 - ZUJF-C, 47/15 - ZZSDT,\
  \ 61/17 - ZUP\u0160 and 64/17 - ZZDej-K; hereinafter referred to as \"ZZVZZ\"),\
  \ which in our opinion cannot in any way be transformed into an agreement with the\
  \ employer. Only a doctor has the expertise to identify medical conditions and to\
  \ decide on the most appropriate treatment for the patient. In the light of the\
  \ above, we cannot follow what is proposed. It may be added that, when drafting\
  \ future legislation, it was considered, not least in order to relieve the burden\
  \ on the chosen personal doctor, to introduce so-called 3-5 sick days per year,\
  \ which would mean that, in practice, in order to claim them, the patient would\
  \ not have to visit the chosen personal doctor to decide whether he or she was entitled\
  \ to sick leave, but would simply inform the employer that he or she was using these\
  \ so-called sick days. However, it should be borne in mind that before introducing\
  \ such measures on a systemic level, it is necessary to carry out an analysis of\
  \ the multiplier effects of such a measure (not only economic, administrative, but\
  \ also to verify the measure in terms of its effects on public health).Experimental\
  \ introduction of examinations of volunteer firefighters by occupational, transport\
  \ and sports medicine specialists.\r\nWith regard to the above proposal, we would\
  \ like to clarify that in March this year, a new Regulation on the medical fitness\
  \ of operational firefighters was adopted (Official Journal of the Republic of Slovenia,\
  \ No 19/18). The new or amended Regulation concerns the procedures for determining\
  \ the medical fitness of operational firefighters who do not use isolation apparatus.\
  \ This is a group of firefighters whose tasks are different from those of operational\
  \ firefighters who use insulating apparatus and from those of professional firefighters.\
  \ The medical fitness of these firefighters can now be determined by an occupational,\
  \ transport and sports medicine specialist or by the doctor who is most familiar\
  \ with the firefighter's medical condition and who also keeps the firefighter's\
  \ medical records, i.e. the firefighter's chosen personal doctor.Nurses should take\
  \ over the prescription of medical technical equipment. Such an initiative has already\
  \ been submitted to the Ministry of Health and was taken into account in the drafting\
  \ of the new law, which was subsequently not adopted.\r\nWith regard to the reimbursement\
  \ of travel expenses, the proposal is made that the Health Insurance Fund should\
  \ recognise this right in its communication with the insured person. With regard\
  \ to this petition, we would like to clarify that, according to Article 40 of the\
  \ Health Insurance Act, insured persons have the right to reimbursement of travel\
  \ expenses referred to in Article 23(1), (2) and (3) if they have to travel to a\
  \ doctor or a medical institution in another place because there is no doctor or\
  \ appropriate medical institution in their place of employment or permanent residence,\
  \ or if they are referred or called by their personal physician, a medical institution\
  \ or a medical board to a place other than the one of their permanent residence\
  \ or place of employment or place of employment. Depending on the content of Article\
  \ 23(1), (2) and (3) of the Health Insurance Act, the right to travel expenses is\
  \ conditional either on a certain category of insured persons (children, schoolchildren\
  \ and students) or on the treatment of certain medical conditions (e.g. malignant\
  \ diseases, cerebral palsy, haemophilia, occupational diseases, work-related injuries).\
  \ An insured person may also have the right to be accompanied on a journey to a\
  \ provider if, due to his/her state of health or for other reasons, he/she is not\
  \ able to travel on his/her own. The chosen personal doctor shall determine whether\
  \ the stated, professional reasons justifying the need for accompaniment are met.\
  \ The chosen personal doctor treating the insured person is the most familiar with\
  \ the insured person's state of health and is, among other things, competent to\
  \ refer the insured person for specialist services for which the insured person\
  \ needs to travel to a provider. In this context, it is also the clear and logical\
  \ responsibility of the chosen personal physician to issue the insured person with\
  \ a document (Travel Reimbursement - Accompaniment) on which he/she lists all the\
  \ necessary information (personal data of the insured person, reason for treatment,\
  \ need for accompaniment, provider to whom the insured person is referred, etc.).\
  \ On the basis of the document issued (certified on the reverse by the provider\
  \ to whom the insured person has travelled) and on the basis of the relevant supporting\
  \ documents, such as travel tickets, proof of accommodation, etc., the ZZZS decides\
  \ on the entitlement to reimbursement of travel expenses. Therefore, in view of\
  \ all the above, we are unable to follow the proposal, as it would be contrary to\
  \ the provisions of the current regulations, and any different regulation from the\
  \ one currently in force would impose an additional burden on insured persons and\
  \ would significantly prolong the procedure for claiming their rights.Extensiveness\
  \ and inconsistency of the Rules of Compulsory Health Insurance (\"the Rules of\
  \ the Compulsory Health Insurance Scheme\").We are aware of the extensiveness and\
  \ complexity of the content of the Rules of the Compulsory Health Insurance Scheme.\
  \ However, it should be stressed that this is due, on the one hand, to the legal\
  \ regulation of the right and its factual nature of each individual right under\
  \ the EHIC, and, on the other hand, to the intertwined nature of the content and\
  \ their precise definition in terms of implementation. For the above reasons, it\
  \ would not be appropriate for the more detailed legal regulation of the rights\
  \ under the EHIC to be regulated in several, albeit less comprehensive, general\
  \ acts of the ZZZS, as this would increase the possibility of opacity, lack of clarity\
  \ and inconsistency in the more detailed legal regulation of the rights under the\
  \ EHIC. It should therefore be emphasised that all amendments and additions to the\
  \ HIA Rules pursue the following fundamental objectives:\r\n- harmonisation with\
  \ the legislation,\r\n- modification of (outdated) regulations in specific areas\
  \ due to the development of the medical profession,\r\n- the elimination of legal\
  \ gaps,\r\n- elimination of unclear regulations through more precise definitions,\r\
  \n- elimination of unnecessary provisions; and\r\n- elimination of internal inconsistencies\
  \ in the text.\r\nThis also pursues the principle of definiteness, inter alia by\
  \ improving comprehensibility and clarity and by avoiding divergent interpretations\
  \ in practice.\r\nWith regard to the provision of explanations and controls by the\
  \ ZZZS, we would like to clarify that the ZZZS endeavours to provide correct answers\
  \ in relation to the questions submitted, and therefore the ZZZS also issues instructions\
  \ which regulate in more detail the implementation of the procedures for exercising\
  \ certain rights under the EHIC, respond to written questions from providers, and\
  \ provide appropriate explanations in relation to the implementation of the provisions\
  \ of the Rules of the EHIC. In this way, an attempt is made to ensure a uniform\
  \ understanding and conduct of both providers and professionals at the ZZZS. However,\
  \ it is allowed that misunderstandings may occur in the communication between the\
  \ provider and the professional, especially if the communication takes place over\
  \ the telephone (e.g. insufficient or unclear presentation of the circumstances\
  \ of a specific case), which may then be revealed during inspections and lead to\
  \ appropriate suspensions by the ZZZS inspectors.\r\nWith regard to the provision\
  \ of answers to administrative and other questions concerning health care, we would\
  \ like to clarify that ZZZS usually answers all questions raised by telephone or\
  \ e-mail in a timely manner, except in the case of certain systemic or more complex\
  \ issues that require appropriate examination, which takes more time. From the point\
  \ of view of the patient's treatment by the doctor, we do not consider that the\
  \ permanent presence of an on-call employee of the HIA is necessary. The latter\
  \ is also concluded on the basis of the number and content of the questions asked\
  \ so far.\r\nWith regard to the abuse of the emergency service and its non-sanctioning,\
  \ we would like to clarify that the ZZZS, either in the context of requests from\
  \ insured persons or other institutions (e.g. Ombudsman, Patient's Rights Representative)\
  \ for appropriate explanations or in relation to requests from insured persons for\
  \ reimbursement of costs for services rendered, provides answers or decides on the\
  \ eligibility for reimbursement of the costs claimed in an administrative procedure.\
  \ In doing so, the ZZZS acts in accordance with the applicable regulations, which\
  \ means that, for example, it may only grant a request for reimbursement if the\
  \ conditions laid down by law and the Rules of the Health Insurance Fund are fulfilled.\r\
  \n "
Text file: 909.txt
Title: Problems in the practice of family medicine
URL: https://www.stopbirokraciji.gov.si/pobuda/?st=909
