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Doctors refuse to be debt collectors

SEVERAL doctors across Slovakia voiced their concern over the new amendment to agreements with health insurer Dôvera which compels them to inform their patients about possible arrears from unpaid health insurance or even accept the owed sum. The insurer responds that it is the legal duty of doctors to inform patients about their debt and adds that the possibility to take the payment is only voluntary.

SEVERAL doctors across Slovakia voiced their concern over the new amendment to agreements with health insurer Dôvera which compels them to inform their patients about possible arrears from unpaid health insurance or even accept the owed sum. The insurer responds that it is the legal duty of doctors to inform patients about their debt and adds that the possibility to take the payment is only voluntary.

Meanwhile, the Health Care Surveillance Authority (ÚDZS) said it will oversee the activities of the insurer.

“I will not be a collector for the insurer,” psychiatrist Kornélia Fabišíková from Moldava nad Bodvou (Košice Region) told the Sme daily.

She wrote in a blog saying that Dôvera asks doctors to detect online whether the patients paid for insurance or not. If they have, doctors can examine, diagnose and give a prescription. If not, they should inform them they are only entitled to urgent treatment and that they can pay the debt directly to them.

“Our primary task is to treat patients, not collect the owed sum and substitute somebody else’s failure,” Fabišíková wrote, adding such demand is at odds with the licence for providing health care as well as other laws.

Similar reactions to the new amendments were brought by the Pravda daily which addressed several doctors across the country.

Dôvera, which introduced the online verification of the information about insurance and the possibility to pay the owed sum directly to doctors as part of the bigger project called Safe Medication Online, states that the law already obliges doctors to inform patients if they have not payed for the insurance for more than three months, and that in such a case they are entitled only to urgent medical treatment.

Martin Kultan, head of the insurer, explained to journalists on October 21 that they introduced an online system that should simplify the work of doctors. Instead of visiting Dôvera’s website to check whether the patient is or is not a debtor, doctors will see the information directly in their system after entering for example a birth certificate number.

“Dôvera wants nothing other from the doctors than to inform the patient whether or not they are entitled for non-urgent medical treatment in compliance with the law,” Kultan said.

Regarding the acceptance of payments for an owed sum, Kultan stressed it is only a possibility, not a duty.

The ÚDZS, however, refers to the law on health insurers which, among other things, clearly says that clients have to send payments directly to the account of the health insurer.

“This means that only the health insurer is authorised to accept the payment and no provision of the law authorises it to delegate this duty to another subject,” ÚDZS spokesperson Soňa Valášiková told The Slovak Spectator.

Kultan, however, says that the principle is in compliance with the law. According to him, doctors act as mediators. He compared the situation to the case when the health insurer sends a health card to the client via the post office.

He hopes they will clarify the situation with the ÚDZS soon.

Doctor-patient relations

In her text, Fabišíková also pointed to some kind of “reward” doctors should get if accepting the payment, which the media described as 1 percent of the sum patients pay. Kultan explained that this is only the fee for accepting the payment, for example for issuing a receipt. He explained that the reward includes increased amount within the payments doctors get from insurers, but this will apply to those who will support the whole Safe Medication Online project.

Another aspect to which Fabišíková pointed is the impact of proposed measures on the doctor-patient relationship. According to her, it will be difficult to explain to the patients with some kind of mental disease that she is only checking whether they have paid for insurance, or sending the information about a prescription to the pharmacy and the insurer.

Ladislav Pásztor, head of the Association of Private Doctors, said that signing the amendment to the contract will not impact doctor-patient relations. Since most of the treatments in outpatient care are urgent, the doctors will continue treating the patients as they do now.

“If we learn the patients owe money to the health insurer, we will notify them about this in compliance with the law,” Pásztor told The Slovak Spectator, adding they will still get their treatment and medication.

Marián Kollár, head of the Slovak Medical Chamber, even says he hopes that the changes will deepen positive relations between patients and doctors.

Peter Makara, head of the Slovak Society of General/Family Practice SLS, welcomes the connection between the doctors’ computers and lists of debtors. On the other hand, he disagrees with accepting payments for insurance.

“It is certainly appropriate to politely notify the patients that they can have problems if their health condition worsens and send them to the insurer’s branch office,” Makara told The Slovak Spectator. “But I cannot imagine collecting the owed sums. This is something which does not belong in doctor-patient relations.”

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