Outpatient units’ doctors agreed with health insurer on cooperation

The situation that threatened the clients of the Dôvera health insurer with paying cash for treatment at some outpatient units’ doctors has been solved since the doctors and the insurer agreed on conditions of cooperation.

Medical examination, illustrative stock photoMedical examination, illustrative stock photo (Source: TASR)

Doctors associated in the Association of Outpatient Healthcare Providers (ZAP) agreed on October 3 on terms of cooperation with the private health insurer Dôvera, Matej Štepiansky of the health insurer informed the TASR newswire.

The contracts of some 2,000 outpatient doctors with Dôvera, i.e. about one-third of doctors in Slovakia, expired on October 1, with no new ones being signed. Outpatient doctors have been arguing with Dôvera about contracts since the summer, dissatisfied with the sum of payments the private insurer was offering them.

“We’ve agreed that health care will be provided to our policyholders without any restrictions, i.e. in a standard mode," said Štepiansky, as quoted by TASR, adding that the details of the agreement will be fine-tuned in the upcoming days.

The agreement is based on a 5-percent increase in payments as of November 1 provided that the sector’s funding is increased by €100 million.

“Measurable quality parameters form a part of the agreement,” Štepiansky added, as quoted by TASR.

Dispute and its implications

Although doctors have announced a non-contractual relationship as of October, most of them provided health care to patients in the same way as before, i.e. as if a contractual relationship had continued without any change. For patients a non-contractual relationship means that only an urgent health care is refunded by the health insurer to them.

The ZAP members’ decision not to sign a contract addendum had no impact on the situation related to meeting the minimum public network requirement, Dôvera said. The Health Care Surveillance Authority (ÚDZS) started to examine the meeting of this requirement due to the dispute between doctors and the private insurer last week, its spokesperson Andrea Pivarčiová confirmed.

ZAP held talks on cooperating with the state-run Všeobecná Zdravotná Poisťovňa (VšZP) some time ago. They have agreed on the amount of payments. Negotiations are still underway with private health insurer Union. Contracts with Union are valid until the end of March 2018, TASR reported.

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