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07-11-2023

The health insurance funds updated the methodology for setting reference prices

Iliustracija

From the next year, an updated pricing methodology for healthcare services reimbursed by the Compulsory Health Insurance Fund (CHIF) will come into force, which will make calculation of prices much more accurate and fairer, and will be based exclusively on the costs of medical institutions.

“The methodology for setting the prices of services covered by the CHIF is constantly being improved, and over the last few years we have already implemented some methodological changes that were really important to healthcare institutions. However, we do not stop and we have provided a slightly larger update to the methodology. In developing this methodology, we have not only taken into account changes in the legislation governing the components of the cost of healthcare services, but also valuable comments of social partners to whom the planned changes were presented. The proposals to improve this methodology have also been approved by the Compulsory Health Insurance Council,” Gintaras Kacevičius, Director of the National Health Insurance Fund under the Ministry of Health (NHIF), says.

One of the most important changes in the updated methodology is related to the use of data on medicine specialists’ salaries in the calculation of prices for services. Until now, this calculation has been based on the average wage (AW) per post of the relevant group of workers in the country (e.g. doctors, nurses). However, some health care professionals have a higher AW than the national average, and the adoption of a reference price based on the national average makes it difficult to recruit a professional, or they have to be paid a higher salary, that the reference price does not cover. In order to take into account more flexibly the wages of health care professionals in the market, new methodology foresees the use of data on the costs per post of the AW of the employees of selected representative health care institutions, directly related to the provision of a respective service for the purpose of the calculation of the prices of services.

The methodology also provides for the possibility for health care institutions to receive additional funds for the accrual and payment of holiday pays to the employees providing these services when calculating the cost of health care services. Until now, the methodology did not provide for this, and institutions had to use internal resources for holiday pays of the specialists.

Also, in the calculation of prices of services, updated methodology provides for the use of the average of prices indexed to the consumer price indices, published by the State Data Agency. It has also been decided that a decision regarding price indexation linked to inflation growth will be taken on the basis of an assessment of the change of inflation since the last modification of the prices of services, specifically to compensate for the effects of higher inflation.

One more change – calculation of general, administrative and economic costs of healthcare facilities will be more accurate than before, as it will take into account differences in these costs according to the level of the facility – university, republican, regional and district hospital, polyclinic, primary health care centre, or nursing and palliative care hospital.

The changes introduced in the new methodology will be implemented gradually, starting with the prices of services that are newly calculated or recalculated. In addition, the NHIF plans to prepare and submit to the Minister of Health for approval later this year a plan to calculate the prices of services reimbursed by the CHIF in 2024, using the already updated methodology.

(Freepic photo)

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Last updated: 14-12-2023

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