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”ZUM” reimbursement catalogue, a burden of General Health Insurance company (VZP)

The reimbursement of medical devices in acute inpatient care has been a sensitive topic since the inception of the reimbursement catalogue of the so-called separately charged material (ZUM). Its history includes many absurdities. ZUM, for example, has never been properly defined. Thus, a ZUM is a product that someone lists as a ZUM on any performance registration sheet. Years ago, I recall that a medical procedure code was required for inclusion in the ZUM codebook. But the registration sheets for those procedures were not publicly available. Yet, suppliers were registering their devices in the reimbursement catalogue and no one at the VZP wondered where they got these codes. We have now moved on to another absurdity. Entry of a device in the catalogue is required so that providers can report the devices as ZUMs to health insurers. However, this is just a useless statistic that nobody uses for anything. Nothing is reimbursed on the basis of these reports.

How did this situation happen? The Ministry of Health has successfully completed the CZ-DRG project, on the basis of which an increasingly substantial part of the reimbursement for acute inpatient care is transferred. Health insurance companies have somewhat fallen behind in this process and have not built effective control mechanisms. While the way care is reimbursed is based on internationally proven principles, the mechanisms of the insurance companies are set on the performance-based reimbursement of the late 1990s. Let us take a hypothetical example: making one DRG base more expensive by introducing a more expensive ZUM will not lead to higher reimbursement in the system, because increasing the relative weight of one DRG base will automatically reduce the relative weights of the others. However, insurers engage in absurd micromanagement and try in vain to use the ZUM catalogue to keep out of the public health insurance system a screw that is 1% more expensive than one from another supplier. In doing so, they are missing out on far more essential elements of the newly set-up system. Take, for example, the strategy for creating DRG bases. Why we have bases for open and for laparoscopic procedures can be understood. But why are bases being created for robotic procedures when robotic surgery argues that it is actually a more economical offshoot of laparoscopic surgery? Are we going to be the only DRG system in the world with bases set up like this? Wouldn't a marker be enough? The problem is also an artificially created unaddressed retrospective bonuses, which the ZUM reimbursement catalogue strongly encourages. Someone overslept. But development cannot be stopped and everything is moving forward.

Autor: Aleš Martinovský



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