Case report to regulation deductions in its overall complexity in 2012

Summary

The communication draws attention to the problems of regulation deductions in their overall complexity. The general practitioner who had received an almost twofold 597.43 CZK compensation for one recalculated (uniform) policyholder in comparison with the average nationwide compensation of 306.13 CZK protested against the inflicted regulation deduction. This deduction was calculated by the Information system of the insurance company at the level of 79.990 CZK for 2012.

The objections can be classified into 8 groups, which are further subjected to evaluation by the revision physician.

The settlement of these objections by the revision physician shows a complexity of the problems including substantial circumstances influencing the activity of revision physicians.

The author indicates the questionable value of this kind of cost regulation on medical care and associated work of the revision physicians.

Keywords:
compensation/remittance for the policyholder – cost regulation – medical care