20.500.12556/RUL-170118 Vpliv ukinitve dopolnilnega zdravstvenega zavarovanja na porabo in financiranje zdravil ter živil za posebne zdravstvene namene v Sloveniji The impact of the supplementary health insurance withdrawal on the consumption and financing of medicines and foodstuffs for special medical purposes in Slovenia Januarja 2024 je prišlo do sprememb v Zakonu o zdravstvenem varstvu in zdravstvenem zavarovanju. Ključna sprememba je ta, da je zdravstveno zavarovanje zdaj v rokah ZZZS, ter da dopolnilnega zdravstvenega zavarovanja ni več. Namesto slednjega zdaj vsi plačujemo obvezni zdravstveni prispevek v višini 35,00 EUR na mesec. Spremembe zakona in strukture zdravstvenega zavarovanja vplivajo na vse zdravstvene storitve, prav tako tudi na kritje stroškov za zdravila in živila za posebne zdravstvene namene. Do januarja 2024 sta stroške za zdravila in živila krila obvezno (OZZ) in dopolnilno (DZZ) zdravstveno zavarovanje (ali doplačila bolnikov), in sicer odvisno od tega, na katero listo je bilo razvrščeno zdravilo oziroma živilo. Zdravila na listi P70 so bila krita okoli 70,00 % iz sredstev OZZ, medtem ko so bila zdravila in živila z vmesne liste krita približno 10,00 % iz OZZ, razliko pa je moral plačati posameznik sam ali pa se je krila iz premij dopolnilnega zdravstvenega zavarovanja. Posledično sta ukinitev DZZ in prenos ustanove zdravstvenega zavarovanja v roke ZZZS prinesla veliko sprememb in novosti, za nas pa so najbolj zanimive spremembe v kritju in razvrščanju zdravil in živil. Magistrska naloga je bila narejena z namenom ocene vpliva ukinitve dopolnilnega zdravstvenega zavarovanja na porabo in financiranje zdravil in živil na listi P70 in vmesni listi. Naprej smo iz objavljenih podatkov o številu predpisanih zdravil, številu izdanih škatlic, številu predpisanih receptov in skupne vrednosti receptov proučili porabo zdravil in živil po listah (P, P70 in V). Dodatno smo pogledali razvrstitev zdravil po skupinah ATC ter se osredotočili na izbrane primere zdravil, ki so bili razvrščeni na pozitivno in vmesno listo ali samo na vmesno listo. Pogledali smo finančni del plati kritja zdravil in živil ter dva glavna vira plačevanja: prispevki OZZ in DZZ (skupaj z doplačili). Osrednji del magistrske naloge je bila Projekcija finančne vzdržnosti sistema OZP 2024-2028. Metodološko je bila analiza izvedena na podlagi podatkov iz letnih poročil ZZZS in zasebnih zavarovalnic. Na podlagi do takrat znanih podatkov, kot so število zavarovancev, skupna vrednost receptov, izračunani 10-letni koeficienti rasti ter čisti prihodki zasebnih zavarovalnic, smo želeli dobiti projekcijo prihodkov in odhodkov ZZZS v naslednjih petih letih. Izdelali smo tri scenarije in v vsakem upoštevali različne koeficiente rasti skupne vrednosti receptov. S to analizo smo dobili boljši vpogled v finančno prihodnost ZZZS, kar se tiče plačevanja prispevkov in kritja zdravil in živil. Na koncu smo podali našo oceno prispevkov OZP v naslednjih petih letih, ki bodo potrebni, da celoten sistem plačevanja zdravstvenega zavarovanja ostane zdržen. In January 2024, Slovenian Government made significant changes to the Health Care and Health Insurance Act. The biggest change is that the health insurance is now fully managed by ZZZS and that there is no longer any supplementary health insurance. Instead of supplementary health insurance, a new compulsory health insurance contribution of EUR 35,00 per month has been introduced. The changes in the law and the structure of health insurance impacts all health services, as well as coverage of costs for medicines and foodstuffs. Until January 2024, the costs for medicines and foodstuffs were covered by compulsory (OZZ) and supplementary health insurance (DZZ), depending on which list the medicine or foodstuff was classified. Expenses for medicines on the P70 list were covered on average 70,00% from the funds of the OZZ, while expenses for medicines and foodstuffs from the V list were covered on average 10,00% from the OZZ, and the rest had to be paid either out of pocket (by the patients) or from the premium of the supplementary health insurance. As a result, the withdrawal of the DZZ and the transfer of the entire health insurance institution into the hands of the ZZZS brought many changes and novelties. This thesis focuses on most interesting changes in the coverage and classification of medicines and foodstuffs. The objective of this master's thesis was to evaluate the impact of the withdrawal of supplementary health insurance on the consumption and financing of medicines and foodstuffs on the P70 and V list of medicines. Next, from the published data on the number of medicines prescribed, the number of boxes issued, the number of prescriptions prescribed and the total value of prescriptions, we examined the consumption of medicines and foodstuffs by lists (P, P70 and V). In addition, we looked at the classification of drugs by ATC groups and focused on selected cases of drugs that were classified and on the positive and on the V list. We looked at the financial part of the drug payment-coverage and the two main sources of payment: OZZ and DZZ (together with co-payments). The central part of the master's thesis was the projection of financial stability of OZP contributions for the period from 2024 to 2028. Methodologically, the analysis was carried out on the basis of data and information gathered from annual reports of ZZZS and private insurance companies. On the basis of previously known data, such as the number of insured, the total value of prescriptions, the calculated 10-year growth coefficients and the net revenues of private insurance companies, we have made a projection of ZZZS revenues and expenses in the next five years. We have prepared and analyzed three scenarios, and in each we took into account different growth coefficients for the total value spend for prescriptions. With our analysis, we gained better insight into the financial future of the ZZZS when it comes to paying contributions and covering medicines and foodstuffs. Finally, we estimated the OZP contributions over the next five years which will be needed for the entire health insurance system to remain sustainable. obvezno zdravstveno zavarovanje dopolnilno zdravstveno zavarovanje obvezni zdravstveni prispevek poraba in kritje zdravil in živil za posebne zdravstvene namene lista P70 vmesna lista compulsory health insurance supplementary health insurance compulsory health insurance contribution consumption and financing of medicines and foodstuffs P70 list V list true false false Slovenski jezik Angleški jezik Magistrsko delo/naloga 2025-07-02 13:17:10 2025-07-02 13:17:14 2025-07-03 04:43:15 0000-00-00 00:00:00 2025 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 114964 27047.pdf 27047.pdf 1 BC7374A48675301FB5B0593E51D54394 e38267a4d448a8ea8b15dd70e5ce7be6451f1cd63b866d90dc3c760e1e3f3149 35ac54e8-5734-11f0-b232-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=212049 Fakulteta za farmacijo 0 0 0