Management of the funds collected on the basis of the act on insurance for public health insurance at the OZP - the industrial health insurance compan
Press release on completion of the auditing operation No. 05/31
The auditing operation was included in the Annual Audit Plan of the Supreme Audit Office (hereinafter referred to as “SAO”) for the year 2005 under No. 05/31. The auditing operation was managed and audit conclusion drawn up by Mr. Jiří Drábek, the Member of the SAO.
The aim of the audit was to examine an income of the health insurance basic fund and expenditures from this fund for health care payments provided in accordance with health care facilities agreements, and to examine also expenditures from the operational fund of health insurance companies in the framework of the overall management of the funds collected on the basis of the Public Health Insurance Act. The audited period covered the time from January 2003 to June 2005 as well as previous periods in certain cases of relevant connections.
The audited bodies were the Industrial Health Insurance Company for Employees of Banks and Insurance Companies and the Health Insurance Company METAL ALIANCE.
In the audited health insurance companies
- They have endeavoured to fulfil the Act No. 48/1997 Coll. in the area of health care insurance contributions collection, so they implemented precise procedures that were laid down by internal regulations for both the collection of contributions payments and the outstanding receivables administration. Increase of the absolute amount receivables for insurance contributions should have been limited; also by enforcement of existing receivables in maximum volume for minimum time. A desirable effect has not been reached; accounts receivables in both insurance companies have showed an increasing trend for the period audited.
- the SAO auditors found out problems in the area of negotiation ways and rates of payments for health care services between the insurance companies and health care providers. The balance directly depended on negotiation results and procedures, which were required from the health insurance companies by the Ministry of Health payment decrees, issued always for the relevant half-year. The Act No. 48/1997 Coll. counted on these decrees for such cases when e.g. the Ministry of Health found out that negotiation results did not comply with regulations or public interest and it could set up point values, payment rates and health care regulatory limitations. Duty and responsibility to execute these decrees fell upon insurance companies. Cost of payments administration, i.e. working out and distribution of repeatedly issued price amendments of agreements including complete software modifications, amounted to CZK 10 million in the both health insurance companies for the period audited from 2003 till the end on June 2005.
For the year 2006, the Ministry of Health issued decree No. 550/2005 Coll. with applicability from 1.1.2006. It was amended by 1.4.2006, which just brought the problems with health care payments also in the year 2006.
- Both health insurance companies had sound management of funds collected on the basis of the Health Care Insurance Contributions Collection Act, which was evidenced by the zero state of commitments payable to contracted health care providers by 31.12.2003 and 31.12.2004.