Urgent amendments to the Law on Mandatory Health Insurance will be presented to the deputies of the National Assembly of the Republic of Srpska on May 19. Among others, it was proposed to delete the upper limit of co-payments, which would directly endanger patients who, for example, would have to allocate up to 5,000 KM co-payments for an operation that costs 10,000 KM.
Treatment could be much more expensive
Currently, this law implies a co-payment limit of 370 KM per service, but if the proposed changes are adopted, the treatment could be much more expensive.
Lawyer Vladimir Dragičević for “Independent newspaper” clarifies that the proposed amendment to Article 49 of the Law on Compulsory Health Insurance of the RS directly affects patients who need the most expensive types of treatment.
“The previous legal solution provided for a ‘protective ceiling’ – regardless of the total price of the medical service, and the maximum amount of co-payment that the patient had to pay for one service was 370 KM”, says Dragičević.
The nominal limit, expressed in a fixed KM amount, disappears
As he says, by deleting paragraphs 2 and 3 of this article, that nominal limitation, expressed in a fixed KM amount, disappears.
“This means that for an operation or diagnosis that costs, for example, 10,000 KM, instead of the current maximum of 370 KM, the patient could be obliged to pay a percentage (from five to 50 percent), which would be up to 5,000 KM in that case, and there are also more expensive procedures,” Dragičević points out.
Introduction of means test for access to healthcare
According to him, this deletion of the upper limit of participation represents a serious regression in the level of achieved social rights and can be seen as the introduction of a means test for access to health care.
He notes that the Constitution of Republika Srpska, in Article 37, guarantees the right to health care for everyone, and the state is obliged to ensure the availability of that care under equal conditions.
“If the amount of co-payment for major operations becomes so high that the average citizen cannot pay it, health care ceases to be generally available and becomes a privilege of the richest. I believe that such a provision is in potential conflict with the principle of social justice and the constitutional obligation of the state to protect the most vulnerable categories, as it turns the right to treatment into an economic burden that renders the very essence of mandatory health insurance meaningless,” says Dragičević.
The protective limit of 370 KM is deleted
He emphasizes that the proponent’s explanation that the protective limit of 370 KM is deleted due to “operation” and frequent changes to the price list is not acceptable.
“On the contrary, this fixed legal ‘ceiling’ was established as a barrier to further increases in the price of medical services and as a mechanism to protect patients, regardless of the changes foreseen in the price list,” he adds.
He points out that the additional problem of these changes is reflected in a kind of displacement of the regulation in question from the legal framework to the domain of by-laws, which unacceptably narrows the role of the National Assembly.
“Instead of the previously legally established ‘ceiling’ of the participation amount, leaving such a decision to the executive power is completely inappropriate and extremely questionable from a constitutional point of view,” concludes Dragičević.
