natgillin/translations-raw huggingface dataset:
An in-depth reform comprising Acts Nos 581/2004 and 580/2004, which entered into force on 1 January 2005 (the ‘2005-reform’), altered the rules for the redistribution of the collected health insurance contributions and changed the legal form of all insurance companies (whether State-owned or in private ownership) from legal entities sui generis to incorporated limited liability companies (i.e. profit-seeking joint stock companies of private law).
Vendar v času sprejetja tega sklepa še ni bil izveden noben ukrep v okviru omenjenega projektnega načrta [10].
An independent regulatory authority, the Slovak Health Surveillance Authority (‘HSA’) was set up to issue operating licences and to supervise the insurance companies' compliance with the applicable regulations.
ZDRAVSTVENE ZAVAROVALNICE NA SLOVAŠKEM
In essence, these reforms were designed to contribute to improved efficiency in the use of available resources and increase the quality of healthcare provision [3].
V skladu s slovaško zakonodajo je zdravstvena zavarovalnica opredeljena kot delniška družba z registriranim sedežem v Slovaški republiki, ki je ustanovljena, da bi zagotavljala javno obvezno zdravstveno zavarovanje v skladu z dovoljenjem, ki ga je odobril HSA.
In Slovakia, all health insurance companies, public and private, provide compulsory health insurance for Slovak residents [4].
Prebivalci Slovaške si lahko zagotovijo paket obveznega zdravstvenega zavarovanja s sklenitvijo pogodbe z naslednjimi tremi zavarovalnicami:
The possibility in Act No 580/2004 to also provide individual health insurance as a top-up to the basic benefit package under compulsory health insurance has remained marginal, due to the comprehensive healthcare benefits covered by compulsory system [5].
slovaško državno delniško družbo VZP, ki je bila ustanovljena 1. julija 2005.
Furthermore, in 2005, a legislative act introduced the possibility for all health insurance companies to provide voluntary health insurance for those who are excluded from compulsory health insurance [6].
Vzpostavljena je bila s preoblikovanjem javnega podjetja VšZP, ki je bilo ustanovljeno 1. novembra 1994 v skladu z aktom št. 273/1994 kot naslednik Nacionalne zavarovalnice (Národná poisťovňa) v okviru zavoda za zdravstveno zavarovanje.
In 2007, Act No 530/2007 amended Act No 581/2004 and prohibited insurance companies active in the compulsory health insurance sector from paying out profits in the form of dividends with effect from 1 January 2008, thereby imposing an obligation to reinvest surpluses generated in the Slovak health system.
VZP se je 1. januarja 2010 združila z državno zavarovalnico SZP v skladu z aktom št. 533/2009 (zato se, kjer je ustrezno, skupni subjekt v nadaljnjem besedilu imenuje SZP/VZP).
As a result, health insurance companies were not allowed to distribute profits at all as of January 2008.
Slovaška republika je edina delničarka VZP;
However, on 26 January 2011, the Slovak Constitutional Court declared the ban on profit distribution incompatible with several provisions of the Slovak Constitution.
zasebno delniško družbo Dôvera (njena glavna delničarka je srednjeevropska finančna skupina PENTA).
Further to this Judgment, in July 2011, the Slovak authorities amended Act No 530/2007 by Act No 250/2011 to allow health insurers again to distribute (to their shareholders) profits achieved from the compulsory health insurance activity, subject to certain conditions [7].
Dôvera je bila ustanovljena 1. oktobra 2005 in se je 31. decembra 2009 združila z drugo zasebno slovaško zdravstveno zavarovalnico, tj. zavarovalnico Apollo.
As a result of these legislative changes, an infringement procedure concerning the restriction on the disbursement of profit was closed by the Commission in December 2011 [8].
Združeni subjekt je bil leta 2010 največja zasebna zdravstvena zavarovalnica na Slovaškem;
On 31 October 2012, the Slovak authorities approved a project plan for the establishment of a unitary not-for-profit system of compulsory health insurance in the Slovak Republic, which would be introduced either through voluntary buyouts (until 1 January 2014) of the privately-owned health insurance companies or through their expropriation (until 1 July 2014) and would establish a single (State-owned) health insurance company [9].
zasebno delniško družbo Zdravstveno zavarovalnico Union, ki je bila ustanovljena 9. marca 2006 in je članica skupine Achmea (prej Eureko) s sedežem na Nizozemskem.
However, at the time that the present decision was adopted, neither step of the abovementioned project plan had thus far been implemented [10].
Spodnja tabela prikazuje razvoj tržnih deležev različnih zavarovalnic, ki so zagotavljale obvezno zdravstve no zavarovanje v Slovaški republiki v obdobju 2008–2013 [11]:
HEALTH INSURERS IN SLOVAKIA
Leto
Slovak residents have a choice to contract with any of the following three insurers to obtain a compulsory health insurance package:
Število zavarovanih oseb (v %)
the Slovak State-owned public limited company VZP, which was established on 1 July 2005; It was formed by the transformation of the public enterprise VšZP, which was established under Act No 273/1994 on 1 November 1994 as the successor to the National Insurance Company (Národná poisťovňa) of the Health Insurance Fund Administration; VZP was merged with State-owned company SZP on 1 January 2010 pursuant to Act No 533/2009 (therefore, where appropriate, the joint entity is hereafter referred to as ‘SZP/VZP’); The Slovak Republic is the sole shareholder of VZP;
2010: SZP se združi z VZP
the privately-owned public limited company Dôvera (its main shareholder is the Central European financial group PENTA); Dôvera was established on 1 October 2005 and merged with another privately-owned Slovak health insurance company, Apollo, on 31 December 2009.
2010: Apollo se združi z Dôvero
In 2010, the merged entity was the biggest privately-owned health insurance company in Slovakia;
Vse zdravstvene zavarovalnice so delniške družbe, predpisi v zvezi z lastništvom pa omogočajo, da so delničarji državni in tudi zasebni sektorji.
the privately-owned public limited company Union Health Insurance, established on 9 March 2006 and a member of the Netherlands-based Achmea group, formerly Eureko.
Vse zdravstvene zavarovalnice morajo izpolnjevati nekatera merila solventnosti.
The table below shows the evolution of the market shares of the different companies providing compulsory health insurance in the Slovak Republic during the years 2008-2013 [11]:
Ker zanje veljajo stroge proračunske omejitve, so v celoti odgovorne za finančne primanjkljaje.
Year
Kot zasebne delniške družbe, ustanovljene v skladu s splošnim pravom družb, se zdi, da zdravstvene zavarovalnice avtonomno upravljajo svoje dejavnosti in stroške zdravstvenega varstva.
Companies
Zdravstvene zavarovalnice lahko ustvarjajo dobiček in ga tudi ustvarjajo [13].
Number of persons insured (%)
Zavarovalnice na Slovaškem ustvarjajo prihodke iz prispevkov za zavarovanje, državnega proračuna (prispevki v imenu ekonomsko neaktivnih oseb in subvencija za pokrivanje povečanih stroškov zdravstvenih storitev), dohodka od lastnine, daril in drugih dohodkov.
VZP
Poleg tega lahko zdravstvene zavarovalnice ustvarjajo dobiček na primer z izboljšanjem sistema upravljanja in s pogajanji pri sklepanju pogodb z izvajalci zdravstvenih storitev.
2010: SZP merges with VZP
GLAVNE ZNAČILNOSTI SLOVAŠKEGA SEKTORJA OBVEZNEGA ZDRAVSTVENEGA ZAVAROVANJA
2010: Apollo merges with Dôvera
Socialni cilj in javni interes
All health insurance companies are joint stock companies, while ownership regulation allows both the State and private sectors to be shareholders.
Namen slovaške sheme obveznega zdravstvenega zavarovanja je uresničevati socialni cilj, tj. omogočanje zagotavljanja zdravstvenega varstva in vzdrževanje delujočega sistema zdravstvenega zavarovanja.
All health insurance companies are obliged to meet certain solvency criteria.
Državljani imajo pravico do zdravstvenega zavarovanja, prebivalci Slovaške pa morajo biti zavarovani [14].
Being under strict budgetary constraints, they are fully responsible for financial shortfalls.
Zagotavljanje pravice do brezplačnega zdravstvenega varstva, ki temelji na zdravstvenem zavarovanju, je ustavna obveznost Slovaške republike [15].
As private joint-stock companies set under general company law, health insurance companies appear to autonomously manage their operations and healthcare costs.
Po mnenju slovaških organov se šteje, da zdravstvene zavarovalnice, ki zagotavljajo obvezno zdravstveno zavarovanje v Slovaški republiki, izpolnjujejo ustavno obveznost v imenu države, tj. zagotavljanje zdravstvenega zavarovanja prebivalcem Slovaške z upravljanjem sheme obveznega zdravstvenega zavarovanja na Slovaškem.
Health insurance companies can and do make profits [13].
Slovaška republika mora po zakonu financirati sistem zdravstvenega varstva in pokrivati izgube v zdravstvenem sektorju [16].
The revenues of insurance companies in Slovakia are drawn from insurance contributions, the State budget (contributions on behalf of the economically inactive persons and a subsidy to cover rises in health service costs), income from property, gifts and other incomes.
V skladu z oddelkom 2 akta št. 580/2004 o zdravstvenem zavarovanju je zagotavljanje javnega obveznega zdravstvenega zavarovanja dejavnost v javnem interesu, za izvajanje katere se uporabljajo javna sredstva.
Profits can be made by health insurance companies for instance by improving their management system and through their negotiations when contracting with healthcare providers.
Obvezno članstvo, odprt vpis in enotno ocenjevanje
MAIN FEATURES OF THE SLOVAK COMPULSORY HEALTH INSURANCE SECTOR
V skladu z določbami aktov št. 580/2004 in 581/2004 je članstvo v slovaškem programu javnega zdravstvenega zavarovanja obvezno za večino prebivalcev Slovaške republike [17].
Social objective and public interest
Obvezno zdravstveno zavarovanje na Slovaškem zajema tudi osebe, zavarovane v skladu z Uredbo Sveta (EGS) št. 1408/71 [18] do 30. aprila 2010, od 1. maja 2010 pa v skladu z Uredbo (ES) št. 883/2004 Evropskega parlamenta in Sveta [19].
The Slovak compulsory health insurance scheme pursues a social objective, i.e. to allow for the provision of healthcare and the maintenance of a viable health insurance system.
Zavarovane osebe imajo pravico do lastne izbire zdravstvene zavarovalnice in do zamenjave zavarovalnice enkrat na leto.
Citizens have the right to health insurance and Slovak residents have the obligation to be insured [14].
V skladu z obveznostjo odprtega vpisa in načelom enotnega ocenjevanja so zdravstvene zavarovalnice na Slovaškem zakonsko obvezane, da v shemo zdravstvenega zavarovanja vključijo vsakega prebivalca Slovaške, ki to zahteva, če izpolnjuje zakonske zahteve glede zdravstvenega zavarovanja na Slovaškem.
The right to free healthcare based on the health insurance is a constitutional obligation of the Slovak Republic [15].
Zdravstvene zavarovalnice še zlasti ne smejo zavrniti zavarovanja osebe na podlagi starosti, zdravstvenega stanja ali tveganja bolezni [20] in morajo zagotoviti osnovno zdravstveno zavarovanje po isti ceni za vse osebe ne glede na te dejavnike.
According to the Slovak authorities, by providing compulsory health insurance in the Slovak Republic, health insurance companies are considered to fulfil a constitutional obligation on behalf of the State, i.e. the provision of health insurance to Slovak residents through managing the compulsory health insurance scheme in Slovakia.
Slovaški sistem zdravstvenega zavarovanja torej vključuje tudi pravno strukturo za pravično delitev tveganja med zdravstvenimi zavarovalnicami prek izravnalne sheme.
The Slovak Republic is responsible by law for financing the healthcare system and for covering losses in the healthcare sector [16].
V skladu z izravnalno shemo [21] zdravstvene zavarovalnice, ki zavarujejo osebe, povezane z višjim tveganjem, prejmejo sredstva zavarovalnic, katerih portfelj je povezan z nižjim tveganjem, tj. z mesečno in letno prerazporeditvijo prispevkov in izvajanjem prenosov [22].
Under Section 2 of Act No 580/2004 on health insurance, the provision of public compulsory health insurance is an activity in the public interest, in the operation of which public funds are managed.
Prejemki in prispevki, povezani z dohodkom
Compulsory membership, open enrolment and community rating
Slovaški sistem obveznega zdravstvenega zavarovanja temelji na sistemu obveznih prispevkov.
In accordance with the provisions of Act No 580/2004 and Act No 581/2004, participation in the Slovak public health insurance programme is compulsory for most of the population in the Slovak Republic [17].
Stopnje prispevkov so določene z zakonom in so sorazmerne z dohodki zavarovane osebe (podobno kot se zaračunava davek na dohodek) in ne temeljijo na tveganju zavarovane osebe (kot sta starost ali zdravstveno stanje zavarovane osebe).
Compulsory health insurance in Slovakia also covers persons insured in accordance with Regulation (EEC) No 1408/71 of the Council [18], until 30 April 2010, and, as of 1 May 2010, in accordance with Regulation (EC) No 883/2004 of the European Parliament and of the Council [19].
Ti prispevki, ki jih slovaški organi obravnavajo kot del javnih sredstev, se pobirajo od: (1) delojemalcev in delodajalcev; (2) samozaposlenih; (3) prostovoljno nezaposlenih; (4) države (za osebe, ki jih je zavarovala država, tj. skupino večinoma ekonomsko neaktivnih ljudi); in (5) plačnikov dividend.
Insured persons have the right to opt for a health insurance company of their choice and to switch insurance company once a year.
Vsem zavarovanim osebam se zagotavlja enaka osnovna raven prejemkov (v nadaljnjem besedilu: osnovni paket prejemkov).
Under the open enrolment obligation and community rating principle, health insurance companies in Slovakia have a legal obligation to admit to their insurance scheme every Slovak resident who so requests, provided that he/she meets the legal requirements for health insurance in Slovakia.
Med zneskom prispevkov, vplačanih v shemo, in zagotovljenimi prejemki [23] ni neposredne povezave.
In particular, health insurance companies cannot refuse to insure a person on the grounds of age, state of health or disease risks [20] and have to offer basic health insurance at the same price to all persons regardless of these factors.
Zdravstvene storitve, ki jih pokriva obvezno zdravstveno zavarovanje, se zagotavljajo ne glede na prispevke, ki jih plača zavarovana oseba.
The Slovak health insurance system therefore also includes a legal architecture for equitable risk-sharing among health insurance companies through a risk equalisation scheme (RES).
Osnovni paket prejemkov v okviru obveznega zdravstvenega zavarovanja pokriva skoraj vse zdravstvene posege, ki se zagotavljajo v Slovaški republiki, kar pomeni, da se v okviru tega paketa zagotavlja skoraj popolno zdravstveno varstvo.
Under the RES [21], health insurance companies insuring persons associated with a higher risk receive funds from insurance companies whose portfolio is associated with a lower risk, i.e. through monthly and annual reallocation of contributions and the administration of transfers [22].
Osnovni paket prejemkov vsem zagotavlja brezplačno zdravstveno varstvo, razen nekaterih posegov (npr. kozmetična kirurgija) in delnih doplačil za farmacevtske izdelke in zdraviliško oskrbo ter izbrane storitve, povezane z zdravstvenim varstvom (npr. sprejemi na oddelku za nujno medicinsko pomoč).
Benefits and income-related contributions
Osnovni paket prejemkov se lahko omeji ali razširi z vladno uredbo (brez parlamentarnih pogajanj).
Slovak compulsory health insurance is based on a system of compulsory contributions.
Ker slovaška ustava zagotavlja vsakemu državljanu zdravstveno varstvo v okviru sistema obveznega zdravstvenega zavarovanja pod zakonsko določenimi pogoji, zavarovalnice nimajo vpliva na paket prejemkov, raven kritja ali premije osnovnega paketa prejemkov, saj so zakonsko določeni.
Contribution rates are defined by law and are proportional to the income of the insured (similar to the tax levied on income), rather than being based on the insured risk (such as age of the insured or health status).
Slovaške zdravstvene zavarovalnice lahko v osnovni paket prejemkov po svoji izbiri vključijo in tudi vključujejo različna dodatna izplačila (prejemke), ki zajemajo storitve, ki niso vključene v zadevni paket, vendar jih zavarovalnice strankam zagotavljajo brezplačno kot del istega paketa zdravstvenih storitev v okviru obveznega zdravstvenega zavarovanja.
Those contributions, which the Slovak authorities consider to be part of the public funds, are collected from: (1) employees and employers; (2) the self-employed; (3) the voluntarily unemployed; (4) the State (for the ‘State-insured’, i.e. the group of mostly economically inactive people); and (5) payers of dividends.
Na primer, v skladu z razpoložljivimi informacijami se zdi, da se lahko zdravstvene zavarovalnice odločijo, ali bodo zagotovile dodatno kritje nekatere dopolnilne in preventivne oskrbe v okviru istega paketa obveznega zdravstvenega zavarovanja.
All the insured are guaranteed the same basic level of benefits (‘the basic benefit package’).
Ti dodatni prejemki se razlikujejo od storitev v okviru individualnega zdravstvenega zavarovanja, ki se lahko zagotavljajo proti plačilu.
There is no direct link between the amount of contributions paid to the scheme and the benefits [23] received.
Izbira izvajalcev zdravstvenih storitev in storitev
Medical services covered by compulsory health insurance are provided regardless of the contributions paid by the insured person.
Zdravstvene zavarovalnice lahko izbirajo izvajalce zdravstvenih storitev in sklepajo pogodbe z zdravniki in posameznimi bolnišnicami.
The basic benefit package of compulsory health insurance covers almost all healthcare procedures provided in the Slovak Republic, meaning that virtually complete healthcare is provided through that package.
Zdravstvene zavarovalnice tako sklepajo pogodbe s posameznimi izvajalci zdravstvenih storitev; te pogodbe se sklepajo neodvisno druga od druge, posamezni izvajalec zdravstvenih storitev pa lahko sklepa pogodbe z vsemi ali le nekaterimi zdravstvenimi zavarovalnicami in obratno.
Currently, the basic benefit package entitles everyone to free healthcare with the exception of only a few treatments (e.g. cosmetic surgery), and partial payments for pharmaceuticals and spa treatments and selected healthcare-related services (e.g. emergency room visits).
Zdravstvene zavarovalnice povrnejo stroške storitev, ki jih izvajajo državni in tudi zasebni izvajalci zdravstvenih storitev.
The basic benefit package can be narrowed or widened by government decree (without parliamentary negotiations).
Za zagotovitev geografske dostopnosti zdravstvenih storitev je vlada določila minimalno zahtevo glede oblikovanja mreže, da bi vplivala na načrtovanje zmogljivosti.
Since the Slovak Constitution guarantees every citizen healthcare under the compulsory health insurance system according to the conditions laid down by law, insurance companies have no influence over the benefit basket, level of coverage or premiums of the basic benefit package, as these are fixed by law.
Zdravstvene zavarovalnice so zakonsko zavezane, da pri zagotavljanju obveznega zdravstvenega zavarovanja sklepajo pogodbe z minimalno mrežo bolnišnic.
Slovak health insurance companies can and do add to the basic benefit package various additional entitlements (benefits) of their choice, which cover services not included therein, but which are offered by insurers free of charge to their clients, as part of the same healthcare package under compulsory health insurance.
Vsaka zdravstvena zavarovalnica ustvarja svojo mrežo in izboljšuje minimalno mrežo s selektivnim sklepanjem pogodb z dodatnimi bolnišnicami in drugimi izvajalci zdravstvenih storitev.
For example, according to the available information it appears that health insurance companies can decide whether to offer additional coverage of certain complementary and preventive treatments under the same compulsory health insurance package.
Zdravstvene storitve, ki jih opravljajo te bolnišnice in/ali drugi izvajalci zdravstvenih storitev in ki so vključene v obvezno zdravstveno zavarovanje, zdravstvena zavarovalnica pokriva v korist zavarovanih oseb.
These additional benefits are distinct from the individual health insurance services that may be offered for a fee.
Zdravstvene zavarovalnice imajo določeno polje proste presoje pri pogajanjih z bolnišnicami glede cene in kakovosti zdravstvenih storitev, ki se zagotavljajo zavarovanim osebam.
Selection of healthcare providers and services
Regulativni okvir
The health insurance companies are allowed to select healthcare providers and to negotiate contracts with physicians and individual hospitals.
Shema obveznega zdravstvenega zavarovanja v Slovaški republiki je urejena s posebnimi predpisi [24].
Health insurance companies thus contract with individual healthcare providers; those contracts are concluded independently of one another and a particular healthcare provider may contract with all or just some of the health insurance companies and vice versa.
Vse zdravstvene zavarovalnice, ki zagotavljajo obvezno zdravstveno zavarovanje, imajo po zakonu enak status, pravice in obveznosti.
The health insurance companies reimburse services delivered by both the State and private healthcare providers.
Vsaka zdravstvena zavarovalnica mora biti ustanovljena z namenom, da bi zagotavljala javno zdravstveno zavarovanje in ne sme izvajati drugih dejavnosti kot tistih, navedenih v oddelku 6 akta št. 581/2004.
To ensure geographical accessibility of health services, a minimum network requirement is set by the government to influence capacity planning.
Dejavnosti zdravstvenih zavarovalnic, ki upravljajo shemo obveznega zdravstvenega zavarovanja, so pod splošnim nadzorom države, ki ga izvaja zlasti regulativni organ – HSA, ki v zdravstvenem sistemu opravlja nalogo spremljanja in nadzora.
In the provision of compulsory health insurance, the health insurance companies are required by law to contract with a minimum network of hospitals.
HSA nadzoruje skladnost zdravstvenih zavarovalnic in izvajalcev zdravstvenih storitev z zakonodajnim okvirom in posreduje v primeru kršitev.
Each health insurance company creates its own network and improves the minimum network by selective contracting with additional hospitals and other healthcare services providers.
OPIS SPORNIH UKREPOV
Healthcare services rendered by those hospitals and/or other healthcare services providers and included in the compulsory health insurance coverage are thus covered by the health insurer in favour of the insured persons.
Ta sklep proučuje naslednjih šest ukrepov (v nadaljnjem besedilu skupaj imenovani: sporni ukrepi) [25].
Health insurance companies have a certain margin of discretion in negotiating with hospitals on price and quality of the healthcare services rendered to insured persons.
DOKAPITALIZACIJA SZP LETA 2006
Regulatory framework
Zasebna zdravstvena zavarovalnica Dôvera je z dopisom z dne 2. aprila 2007 vložila pritožbo pri Komisiji zoper kapitalsko injekcijo Slovaške republike za državno zavarovalnico SZP v višini 450 milijonov SKK (približno 15 milijonov EUR) v treh tranšah med 28. novembrom 2005 in 18. januarjem 2006.
The compulsory health insurance scheme in the Slovak Republic is regulated by special regulations [24].
Ta dokapitalizacija je bila povezana z reformo zdravstvenega sektorja in reformo sektorja zdravstvenega zavarovanja v Slovaški republiki v obdobju 2004–2005.
All health insurance companies providing compulsory health insurance have, by law, identical status, rights and obligations.
Dejansko je bila SZP, ko je bila leta 2005 ustanovljena v obliki delniške družbe, kot pravna naslednica javne ustanove [26] zakonsko obvezana, da prevzame sredstva prvotne zavarovalnice, pa tudi njene obveznosti, ki so nastale pred letom 2005 in katerih obseg je povzročil neustrezno stopnjo solventnosti glede na zahteve iz oddelka 14(1) akta o zdravstvenih zavarovalnicah (akt št. 581/2004).