The Czech Republic Annual Report 2010 Drug ... - Drogy-info.cz

1.3.2 Drug Treatment Costs Incurred by Health Insurance Companies
In 2010, for the first time, it was possible to obtain data, pertaining to the period 2007–2009, on the costs incurred
by health insurance companies in relation to the treatment of drug users. The data are processed by the Czech
Statistical Office using the information from health account statistics compiled in line with the System of Health
Accounts international methodology designed for the comprehensive reporting of all the expenditures 34 on health
care, or health services in general terms, while differentiating between the individual sources of the funding of
health care. In the Czech Republic, health care is funded from three main sources: health insurers (public health
insurance), public budgets (the state budget, local budgets), and households. Covering approximately three
quarters of all the expenses, health insurers provide the largest segment of funding.
The total volume of expenditures incurred by health insurers amounted to CZK 169 billion (€ 6,682 million) in
2007, CZK 180 billion (€ 7,117 million) in 2008, and CZK 209 billion (€ 8,264 million) in 2009. CZK 6.4 billion (€
253 million), CZK 6.6 billion (€ 261 million), and CZK 7.7 billion (€ 304 million) were spent on the treatment of
mental and behavioural disorders (Chapter V, ICD-10) in 2007, 2008, and 2009 respectively. On the basis of data
reported by health insurers, the annual costs of treatment related to conditions caused by psychoactive substance
use (excluding alcohol; dg. F11–F19) were estimated to have amounted to CZK 336 million (€ 13,267 thousand),
CZK 395 million (€ 15,628 thousand), and CZK 448 million (€ 17,703 thousand) in the years 2007, 2008, and
2009 respectively.
In this section, the costs incurred by health insurers in relation to the F11–F19 diagnostic groups are broken down
according to the type of healthcare facility and the type of health care provided, as specified in the code list of
contractual specialisations.
The diagnosis classification may be used to divide the health insurers’ costs into those associated with the primary
diagnosis and other costs bearing no relationship to the diagnosis. The diagnosis-related costs are categorised
into diagnosis groups which correspond to the ICD-10 chapters and are further broken down into diagnosis
classes. The F11–F19 diagnoses, i.e. mental and behavioural disorders caused by psychoactive substances
other than alcohol, constitute one of the diagnosis classes. In the tables below, these directly identifiable costs
incurred by health insurers are indicated in the column called Identifiable diagnosis-specific costs. They accounted
for an average of 70% of the total annual costs incurred by health insurers in relation to treatment for the use of
drugs other than alcohol in the period under scrutiny.
The remaining costs with no link to a diagnosis had to be adjusted before being processed. They had to be set
apart from health insurance companies’ operating costs, per capita payments to general practitioners for adults,
per capita payments to general practitioners for children and adolescents, and some other costs of care which
cannot be determined on the basis of contractual specialisations, or are recorded separately for the sake of
greater statistical accuracy, but are defined using other suitable methods, such as a group of health interventions
and codes from the classifiers of health resources. The following costs incurred by health insurers were further
excluded from these additional costs of care: convalescent care, spa care in spa sanatoria for children, acute and
emergency care provided abroad, refunds to patients, vaccination provided by general practitioners for children
and adolescents, preventive check-ups by general practitioners, and occupational medicine related to the
specialisation of an occupational physician for adults. On average, in the years 2007–2009 these costs accounted
for almost a quarter of the costs other than those linked to a specific diagnosis.
Following the above adjustments, the other costs were used as the basis for the estimation of the total amount of
unidentifiable costs of the F11–F19 diagnoses. The share of the costs of this group of diagnoses in the overall
identifiable costs (i.e. diagnosis-related costs) was used to estimate the share of the costs of this group of
diagnoses in the total amount of unidentifiable costs. This total volume of the remaining costs incurred by health
insurers in relation to drug treatment was further broken down according to the type of healthcare facility and the
type of health care provided (by different specialist physicians).
The costs incurred by health insurers in relation to the treatment of users of non-alcohol drugs by different health
facilities are summarised in Table 1-9. Unidentifiable costs attributed to the different types of facilities were
estimated using the structure of the overall unidentifiable costs. The largest proportion of the total costs (73%)
incurred by health insurers (i.e. both directly identifiable and estimated unidentifiable expenditures) in relation to
the F11–F19 diagnoses was spent on inpatient healthcare facilities in the period under study (hospitals and
psychiatric hospitals consumed 30% and 39%, respectively, of the resources). These costs encompass those
expended on inpatient care, as well as those covering other types of care, including outpatient and
pharmaceutical services, provided by these inpatient facilities. Independent outpatient facilities accounted for 7%
of the total costs incurred by health insurers in relation to the F11–F19 diagnoses, of which 3% and almost 14%
were paid to specialist physicians (mainly outpatient psychiatric services) and pharmacies respectively. The cost
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Although there is a material distinction between the terms “expenditure” and “cost” involving different accruals, both terms will be
used interchangeably and referred to as “costs” throughout the following section.
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