Regulation of spa care

There are still many misconceptions and myths surrounding the regulation of spa care.

Contributory spa care
One of them is the dispute over the possibility of providing contributory spa care in the form of outpatient care. In this context, we would like to point out that CnSC is a form of spa care that is inpatient care and must therefore be provided only as inpatient care in the relevant spa facility. This fact has also been confirmed by the Czech Health Insurance Companies Association, whose statement on this issue can be found here, as well as by VZP, whose position can be read here.

Spa care and regulatory limits
Some doctors refuse to issue spa care proposals for their patients, saying that the expenses for spa stays of other patients have been deducted from their reimbursements as a penalty, etc. Similar arguments accompanying the refusal to issue a proposal always appear when the media is filled with reports about strict regulatory limits in the reimbursement decree.

The reality, however, is that none of the Ministry of Health's reimbursement decrees to date has classified spa treatment as 'induced' or requested care, for which the regulatory conditions and relevant limits are defined in Annex 3 of the reimbursement decree, the exceeding of which may result in penalties for the referring doctor (as is the case, for example, when the volume of drug prescriptions is exceeded, etc.).

The only regulation enshrined in legal standards is the actual system of referrals for spa care, as defined in Section 33 of the current Act No. 48/1997 Coll. and the Indication List for Spa Care for Adults, Children and Adolescents. Along with the indication conditions that the insured person's health must meet, these legal standards also define contraindications that exclude a stay at a spa. Supervision of the correct application of the rules for entitlement to covered spa care is ensured by insurance company reviewing doctors, who must approve proposed spa care before it is provided to an insuree; in this way, the health insurance company assumes full control over spa care expenses and responsibility for their total amount.

It is precisely this prior approval that makes spa care requests fundamentally different from prescribing medication or sending a patient for examination by a specialist or for hospitalisation with an 'exchange voucher', which the insurance company only learns about after the relevant healthcare facility has invoiced such care or medication.

However, beyond the scope of regulation and sanctions, since 2010 doctors have been motivated by VZP with a financial bonus under the AKORD quality programme for not exceeding the one-year-old reference amount of average expenditure for 'eligible care' per weighted patient. Eligible care includes spa care along with expenses for medicines, medical devices, hospitalisation and care provided by specialists. This incentive led many doctors to try to limit all eligible care, but they found that they were unable to set specific cost targets for the requested care of their clinics and their specific patients based on the reference expenditure amount, and they are certainly unable to influence the care prescribed to their patients by specialists and other doctors, even though such care is also included in eligible care.

In conclusion, it can be said that spa care is clearly a highly regulated form of care, but it is not included in the regulatory limits.