Basket resolutions or how the list of guaranteed benefits is created

The regulations for the creation of a guaranteed benefit basket were introduced by the amendment of the Act of 26 June 2009 on health care benefits financed with public funds, also known as the “basket act".

Benefit basket: procedures and financing level

The guaranteed basket fund includes benefits and procedures financed with public funds. The document also defines the conditions for the realisation of a guaranteed benefit and the establishment of the benefit financing level. This means that the benefits and procedures will not necessarily be fully financed by the National Health Fund.

The guaranteed benefits are divided into groups for which separate basket resolutions are issued. These groups include the following:

1. primary health care,
2. outpatient specialised care,
3. hospital treatment,
4. psychiatric care and addiction treatment,
5. medical rehabilitation,
6. nursing and care services in the field of long-term care,
7. dentistry,
8. health resort treatment,
9. provision with orthopaedic medical devices and auxiliary products,
10. medical rescue,
11. palliative and hospice care,
12. highly-specialised benefits,
13. health programmes.

How the benefit basket is created

The decision on placing a benefit in the basket is made by the minister of health, who initially orders the Agency of Health Technology Assessment (AOTM) to prepare a recommendation on the eligibility or ineligibility of the benefit as guaranteed. The AOTM president also recommends the financing level for the benefit.

The president of the Agency issues the recommendations based on the opinions of national consultants, the National Health Fund, and the position of the Consulting Council.

These opinions are then presented to the AOTM Consulting Council. The Council presents its opinion as to whether the “basket" eligibility or ineligibility of a given benefit is justified. The AOTM president considers the position of the Council, issues an adequate recommendation, and submits it to the minister of health.

The basis for a health care benefit to be eligible as guaranteed is its assessment, which includes the impact on the improvement of the health of the citizens, the resulting effects of the disease or health status, clinical effectiveness and safety, the relations of the obtained benefits to the health risk, of the costs to the health effects, and of the financial effects to the health care system.

Changes to the benefit basket

The minister of health is also entitled to remove a benefit from the list or change the way or mode of financing or providing a guaranteed benefit. This may be done ex officio or by way of a request.

This request can be filed by national consultants in the medical field adequate to the given benefit, the National Health Fund president, and, through the national consultants, associations which, according to their statutes, are scientific societies operating on a national scale, and associations and foundations with the statutory objective of protecting patient rights.

In the event of changes to the basket, the minister also recognises the AOTM recommendations.