The Government approved today the consolidation project of the National Health Insurance Fund (NHIF) in order to optimize the activities of the Compulsory Health Insurance Fund (CHIF) and to make its management structure simpler. Thus, the compulsory health insurance (CHI) would be under responsibility of sole legal entity – NHIF with its regional units – from the beginning of 2021. They would replace the present territorial health insurance funds (THIF).
The State control mentioned need of changes in the health insurance system one and a half years ago. Then the controllers announced that in order to simplify CHIF management, all the THIF should be united.
According to the Minister of Health, Aurelijus Veryga, the decrease of administrative burden, increase of effectiveness of performance of the NHIF, and unification of practice – the goals of such changes – are relevant for both, medical institutions and patients.
"The NHIF has always been reliable and has been safeguarding financial sustainability of health system in the country by its professional work. I have no doubts that these changes in modernization of the NHIF will only strengthen guarantees to make each person feel healthy and able to use possibilities granted by compulsory health insurance," – says Minister A. Veryga.
At present, CHI in Lithuania is under responsibility of CHI Council, NHIF and five THIF, who have status of individual legal entities. The main functions of THIF are conclusion of contracts with medical institutions and pharmacies, payment for services provided to the insured persons and issued compensated drugs and medical means, handling of CHI register, control of accessibility, suitability and quality of the provided services, etc.
If status of THIF as separate entities is waived, it is suggested to revise rights and functions of NHIF, and regulations on conclusion of contracts with medical institutions. Thus, contrary to present situation, when medical institutions enter into contracts with different THIF, only one contract will be signed. For the sake of convenience, this service will be continued to be provided to contractual partners in the regions for some time. It is expected that if standard conditions of the contracts are announced beforehand, the administrative burden will decrease, the legal explicitness will increase, and the applied uniform practice will grant more clarity.
One more possibility planned in the project is to solve disputes between medical institutions, pharmacies and other economic operators in pretrial mode. For this purpose, the Reconciliation Commission would be formed in NHIF. At present only THIF have such commissions, so the model that has stood its purpose should be kept in the future. It is expected to reduce number of judicial proceedings for NHIF in such a way, to save time and money of medical institutions and other economic operators.
It is suggested to legalize several novelties related to CHIF income structure in the project. For example, it is offered not to assign to CHIF money paid by medication marketing right holders (their representatives) and legal entities, who have licence for wholesale distribution under the contracts on improvement of medication's accessibility and risk distribution entered into with NHIF. This money could be used to compensate new medications. It should be noted that approx. 25 million euros are transferred to CHIF every year under the contracts on improvement of medication's accessibility and risk distribution.
If the Government approves consolidation of the NHIF, the draft laws will be transmitted to the Parliament.
The NHIF invites you:
Your questions are welcome by email firstname.lastname@example.org or phone: local (8 5) 232 2222, international +370 5 232 2222