The Constitutional Court overturns the limits on hospital treatment

According to the provision of Article 55a, paragraph 2 of the Health Insurance Act, the National Health Insurance Fund (NHIF) does not cover the costs of medical and dental care provided by medical institutions for insured individuals when this care is delivered by an institution that has exceeded the limits outlined in its individual contract with the NHIF (or the relevant Regional Health Insurance Fund).

These “limits” on the amount of expenses for providing medical care, which are paid by the NHIF to medical institutions as providers of medical care, gave rise to disputes.

The practice of first-instance and appellate courts initially showed contradictions in determining whether the NHIF should reimburse medical institutions for amounts exceeding the limits. Subsequently, the practice stabilized, with activities exceeding the limits being deemed payable.

With Decision No. 6 dated April 11, 2024, the Constitutional Court definitively ruled the discussed provision of Article 55a, paragraph 2 of the Health Insurance Act unconstitutional. According to the Constitutional Court, “The imposition of limits on medical institutions cannot reduce the number of patients (and the costs of their treatment), but merely redirects them from one medical institution that has exhausted its designated administrative limit to another that has not. Therefore, the limits on the activities performed by medical care providers do not constitute a measure leading to the reduction of NHIF expenses or to their better planning. Impeding access to affordable medical care through such legislative measures, as contested in the present case, exceeds the socially necessary and publicly justified constitutional obligation to the right to health insurance for every citizen.”

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