Market access for medical technologies in the Czech Republic

Reimbursement

Hospital care is predominantly financed via a global budget adjusted for activity based on DRGs. However, other payment mechanisms (such as case-by-case reimbursement via CZ-DRG, individually agreed payment mechanisms and reimbursement amounts between hospitals and insurance companies) can also be used to pay for hospital care. The payment mechanisms and reimbursement tariffs are defined annually in the “Reimbursement Directive”. 

CZ-DRGs are determined by the combination of a procedure code (SZV) and a diagnosis code (ICD-10). The SZV nomenclature is maintained by the Ministry of Health, but is expected to be replaced soon by a new classification, the Classification of Hospitalization Procedures (KHP). The CZ-DRG system is maintained by the Central Institute of Health Information and Statistics (UZIS) and is updated annually.

Some (but not all) materials and devices can be considered as “separately billed materials” (ZUM). In outpatient settings, their cost can be billed separately, on top of the fee for the procedure. However, In hospital settings, the ZUM materials are not reimbursed separately; rather, the costs of medical devices are covered by the DRG tariff, but the presence of the ZUM material can impact the DRG allocation or influence adjustment of DRG tariff.