General Health Insurance Company Research Articles

Analysis of progression of number and structure of scans performed using PET, PET/ CT and PET/ MRI in the Czech Republic in 2013- 2021.

Positron emission tomography (PET) is a state-of-the-art diagnostic method of nuclear medicine, used for diagnostics of many pathological states in the organism, first and foremost in oncological issues. The first analysis of utilization and potential utilization of PET in the Czech Republic was published in 2013. In the following years, there was a sharp increase in a number of PET/CT and PET/MRI scanners in the country; in 2013-2021, it doubled. Simultaneously with the increase in scans performed, the range of available radiopharmaceuticals also broadened. The study analyses the numbers and structure of PET, PET/CT and PET/MRI scans in the 2013-2021 period, using the pseudonymized data acquired from the General Health Insurance Company of the Czech Republic. The data was evaluated through a series of qualitative and quantitative indicators (number of scans performed, structure of diagnoses, use of different tracers, and availability of a scan for a patient). In the observed interval of time, the number of scans performed practically doubled, both thanks to more scanners installed and more radiopharmaceuticals available. The percentage of oncological and non-oncological scans remains more or less the same. Nevertheless, the regional differences in a number of scans performed persist, as does the availability of the scan for patients. PET is still a dynamically developing molecular imaging method in the Czech Republic. The analysis of a number and structure of scans performed offers a priceless overview of the development of the method over the years, in regard to diagnoses, utilization of individual radiopharmaceuticals or geographic distribution of scans performed. The observed findings are a motivation for further analyses.

Does advanced maternal age explain the longer hospitalisation of mothers after childbirth?

Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Use of diabetic healthcare according to the accessibility of diabetology services

Abstract Background Diabetologists, as other specialists, are more likely concentrated in towns and cities rather than in the countryside so the people who live in these municipalities have a wider supply of health services. Our aim is to determine whether there are significant differences in the use of diabetology services between patients who live in the municipality with these services or not in Czechia. Methods The sorted anonymized data obtained from the General Health Insurance Company of the Czech Republic (GHIC CR) were used. The studied patients were people with a diagnosis of type 2 diabetes mellitus (E11) who were insured by GHIC CR and used health services in 2019 in Czechia. Results The distribution of providers of diabetology services (PDS) is relatively even throughout the country, and PDS are mainly concentrated in the municipality with a large population. In total, 52% of patients have the diabetologist in their municipality of residence. Patients living in the municipality with PDS have greater odds of using their services (OR 1.63, Cl 1.61-1.65). Specifically, 67% of the patients who have the diabetologist in their municipality of residence use diabetology services compared to 55% of the patients living in the municipality without PDS commute for diabetology services to the other municipality. Conclusions The results show that diabetology services are concentrated mainly in towns and cities and patients living in the municipality with the diabetologist use more diabetology services compared to patients living in the municipality without them. At the same time, it seems that more than half of the patients in the municipality where is not PDS are willing and able to commute for diabetology services. Key messages • Although patients living in the municipality without the diabetologist use diabetology services less often than with them, due to the commuting for healthcare, the differences are blurred.

A Geodemographic View of the Accessibility of Selected Outpatient Services in Czechia.

Objectives: Although people use health services throughout their lives, there are important differences in timing, location, and frequency of utilization. The aim of this article is to identify and explain these differences in terms of healthcare accessibility. Methods: Outpatient health services—diabetology, cardiology, and psychiatry—are analysed using anonymized data from the General Health Insurance Company (GHIC) in Czechia for 2019. Healthcare utilization is studied in relation to selected geodemographic characteristics—patient’s age, sex, place of permanent residence, and location of healthcare provision. Results: The analysis found significant differences in the utilization of the selected health services in terms of age, sex, and size of the patient’s municipality of residence. Generally, men tended to travel outside their municipality for healthcare more than women. Young patients were more likely (and also further) to travel outside their municipality for healthcare than older patients. Conclusion: The reasons for this were the location of the health service provider (mostly concentrated in local/regional centres), the patient’s ability and willingness to travel for healthcare, and differences in the patient’s permanent and ordinary place of residence.

Non-Persistence With Antiplatelet Medications Among Older Patients With Peripheral Arterial Disease.

Introduction: Antiplatelet therapy needs to be administered life-long in patients with peripheral arterial disease (PAD). Our study was aimed at 1) the analysis of non-persistence with antiplatelet medication in older PAD patients and 2) identification of patient- and medication-related characteristics associated with non-persistence. Methods: The study data was retrieved from the database of the General Health Insurance Company. The study cohort of 9,178 patients aged ≥ 65 years and treated with antiplatelet medications was selected from 21,433 patients in whom PAD was newly diagnosed between 01/2012 and 12/2012. Patients with a 6 months treatment gap without antiplatelet medication prescription were classified as non-persistent. Characteristics associated with non-persistence were identified using the Cox regression. Results: At the end of the 5 years follow-up, 3,032 (33.0%) patients were non-persistent. Age, history of ischemic stroke or myocardial infarction, clopidogrel or combination of aspirin with clopidogrel used at the index date, higher co-payment, general practitioner as index prescriber and higher overall number of medications were associated with persistence, whereas female sex, atrial fibrillation, anxiety disorders, bronchial asthma/chronic obstructive pulmonary disease, being a new antiplatelet medication user (therapy initiated in association with PAD diagnosis), and use of anticoagulants or antiarrhythmic agents were associated with non-persistence. Conclusion: In patients with an increased probability of non-persistence, an increased attention should be paid to improvement of persistence.

PSY55 TREATMENT OF PSORIASIS: ANALYSIS OF REAL-WORLD EVIDENCE

Psoriasis is one of the most common skin dermatoses affecting 2-3% of the Central European population. For the treatment of psoriasis (L40), the conventional, the local and the biological treatment are available in the Czech Republic. Due to increasing use of biological treatments and biosimilars in recent years, analysis of real-world evidence (RWE) was conducted. The aim of the study was to analyze the use of treatments in rea world settings, to determine the time to biological treatment, describe the treatment sequences, using biosimilars and to determine whether biological treatment prescriptions in the Czech Republic are exploited to their full potential. The patient level data on prescriptions connected with L40 diagnosis was collected from General Health Insurance Company of the Czech Republic, which represents approximately 60 % of patients in the Czech Republic. The data were processed by SQL and extrapolated to all Czech population. There are almost 100 thousand patients treated with psoriasis in the Czech Republic every year. Most of them are treated by local therapy, only 1.5 % of patients uses biological treatment. The patient takes on average more than 3 years and almost 5 treatment molecules from the first treatment before getting to the biological treatment. Since patients get the biological treatment they remain on this treatment – 70 % of patients have only one line of biological treatment. Biosimilars replace original biological treatment very slowly. The biological treatment is highly effective but much more expensive therapy. Only small number of patients uses biological treatment in psoriasis, and it takes long time to get on it. The entry of new biosimilars (infliximab and etanercept) did not bring huge change in number of patients or switching to cheaper drug. The additional analysis should be conducted in the future with new adalimumab biosimilars.

PCV66 - COSTS OF EARLY REHABILITATION AFTER STROKE IN CZECH CEREBROVASCULAR CENTERS

In 2010, a network of cerebrovascular centers was established in the Czech Republic. Their integral parts are inpatient early rehabilitation units. This rehabilitation is much more intense than in general rehabilitation wards, which makes it more expensive. The goal of the study was to calculate the costs of the early rehabilitation units after stroke, and initiate the change of (DRG based) reimbursement of this type of care. The sample consisted of 94 patients with stroke diagnosed after 01 April 2017 recruited in three hospitals (Prague-30, Ostrava-30, Ústí nad Labem-34). There were 55 men and 39 women, the age ranged from 31 to 95 years. The costs were calculated by microcosting for each patient in the sample separately. Quantitative data (amounts, times) were recorded continuously into patient sheets. The collected data were processed by statistical modules of MS Excel and R Commander. It was proved that the costs of rehabilitation treatment depend on the degree of disability of the patients. The patients were categorized into 4 disability groups in agreement with the Czech Reimbursement Decree (Decree No. 134/1998 Coll. as amended). Then the costs ranged from CZK68,825 to CZK167,530 for the whole time of hospitalization, or from CZK4,283 to CZK6,164 as a one-day average. The main differences were in material costs and nursing costs. Cost and functional differences in early rehabilitation within a single diagnosis (stroke) were proved. The project showed that the costs of treatment grow with the severity of the damage, while this relation is more obvious in the motor domain and less expressed (although also present) in the cognitive domain. The results were presented to the General Health Insurance Company to be used in the reimbursement revision.

Onemocnění štítné žlázy v České republice: projekt EUthyroid a vyhodnocení epidemiologických dat VZP za období let 2012-2015

Institute of Endocrinology participates in the grant of European Commission EUthyroid (Towards the elimination of iodine deficiency and preventable thyroid-related diseases in Europe), together with other 28 European countries. The role of Institute of Endocrinology in EUthyroid is among other things to ensure access to national registers relating to thyroid diseases. The results presented here correspond to the years 2012-2015 and are based on data from the General Health Insurance Company Czech Republic (VZP CR), which has 6 million insured persons (ratio male : female = 1 : 1). The set is sufficiently representative to be related to the whole of the Czech Republic. According to VZP data, the prevalence of thyreopathies is constantly increasing, for example according to the code of diagnoses E00-E07 and the unique birth number, the prevalence of thyreopathies increased from 6.8 % in 2012 to 7.5 % in 2015. The increase of the prevalence is mainly concentrated to clinical manifestation of hypothyroidism (code E03, an increase from 2.8 % in 2012 to 3.2 % in 2015); the second is nontoxic struma (code E04), which had a constant prevalence of 2.5 % in the given period. On the other hand, thyroiditis (code E06), the third in the order of occurrence, increased from 1.8 % in 2012 to 2 % in 2015. The decrease in prevalence only occurred in hyperthyroidism (E05) from 0.7 % in 2012 to 0.6 % in 2015. Other thyreopathies had a prevalence of less than 1 %, and was constant between 2012 and 2015 (other thyroid disorders E07 0.8 %, thyroid disorders associated with iodine deficiency E01 0.2 %, E02 0.07 %, E00 0.01 %, thyroid carcinoma C73 0.13 %).Key words: EUthyroid - General Health Insurance Company- occurrence of thyreopathies - thyroid disease in the Czech Republic.

Specifics in the review of health documentation.

The objective of the work was to identify if health documentation management is depending of actually current legislation. Also to review range and consistency records. The work described forms and content of documentation, relating to treat wounds and decubitus. A content analysis of 139 health documentation of insurer of General Health Insurance Company, which were treated by 28 home care agencies (hereinafter "HCA") and in the HCA was done directly audit in 2012 and 2014. We set 29 assessment items, with criteria separation according structure, process and outcome. Documentation, we analyzed three ways: through 5 grade rating scale, by choosing a clear answer to the question: yes, no and evaluation of specific items of documentation. The research confirm dependence keeping medical records in home nursing care agencies from legislation. On the other hand, it was found that the form of the recording method of health care in many cases are varied and fragmented. Deficiencies were found in the area of criteria such as structure, process and outcomes and transparency in the management of documentation pressure ulcers and chronic wounds. Only 62.9 % of the documentations was written nursing care and sent to Health Insurance Company in full compliance or with minor shortcomings. Research has shown that in the legislation defined by standard forms was recorded the lowest number of deficiencies. This fact needs to be used for the development of new legislation, which directed to setting documentation with clearly defined, structured information's. WHO adopted the International Classification for Nursing Practice (ICNP) as essential and complementary part of professional health services (Tab. 2, Fig. 2, Ref. 22).

Alzheimer's disease and its treatment costs: case study in the Czech Republic.

This paper deals with the analysis of the costs, applied, for example, when treating specific diseases – an important aid in prioritizing the process of resource allocation. In our review, the specific disease is dementia caused by Alzheimer’s disease. This paper aims to provide more information on the partial costs per patient that are calculated according to the aggregated data from publicly available sources as well as from the results of authors’ own investigation. The University Hospital in Hradec Králové and the General Health Insurance Company of the Czech Republic participated in this research. The elementary research objective was to compare the costs per patient diagnosed early onset, to those of the patient diagnosed later. The Czech Republic lacks information regarding dementia. Therefore, these issues require attention. The methods used in this paper included time series analyses, methods of direct questioning, interviews with experts, and analyses of medical documentation. These methods were combined to exploit their particular advantages and to ensure the issues discussed, were covered. The investigation showed that the underpinning of patients with Alzheimer’s disease at early onset is advantageous from an economic perspective, because the cost of outpatient care is much lower compared with that of inpatient care. The international comparisons of the volume of care provided should be approached with great caution. These are based solely on the facts of various expert estimates and are not usually supported by hard data. Yet, they still illustrate the overall view of our ability to take care of people with dementia. According to experts, care in the Czech Republic significantly lags behind the rest of developed Europe. While services are provided to 26% of people with dementia in Germany and 50% in France, the experts estimate that services are provided to only 10% of the population in the Czech Republic. If we were to offer a similar volume of services in the Czech Republic, to the same extent as the average in Europe, we would have to triple the existing capacities.

Adherence to denosumab in the treatment of osteoporosis and its utilization in the Czech Republic

Objectives:The objective was to analyze adherence and current trends in utilization and prescription practice patterns of the anti-RANKL monoclonal antibody denosumab in the treatment of postmenopausal osteoporosis (OP).Methods:The prescription-based database of the General Health Insurance Company of the Czech Republic that covers approximately 60% of the Czech population (6 million) was used as the data source. Medication possession ratio (MPR) and persistence were calculated for all patients (both OP medication-naïve and medication-experienced) with postmenopausal OP from the start of their therapy with denosumab 60 mg per ml subcutaneous injection within a period between September 2011, i.e. first denosumab availability, and May 2014. Clinical data such as fractures, co-morbidities and co-medication were not analyzed.Results:A total of 7904 women treated with denosumab were analyzed; 93.8% of patients were identified as compliant (MPR ≥0.8) while 6.2% were non-compliant (MPR < 0.8). Persistence (base case, i.e. refill gap ≤30 days) was 59.1% after 12 months and 34.8% after 24 months. By 2013, i.e. within 2 years, denosumab became the second most utilized and most costly drug after oral bisphosphonates.Conclusions:Despite relatively high MPR and persistence rate observed in denosumab treatment, adherence enhancing strategies, focused on persistence in particular, are still needed. The uptake of denosumab has been rapid, its utilization keeps rising swiftly, and denosumab already represents a significant part of the osteoporosis therapy budget.

The relationship between iodine intake and serum thyroglobulin in the general population.

The relationship is shown between a concentration of urinary iodine and serum thyroglobulin in population studies carried out on a general population that was randomly selected from the registry of the General Health Insurance Company (individuals aged 6-98 years, 1751 males, 2420 females). The individuals were divided into subgroups with a urinary iodine concentration of <50, 50-99, 100-199, 200-299 and >/=300 microg/l. The mean and median of thyroglobulin were calculated in these subgroups. Tg concentrations were dependent on gender (males<females), age (thyroglobulin increased with age) and statistically significant negative relationship was observed between thyroglobulin and urinary iodine in individuals with urinary iodine <300 microg/l and the age under 65 years. Upper nonparametric tolerance limits of thyroglobulin in relation to iodine intake were calculated in subgroup of normal individuals (n=1858, thyroglobulin, urinary iodine, thyrotropin and free thyroxine were within the normal reference range). Upper limits were dependent on gender and age. The total value of upper limits is 44 microg/l; for individuals aged 6-17 years it is 39.1 microg/l; 18-65 years = 51.4 microg/l and 66-98 years = 60.6 microg/l. In general, thyroglobulin serum concentrations higher than 40 microg/l should be an indicator for determining urinary iodine.

The impact of changes in national prescribing conditions for statins on their public expenditure and utilization in the Czech Republic 1997–2013

ObjectivesIn the Czech Republic (CZ) extensive price regulation and prescribing conditions are common instruments often employed with new drugs. Since the introduction of statins onto the market in 1990s the originally strict conditions gradually relaxed while the prescription rates and public costs were rising. The aim was to analyze long-term utilization trends of statins, changes in their reimbursement prices and prescribing conditions, and the evolution of the market. MethodsFrom January 1997 to December 2013 statin use was measured in terms of defined daily doses per 1000 insured per day (DDD/TID). The prescription-based database of the General Health Insurance Company of the Czech Republic in 1997 covering 7825,216 inhabitants, i.e. 76% of CZ population, was used as the administrative data source. Also the overall expenditure, unit prices, and reimbursement criteria were analyzed. ResultsBetween 1997 and 2013 the utilization of statins rose from 2 to 96 DDD/TID while the expenditure rose 5.5-fold. The rise of prescription for each molecule was always observed after the liberation of the prescribing criteria. In the study period reimbursement prices of simvastatin and atorvastatin gradually decreased to just 5% of their initial values. ConclusionsThe rising consumption of statins in CZ clearly corresponds in time with the liberation of prescribing conditions allowing for prescription by general practitioners and with the introduction of generics accompanied by a swift and repeated reimbursement price cuts.

Economic and Managerial Aspects of Alzheimer's Disease in The Czech Republic

Abstract The world report about the Alzheimer's disease (World Alzheimer's Report 2013) points out that there is a lack of carers (social workers) and also lack of dependants support. The report shows, that with an aging world population the traditional informal care provided by family, friends and community ceases to be sustainable. The world report expects that in approximately 40 years the number of dependent older people will be almost three times higher - from 101 million in 2010 to 277 million in 2050. The World Health Organisation (2013) divided old age into three stages. From early old age, 60 to 74, from 74 to 89 years of age and 90 years or more is denoted like longevity.As the biggest health insurance company in the Czech Republic, the General Health Insurance Company (VZP) issues nearly 600 million Czech crowns for the treatment of patients with the Alzheimer's disease. Every year there are more and more patients, last year VZP recorded more than 27 thousand patients. While not in all cases is disease diagnosed in time. Experts estimated that Alzheimer's disease which is in most cases the most common cause of dementia is suffered by more than 130 thousand of citizens of Czech Republic. Every state creates its own program which focuses on old age and aging in the Czech Republic it is the “National program of preparation for aging of the population”. The aim of this program is to create conditions for the solutions of aging issues and to achieve changes in attitudes and approaches at every level. Therefore, it is necessary provide support from state and other non-state institutions which can improve the quality of life for senior citizens. The support means some kind of handover or support in various forms of assistance in diverse situations (material, economical, informational etc.).The paper describes the latest national and regional trends for people with dementia in need of care and represents an economic and managerial analysis of the long-term care systems, in the Czech Republic.

The trends in antibiotic use by general dental practitioners in the Czech Republic (2006–2012)

We assessed antibiotic prescribing in practical dentistry in the Czech Republic, as antibiotics are widely prescribed by dental practitioners and warning signals of their overuse can be observed. The individual antibiotic prescriptions were extracted from the database of the General Health Insurance Company and further analysed. The proportion of dentists' prescription within the whole primary health-care sector and the rate of prescriptions of particular antibiotics were both in defined daily doses per 1,000 insurees and day (DID) and in number of prescriptions calculated. The proportion of antibiotic use in dentistry increased from 0.63 DID in 2006 to 0.75 DID. We found a decline in use of narrow-spectrum penicillins by 4.8%, tetracyclines by 3.5% and macrolides by 3.6%, accompanied by increasing rate of prescription of aminopenicillins combined with beta-lactamase inhibitor by 8.9% and lincosamides by 8.5%. The consumption of clindamycin and amoxicillin combined with clavulanate in DID has increased by approximately 60% since 2006 thanks to the exclusive prescribing of two commercial oral products only. Factors contributing to this unfavourable trend are commercial influence or defensive medicine practice.

Utilization of lipid modifying agents in the Karvina district: A comparison with the Czech Republic, 2002 to 2009

The objective of this study was to evaluate the structure and development of consumption of hypolipidemic agents. Data concerning utilization of individual hypolipidemic drugs from 2002 to 2009 were obtained from the State Institute for Drug Control database and General Health Insurance Company, Karvina district database. Utilization of hypolipidemic drugs were stated in DDDs in correspondence with the anatomical therapeutic chemical (ATC) classification, and the costs in CZK. Information on utilization is expressed in the number of DDD per 1,000 inhabitants per 1 day (DID). The utilization of fibrates slightly decreased, while statins increase from 13.55 DID (2002) to 60.10 DID (2009) was observed. The total utilization of hypolipidemic drugs in DID have been continuously increasing (32.34 DID in 2002, 76.30 DID in 2009). In the compared data from the Karvina district, an increased utilization of fibrates and decreased utilization of statins were observed. The most significant difference was noted in the utilization of ezetimibe (the utilization of which from 2006 to 2009 was 2 to 3 times higher than was the average in the Czech Republic). Increasing availability of hypolipidemics was noticed with some regional discrepancies and sex differences in consumption of this group of medicines. Key words: Utilization of medicinal products, lipid modifying agents, hypolipidemic drugs, statins, fibrates, ezetimibe.

P-1284 - Analysis of one-year prescription of antipsychotics and rate of rehospitalizations in patients with schizophrenia spectrum disorders in slovakia

Introduction Schizophrenia is a disorder with chronic course and a need of a long-term antipsychotic treatment to prevent rehospitalizations. Objectives To find a possible association between treatment with different types of antipsychotics and rate of rehospitalizations in patients with schizophrenia spectrum disorders. Aims To analyze the rate of rehospitalizations in groups of patients treated with typical, atypical and depot antipsychotics. Methods Data of 1400 patients discharged from hospitalization in 2010 with ICD-10 diagnoses F20.x were obtained from the General Health Insurance Company which covers the majority of the population with chronic mental disorders in Slovakia. The structure of patients according to age and sex represented the whole adult population hospitalized with diagnoses F20.x in Slovakia. Results 27.4% of patients had 1 to 8 readmissions after the index discharge from hospitalization in the same year. 29347 prescriptions of psychopharmacological drugs were registered for 499886 patient/days in outpatient settings. 14781 prescriptions for antipsychotics consisted of 67.3% prescriptions for p.o. atypical antipsychotics, 16.9% for p.o. typical antipsychotics, 11.5% for atypical depots and 4.2% prescriptions for typical depots. No statistically significant association between prescriptions of particular group of antipsychotics (typical, atypical, depot) and the occurrence of at least one rehospitalization was found. Conclusions No association between prescription of certain type of antipsychotic and probability of rehospitalization based on analyses of prescriptions rate could not reflect the clinical reality properly. Further analyses with consideration of dosage, combinations of antipsychotics and rate of prescriptions for individual patient should be done.

An economic evaluation of a Web-based national patient records system

IZIP is a Web-based health record system for the general population which has been used in the Czech Republic since 2004. The system provides access to medical data for health-care providers and clients; only the latter can authorise health-care professionals to view their data. We conducted a cost-benefit analysis of the system. There was a strong positive overall economic return. The benefits to the clients were control and more effective care, estimated at about 10% of total gains. Professionals had the advantage of on-demand information and time savings, estimated to represent 37% of the benefits. The biggest partner of IZIP, the General Health Insurance Company of the Czech Republic was able to avoid duplicated tests and treatment, which amounted to 53% of the economic benefits. It took eight years to achieve a net cumulative benefit. The estimated annual net benefit exceeded €60 million in 2008.

Smoking Attributable Hospital Treatment, Treatment Costs and Smoking Attributable Mortality in the Czech Republic in 2002

The main objective of this work is to quantify the number of hospitalizations caused by smoking, estimate the costs of hospital treatment and to estimate contribution of smoking to mortality in the Czech Republic (CR) in 2002. The estimate of the proportion by which smoking contributed to hospitalizations and to mortality in the CR was computed using the method of smoking-attributable fractions (SAF). The SAF was computed from relative risks established in the American study Cancer Prevention Study II and from estimates of the prevalence of smoking in the CR from a nationwide study conducted in 2002. In 2002, based on data provided by the General Health Insurance Company, there were 145,336 hospitalizations, and the total cost of hospital treatment was estimated as 4.727,612 (in thousands) CZK. The total number of deaths caused by smoking was 20,550 (95% CI: 18,851-22,262), 14,525 in men and 6,025 in women. Deaths caused by smoking represented 19% of the total nationwide mortality for 2002. Earlier estimates were published by Peto and Lopez for 1995 (22,300 deaths caused by smoking) and 2000 (17,746 deaths). The estimate arrived by authors using the SAF method for 2002 corresponds quite well with that by Peto and Lopez for 2000. The high morbidity and mortality rate related to smoking is directly connected to high prevalence of smoking in the Czech Republic. An effective tobacco control policy, including restrictive measures on availability of tobacco products combined with preventive programmes and smoking cessation programmes, could contribute to the reduction of smoking and save lives and treatment costs caused by smoking.

Příjmy a výdaje systému veřejného zdravotního pojištění a jejich vliv na finanční výkaznictví zdravotních pojišťoven

Cilem přispěvku je posouzeni vypovidaci schopnosti ucetnich výkazů zdravotnich pojisťoven se zaměřenim předevsim na Vseobecnou zdravotni pojisťovnu Ceske republiky. Pro pochopeni ucetniho výkaznictvi zdravotnich pojisťoven je v přispěvku provedena i obecna analýza přijmů a výdajů systemu veřejneho zdravotniho pojistěni vcetně přijmů a výdajů provaděných Vseobecnou zdravotni pojisťovnou Ceske republiky.