The Issue of Individually Elaborated Orthopedic - prosthetic Appliance: a Case Study of a Contact with a Health Insurant

Overview

A case study focuses on the issue of solving the complaint of a health insurant related to the quality of providedhealth care and function of an individually elaborated ortopedic-prosthetic appliance of the “Canadian type“.The procedure of the case refers to an uneasy task of the revisory medical officer during the approval process.The difficulties stem from the willingness to accommodate the health insurant even in the case of complexcompetitive relationships among specialized ortopedic-prosthetic departments in the situation when the healthinsurance company is not able to make a contract with external revisory medical officer specialized in the fieldof orthopedic-prosthetics in the region. The procedure of selection of the department for making a new specialprosthesis and the issue of financial coverage are presented in the above mentioned context.It is a typical example of a health and social issue in the practice related to approval and revisory activities ofrevision medical officer.

Key words:
quality of provided health care – complaint of a health insurant – approval activities of revisory medical