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\cltxlrtb\clftsWidth1\clshdrawnil \cellx9087\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9051187 {\rtlch\fcs1 \af36\afs16 \ltrch\fcs0 
\f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
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\cltxlrtb\clftsWidth1\clshdrawnil \cellx9087\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts11\trgaph15\trleft-15\trftsWidth2\trwWidth5000\trautofit1\trpaddl15\trpaddt15\trpaddb15\trpaddr15\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth2\clwWidth1250\clshdrawnil \cellx1415\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil 
\cellx8987\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9037\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9087
\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9051187 {\rtlch\fcs1 \ab\af36\afs16 \ltrch\fcs0 \b\f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 Pripomienka k:
\cell }{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 Pripomienka \'e8.1 - n\'e1vrh \'fapravy mno\'9estevn\'fdch limitov pre testovacie pr\'fa\'9eky do glukometrov}{\rtlch\fcs1 \af36\afs16 
\ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 \cell \cell }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 \trowd \irow5\irowband5\ltrrow
\ts11\trgaph15\trleft-15\trftsWidth2\trwWidth5000\trautofit1\trpaddl15\trpaddt15\trpaddb15\trpaddr15\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth2\clwWidth1250\clshdrawnil \cellx1415\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx8987\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr
\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9037\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9087\row \ltrrow}\trowd \irow6\irowband6\lastrow \ltrrow
\ts11\trgaph15\trleft-15\trftsWidth2\trwWidth5000\trautofit1\trpaddl15\trpaddt15\trpaddb15\trpaddr15\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth2\clwWidth1250\clshdrawnil \cellx1415\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx8987\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr
\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9037\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9087\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9051187 {\rtlch\fcs1 \ab\af36\afs16 \ltrch\fcs0 \b\f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 Text pripomienky:\cell }{
\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 Pripomienka \'e8. 1.) V predkladanom dokumente v \'93\'c8as\'9d A - Limitov\'e9 tabu\'beky, preskrip\'e8n\'e9 obmedzenia a indika\'e8n\'e9
 obmedzenia\'94 v tabu\'beke \'93Limit skupiny D - Zdravotn\'edcke pom\'f4cky pre diabetikov\'94 na strane \'e8.10 dokumentu cast_2_limity.rtf navrhujem v polo\'9eke\'93D3 Testovacie pr\'fa\'9eky na stanovenie gluk\'f3zy v krvi \'94 upravi\'9d mno\'9e
stevn\'e9 limity nasledovne: 1.a) Pre diabetikov lie\'e8en\'fdch intenzifikovan\'fdm re\'9eimom: na 150 pr\'fa\'9ekov za mesiac 1.b) Pre deti do 18 rokov veku a nezaopatren\'e9 osoby na 175 pr\'fa\'9ekov za mesiac do 25 rokov veku lie\'e8en\'fd
ch intenzifikovan\'fdm re\'9eimom 1.c) Diabeti\'e8ky v obdob\'ed gravidity na 250 pr\'fa\'9ekov za mesiac 1.d) Diabetikov lie\'e8en\'fdch konven\'e8n\'fdm re\'9eimom na 75 pr\'fa\'9ekov za mesiac 1.e) Diabetikov lie\'e8en\'fdch peror\'e1
lnymi antidiabetikami na 75 pr\'fa\'9ekov za mesiac a di\'e9tou Zd\'f4vodnenie pripomienky \'e8.1: S\'fa\'e8asn\'e1 lek\'e1rska veda zatia\'be nepozn\'e1 prostriedky na vylie\'e8enie chronick\'e9ho ochorenia Diabetes Mellitus, ale zato pozn\'e1 \'fa\'e8
inn\'e9 prostriedky a sp\'f4soby lie\'e8by, ktor\'e9 umo\'9e\'f2uj\'fa diabetikom \'9ei\'9d plnohodn\'fd \'9eivot a vykon\'e1va\'9d aj tie najn\'e1ro\'e8nej\'9a\'ede povolania, ako je napr\'edklad riadiaci pracovn\'edk leteckej prev\'e1
dzky, alebo dokonca pilot ve\'bek\'e9ho dopravn\'e9ho lietadla.1) Hodnoty glyk\'e9mie, glykoz\'farie a aceton\'farie nie su po\'e8as d\'f2a kon\'9atantn\'e9, ale menia sa vplyvom viacer\'fdch faktorov, napr\'edklad \'fa\'e8innos\'9dou podanej d\'e1
vky antidiabet\'edk, prijat\'fdm mno\'9estvom sacharidov v potrave a jej glykemick\'fdm indexom, fyzickou a psychickou z\'e1\'9da\'9eou organizmu pacienta, vplyvom in\'fdch ochoren\'ed a podan\'fdch lie\'e8iv proti nim, vplyvom neust\'e1
lych zmien organizmu u grav\'eddnych diabeti\'e8iek a \'efal\'9a\'edch vplyvov. ___
________________________________ 1) Flying on Insulin, Steve Steele, Diabetes Health, October-November 2008, http://digital.diabeteshealth.com/read/08/10/30.html Hodnoty glyk\'e9mie sa po\'e8as d\'f2a menia u v\'9aetk\'fdch \'beud\'ed
, nielen u diabetikov. Diabetici sa v\'9aak, na rozdiel od ostatnej nediabetickej popul\'e1cie, nem\'f4\'9eu spolieha\'9d na autoregula\'e8n\'fa schopnos\'9d glycidov\'e9ho metabolizmu. "Dosiahnutie krit\'e9ri\'ed intenz\'ed
vnej glykemickej kontroly (t.j. glyk\'e9mi\'ed, ktor\'e9 sa pribli\'9euj\'fa k fyziologick\'fdm pomerom) alebo aspo\'f2 maxim\'e1lne pribl\'ed\'9eenie sa t\'fdmto krit\'e9ri\'e1m by malo by\'9d cie\'beom u ka\'9ed\'e9ho pacienta od za\'e8
iatku ochorenia." 2) Star\'9a\'ed - direkt\'edvny sp\'f4sob lie\'e8by diabetu, upravuj\'faci d\'e1vkovanie antidiabet\'edk iba lek\'e1rom na z\'e1klade laborat\'f3rnych v\'fdsledkov z\'edskan\'fdch po\'e8as pravideln\'fdch n\'e1v\'9atev 
pacienta v diabetologickej ambulancii je pre norm\'e1lny \'9eivot ve\'bemi obmedzuj\'faci a je vhodn\'fd iba pre mal\'fa skupinu diabetikov. Modern\'fd sp\'f4sob lie\'e8by diabetu zalo\'9een\'fd na princ\'edpoch d\'f4kladnej aplik\'e1
cie selfmonitoringu, ako neoddelite\'benej s\'fa\'e8asti lie\'e8by diabetu, men\'ed doteraj\'9a\'ed direkt\'edvny sp\'f4sob lie\'e8by a z pacienta, na rozdiel od direkt\'edvneho sp\'f4sobu lie\'e8by, rob\'ed akt\'edvneho a plne zainteresovan\'e9ho \'e8
lena lie\'e8ebn\'e9ho t\'fdmu, pre ktor\'e9ho selfmonitoring neznamen\'e1 iba odmeranie hodnoty glyk\'e9mie v dom\'e1cich podmienkach a jej pozna\'e8enie do denn\'edka diabetika, ale predstavuje komplex \'fakonov smeruj\'facich k optimaliz\'e1cii d\'e1
vok antidiabet\'edk, stravy, fyzickej a psychickej n\'e1mahy.. Pri dobre nastaven\'fdch d\'e1vkach antidiabet\'edk, ktor\'e9 si pacient na z\'e1klade anal\'fdzy nameran\'fdch hodn\'f4t glyk\'e9mie zodpovedaj\'facim sp\'f4sobom operat\'edvne upravuje s\'e1
m, je mo\'9en\'e9 dosiahnu\'9d v\'fdborn\'fa kompenz\'e1ciu diabetu s ve\'bemi mal\'fdmi odch\'fdlkami hodn\'f4t glyk\'e9mie od normoglyk\'e9mi\'ed, \'e8o je predpokladom k dosiahnutiu plnohodnotn\'e9ho \'9eivota diabetikov s eliminovan\'edm re\'e1
lnych hrozieb vzniku \'9da\'9ek\'fdch komplik\'e1ci\'ed diabetu. Preto je pre v\'9aetk\'fdch diabetikov, bez oh\'beadu na typu diabetu, d\'f4le\'9eit\'e9 ma\'9d k dispoz\'edcii tak\'fd po\'e8et pr\'fa\'9ekov do glukometrov, ktor\'fd im dovol\'ed realizova
\'9d merania glyk\'e9mie pod\'bea ich individu\'e1lnych potrieb. Po\'e8et diabetikov v Slovenskej republike bol na konci roku 2008 nasleduj\'faci 3): Po\'e8ty diabetikov pod\'bea typu diabetu a sp\'f4sobu lie\'e8by: - celkov\'fd po\'e8
et diabetikov na konci r. 2008: 302 361 - diabetici s DM typu 1 24 473 - diabetici s DM typu 2 271 680 - gesta\'e8n\'fd diabetes 1 971 - diabetici s in\'fdm typom diabetu 4 237 - celkov\'fd po\'e8et diabetikov lie\'e8en\'fdch inzul\'ed
nom 72 867 - diabetici lie\'e8en\'ed intenzifikovan\'fdm inzul\'ednov\'fdm re\'9eimom celkovo 37 698 - deti do 18 r. 1 860 - tehotn\'e9 diabeti\'e8ky s DM 1.typu 104 - po\'e8et tehotn\'fdch diabeti\'e8iek spolu 156 - tehotn\'e9 diabeti\'e8
ky s DM 1.typu 104 - tehotn\'e9 diabeti\'e8ky s DM 2.typu 52 - po\'e8et diabetikov lie\'e8en\'fdch peror\'e1lnymi antidiabetikami a di\'e9tou 44 312 - po\'e8et diabetikov lie\'e8en\'fdch iba di\'e9tou 76 347 Predpokladan\'e9 nav\'fd\'9aenie v\'fd
davkov zo zdravotn\'e9ho poistenia, ktor\'e9 si vy\'9eaduje navrhovan\'e9 zv\'fd\'9aenie po\'e8tu testa\'e8n\'fdch pr\'fa\'9ekov pod\'bea pripomienky \'e8.1 sa m\'f4\'9ee zda\'9d na prv\'fd poh\'bead neprijate\'ben\'fdm\'85 Potrebn\'e9 je uvedomi\'9d
 si skuto\'e8nos\'9d, \'9ee sa jedn\'e1 o prijate\'ben\'e9 n\'e1klady na prevenciu vzniku neskor\'9a\'edch v\'e1\'9enych komplik\'e1ci\'ed diabetu s ove\'bea vy\'9a\'9a\'edmi po\'9eiadavkami na financovanie samotnej lie\'e8by vzniknut\'fdch komplik\'e1ci
\'ed! ___________________________________ 2) Racion\'e1lna lie\'e8ba Diabetes Mellitus 1. typu, Doc. MUDr.Emil Martinka, PhD, NED\'da \'bcuboch\'f2a, Metodick\'fd list \'dastrednej komisie racion\'e1lnej farmakoterapie a liekovej politiky MZ SR \'e8
.32, Racion\'e1lna lie\'e8ba Diabetes Mellitus 1. typu, Ro\'e8n\'edk8, Marec 2004, \'c8\'edslo 1\endash 2, http://www.health.gov.sk/redsys/rsi.nsf/0/a74a6edc4014b3b6c1256cbe004926f5/$FILE/met_list_rf_32.pdf 3) Dokument: "\'c8innos\'9d diabetologick\'fd
ch ambulanci\'ed v SR 2008", vydan\'fd N\'e1rodn\'fdm centrom zdravotn\'edckych inform\'e1ci\'ed, Lazaretsk\'e1 26, 811 09 Bratislava (pre verejnos\'9d dostupnom na na internetovej adrese: http://data.nczisk.sk/publikacie/zs0911.pdf) Po\'e8et komplik\'e1
ci\'ed diabetu u diabetikov v Slovenskej republike v r. 2008 4): - chor\'ed na diabetes mellitus s infarktom myokardu 20 888 - chor\'ed na diabetes mellitus s cievnou mozgovou pr\'edhodou 20 748 - chor\'ed
 na diabetes mellitus s diabetickou neuropatiou 69 364 - chor\'ed na diabetes mellitus s amput\'e1ciou dolnej kon\'e8atiny 4 257 - chor\'ed na diabetes mellitus s art\'e9riovou hypertenziou 162 385 - chor\'ed
 na diabetes mellitus s poruchou metabolizmu lipidov 132 081 - chor\'ed na diabetes mellitus s obli\'e8kov\'fdmi komplik\'e1ciami spolu 33 054 - dial\'fdzovan\'ed 1 034 - transplantovan\'ed 151 - chor\'ed na diabetes mellitus s o\'e8n\'fdmi komplik\'e1
ciami spolu 56 933 - slep\'ed 884 Trend rastu v\'fdskytu iba jednej \'9da\'9ekej komplik\'e1cie diabetu \endash  diabetick\'e1 nefropatia, vy\'9eaduj\'facej pomerne n\'e1kladn\'fa lie\'e8bu je n\'e1zorne zobrazen\'fd na nasleduj\'facom grafe
4) *********************************************** * Tu mal by\'9d obr\'e1zok grafu (vi\'ef text), editor * * na zad\'e1vanie pripomienok na Port\'e1li pr\'e1vnych * * predpisov nedovo\'beuje vklada\'9d obr\'e1zky * * a \'9atrukt\'farovan\'fd
 text, preto bude \'e8itate\'ben\'e1 podoba * * tejto hromadnej pripomienky zaslan\'e1 na Ministerstvo * *zdravotn\'edctva SR aj e-mailomvoform\'e1te .pdf, kde * * bude text v \'e8itatelnej\'9aej forma ako dovo\'beuje zad\'e1va\'9d * *Port\'e1l pr\'e1
vnych predpisovaj s obr\'e1zkami ko * *********************************************** Z vy\'9a\'9aie zobrazen\'e9ho grafu vypl\'fdva tendencia rastu dial\'fdzovan\'fdch diabetikov pribli\'9ene o 68 pacientov ro\'e8ne. Ro\'e8n\'e9 n\'e1klady pois\'9d
ovne na lie\'e8bu dial\'fdzovan\'e9ho pacienta (dial\'fdza, EPO a lieky) s\'fa 1 000 000 Sk, \'e8o je pribli\'9ene 33 194\'80 5) Priemern\'fd ro\'e8n\'fd n\'e1rast n\'e1kladov na lie\'e8bu diabetickej nefropatie pomocou dial\'fd
zy predstavuje potom sumu vo v\'fd\'9ake a\'9e 2 257 192\'80 (cca 68 000 166 Sk). Podobn\'fdm sp\'f4sobom rast\'fa ro\'e8n\'e9 n\'e1klady aj na lie\'e8bu \'efal\'9a\'edch komplik\'e1ci\'ed diabetu. Tieto ka\'9edoro\'e8ne rast\'face n\'e1klady je mo\'9en
\'e9 v\'fdrazne zn\'ed\'9ei\'9d podporen\'edm aplik\'e1cie d\'f4sledn\'e9ho selfmonitoringu diabetikmi pod\'bea odpor\'fa\'e8an\'ed z Metodick\'e9ho listu \'dastrednej komisie racion\'e1lnej farmakoterapie a liekovej politiky Ministerstva zdravotn\'ed
ctva Slovenskej republiky2) pre v\'9aetk\'fdch diabetikov SR akceptovan\'edm n\'e1vrhu zmien pod\'bea pripomienky \'e8.1 vo fin\'e1lnej podobe Kategoriz\'e1cie zdravotn\'edckych pom\'f4cok \'e8. 26958/2009-OL. ___________________________________ 4) Zdroj 
\'fadajov pre vytvorenie grafu: Nefrologick\'e1 starostlivos\'9d a lie\'e8ba nahr\'e1dzaj\'faca funkciu obli\'e8iek v SR 2008, Ro\'e8n\'edk 2009 Z\'8a-31/2009, \'a9 N\'e1rodn\'e9 centrum zdravotn\'edckych inform\'e1ci\'ed
. Bratislava 2009", http://data.nczisk.sk/publikacie/zs0931.pdf 5) Pos\'fadenie \'fadajov t\'fdkaj\'facich sa farmakoekonomick\'e9ho hodnotenia lieku, Tomek 2008, Odborn\'e1 pracovn\'e1 skupina pre farmakoekonomiku a klinick\'e9 v\'fdstupy, Odborn\'fd
 poradn\'fd org\'e1n Kategoriza\'e8nej komisie pre lie\'e8iv\'e1 MZ SR, http://www.symsite.sk/Documents/3_Dominik_Tomek-Farmaekonomika.ppt Opodstatnenos\'9d zv\'fd\'9aenia po\'e8tu pr\'fa\'9ekov plne hraden\'fdch zo zdravotn\'e9ho poistenia pre jednotliv
\'e9 skupiny diabetick\'fdch pacientov, pod\'bea navrhovan\'fdch zmien v pripomienke \'e8.1 je dokazovan\'e1 v nasleduj\'facich bodoch zd\'f4vodnenia pripomienky \'e8.1: Ad. body 1.a) a 1.b) pripomienky \'e8.1: N\'e1vrh kategoriz\'e1cie zdravotn\'ed
ckych pom\'f4cok \'e8. 26958/2009-OL v mno\'9estevn\'fdch limitoch nere\'9apektuje odpor\'fa\'e8ania po\'e8tu meran\'ed hodn\'f4t glyk\'e9mie, ktor\'e9 boli v roku 2004 publikovan\'e9 v Metodickom liste \'dastrednej komisie racion\'e1
lnej farmakoterapie a liekovej politiky MZ SR 2) , citujem: "2.4 Monitorovanie glyk\'e9mi\'ed a \'faprava lie\'e8by D\'e1vky baz\'e1lneho inzul\'ednu upravujeme pod\'bea hodn\'f4t glyk\'e9mie r\'e1no nala\'e8no a pred jedlami, d\'e1vky prandi\'e1
lneho inzul\'ednu pod\'bea glyk\'e9mie 2-3 hodiny po jedle (pozri obr. 9). Ve\'bemi d\'f4le\'9eit\'fdm obdob\'edm je aj monitorovanie glyk\'e9mie pred span\'edm a nad r\'e1nom medzi 2-3 hodinou. Ke\'ef\'9ee naj\'e8astej\'9a\'edmi probl\'e9mov\'fd
mi obdobiami u v\'e4\'e8\'9ainy pacientov s\'fa glyk\'e9mia r\'e1no nala\'e8no, po ra\'f2ajk\'e1ch, pred ve\'e8erou (a nad r\'e1nom), t\'fdmto obdobiam je potrebn\'e9 venova\'9d zv\'fd\'9aen\'fa pozornos\'9d." Citovan\'fd Metodick\'fd list \'da
strednej komisie racion\'e1lnej farmakoterapie a liekovej politiky MZ SR zoh\'bead\'f2uje odpor\'fa\'e8ania viacer\'fdch n\'e1rodn\'fdch a medzin\'e1rodn\'fdch organiz\'e1ci\'ed diabetol\'f3gov a diabetikov a \'9apecializovan\'fdch pracov\'edsk, ako s\'fa
 napr\'edklad: American Diabetes Association (ADA), British In Vitro Diagnostics Association (BIVDA), \'c8esk\'e1 diabetologick\'e1 spolo\'e8nos\'9d, Diabetes UK, Gynekologicko-p\'f4rodn\'ed
cka klinika JLF UK a MFN Martin, International diabetes federation (IDF), Institute of Agricultural Medicine in Lublin, Juvenile Diabetes Research Foundation International (JDRF), NED\'da \'bcuboch\'f2a, National In
stitute of Diabetes and Digestive and Kidney Diseases (NIDDK), Slovensk\'e1 diabetologick\'e1 spolo\'e8nos\'9d a \'efal\'9aie. Navrhovan\'e9 mno\'9estevn\'e9 limity v dokumente 26958/2009-OL pre diabetikov lie\'e8en\'fdch intenz\'edvnou inzul\'ed
novou terapiou (\'efalej iba IIT) nere\'9apektuj\'fa vy\'9a\'9aie citovan\'e9 odpor\'fa\'e8ania \'dastrednej komisie racion\'e1lnej farmakoterapie a liekovej politiky MZ SR a diabetikom na IIT neumo\'9e\'f2uje realizova\'9d ani len polovi\'e8n\'e9 mno\'9e
stvo meran\'ed glyk\'e9mie (tzv. mal\'fd glykemick\'fd profil) po\'e8as be\'9en\'e9ho 30-d\'f2ov\'e9ho mesiaca. Denn\'e1 realiz\'e1cia mal\'e9ho glykemick\'e9ho profilu predstavuje 120 pr\'fa\'9ekov do glukometrov za mesiac (30x4=120) pri \'9a
tandardnom 30-d\'f2ovom mesiaci. mesiaci Realiz\'e1cia denn\'e9ho mal\'e9ho glykemick\'e9ho profilu a jedn\'e9ho ve\'bek\'e9ho profilu (7 a\'9e 10 meran\'ed za de\'f2) po\'e8as 30-d\'f2ov\'e9ho mesiaca si vy\'9eaduje 127 a\'9e 130 pr\'fa\'9e
kov za mesiac. U detsk\'fdch diabetikov je re\'e1lna potreba kontroly glyk\'e9mie ove\'bea vy\'9a\'9aia. Kol\'edsanie hodn\'f4t glyk\'e9mie je u detsk\'fdch diabetikov silne z\'e1visl\'e9 od veku, od pohybovej aktivity die\'9da\'9da a tie\'9e
 od lability jeho diabetu sp\'f4sobovanej zmenami vyv\'edjaj\'faceho sa organizmu die\'9da\'9da. N\'e1vrh v bodoch 1.a) a 1.b) pripomienky \'e8.1 re\'e1lne zoh\'bead\'f2uje po\'e8et pr\'fa\'9ekov potrebn\'fdch pre ka\'9edodenn\'fd mal\'fd glykemick\'fd
 profil, t.j. 4 glyk\'e9mie denne a sp\'e5\'f2a tie\'9e po\'9eiadavku realizovania ve\'bek\'e9ho glykemick\'e9ho profilu minim\'e1lne 1 kr\'e1t za mesiac pre dospel\'fdch diabetikov lie\'e8en\'fdch IIT a rovnako aj pre deti s diabetom, ktor\'e9 s\'fa lie
\'e8en\'e9 IIT. Z vy\'9a\'9aie uveden\'fdch d\'f4vodov navrhujem upravi\'9d po\'e8et pr\'fa\'9ekov pre detsk\'fdch diabetikov a diabetikov lie\'e8en\'fdch IIT (Intenz\'edvna Inzul\'ednov\'e1 Terapia) pod\'be
a bodov 1.a) a 1.b) tejto pripomienky. Ad. bod 1.c) pripomienky \'e8.1: Odborn\'edci pre gynekol\'f3giu a diabetol\'f3giu v Slovenskej republike jednozna\'e8ne podporuj\'fa aplik\'e1ciu d\'f4sledn\'e9ho selfmonitoringu u tehotn\'fdch diabeti\'e8
iek. Slovensk\'ed \'9apecialisti na diabetes a gynekol\'f3giu v \'e8l\'e1nku Diabetes a gravidita6) p\'ed\'9au o potrebe dosiahnutia dobrej kompenz\'e1cie nasledovne, citujem: \'93V\'efaka modern\'fdm sp\'f4sobom lie\'e8by, zlep\'9aeniu p\'f4rodn\'ed
ckej starostlivosti a mo\'9enostiam posudzovania stavu plodu v maternici, je vysoko pravdepodobn\'e9, \'9ee dobre kompenzovan\'e1 diabeti\'e8ka porod\'ed zdrav\'e9 die\'9da. Z\'e1kladom ost\'e1va pl\'e1novanie tehotenstva a udr\'9eanie dobrej kompenz\'e1
cie diabetu pred a po\'e8as cel\'e9ho jeho priebehu. T\'fdm je umo\'9enen\'e9 minimalizova\'9d riziko mo\'9en\'e9ho po\'9akodenia u potomka a zabezpe\'e8i\'9d dobr\'fa kond\'edciu matky.\'94 Na potvrdenie toho, \'9ee v\'fdborn\'fa kompenz\'e1
ciu diabetu je mo\'9en\'e9 u tehotn\'fdch diabeti\'e8iek dodr\'9ea\'9d pomocou \'e8astej\'9aieho merania glyk\'e9mie, ako dovo\'beuj\'fa s\'fa\'e8asn\'e9 mno\'9estevn\'e9 obmedzenia kategoriz\'e1cie ZP, citujem z pr\'edspevku diabeti\'e8ky - mami\'e8
ky 1,5-ro\'e8n\'e9ho die\'9da\'9da7): "DM1 mam od sovjich 10 rokov, teda som otehotnela po 21r s dia.. Polroka pred otehotnenim so sa totalne davala do poriadku - HBA1C som mala 4,5-5,7 - pred aj pocas tehu. Som na perach a glycky som rob
ila 6-8x denne... Inak ked som sla rodit, mala som tam vysledky z dia pocas celeho tehotentstva - na perach - , a ten lekar, co mi riesil zvyseny tlak mi hovoril, ze to nie je mozne, ze mam HBA1C 4,5 - lebo to vraj maju len zdravi ludia." Pri prerokov\'e1
van\'ed tejto \'e8asti pripomienky \'e8.1 by Kategoriza\'e8n\'e1 komisia mala bra\'9d do \'favahy nasleduj\'face skuto\'e8nosti: a) Mno\'9estevn\'fd limit pr\'fa\'9ekov do glukometra pre tehotn\'e9 diabeti\'e8ky, u ktor\'fdch je potreba dosiahnutia a udr
\'9eania dobrej kompenz\'e1cie d\'f4le\'9eit\'e9 pre norm\'e1lny v\'fdvoj plodu, ur\'e8en\'fd n\'e1vrhom kategoriz\'e1cie zdravotn\'edckych pom\'f4cok \'e8.26958/2009-OL nezodpoved\'e1 odpor\'fa\'e8aniam uveden\'fdm v Metodickm liste \'da
strednej komisie racion\'e1lnej farmakoterapie a liekovej politiky MZ SR \'e8.32 - Racion\'e1lna lie\'e8ba Diabetes Mellitus 1. typu 2) b) V \'e8l\'e1nku Diabetes a gravidita8) autori P. Koles\'e1r a K.Planck o potrebe dosiahnutia dobrej kompenz\'e1
cie diabetu u diabeti\'e8iek pred a po\'e8as gravidity p\'ed\'9au nasledovne, citujem: \'93Plod a die\'9da diabeti\'e8ky \'e8i u\'9e predt\'fdm diagnostikovanej a lie\'e8enej, ako aj diabeti\'e8ky s gesta\'e8n\'fdm diabetom, je pri nespr\'e1vnej lie\'e8
be diabetu po\'e8as gravidity ohrozen\'fd vznikom diabetickej f\'e9topatie a u diabeti\'e8iek zn\'e1mych u\'9e pred otehotnen\'edm aj diabetickou embryopatiou. Najlep\'9aou prevenciou vzniku diabetickej f\'e9topatie je dobr\'e1 metabolick\'e1 vyrovnanos
\'9d diabetu po\'e8as celej tehotnosti. Ove\'bea z\'e1va\'9enej\'9aou problematikou zost\'e1va v\'fdskyt diabetickej embryopatie, vroden\'fdch v\'fdvojov\'fdch ch\'fdb u det\'ed diabeti\'e8iek aj napriek tomu, \'9ee ich v\'fdskyt sa jednozna\'e8ne zni\'9e
uje. Diabetick\'e1 embryopatia z\'e1va\'9ene ovplyv\'f2uje prenat\'e1lnu a perinat\'e1lnu mortalitu plodu a neonat\'e1lnu morbiditu die\'9da\'9da diabetickej matky.\'94 Tieto v\'e1\'9ene hrozby je mo\'9en\'e9 eliminova\'9d poskytnut\'edm dostato\'e8n\'fd
ch prostriedkov na aplik\'e1ciu kvalitn\'e9ho selfmonitoring diabeti\'e8k\'e1m pred pl\'e1novanou graviditou a po\'e8as cel\'e9ho obdobia gravidity bez oh\'beadu na to \'e8i gravidita bola, alebo nebola pl\'e1novan\'e1. c) Tehotn\'e9 diabeti\'e8
ky predstavuj\'fa iba mal\'e9 percento z celkov\'e9ho po\'e8tu diabetikov na Slovensku (v roku 2008 to bolo len 0,052%3) ) a navrhovan\'e9 zv\'fd\'9aenie po\'e8tu pr\'fa\'9ekov pod\'bea bodu 1c) tejto pripomienky by bolo iba na dobu ur\'e8it\'fa. Z vy\'9a
\'9aie uveden\'fdch d\'f4vodov navrhujem v tabu\'beke Limit skupiny D - Zdravotn\'edcke pom\'f4cky pre diabetikov\'94 v polo\'9eke \'93D3 Testovacie pr\'fa\'9eky na stanovenie gluk\'f3zy v krvi\'94 upravi\'9d po\'e8et pr\'fa\'9ekov pre tehotn\'e9 diabeti
\'e8ky pod\'bea bodu 1.c) pripomienky \'e8.1. ___________________________________ 6) Diabetes a gravidita, MUDr. Silvia D\'f3ku\'9aov\'e1, Diabetologick\'e9 odd. NED\'da \'bcuboch\'f2a , MUDr. Karol D\'f3ku\'9a, PhD, Gynekologicko-p\'f4rodn\'ed
cka klinika JLF UK a MFN Martin, http://www.nedu.sk/index.php?option=com_content&task=view&id=4&Itemid=99 7) Tehotenstvo a diabetes - diskusn\'e9 f\'f3
rum servra Diabetikinfo.sk, http://www.diabetikinfo.sk/diskusne-forum.html?topic=11 8) Diabetes a gravidita, Pavol Koles\'e1r, Karol Plank, PRAKTICK\'c1 GYNEKOL\'d3GIA, 4, 1997, \'e8
. 3, s. 121-125, http://www.sav.sk/journals/gynek/full/pg397b.pdf Ad. body 1.d) a 1.e) pripomienky \'e8.1: V pripomienkovanom materi\'e1li \'e8. 26958/2009-OL je po\'e8et pr\'fa\'9ekov do glukometra pre diabetikov lie\'e8en\'fdch konven\'e8nou inzul\'ed
novou terapiou (\'efalej len KIT) stanoven\'fd iba na 50 kusov za 2 mesiace a pre diabetikov lie\'e8en\'fdch peror\'e1lnymi antidiabetikami a di\'e9tou (\'efalej iba PAaD) iba na 50 kusov za 4 mesiace. U diabetikov lie\'e8en\'fdch KIT, ku ktor\'fd
m sa zara\'efuj\'fa pacienti s diabetom typu {\*\xmlopen\xmlns2{\factoidname metricconverter}{\xmlattr\xmlattrns0{\xmlattrname ProductID}{\xmlattrvalue 1 a}}}1 a{\*\xmlclose} rovnako aj s diabetom typu 2 lie\'e8en\'ed inzul\'ed
nom samostatne, alebo v kombin\'e1ci\'ed s peror\'e1lnymi antidiabetikami, je odpor\'fa\'e8an\'e9 mera\'9d glyk\'e9miu minim\'e1lne dvakr\'e1t denne.9) Mno\'9estevn\'fd limit navrhovan\'fd v pripomienkovanom n\'e1vrhu kategoriz\'e1cie \'e8
. 26958/2009-OL, nedovo\'beuje t\'fdmto diabetikom realizova\'9d odpor\'fa\'e8an\'fd po\'e8et kontroly glyk\'e9mie po\'e8as cel\'e9ho obdobia definovan\'e9ho v tabu\'beke Limit skupiny D - Zdravotn\'edcke pom\'f4cky pre diabetikov, D3 TESTOVACIE PR\'da
\'8eKY NA STANOVENIE GLUK\'d3ZY V KRVI GLUKOMEROM. Z tohto d\'f4vodu navrhujem upravi\'9d \'fapravu mno\'9estevn\'e9ho limitu pre diabetikov lie\'e8en\'fdch konven\'e8n\'fdm inzul\'ednov\'fdm re\'9eimom pod\'bea n\'e1vrhu uveden\'e9
ho v bode 1.d) pripomienky \'e8.1. \'93Selfmonitoring glyk\'e9mi\'ed (stanoven\'ed denn\'edch glykemick\'fdch profil\'f9 hladin krevn\'edho cukru v b\'ec\'9en\'fdch \'9eivotn\'edch podm\'ednk\'e1ch) je ned\'edlnou sou\'e8\'e1st\'ed dob\'f8e veden\'e9 p
\'e9ce o diabetika 2. typu. Po odhalen\'ed cukrovky zvy\'9auje selfmonitoring pochopen\'ed z\'e1kladn\'edch l\'e9\'e8ebn\'fdch opat\'f8en\'ed (p\'f8edev\'9a\'edm stravovac\'edch n\'e1vyk\'f9) a zvy\'9auje motivaci nemocn\'fdch ke spolupr\'e1
ci. Znalost postprandi\'e1ln\'edch glyk\'e9mi\'ed umo\'9e\'f2uje c\'edlen\'ec upravit l\'e9\'e8ebn\'fd re\'9eim a doc\'edlit uspokojivou kompenzaci diabetu. V dal\'9a\'edm pr\'f9b\'echu diabetu je intermitentn\'ed selfmonitoring vhodn\'fd p\'f8
i reedukaci nemocn\'e9ho. Selfmonitoring je indikov\'e1n zejm\'e9na p\'f8i nesouladu hladin glyk\'e9mie nala\'e8no s hodnotami glykovan\'e9ho hemoglobinu.\'94 - takto o SMBG hovoria Standardy p\'e9\'e8e o diabetes mellitus 2. typu \'c8
eskej diabetologickej spolo\'e8nosti10) British Diabetic Association odpor\'fa\'e8a realiz\'e1ciu SMBG jeden a\'9e dvakr\'e1t denne pri pacientoch s diabetom typu 2, ktor\'ed s\'fa lie\'e8en\'edh deriv\'e1tmi sulfonylmo\'e8oviny samostatne, alebo v kombin
\'e1cii s in\'fdmi peror\'e1lnymi antidiabetikami. Pri ochoren\'ed tejto skupiny diabetikov odpor\'fa\'e8a meranie {\*\xmlopen\xmlns2{\factoidname metricconverter}{\xmlattr\xmlattrns0{\xmlattrname ProductID}{\xmlattrvalue 4 a}}}4 a{\*\xmlclose} viacejkr
\'e1t za de\'f2.9) International Diabetes Federation v dokumente Odpor\'fa\'e8ania pre mana\'9ement postpradi\'e1lnej glyk\'e9mie11) o potrebe selfmonitoringu u diabetikov s diabetom typu 2 hovor\'ed takto, citujem: \'93Zatia\'be \'e8o v\'e4\'e8\'9aina pr
\'e1c sa prim\'e1rne zameriava na u\'9eito\'e8nos\'9d SMBG u diabetikov lie\'e8en\'fdch inzul\'ednom, mnoh\'e9 \'9at\'fadie preukazuj\'fa, \'9ee terapeutick\'e9 riadiace programy, ktor\'e9 zahr\'f2uj\'fa \'9atrukturovan\'e9 v\'fdsledky SMBG ved\'fa k v
\'e4\'e8\'9aiemu zn\'ed\'9eeniu HbA1c u diabetikov 2. typu, ktor\'ed nevy\'9eaduj\'fa lie\'e8bu inzul\'ednom v porovnan\'ed s programami bez pou\'9eitia SMBG. \'93Na dosiahnutie optim\'e1lnej glykemickej kontroly s\'fa potrebn\'e9 lie\'e8ebn\'e9 re\'9e
imy, ktor\'e9 ovplyv\'f2uj\'fa glyk\'e9miu nala\'e8no, ako aj glyk\'e9miu po jedle. Optim\'e1lnu glykemick\'fa kontrolu nie je mo\'9en\'e9 dosiahnu\'9d bez primeran\'e9ho mana\'9ementu postprandi\'e1lnej glyk\'e9mie. Lie\'e8bu hyperglyk\'e9mie nala\'e8
no ako aj postprandi\'e1lnej hyperglyk\'e9mie je nutn\'e9 za\'e8\'edna\'9d s\'fa\'e8asne pri akejko\'bevek hodnote HbA1c. Hoci cena zost\'e1va d\'f4le\'9eit\'fdm faktorom pri ur\'e8ovan\'ed vhodnej lie\'e8by, mana\'9ement glyk\'e9mie je jednozna\'e8
ne menej n\'e1kladn\'fd ako lie\'e8ba komplik\'e1ci\'ed DM.\'93 \'dastredn\'e1 komisia racion\'e1lnej farmakoterapie a liekovej politiky MZ SR, pre lie\'e8bu diabetu typu 2 odpor\'fa\'e8a, citujem: "Z komplexn\'e9ho poh\'beadu sa v\'9edy mus\'ed h\'beada
\'9d optim\'e1lna rovnov\'e1ha medzi dostupn\'fdmi zdrojmi a dosiahnut\'edm kvalitnej zdravotn\'edckej sta\'acrostlivosti o pacientov s diabetom 2. typu. V kone\'e8nom d\'f4sledku zlep\'9aenie kvality \'9eivota pacientov a zn\'ed\'9eenie nepriamych n\'e1
kladov na ochorenie m\'f4\'9eu by\'9d omnoho v\'fdraznej\'9a\'edm pr\'ednosom ako priame n\'e1klady na lie\'e8
bu." 12) ___________________________________ 9) 8. Guidelines for self monitoring of blood glucose, Care recommendations Self-monitoring of blood glucose (SMBG
), http://www.diabetes.org.uk/About_us/Our_Views/Care_recommendations/Self-monitoring_of_blood_glucose 10) Standardy p\'e9\'e8e o diabetes mellitus 2. typu, \'c8esk\'e1 diabetologick\'e1 spole\'e8
nost, 2005, http://www.diab.cz/modules/Standardy/dm2.pdf 11) Odpor\'fa\'e8ania pre mana\'9ement postpradi\'e1lnej glyk\'e9mie, \'a9 International Diabetes Federation 2007,ISBN 2-930229-48-9. http://www.idf.org/webdata/docs/Slovak_GMPG_FINAL.pdf 12) RACION
\'c1LNA LIE\'c8BA DIABETU 2. TYPU Metodick\'fd list \'dastrednej komisie racion\'e1lnej farmakoterapie a liekovej politiky MZ SR, Ro\'e8n\'edk 5, November/December 2001, \'c8\'ed
slo 8, http://www.health.gov.sk/redsys/rsi.nsf/0/a74a6edc4014b3b6c1256cbe004926f5/$FILE/met_list_rf_21.pdf V\'fdsledky ve\'bekej nemeckej klinickej \'9at\'fadie ROSSO13) vyvracaj\'fa tvrdenie Kategoriza\'e8nej komisie, citujem: \'93Efektivita a v\'fd
znam selfmonitoringu je najpreuk\'e1zate\'benej\'9aie deklarovan\'e1 klinick\'fdmi \'9at\'fadiami a metaanal\'fdzami pacientov lie\'e8en\'fdch inzul\'ednov\'fdm re\'9eimom.\'93 ktor\'e9 boli komisiou v rokoch {\*\xmlopen\xmlns2{\factoidname 
metricconverter}{\xmlattr\xmlattrns0{\xmlattrname ProductID}{\xmlattrvalue 2008 a}}}2008 a{\*\xmlclose} 2009 viacejkr\'e1t pou\'9eit\'e9 ako zd\'f4vodnenie zamietnutia n\'e1vrhu na zv\'fd\'9aenie po\'e8tu pr\'fa\'9ekov pre diabetikov lie\'e8en\'fd
ch PAaD pod\'bea bodu 1.e) pripomienky \'e8.1. Efektivitu a ekonomick\'fd pr\'ednos selfmonitoringu pacientov s diabetom typu 2 jednozna\'e8ne dokazuje \'9avaj\'e8iarska \'9at\'fadia "Cost impact of blood glucose self-monitoring on compl
ications of type 2 diabetes: a Swiss perspective (ROSSO study No. 11)14) ktor\'e1 v z\'e1vere vyhodnocuje dosiahnut\'e9 \'faspory syst\'e9mu zdravotn\'e9
ho poistenia takto, citujem: "Blood glucose meters, strips and lancets accounted for 1.7% and 1.6% of total costs in the 
OAD-only and OAD + insulin cohorts. Assuming a 7.2% prevalence of diabetes in the Swiss population, we have 533,000 patients with diabetes in Switzerland, of whom 450,000 with type 2 diabetes. We assume furthermore that 50% of the latter are treated with 
O
AD, 25% with OAD and/or insulin and 50% of patients perform SMBG. If we project the calculated savings to patients actually not performing SMBG, the use of SMBG could save the Swiss statutory health insurance system approximately CHF 255 million per annum
." V syst\'e9me zdravotn\'e9ho poistenia Slovenskej republiky sa daj\'fa dosiahnu\'9d \'faspory v podobnom pomere, ak\'e9 boli deklarovan\'e9 v \'9at\'fadii, preto\'9ee percentu\'e1lne zast\'fapenie diabetikov k celkov\'e9mu po\'e8tu obyvate\'beov a aj 
\'9atrukt\'far\'e1lne rozdelenie diabetickej popul\'e1cie na Slovensku je ve\'bemi bl\'edzke pomerom vo \'8avaj\'e8iarsku.. K dosiahnutiu tak\'fdchto \'faspor pri lie\'e8be diabetu lie\'e8en\'e9ho PAaD je potrebn\'e9 vytvori\'9d
 v Slovenskej republike materi\'e1lne predpoklady pre plnohodnotn\'fd selfmonitoring a tie\'9e zabezpe\'e8i\'9d pre t\'fato skupinu pacientov patri\'e8n\'fa eduk\'e1ciu zameran\'fa na spr\'e1vnu interpret\'e1ciu nameran\'fdch hodn\'f4t glyk\'e9
mie a managemnt diabetu pacientom. Kategoriza\'e8n\'e1 komisia m\'f4\'9ee, schv\'e1len\'edm n\'e1vrhu na nav\'fd\'9aenie po\'e8tu pr\'fa\'9ekov pre diabetikov lie\'e8en\'fdch pomocou PAaD pod\'bea bodu \'e8. 1e) pripomienky \'e8.1, vytvori\'9d materi\'e1
lne predpoklady pre dosiahnutie \'faspor v syst\'e9me zdravotn\'e9ho poistenia pri lie\'e8be diabetu pomocou PAaD. }{\rtlch\fcs1 \af36\afs16 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 \cell }{\rtlch\fcs1 
\af0\afs20 \ltrch\fcs0 \fs20\lang1051\langfe1042\langfenp1042\insrsid9051187\charrsid11803148 \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
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\cltxlrtb\clftsWidth2\clwWidth1250\clshdrawnil \cellx1415\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx8987\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr
\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9037\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth1\clshdrawnil \cellx9087\row }\pard \ltrpar
\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13241662 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2309185 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7608879 {\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 Z\'e1ver:
\par 
\par Komisia zhodnotila v\'fddavky zdravotn\'fdch pois\'9dovn\'ed na predmetn\'fa podskupinu zdravotn\'edckych pom\'f4cok a\~zistila, \'9ee n\'e1klady z\~verejn\'e9ho zdravotn\'e9ho poistenia boli za rok 2009  9\~405 412,9 eur, \'e8o predstavuje n\'e1rast o\~
781 781,82  eura t. z. 8,3 % oproti roku 2008.
\par Komisia pos\'fadila pripomienku v\~s\'fa\'e8innosti s \'a7 40a z\'e1kona \'e8. 577/2004 Z.z. a\~rozhodla, \'9ee  pri s\'fa\'e8asnom n\'e1raste v\'fddavkov z\~verejn\'e9ho zdravotn\'e9ho poistenia nie je mo\'9en\'e9 schv\'e1li\'9d po\'9eadovan\'e9 zv\'fd
\'9aenie.
\par }{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid14360364\charrsid7608879 Pod\'bea \'a7 42 ods. 4 p\'edsm. b) zdravotn\'e1 pois\'9dov\'f2a m\'e1 pr\'e1vo uhradi\'9d poistencovi \'e8as\'9d \'fahrady, ktor\'e1 zodpoved
\'e1 jeho spolu\'fa\'e8asti, ak sa poistenec pravidelne podrobuje prevent\'edvnym prehliadkam, prevent\'edvnemu o\'e8kovaniu a vedie zdrav\'fd sp\'f4sob \'9eivota, a to vo v\'9aetk\'fdch pr\'edpadoch, ktor\'e9 sp\'e5\'f2aj\'fa krit\'e9ri\'e1 ur\'e8en\'e9
 a uverejnen\'e9 zdravotnou pois\'9dov\'f2ou.
\par }{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 
\par }{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid14360364\charrsid7608879 Hlasovanie za hore uveden\'fd z\'e1ver:}{\rtlch\fcs1 \af36 \ltrch\fcs0 
\f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 
\par 
\par za:}{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid14360364\charrsid7608879  8}{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 
\par 
\par proti:}{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid14360364\charrsid7608879 1}{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 
\par 
\par zdr\'9eal sa:}{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid14360364\charrsid7608879  0}{\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af36 \ltrch\fcs0 \f36\fs16\cf17\lang1051\langfe1042\langfenp1042\insrsid2309185\charrsid7608879 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2309185 
\par 
\par 
\par }}