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L’assurance médicaments est un des facteurs qui peuvent influencer l’adhésion aux médicaments. Les objectifs de ce mémoire étaient d’évaluer l’impact du type d’assurance médicaments (publique versus privée) sur l’adhésion et le coût des antihypertenseurs et d’évaluer l’impact des procédures de remboursement et de la contribution du patient sur l’adhésion aux médicaments prescrits pour traiter une maladie chronique. Afin de répondre à ces objectifs, deux cohortes rétrospectives ont été construites à partir des bases de données de la RAMQ et reMed : une cohorte appariée d’utilisateurs d’antihypertenseurs couverts par une assurance médicaments privée ou publique et une cohorte de patients couverts par une assurance médicaments privée ayant rempli au moins une ordonnance pour un médicament traitant une maladie chronique. Les résultats montrent que le niveau d’adhésion aux antihypertenseurs était similaire entre les deux types d’assurance médicaments et que le coût des antihypertenseurs était 28,9 % plus élevé au privé. De plus, il a été observé que les procédures de remboursement n’affectaient pas l’adhésion, alors que le niveau de contribution des patients l’affectait. Les patients qui déboursaient un plus grand montant à l’achat de leurs médicaments étaient moins adhérents (différence : -19,0 %, Intervalle de confiance [IC] à 95 % : -24,0 à -13,0), alors que les patients qui n’avaient rien à débourser étaient moins adhérents (différence : -9,0 %, IC à 95 % : -15,0 à -2,0), que ceux qui devaient débourser une petite somme. Les résultats présentés dans ce mémoire montrent que l’assurance médicaments influence l’adhésion par l’entremise des caractéristiques des plans d’assurance. / Drug insurance is one of many factors that can influence medication adherence. The objectives of this thesis were to evaluate the impact of the type of drug insurance (private versus public) on adherence to antihypertensive medications and the cost of medications, and to evaluate the impact of drug reimbursement procedures and out-of pocket expenses on adherence to medications prescribed for chronic diseases. To meet these objectives, two retrospective cohorts were constructed from the RAMQ and reMed databases: a matched cohort of antihypertensive users covered by private or public drug insurance and a cohort of patients covered by private drug insurance who filled at least one prescription for a medication prescribed for a chronic disease. The results have shown that the level of adherence to antihypertensive medications was similar between the two types of drug insurance and that the cost of antihypertensive medications was 28,9% higher for those privately insured. It was also observed that drug reimbursement procedures didn’t affect medication adherence, while the level of out-of-pocket expenses affected it. Patients with the highest out-of-pocket expenses were less adherent (difference: –19.0%; 95% confidence interval [CI]: –24.0 to –13.0), while patients with no out-of-pocket expenses were less adherent (difference: -9.0%; 95% CI: –15.0 to –2.0) than those with low out-of-pocket expenses. The results presented in this thesis have shown that drug insurance affects medication adherence through the characteristics of drug insurance plans.

L’objectif de ce travail était d’analyser de manière conjointe différents indicateurs d’abus, de dépendance et de détournement de médicaments psychoactifs en conditions réelles d’utilisation issus de sources de données hétérogènes afin d’en présenter une vision synthétique. Les sources de données utilisées dans ce travail sont issues des outils et programmes des Centres d’Evaluation et d’Information sur la Pharmacodépendance – Addictovigilance (CEIP-A). Elles permettent de mesurer directement l’abus auprès de populations spécifiques de patients dépendants ou sous traitement de substitution par l’enquête OPPIDUM (Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse). Ces outils permettent aussi de mesurer le détournement via la mesure du nombre d’ordonnances falsifiées par l’enquête OSIAP (Ordonnances Suspectes, Indicateur d’Abus Possible) ainsi que la mesure du phénomène de « Doctor Shopping » (chevauchement d’ordonnances) et la mesure du nombre de patients présentant des comportements déviants (issu d’une analyse de classification) à partir de bases de données de remboursement de l’assurance maladie. Cette approche multi-sources a d’abord été appliquée à l’analyse de l’importance du détournement d’usage du clonazépam (Publication n°1). Ce travail a permis de mettre en évidence le détournement émergent du clonazépam et a surtout permis d’illustrer les difficultés à faire émerger cette information de manière cohérente et standardisée au travers des différentes sources de données. Ensuite, l’un des pré-requis d’un système de surveillance de l’abus et du détournement de médicaments étant de permettre d’étudier des tendances évolutives, nous avons proposé la méthode de classification visant à établir des profils de sujets déviants de manière à analyser l’évolution de détournement d’usage de méthyphénidate sur quatre années (Publication n°2). Cette méthode de classification a par la suite, été appliquée de manière conjointe à une méthode de mesure du « Doctor Shopping » pour étudier le détournement d’usage de la Buprenorphine Haut Dosage (BHD) dans la région PACA-Corse (Publication n°3). Cette étude nous a non seulement permis de mettre en évidence un problème important de détournement d’usage de la BHD mais elle nous a permis aussi de montrer la concordance entre ces deux méthodes (mesure du « Doctor Shopping » et méthode de classification) et d’évaluer leurs apports respectifs pour la surveillance de l’abus des médicaments. Ces deux méthodes ont par la suite été analysées de manière conjointe aux données issues des enquêtes OPPPIDUM et OSIAP pour permettre d’étudier et de comparer le détournement d’usage des médicaments de la famille des benzodiazépines (Publication n°4) et des opioïdes (Publication n°5). Cette approche multi-sources permet de limiter les biais inhérents à chaque méthode ou source prise isolément. L’ensemble de nos travaux met en exergue la pertinence d’un tel système pour évaluer l’abus d’un médicament mais aussi pour le comparer à d’autres substances. Néanmoins, le développement d’un tel système appliqué au domaine de la pharmacodépendance est relativement nouveau, et nécessite des améliorations tant dans l’intégration d’autres sources de données, que dans la méthodologie employée pour intégrer et synthétiser l’information ainsi obtenue. Finalement, cette thèse a montré que les CEIP-A avaient le potentiel pour mettre en œuvre un système multi-sources pouvant apporter une réelle contribution à l’étude de la pharmacodépendance en France. / The objective of this work was to analyze abuse, dependence and diversion of psychoactive medicines in real settings using jointly different indicators issued from mixed datasources in order to present a synthetic vision. The datasources used in this work are issued from the tools developed by the Centres for Evaluation and Information on Pharmacodependency (CEIP). They allow to measure directly drug abuse with specific populations of dependent patients or under opiate treatment (OPPIDUM (Observation of the Illicit Psychotropic Products or Diverted from their Medicinal Use) survey)). These tools also allow to measure the diversion via the measure of the phenomenon of “doctor shopping” (overlapping of prescriptions) and the measure of the number of patients presenting a deviant behaviour from general health insurance databases; then they measure diversion through falsified prescriptions presented at pharmacies (the OSIAP (Forged prescriptions indicating potential abuse) survey).This multisources approach has been firstly applied to analyse abuse and diversion of clonazepam (1st publication). This study has highlighted the emerging problem of diversion of clonazepam, after flunitrazepam and has also illustrated the difficulty of analysing with consistency the information gathered by these different datasources. A good system for controlling drug diversion and abuse has to allow analysing trends. We have so proposed a classification method aiming at revealing profile of subjects with deviant behaviour to use it on an evolutive manner so as to study diversion of methylphenidate on a four year period (2nd publication). This classification method has then been applied jointly with a method measuring the “doctor shopping” to analyse diversion of High Dosage Buprenorphine (HDB) (3rd publication). This study has revealed an important problem of diversion of HDB, has also demonstrated that the two methods were globally concordant and has allowed to evaluate their advantages for the controlling of the abuse and diversion of prescription drugs. These two last methods have then been analysed jointly with data from the OPPIDUM and OSIAP surveys to allow to study and compare diversion of benzodiazepine drugs (4th publication) and opioids drugs (5th publication). This multisource approach allows to limit biases linked to each method seen individually. Our work points out the relevance of such a multisources system to estimate the abuse of a prescription drug and to compare it with the other substances. Nevertheless, the development of such a system applied to the domain of the drug dependency is relatively new, and requires improvements concerning the integration of the other sources of data and the methodology used to join and synthetize the information obtained. Finally, such a system "multi-sources” has the potential to exist and to make a real contribution to the domain of the drug dependency in France.

Laisvo pacientų judėjimo Europos Teisingumo teismo jurisprudencijoje tema yra aktuali, kadangi Europos Teisingumo teismui tenka pagrindinis vaidmuo kilus abejonėms dėl Europos Bendrijos taisyklių taikymo srities, jų taikymo atskirais atvejais ir jų išaiškinimo nacionalinės teisės aktų atžvilgiu. Tema yra nauja, kadangi darbe nagrinėjamos naujausios Europos Teisingumo teismo bylos pacientų judėjimo srityje, analizuojamas jų poveikis Lietuvos teisės aktams, reglamentuojantiems gydymąsi užsienyje. Tiriama problema – laisvo asmenų judėjimo kliūtys ES bei nacionalinės teisės lygmenyje. Magistro baigiamojo darbo tyrimo objektas – laisvas pacientų judėjimas ETT jurisprudencijoje. Magistrinio darbo tikslas – išanalizuoti ETT jurisprudencijos įtaką laisvam pacientų judėjimui ES, EEE šalyse bei Šveicarijoje, jos pagrindu sukurti praktines rekomendacijas Lietuvos teisės aktų, reglamentuojančių laisvą pacientų judėjimą, tobulinimui. Uždaviniai: atskleisti laisvo pacientų judėjimo sampratą; išanalizuoti ETT jurisprudenciją pacientų judėjimo srityje; įvertinti ETT jurisprudencijos poveikį Lietuvos teisei; remiantis atlikta analize, pateikti savo vertinimus ir pasiūlymus Lietuvos teisės aktų pacientų mobilumo srityje tobulinimui. Hipotezė: ETT jurisprudencija sąlygoja pacientų mobilumo didėjimą; laisvą pacientų judėjimą ES reglamentuojantys nacionaliniai teisės aktai yra tobulintini vadovaujantis suformuota ETT praktika. Darbe naudoti mokslinio tyrimo metodai: loginis, lingvistinis... [toliau žr. visą tekstą] / The theme of this Master’s thesis is relevant since the European Court of Justice plays the main role when there are doubts concerning application area of the European rules, their application in individual cases, and their explication with regard to the national legislation. The subject is new as new cases from the European Court of justice and their implication on the Lithuanian legislation regulating treatment abroad are analyzed. Obstacles of free patient movement at the level of the European Union and at the national level comprise the problem of this thesis. The object of this research is free movement of patients in the jurisprudence of the European Court of Justice. The aim of this Master’s work was to analyze the impact of jurisprudence of the European Court of Justice on the free mobility of patients in the countries of the European Union, European Economic Area and Switzerland, and on the basis hereof to create practical recommendations for the improvement of the Lithuanian legislation in the patient mobility area. Hypothesis: jurisprudence of the European Court of Justice stimulates movement of patients; national legislation regulating free movement of patients within the European Union must be improved on the basis of the practice of the European Court of Justice. The following scientific research methods were applied: logical, linguistic, systemic analysis, documentary, analysis of the scientific methodologic literature. Results. 7 new cases since 2004 from the... [to full text]

The diploma aims to ascertain the opinions of diabetics on the current system of reimbursements of medical devices and medical procedures from the public health insurance. The diploma thesis is strategically divided into theoretical and practical bases. The theoretical bases are divided into three parts. The first part is focused on the disease diabetes mellitus, the second part provides a basic description of the concept of health insurance, and the third part describes the facts arising from the relationship between health insurance and diabetes, including e.g. provision and reimbursement of medical devices or medical procedures. The practical bases include the thesis objective, hypotheses, methods, research results and discussion. In order to process the data, a quantitative research strategy was used, and the data were collected by the questioning method and the questionnaire technique. The questionnaire I drew up for the diploma thesis started with the introductory page on which I introduced myself to the respondents and informed them about the purpose of the questionnaire survey, anonymity and use of the obtained data. The research set comprised the diabetics registered with a selected physician running an outpatient diabetes office. I distributed 300 questionnaires and received 248 completed questionnaires. So the rounded return rate was 82.7%. From the total number of 248 questionnaires, only 232 questionnaires could be used for the research, while 16 questionnaires were excluded because the respondents gave incomplete, inaccurate or logically incorrect answers to the questions important for the research. In order to achieve the set objective, two hypotheses were raised. The first one was: Type 1 diabetics are satisfied with the number of medical devices reimbursed from the public health insurance more than type 2 diabetics. Based on the research results, the conclusiveness of this hypothesis was found statistically significant so it was confirmed that type 1 diabetics are satisfied with the number of medical devices reimbursed from the public health insurance more than type 2 diabetics. The second hypothesis was: Type 1 diabetics are satisfied with the number of medical procedures reimbursed from the public health insurance more than type 2 diabetics. Based on the research results, the conclusiveness of this hypothesis was not found statistically significant in this case so type 1 diabetics are not satisfied with the number of medical procedures reimbursed from the public health insurance more than type 2 diabetics. The diploma thesis could be helpful in extending the knowledge of not only diabetics but also the general public. I would also be very glad if my thesis was used by health insurers as a source of information about clients covered by public health insurance, namely about people with the chronic disease diabetes mellitus. In later years, this thesis might also inspire further research in this issue.

This thesis focuses in its content on the impact of changes in the rate of value added tax on the subjects of the pharmaceutical market. Thesis explains the basic concepts of taxation and simultaneously describes the theoretical basement of price and reimbursement regulation of medicines and foods for special medical purposes. The thesis contains an analysis of the actual impact of changes in the rate of value added tax on the expenses of health insurance companies and patients.

Ziel: Entwicklung eines gesundheitsökonomischen Evaluationskonzepts zum Nachweis einer Kostenreduktion unter gleichzeitiger Optimierung des medizinischen Nutzens durch pharmakogenetisches Screening bei Erstdiagnose einer Schizophrenie. Finale Zielsetzung ist die Aufnahme der pharmakogenetischen a priori-Diagnostik für die Indikation Schizophrenie in die GKV-Regelversorgung. Methodik: Basierend auf dem aktuellen Stand gendiagnostischer Forschung sowie der evidenzbasierten Schizophrenietherapie wurde eine prospektive, randomisierte und kontrollierte, dreiarmige, offene, multizentrische Pilotstudie im Paralleldesign über 3 Jahre konzeptioniert. Studienpopulation: 300 Patienten (1:1:1) im Alter von 18 bis 65 Jahren mit erstmaliger F20-Diagnose (ICD-10). Interventionen: pharmakogenetisches Screening und integrierte Versorgung; integrierte Versorgung; Standardversorgung. Die Erhebung des medizinischen Nutzens erfolgt durch Messung des klinischen Outcome bzgl. der patientenrelevanten Endpunkte Mortalität, Morbidität, Lebensqualität und Nebenwirkungen zu definierten Zeitpunkten. Perspektivisch relevante Kosten werden im "piggy back"-Verfahren ermittelt. Ergebnisse: Angesichts zurzeit bestehender Limitationen im deutschen Gesundheitssystem (z.B. unzureichendes intersektorales Schnittstellenmanagement bei der Arzneimittelversorgung und Informationsweitergabe) wird die Integrierte Versorgung als geeignete Versorgungsform für den Nutzennachweis eingestuft. Die Integrierte Versorgung stellt jedoch momentan nicht den allgemeinen Standard der psychiatrischen Patientenversorgung dar. Aus GKV-Perspektive wesentliche Kostentreiber der Schizophrenietherapie sind Rückfälle, Krankenhausaufenthalte, Arbeitslosigkeit und vorzeitige Verrentung. Eine Verringerung der Häufigkeit dieser Parameter könnte z.B. zu einer Reduktion der Erstjahres-Behandlungskosten (zurzeit ca. 30% der Gesamtkosten) führen. Die Kosten-Effektivitäts-Analyse erweist sich als Studienform mit der geringsten Anfälligkeit für Bias und Confounder. Trotz einer vergleichsweise hohen externen Validität ist das Studiensetting nicht uneingeschränkt übertragbar auf die Versorgungsrealität des deutschen Gesundheitssystems. Es existiert aktuell keine generelle Empfehlung für den Einsatz der Gendiagnostik zur Steuerung der Arzneimitteltherapie in Psychiatrie. Ebenso hat die integrierte Versorgung bisher keinen umfassenden Einzug in den psychiatrischen Behandlungsalltag gefunden, so dass die beschriebenen Limitationen einen positiven Nutzennachweis erschweren. Dennoch ist das Konzept als praktisch umsetzbar zu bewerten. Schlussfolgerung: Bei dieser Faktenlage ist das Interesse der GKV an der Veranlassung einer gesundheitsökonomischen Evaluation mit dem Ziel einer Erstattungsfähigkeit des a priori durchgeführten pharmakogenetischen Screenings bei Schizophrenie als eher gering einzustufen. Jedoch lassen das Update der S3-Praxisleitlinie mit dem Einbezug der strukturierten u. integrierten Versorgung sowie der Aktionsplan „Individualisierte Medizin“ des Bundesforschungsministeriums auf eine Fokussierung auf diese Fragestellung und veränderte Interessenlage bzgl. der Initiierung der Pilotstudie hoffen. Weitere Forschungstätigkeit sowie die praktische Erprobung neuer gendiagnostischen Verfahren sind, basierend auf versorgungsbezogenen Pilotstudien wie der hier konzeptionierten, fachübergreifend erforderlich, um die Relevanz der Methodik für den psychiatrischen Versorgungsalltag zu belegen. / Purpose: Development of a health-economic investigation method to study whether a cost reduction under concurrent optimisation of the medical use exists by using pharmacogenetic a- priori- screening with first diagnosis of a schizophrenia. Final objective is the reimbursement of pharmacogenetic diagnostics for the indication schizophrenia in the German health statutory insurance (GKV). Methods: A prospective, randomised and controlled, 3-armed, parallel, open, multicentre pilot study with a duration of 3 years was designed based on the actual status of genetic-diagnostic research as well as the evidence-based therapy of schizophrenia. Study population: 300 patients (1:1:1) aged 18 to 65 years with initial F20 diagnosis (ICD-10). Interventions: pharmacogenetic screening and integrated care; integrated care; standard care. For evaluation of the medical benefit the clinical outcome is measured at defined times with regard to the patients' relevant endpoints mortality, morbidity, quality of life and side effects. In perspective relevant costs are determined by "piggy back" procedure. Results: In view of actually existing limitations within the German health system (e.g., insufficient intersectional medication and information management) the integrated care is considered being a suitable setting to demonstrate the advantage of using pharmacogenetic screening. Nevertheless, the integrated care does not show the general standard of the psychiatric patient's care at the moment. From GKV perspective essential cost drivers of schizophrenia therapy are relapses, hospital stays, unemployment and untimely superannuation. Diminishing the rate of these parametres could lead, e.g., to a reduction of the first year medical costs (at the moment approx. 30% of the total expenses). The cost-effectiveness analysis seems to be the study form with the slightest susceptibility to bias and confounding. In spite of a relatively high external validity the study setting is not unconditionally transferable to the German health system. Currently no general recommendation exists for the application of the genetic diagnostics to manage medication therapy in psychiatry. Up to now also the integrated care has not found a comprehensive entry in psychiatric practice, so that the described limitations are complicating a positive use proof. Nevertheless, the investigational concept can be regarded as feasible. Conclusion: Based on the existing situation the GKV's interest in performing a health-economic evaluation, which is focussed on the reimbursement of pharmacogenetic a priori-diagnostics in schizophrenia, is considered to be low. However, the situation may change in view of the expected update of the S3-practise guideline with the focus on structured and integrated care as well as the action plan „individualised medicine“ of the German federal research ministry. Thus, there is hope for changing interests in a pilot study. Based on care-related pilot studies as presented here, further research activities and practical testing of recent gene diagnostic procedures are necessary to demonstrate the relevance of the methodology for psychiatric practice.

Byggbranschen är, jämför med andra branscher konservativ. Förändringar, förbättringar och effektivisering sker men inte i den utsträckning och takt det borde. Under mitten av 1980-talet utvecklades en ny samarbetsform i USA och Storbritannien, som kom att kallas för Partnering. Vårt huvudsyfte med denna rapport är att se hur tillämpning av samarbetsformen partnering är inom småhusprojekt. Partnering är ett begrepp som används där man har gemensamma mål, öppenhet med öppna böcker och stor tillit för byggherrens bästa. Att försöka definiera partnering i Sverige har inte varit angeläget eftersom stora variationer i arbetssätt gjorts till respektive projekt. Tidigare studier i England, Danmark och USA har definierat partnering på dessa sätt. Ett partnering team skall bestå av projektledning, projektoptimering och produktion, för att åstadkomma ett gott resultat där alla strategiska leverantörer bidrar med den mest fördelaktiga och optimala lösningen. Man skall skilja på samverkansform, entreprenadform och ersättningsform. Samverkansform/partnering är en del av byggprojektets delar och kan användas vid alla entreprenad-, ersättning- och upphandlingsformer. Eftersom det kan vara besvärligt att ta fram ett riktpris med incitament så har man nu börjat använda en ersättningsmodell i form av budgetmodellen, modellen används av byggherrar som ofta bygger. Grundfilosofin för partnering är öppenhet, tillit, gemensamt uppsatta mål, tid, ekonomi och grupparbete. LEAN är ett produktionssystem som kommer ifrån japanska Toyota, även kallat TPS. Syn och tankesätt kring LEAN handlar om att effektivisera och öka produktiviteten. Ett tydligt exempel på detta är hur lastbilstillverkaren Scania har tillämpat och utvecklat produktionssystemet i sin dagliga verksamhet. Efter sammanställning av detta kandidatexamensarbete kan vi nu återkoppla och besvara vår problemformulering. Partnering är möjligt att tillämpa inom småhusprojekt, och är en bra metod för byggherren att medverka i och påverka tidplan, kvalitet samt budget. Tillämpningen av samverksformen partnering i ett enskilt småhusprojekt kan framstå som invecklat och ofta svårtillämpat. Vi har även fått nya infallsvinklar kring tillämpning av partnering i småhusprojekt, vilka kan vara intressanta för vidare studier. / The construction industry is conservative compared with other industries. Modifications, improvements and efficiency improvements occur, but not to the extent and in the rate that it should. During the mid-1980s, a new form of cooperation was developed in the United States and in Great Britain, which came to be known as partnering. Our main purpose of this report is to see how the appliance of partnering is within a homebuilding project. Partnering is a concept used where there are common goals, openness with open books and great trust in the client's best. Trying to define partnering in Sweden has not been imperative since large variations in approaches have been done to respective project. Previous studies in Great Britain, Denmark and the United States have defined partnering on these ways. A partnering team shall consist of project management, project optimization and production, to achieve a good result where all strategic suppliers contribute with the most beneficial and optimal solution. One should distinguish between the form of collaboration, the form of contract and compensation terms. The form of collaboration/partnering is a part of the construction project parts and can be used for all contract-, replacement- and purchase forms. Because of the difficulty to produce a target price with incentives, it is known to use a compensation model in the form of a budget model. This model is often used by a developer who often builds. The basic philosophies of partnering are openness, trust, common goals, time, finances and team work. LEAN is a production system that comes from the Japanese Toyota, also known as TPS. Sights and thinking regarding LEAN is to render more effective and to increase the productivity. An example of this is how the truck manufacturer Scania has applied and developed the production system in their daily activity. Partnering is possible to apply within small house projects, and is a good method for the future proprietor to contribute in and to influence time flat, quality and budget. The application of the interacting mould partnering in an individual small house project can seem complicated and often difficult to apply. After the summary of this study, we can now re-engage and answer our problem wording. We have also received new insights about the application of partnering in homebuilding projects, which may be of interest for further study.

Objectives: The Dental and Pharmaceutical Benefits Agency (TLV) is responsible for deciding which prescription pharmaceuticals should be subsidized in Sweden. Cost-effectiveness analyses are fundamental to its decision-making, but future price reductions following patent expiry are excluded from these analyses. The purpose of this study is to investigate and illustrate the economic and strategic aspects of including these future price changes in reimbursement decisions for prescription pharmaceuticals. Methods: We construct a Markov model in R to serve as a laboratory and evaluate the cost-effectiveness of a completely fictional drug, Liunek, under eight sets of assumptions and study differences in incremental cost-effectiveness ratios. Results: Including future price changes in TLV's reimbursement decisions will lead to increased healthcare expenditures if producers respond by raising prices, but may strengthen incentives to develop new pharmaceuticals. Policy implications: Sweden needs to decide whether it is TLV's responsibility to incentivize the development of new pharmaceuticals, and to what extent this should be done.

- RESUME This work is concentrated on issue of purchase of medical practices which in this market period gains the importence. Even though today there is bigger and bigger demand for this transaction, legislation is not very well adapted to that. Medical practice can be perceived as undertaking pursuant to § 502 civil code. Because of that, it is possible to sell it (besides other ways) based on legal title business purchase contract pursuant to § 2175 civil code. Legal title business purchase contract is in practice used often, nevertheless whole process of purchase of medical practice based on legal title business purchase contract is not smooth. I would like to highlight the problems which can emerge. It is possible to divide this work into two parts. The first part deals with legal definitions and legal analysis of basic legal terms as undertaking, medical practice, provider of medical assistance services. We can find here also justification why it is possible to perceive medical practice as undertaking. The second part is focused on business purchase contract in general with specifics, which can arise in case of purchase of medical practice based on legal title business purchase contract. In second chapter (after the introduction), I define in general the concept of undertaking and I also...