Coalition leaders agree on outlines of health care reform

Leaders of the Czech coalition government have approved the basic outlines of the planned health care reform. The first phase of the reform, which should be introduced in January 2012, should increase patients’ fees and curb the system administrative costs. At their meeting on Wednesday, the officials also agreed that the reform’s key principle – a new bill determining standard care covered by insurance and “above-standard” care patients will pay for themselves – would be sent to Parliament in mid-June. But a leading Czech expert in medicinal law, Ondřej Dostál says the debate on the health care reform has failed to include those who pay for it.

“I think the debate needs to involve the citizens who pay for all the costs; they should be involved in the decision-making process. It’s not just an expert decision. It’s also ethical and social decision and the citizens should have an opportunity to participate.

“The health care bill should basically set the criteria for how to define what will be included in the public benefits package, for instance, cost-effectiveness or the necessity to save lives. At the same time, it should establish a body – also consisting of the members of the public – which will apply these criteria to various medical procedures.”

The government says it will next year need to fill a gap of around 10.6 billion crowns in the health care budget. To do that, the officials have come up with two steps: patients’ out-of-pocket payments should increase by 5 percent, and the system should save on administration. Do you consider it a good start for the health care reform?

Ondřej Dostál
“I do. But what I miss is a more precise analysis of what is behind these numbers. In my opinion, the insurance companies can save enough by following more rigid criteria in purchasing medical care, drugs and medical instruments through contracts with health care facilities.

“Unfortunately, public health insurance companies declined to make these funding contracts available for the public. Many experts believe that tens of billions of crowns could be saved here that could fill the gap without the patients having to pay more.”

One of the planned changes will involve patients paying the total cost of any medicine cheaper than 50 crowns. Do think this is a good move?

“This is difficult to say because this proposal was put on the table without any precise analysis what it will mean for pharmaceutical companies, for patients and for doctors. Some countries have introduced similar limits; their experience shows that patients began consuming drugs that were slightly more expensive in order to bypass the limit.

“Furthermore, from a theoretical point of view, we can say that say it’s better to decided which drugs will be covered by insurance and which will not on the basis of cost-effectiveness rather than on the basis of costs.”

The government would like the respective bills to come into effect in January 2012. Do you think it’s likely, given the rather tense situation within the coalition?

“I think it is likely but I don’t think it’s fortunate because the legislation is not well prepared. It’s impossible to make a good law within such a short time. It typically takes years to create a good law – for instance, the new Civil Code has taken seven or eight years and it’s still not ready.

On the other had, very important legislation with serious impact on the health of the population is being created from one day to another. And I also think that legislators should allow more public debate on these long-term changes.”