Generous subsidies of cheaper drugs limiting budget for modern treatment of serious illnesses

Czech patients, compared to patients in the rest of Europe, are facing troubling conditions when it comes to accessibility to modern medicine. Despite having quite a good reputation in cancer research, for example, the state subsidies for cancer drugs are very low. That's also one of the reasons why the Czech Republic was ranked 22nd in a health care study of the 25 states in the European Union.

"You have very good access to everyday health services like medical checkups with primary doctors and dentists but rather limited access to more advanced treatment and to sophisticated pharmaceuticals."

...says Arne Bornberg from Health Consumer Powerhouse, which conducted the study earlier this year. In an effort to reform the financially troubled health care sector, the health ministry has issued a number of directives that have led to two main problems. In some cases doctors are allowed to prescribe the most modern drugs only to a limited amount of patients - simply because they are too expensive and insurance companies do not want to cover them. In other cases, insurance coverage of the drugs has been set very low and most patients cannot afford to pay the difference and are thereby forced to go for cheaper, less modern forms of treatment.

Pharmaceutical companies have sharply criticised the austerity measures taken by the health ministry. Due to the limited prescriptions and low subsidies, the revenues of some drug makers operating in the Czech Republic fell by at least one billion crowns in the first four months of this year. As a result, some of them are not introducing the most modern medicines onto the Czech market.

The drug Certican, for example, helps patients who have undergone an organ transplant by reducing the risk of organ rejection. But the drug will not be on the Czech market, says its manufacturer Novartis. The Health Ministry's medicine commission decided that insurers cover 30 percent less of its cost than the European average. But since patients would have to pay thousands of crowns a month for the drug, it would only be accessible to the few who can afford it. That would be discriminating, says Novartis representative Martin Klimek:

"The reimbursement level is quite low and our aim is to make the product available to all patients. When patients have to pay high amounts of money the product is inaccessible to older patients and that is why we decided not to introduce the product onto the market."

Are you also not introducing the drug on other European markets for the same reason?

"Fortunately, it is only a case of the Czech Republic. In the majority of European countries the product has already been introduced."

Are pharmaceutical companies or drug makers now in talks with the health ministry to try and change the situation?

"The pharmaceutical association is doing a lot to discuss the current conditions with the authorities and to improve the transparency in the future. In this particular case, we are also negotiating the conditions with other authorities like the health insurance companies to get a better reimbursement because our aim is, of course, to launch the product on the Czech market."

Czech doctors are also bound by a directive that only allows them to prescribe selected expensive drugs to patients that are in their final phases of their illness. But if the state of health of the patient is already advanced and critical, the patient's life is not saved, it is only prolonged.

Tomas Julinek
Paradoxically, most Czechs pay three times less for medicines than the average residents pay in the rest of Europe. That's because common drugs like pain killers, cough syrup and antibiotics are cheap, as the state and health insurers' subsidise a big chunk of their cost - a system inherited from the Communist regime.

According to Senator and shadow health minister Tomas Julinek of the opposition Civic Democrats, who won the last elections and are in the process of forming a new government, the state is paying for cheaper medicines that the majority of patients need leaving little money for the expensive drugs for those with serious health problems. So, how do Czechs feel about this peculiar situation?

Man: "I think that the general, cheaper drugs should be covered by the patient, with the exception of pensioners, who really can't afford them. I think it is an outrage that people with serious illnesses, whose lives often depend on the drugs, have to pay for the treatment which is getting ever more expensive. I'm a diabetic and I can't imagine how I would cope if my situation were to get worse and I would need more advanced medicine. It would cost me a hell of a lot of money!"

Woman: "I don't think it's entirely true that people who are seriously ill do not get the care they deserve. It is true that the state does not have enough money but my cousin, for example, suffers from multiple sclerosis and is in a programme where she gets special injections and treatment and she's very happy with it."

Man: "I think the state should find a way to subsidise all kinds of medicine - the cheaper and the expensive."

Woman: "I think we should pay more for the regular cheaper drugs like pain killers and so on. We need to even out the amount we put into health care to make drugs more accessible to people suffering from serious problems like epilepsy, diabetes, and high blood sugar levels."

Earlier this year, a breast cancer patient from Swindon, England, won her case after she took her health insurer to court because she was not given access to medical treatment with the sophisticated drug Herceptin. Since the Czech Constitution also guarantees the right to the most modern forms of medical treatment, lawyers say Czech patients have a strong chance of winning should they take their case to court. But often patients suffering from osteoporosis, high blood pressure, arthritis, or some forms of cancer are unaware that they are not getting the most sophisticated medicine. Patients with serious illnesses have no time to waste. With the slow pace with which the Czech courts move, it is likely that a verdict would come too late.