GPs go ahead with one day strike

Money problems in the Czech health sector appear to have reached a head. Hundreds of private GPs across the country closed their offices for a one day strike on Thursday, ignoring an appeal from the Prime Minister for them to be patient for a while longer. Doctors say the cash flow problem is worse than ever and late reimbursements from insurance companies are threatening their livelihood.

The Czech health sector is sinking ever deeper into debt. It is now labouring under a ten million crown deficit in spending and yet there is not enough money to go round. Both state owned and private institutions operate on contracts with health insurance companies and they claim that they now get reimbursed with a delay of up to two months. Many have had to take out loans or dip into their own savings in order to pay their nurses and buy medicaments. On the other hand VZP, the largest state owned insurance company, counters that it cannot help the delay because it is short of money itself. The reason why it claims to be cash-strapped is that the health ministry, which is keeping a firm grip on the running of the health sector, makes it pay doctors more than it is receiving in insurance payments. Both doctors and insurance companies thus blame health minister Milada Emmerova for failing to effect proper reforms and maintaining a highly centralized, socialist style system that is no longer tenable.

Mrs Emmerova, the eleventh minister to take on the challenge of reforming the health sector in the last 16 years, is refusing to accept responsibility for the cash-flow crisis - and has sent teams of auditors to check how insurance companies are managing their funds. A member of the ruling Social Democrats, minister Emmerova has often made it clear that while she is in office patients will not be asked to pay a single crown extra when they visit their GP, have to go to hospital or pick up their prescription at the pharmacy.

Health minister Milada Emmerova,  photo: CTK
Private physicians claim that she tends to favour state run institutions and hospitals over the private sector - on the misleading assumption that private clinics cannot be relied upon to cover the broad spectrum of care and would only focus on areas that are highly profitable. Meanwhile state-run institutions deny that they get preferential treatment - arguing that they put in more work for less money and will now have to shoulder an extra workload because private practitioners have decided to strike.

In short there is an all out war raging in the health sector - and although the prime minister has made a last-minute effort to diffuse the tension, inviting a long time critic of the ministry - the president of the Czech Doctors' Chamber - to accept the post of deputy health minister, many observers believe that the health sector's problems will not go away without far-reaching structural reforms. As for the views of patients - when I went out into the streets of Prague earlier today I found people as divided over the matter as people are in the health sector itself.

"I know for certain that they get reimbursed late. But I think that is something that anyone in a private business faces. I run my own firm and I sometimes get paid six months late."

"I do mind. Because most of them make 70 to 80 thousand crowns a month and those of us who work in the education sector make a fraction of that."

"Of course I don't mind. I support them. They are not getting paid for their work - and you can't expect them to work for free now, can you?"

A doctor's view of the dispute

Photo: CTK
Dr Zorian Jojko is a heart specialist with a private practice in the central Prague residential district of Letna. David Vaughan spoke to him about his participation in the doctors' protest. He began by asking him to clarify how the role of the private sector in health care differs from the situation in some other developed countries, such as the UK, where there is a very distinct line between the public and private sector.

"It's different in this country. There is a private sector here, but in practice even the private sector is funded 99 percent by the state health insurer. So that means Czech patients pay for almost nothing, with the exception of preventative treatment or a doctor's examination for a new job and so on. So private doctors are paid by health insurance companies, just like doctors who work at state-run hospitals."

This brings us to the core of the problem. Doctors claim that the insurance companies are not coming up with the money that they owe them for their services.

"Our problem - and it's a problem for anyone working in the private sector - is that for several years the insurance companies have been late in paying us. It's quite normal for payments to arrive 20 days late, and in recent months we've had to wait even longer. So today it's quite common for us to wait between 70 and 90 days before being paid. And all the reports we're getting suggest that if something isn't done soon, at the beginning of next year the period will be extended even further, which could threaten the very existence of many practices."

The insurance companies claim that they are in the same boat as you are, that it's the fault of policy rather than the way that the insurance companies have been running their finances.

"Things are the way the insurance companies say they are. The truth is that for the last few years, health insurance payments have amounted to less than the health insurance companies are obliged to pay out. This is thanks to the Health Ministry, which is trying to give more money to hospitals at the expense of private practices. I think this is something that the health insurance companies have no power to influence. Clearly it's the Health Ministry that's at fault."