Health minister under fire over proposed reforms

Reform in the health sector has proven one of toughest challenges since the fall of communism, with the post of health minister held by 13 people since 1993. The current minister, Tomáš Julínek, came out with far-reaching reforms, but his plans have since hit increased opposition. And, his days too as health minister may be numbered. Although the prime minister has again backed the embattled Mr Julínek, the Czech Medical Chamber sent a clear signal, opposing reform plans to be submitted to the government this week and calling for his dismissal.

Health Minister Tomáš Julínek, photo: CTK

Health Minister Tomáš Julínek is fighting for the future of his proposed health reforms, but the prognosis appears increasingly bleak, with some Czech papers stating outright they are at an end. So far, the increasingly unpopular Mr Julínek has managed to push through only a first wave: health fees since the beginning of the year of 30, 60, and 90 crowns at surgeries, hospitals, and emergency services. These have proven increasingly unpopular with much of the public despite positive effects, the most obvious being the injection of badly-needed funds into the health sector.

But it may stop at that: the debacle suffered by the government in recent local elections – in which the fees were seen as a deciding issue – is likely to make additional reforms impossible. There is opposition even within the coalition itself: the Christian Democrats fear some legislation could jeopardise services covered by insurers, ultimately raising costs for patients. They are also firmly against the planned easing of abortion legislation regarding those without residency status. And there are other issues; Christian Democrat Ludvík Hovorka spoke to Czech TV, criticising the minister’s approach:

“From the very beginning these proposals have been pushed through with arrogance and force, rolling over coalition partners and disregarding party suggestions.”

Ludvík Hovorka, photo: Zdeněk Vališ

Other coalition partners have gone further, saying the proposals should be fully overhauled even before they reach the government. To add fuel to the political fire, the Czech Medical Chamber has come out against further proposals, albeit narrowly: a slim majority of delegates at the weekend voted against Mr Julínek’s reforms and approved a call for the minister to be dismissed. The minister fired back with the charge that the body’s leadership was closely tied to the political Left.

Can the health minister still somehow emerge triumphant? Many wouldn’t bet on it. Although the prime minister has again given him his backing, it is not unconditional support: he warned that if Mr Julínek was unable sell his reforms properly, his staying on would be uncertain. The health minister will now have to stretch to persuade others to back his vision: a tough task, beginning with a key meeting with the Christian Democrat leader on Monday. The opposition Social Democrats, meanwhile, are continuing to play on the topic, pledging that any reforms by Mr Julínek, especially his health fees, will be rolled back if they gain the voters’ trust in 2010.