Health workers oppose reforms with "week of unrest"

I have just walked out of a pharmacy with prescription pain killers for my ailing back, anti-histamines against my allergies, and some medication for my sprained wrist, which I just had x-rayed. It's been a week full of doctor's appointments and guess how much it's all cost me...a mere 45 Czech crowns, that's just about two US dollars. The rest was covered by my health insurer. If there is one thing that Czechs can boast about, then it's a very cheap and generous health care system, inherited from forty years of socialism. But this system is becoming increasingly difficult to sustain. There is consensus that the Czech health care sector needs reform, but what form should these reforms take?

Health Minister David Rath,  photo: CTK
Several attempts by the health ministry to get it right have failed; Social Democrat David Rath is the twelfth health minister in the sixteen years since the fall of communism. In his seven months in office, Mr Rath has not shied away from drastic measures - he has put the country's biggest health insurer, VZP, under forced administration, has dismissed several dozen health ministry officials and put forward various new regulations, bills and amendments, with the aim of bringing as much reform as possible before the parliamentary elections in June.

This barrage of reforms has been met with an equal amount of criticism. Some health workers say the health care is gradually taking a U-turn back to the years before 1989, when it was entirely in the hands of the state. A bone of contention this week was a bill on non-profit hospitals that Mr Rath managed to push through parliament with the help of Social Democrat and Communist deputies. The law was vetoed by Czech President Vaclav Klaus and the protesting health workers say it is an attempt to nationalise the hospitals. Vaclav Smatlak is the president of the General Practitioners' Association:

Vaclav Smatlak
"The main reason for our protests is the unacceptable restriction of the provision of medical care. It started on January 1 with regulations introduced by health minister Rath. The Minister of Health makes all the decisions personally, without any discussion. He is concentrating all the power and all the money into his own hands. The system of healthcare provision in the Czech Republic is based on health insurance, and his steps led to the situation that all these health insurance companies are, or will soon be, fully powered and managed by him."

An opinion shared by a wide spectrum of other groups in the health sector - from private practitioners, to nurses, dentists, and pharmacists. The latter, for example, oppose plans to stop restricting the supply of medicines only to pharmacies. Pharmacists fear their income would plummet if patients could also get medicines directly from their doctors or hospitals. Dentists and doctors are also protesting against a measure in which they are fined whenever they decide to treat more patients than allowed by the health insurers.

The week of unrest in the health sector officially began last Saturday with a congress of dentists in Prague, at which health minister Rath and dentists from around the country discussed the issues at stake. Unfortunately, the congress was overshadowed by a personal row that turned physical between Mr Rath and Civic Democrat Miroslav Macek.

'Adoption' of the rabbits from Prague Zoo,  photo: CTK
On Monday at five past noon, the protesting health workers began distributing up to half a million leaflets. They are also engaging in debate with the public. And, to bring attention to their slogan, the Crisis Committee of the protesting health care workers took to a very unusual measure. Four rabbits from Prague Zoo were "adopted" on Sunday to fit the slogan "we are not the guinea pigs (in Czech that would be rabbits) of Dr. Rath". Although the planned events will be largely symbolic, many thousands of health workers from around the country are taking part. Zuzana Vystrcilova from the Czech Chamber of Dentists in south Bohemia says the week of unrest is not being taken lightly:

"Though this is not a demonstration, it is an event that is to bring attention to a problem. Not much will change for much of the week. We will be here in our white coats, but we will have stickers, banners, and we will give out flyers. But we're not going to close our offices and take to the streets and city squares for now."

The week of unrest will peak, though, with protest marches through the three largest cities - in south Moravia's Brno on Wednesday, north Moravia's Ostrava on Thursday, and Prague on Friday.

Eduard Solich from the Association of Bohemian and Moravian Hospitals says, despite the demonstrations, hospitals will ensure that the patients will not suffer from restricted care:

"Our hospitals' services, the health care and office hours, will remain unchanged. Those patients of the general practitioners and specialists, who will join in the protests, will be welcomed and treated at our hospitals."

In the Czech capital, private practitioners, dentists, and some 180,000 other health care workers including nurses, physiotherapists, lab workers, and psychologists, will march from the health ministry to the government building. But there are some groups in the health care sector that see no cause for the protest actions. Since the first wave of protests in February, Minister Rath has relaxed some of his initial budget tightening measures - for example once again increasing the amount that the state owned health insurer VZP pays to doctors for their services. In the wake of such changes the influential Trade Union of Physicians supports Minister Rath. This new wave of protests, it says, is a political attempt to get rid of the minister at the expense of patients.

Milan Kubek
The doctors' professional body, the Czech Chamber of Doctors, is also not involved in the week of unrest. Its President Milan Kubek gives Health Minister David Rath his full backing.

"Access to and quality of healthcare is not threatened in the Czech Republic. The new regulations on payments for services that came into effect this April ensured that the increased resources that will go into healthcare will reach individual facilities, so that we can reasonably and effectively use them as we care for our patients."

But the Chamber of Doctors' board have issued a statement in which they express understanding for the protests. They blame politicians for the current situation, saying that since 1993, they have failed to admit that the health care that the state has been offering is far too expensive to be covered by its limited budget.

So, the health sector seems to be divided over Mr Rath's reforms and critics of the health workers' protests suspect the move is political. David Rath himself is convinced that the opposition right-of-centre Civic Democrats have generated the unrest. As the Social Democratic Party's leading election candidate in Prague, Mr Rath believes the protests have been staged by the opposition to damage his party and reduce his chances of winning in the Czech capital:

"This is clearly a pre-election campaign in support of the Civic Democratic Party, which aims at the privatisation of hospitals, and wants to see free health care done away with."

Health worker Jan Jelinek is one of the thousands engaged in the week of unrest:

"These measures are in no way connected to the Civic Democrats. We do share some of their positions on health care but that should not be criticised, it should lead Mr Rath to reconsider his strategies. As far as I know, with the exception of one Social Democrat, our Crisis Committee is full of independent, non-affiliated members. So, if anyone wants to claim that we're being driven by the Civic Democrats, then Mr Rath is driven by Fidel Castro."

Whatever the case may be, it is clear that health reform has become one of the major party political issues of the forthcoming election, and the future shape of the Czech health sector will certainly be heavily influenced by who wins on June 3rd.