Healthcare fees the cornerstone of planned health-system reforms

Health minister Tomas Julinek

This week the health ministry will officially reveal all the details of planned reforms in the healthcare sector but already many are known, among them that Czechs may soon have to pay health care fees for prescription drugs as well as for visits to the doctor's. Until now the Czech Republic has been one of the few countries in the European Union without such mandatory fees.

The planned reforms in the health sector will affect almost everyone: new payments for health services. 30 crowns (the equivalent of around one US dollar fifty) for each visit to the doctor's; the same for individual prescriptions; and that's not all. Also included: visits to the hospital (60 crowns per day) and emergency care (90 crowns). The aim is both to save and bring new funds into the health sector, dramatically changing the way things were done until now. Health ministry spokesman Tomas Cikrt told public broadcaster Czech TV on Tuesday that such fees were necessary to curb an apparent massive squandering of funds and resources within the current healthcare system:

"We need regulatory fees because there is an incredible [waste of funds] in the health sector. Billions worth of prescribed medication just gets flushed down the sewer."

It's well-known that Czechs visit the doctor's twice as often as many fellow EU citizens (at least in the original 15 member states), resulting in over-crowded waiting rooms and a needlessly high number of prescriptions, which critics say are an enormous financial burden. In other words, the new proposal would like to curb many Czechs' bad habits, reducing the number of "unnecessary visits" to the doctor's in order to save millions. These could then be spent for improved medical care where it's most needed. Still, the proposal is not without its sceptics: on Tuesday Social Democrat MP and former health minister David Rath blasted the reform plans, saying they exceeded his "darkest expectations":

David Rath, photo: CTK
"Costs for ordinary patients visiting the doctor will reach a thousand crowns instead of the few dozen crowns it costs them now."

As it stands, many in the public especially the elderly, have already expressed misgivings about the reforms; fearing additional costs will stretch their already meagre pensions. But proponents of the reforms have countered by saying the new fees are necessary and that the overall impact would not be negative. They argue that under the proposal individuals will have a 5,000 crown annual limit or "cap", leading to savings for some. Also, toddlers up to the age of three as well as an estimated 150,000 chronically ill patients around the country will be fully exempt. But it's not likely that this will allay all fears, like those held by this elderly lady I spoke to on a street in Prague:

"It's terrible. For old people it is bad news. But we'll see how it turns out. Already my pension is very small and I'm at an age when going down the street for me is a risk: I can faint or fall down and when I'm ill I have to see the doctor and now pay for it? I wouldn't wish that on any old person; I wouldn't wish that on anybody."

But that feeling, shared by some, was not held by everyone I was able to talk to on Wednesday morning:

Woman, early 50s: "This reform is only a small part of greater reforms that our economy needs. Czechs visit the doctor too often and the population is far too 'ill'!"

Young man, mid 20s: "I'm only very occasionally ill so I have no experience with that. It could be a problem but I think that if the payments aren't too big it could work well."

Young woman, early 20s "Well, it's of course not very happy news for us because we'll have to reach for our pocketbooks much more. And that means that we will actually try to avoid going to the doctor's. People will be afraid of going if it will be expensive to pay. It's already expensive to go to the dentist's and so on, so this is very bad I think. It's not a good policy."