Healthcare sector stand-off continues

Health minister David Rath's radical reforms have divided the health sector—hundreds of general practitioners, specialists, dentists and pharmacists are demanding his dismissal. They claim that his radical efforts to reform the sector have proved destructive for the system and dangerous for patients. Others feel that the minister has finally managed to stem the money drain from the sector and has successfully addressed long-standing problems.

Vaclav Smatlak

"The operation was successful, but the patient is dead"—that is how many doctors describe the health minister's severe cost-cutting measures. According to the president of the General Practitioners' Association, Vaclav Smatlak, the financial restrictions which the minister imposed on the health care system have resulted in patients being turned away because doctors can't afford the treat them. This concerns particularly elderly patients with multiple illnesses who are expensive to treat. Overstepping the set limit per patient means that anything extra has to be covered either by the doctor or by the patient - out of their own pocket.

"We are forced to make selections among patients. If you are prosperous you can get better care, but if you are not you can only get the old-fashioned treatment. It's unacceptable for us, and for our patients as well. We try to provide the best care we can, but we don't want to make selections. As I mentioned before, the care, prescription of drugs, or examinations—these are things we pay ourselves, and it's unacceptable for us."

Milan Kubek and Jiri Paroubek, photo: CTK

The General Practitioners' Association is now calling for the health minister's immediate resignation and has collected 37 000 signatures in support of this demand. However the government, headed by Prime Minister Jiri Paroubek, is standing firm. The Prime Minister's position is that thanks to the minister's radical therapy the health sector is finally over the worst of its problems which means that the financial restrictions can now be gradually eased. In what the General Practitioners' Association sees as a belated concession, the health minister has promised to amend the directive which lays down the painful financial restrictions. As of April 1st doctors should get more money for treatment. Moreover, on Wednesday the government earmarked an additional 2.8 billion crowns (117 million dollars) from the state budget in order to increase health insurance payments for students, pensioners and the unemployed. Milan Kubek, president of the Czech Medical Chamber, says that after this any protest actions against the health minister would be purely political - because the money crisis is over.

"Access to and quality of healthcare is not threatened in the Czech Republic. The new regulations on payments for services that come into effect this April will ensure 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."

Health minister David Rath, photo: CTK

Despite the promise of badly needed funds, doctors opposed to minister Rath are refusing to back down. They claim that money is only part of the problem. They are also critical of what they call "centralized decision making, socialist-style reforms and too much power in the hands of the minister." Dr. Smatlak again:

"The Minister of Health makes all the decisions personally, without discussions. He was concentrating all the power and all the money into his own hands. The system of healthcare provisions in the Czech Republic is based on health insurance, and his steps led to the situation that all these health insurance companies are—or they will be in a few weeks—fully powered and managed by him. The steps to a totalitarian regime of the kind we remember are really endangering us. We are really scared about it."

Photo: CTK

Three months ahead of the June general elections the situation in the health sector has become a hotly debated political issue. The opposition Civic Democrats are accusing the government of leading the health sector into a serious crisis. The government counters that the anti-government demonstrations are politically motivated and orchestrated by the power-hungry Civic Democrats.

As for patients—they just want the best possible care—although they may not always agree on how that should be achieved.

"I think that all of a sudden everyone wants to strike, and people are always dissatisfied with something. Doctors will receive an increase in salary, and it just seems like a political provocation."

"I'm convinced that the Ministry of Health is trying to re-socialize our healthcare system. They want to increase the role of the state in healthcare again, to emphasize the state's regulatory role. I think this is fundamentally wrong, so I can't agree. Instead I would focus on the systems that exist in states like Switzerland or New Zealand, but I wouldn't go in the direction we're going here today."

"Healthcare has become an economic issue today, and doctors are acting more like economists than physicians."