How are ambulatory physicians and smaller health insurance companies faring under the current Czech health care system?

At the beginning of the year, the majority of the Czech ambulatory services, some 22,000 health care professionals, closed their doors to patients and customers for an hour, to protest against the government's failure to meet their demands during its reform of the health care sector. The Czech Coalition of Ambulatory Physicians and the Union of Health Insurance Companies say since their protest act, neither the government, nor Health Minister Marie Souckova, have taken steps to consider the needs of the ambulatory services and health insurance companies in their reform plans. In this week's Talking Point, Dita Asiedu speaks with Jaromir Gajdacek from the Union of Health Insurance Companies, and gynaecologist and obstetrician Dr. Vladimir Dvorak, from the Coalition of Ambulatory Physicians after a two-day conference that was held recently to discuss their state in the current health care system:

How are ambulatory physicians and smaller health insurance companies faring under the current Czech health care system?

JG: "Our collective declaration contained the proposal for financial stabilization of health care in the Czech Republic. Our short time steps to the stabilization are the slow down trend of the accrual of health care, to stop the accrual of the price and aid that are paid from the public health insurance system, to prohibit interference of the government to contracts between health insurance companies and providers of health care, speed up the installation pay system DRG (Diagnosis related groups) in Czech hospitals. Further reforming efforts should be based on the following assumptions; high priority of justified interests of the Czech subjects - insured persons and their active involvement in the system of financing, maintenance of solidarity, motivation to responsible and economical behaviour, maximal efficiency of resource utilization, multi-source financing of health care, interconnection of health, sickness, and statutory accident insurance."

Marie Souckova, photo: CTK

VD: "There is really too much solidarity in this system. There is no space for private insurance. Health insurance is more like taxes. You just have to pay it and the patient cannot decide what he or she will pay extra and what will be insurance. So, I think that's the biggest problem. The other problem is that if you compare the situation with the other industrialised countries, in our country, the government spends more and more money for hospitals, which is really the most expensive part of health care and insurance companies have a very difficult situation because the ministry can tell them what they should spend their money for, and they spend more and more for hospitals so they don't have enough for the ambulatory physicians. There are many things we don't like because physicians in hospitals don't have the same situation, they have a lot of support from the government and it is difficult to compete. On the other hand, I think the patients prefer the private physicians because it's more comfortable for them and usually they are also better equipped."

How did Minister Souckova, who also attended the conference, react to your declaration?

JG: "Minister Souckova doesn't agree with the majority of our opinions for a solution in financing health care. She puts emphasis on strengthening the state's position in decisions about this and I, together with VDs, think the government cannot butt into a separately working system of public health insurance. Minister Souckova doesn't want to listen to our opinions and opinions of the majority of the skilled public. She has her own vision, which is impracticable."

Health Minister Marie Souckova has prepared her own proposal to an amendment to the law on health care. What points do you agree with and which areas in her proposal do you oppose?

JG: "We agree with reducing of the network of health institutions, with own trend of accrual of health care and drugs. We support patient's cash paying on some services according health care. We don't agree above all with reform system of redistribute many from premium for the public health care system. She wants to bring a lot of money from employees health insurance companies for the benefit of General insurance company. Now our insurance companies pay to General Insurance Company hundreds millions crowns every year and she wants more. When the change is accepted in our parliament, our companies will have some problems with paying and will come forced management, because they will be in paying incompetence."

VD: "It is difficult to talk about reform. I don't think that this material of Mrs Souckova is really serious reform. She has got a couple of good ideas but she doesn't have an idea of how to realise it. The most important is that she doesn't have the political support from her own party. So, it's very nice to talk to her and listen to the ideas but I don't think that anybody believes that anything good from those reforms can happen. Bad things can really happen."

What are your chances, in your opinion, of getting what you want, and making it become a part of Czech law?

JG: "The Parliament has to prepare lot of change in lows which included financing of health care. The changes that are prepared by the ministry of health has a low quality. It is for example low about public health insurance, about hospitals and health care. In this time are two lows exists concern health insurance companies, and General insurance company has better position than other. This is not good."

VD: "We try as the coalition of ambulatory physicians to talk not only with the ministry but also with other politicians and with some people from other political parties. Sometimes, it looks promising but the results are uncertain because if you want to do the necessary things, they are not very popular. And I don't think that Mrs Souckova is the first who acts like this. I think all our ministers of health were roughly the same in this matter. It's everywhere in a democracy, always before the elections or after the elections they are preparing new things to be elected and this is really not the way how to be re-elected. I think we have some hope. I hope that the best way would be to let us do what we should do with insurance companies and the ministry of health should be just something like an advisor and the ministry shouldn't play the role like now. It's too socialistic. It's just against any freedom of the patient and the physicians. We didn't receive any reaction yet, so we will see what Mrs Souckova will say. I assume that she will just say that there are problems and she will try to solve them. So, I think nothing new will happen."