Can proposed new reforms save failing healthcare system?

For Czechs, extensive medical care has been the norm for generations. Healthcare was free for all in this country under communism. Since the Velvet Revolution, Czechs have continued to have easy and cheap access to medical services after the national health system was changed to a social-insurance model similar to that which operates in other European countries such as Germany. This means that Czechs pay obligatory contributions to state health insurers, which are proportionate to their earnings. This entitles them to the same level of health coverage regardless of their income. Although this sounds like an ideal and equable system, problems in the Czech health service have been mounting for some time now.

Dr. Pavel Hrobon

In theory, the health service is supposed to provide adequate care for all. Unfortunately, the relatively low amount Czechs contribute to healthcare coupled with spiralling costs for medical treatment means that the system is crippled with debts and cannot provide the level of care people have come to expect.

It's a problem acknowledged by the new Deputy Minister for Health, Dr. Pavel Hrobon:

"There are definitely serious problems in the current system. We have what used to be a standard European system 15 or 20 years ago. I'm fully convinced that everywhere in Europe the healthcare systems will have to change profoundly in the next 10 to 15 years because of pressures stemming from population aging, newer technologies and higher consumer demands. The Czech system will probably have to change earlier for two reasons: (A) We have missed some of the steps that have already been implemented in Western Europe in the last decade or so and (B) our pockets are not so deep. Therefore, the Czech Republic principally has to face the same problems as the German system, but we have less money that the Germans to subsidise our inefficient system."

As someone who is working for the new centre-right coalition government, Dr. Hrobon feels it's time to overhaul the current healthcare system. This includes following the lead of countries like Germany by making the insurance market more competitive and turning the nine state insurers into stock companies operating along normal business lines, which advocates say should make them more efficient and willing to offer better services.

Dr Hrobon also wants Czechs to contribute more to their medical care. This would include paying higher fees to see doctors, stay in hospital and be issued with prescriptions. As most of these services are currently free for Czechs, introducing a measure like this would be a bitter pill for many of them to swallow. Nevertheless, Dr Hrobon is hopeful that many people will appreciate that the benefits should outweigh the drawbacks:

"I should say that Czechs undoubtedly have the lowest doctors' fees in Europe and of course nobody wants to pay more. But even if you ask the obviously unpopular question as to whether people are willing to pay more out of their own pockets for visiting a physician, you find that there is a significant part of the population - roughly 50% - that is willing to pay more if they will get better services and a better choice."

Dr Hrobon argues that at the moment, the chronically under funded health system is only able to offer a universally mediocre standard of care. The new system, however, would allow Czechs to avail of better services by paying a surcharge on top of their standard insurance contributions.

One person who is against this idea is Josef Mrazek, the vice-president of the Czech Association of Patients:

"We want to develop the healthcare system from the right of the patient to get full healthcare based on the principle of solidarity. The official authorities say that they only have Czech levels of funding and so we don't have the budget for this. We say that this is not a question for officials but for the inhabitants of the country. The inhabitants want full care and therefore the authorities should find the optimum way of getting this full care. They should find out how much it will cost and then get the money for it. But the priority should be the provision of full care and not the amount of money it costs."

In championing the current socialised method of providing healthcare in the Czech Republic, Mr Mrazek believes he has the support of the vast majority of Czech citizens:

"In the Czech Republic, 85% of inhabitants want full solidarity, because they know that they may be wealthy one day, but be in financial trouble the next day. That's perhaps the reason why it's not just people from the Social Democrat party, but also many people from other parties are in favour of full solidarity. They are in favour of an insurance system where the insurance company can provide them with full healthcare."

Dr Hrobon says that he agrees with the principle of "solidarity" in the provision of healthcare, but that limits have to be put on people's expectations as to what the public health service can actually provide:

"It depends what you mean by 'solidarity'. I'm definitely among those 85%. But solidarity in my eyes means that everybody has access to necessary health services regardless of his or her ability to pay. But the way I see it, solidarity does not mean that everything is paid down to the last cent from common funds and that these funds are therefore wasted."

Mr Mrazek feels that if the Czech people want their government to ensure full and adequate healthcare, then it is up to the government to find the funds to ensure this, and that it has no right to introduce a market-based system of commercial health insurance, which he claims is not what the majority of people in this country want:

"This is the problem of the party that is in government. They say they can take some solidarity, which is solidarity between healthy and ill people. But they are not willing to accept solidarity between wealthy and poor people. Nevertheless, common insurance is not commercial insurance where everybody pays for the risk of each individual case. With common insurance everybody pays what he can pay depending on their income, and then everybody can get the same level of care from the insurance company. It's not possible to organise it any other way."

The Ministry for Health's proposed reforms should go before the parliament in June, but it is still unclear if they will be approved. The present centre-right government is dependent on the support of two rebel Social Democrat MPs, who might balk at the introduction of a market-based healthcare system. Pavel Hrobon is hopeful that the issue of a more efficient health service can be viewed objectively and not along ideological lines:

"I think the issue has been politicised. That's the main problem I see. At least to some extent substantial changes to the healthcare system have to be based on consensus or compromise between the main political parties. The tragedy of Czech healthcare is that health reform debate has been based on an ideological approach not on facts. This has to change. If nobody abuses the steps that have to be taken [for political reasons] then the part of the population that would be really resistant to the reforms is pretty low."