To pay or not to pay:controversy over medical fees ahead of reform

With less than two weeks to go to the end of the year, doctors’ offices are bursting at the seams. However, it is not a flu epidemic that’s filling waiting rooms; people are concerned about having to pay fees for medical services as of next year, and are stocking up on medicines just as they would hoard up on food ahead of an expected price hike. The rumblings of discontent over the health reform are growing and they are leading to a last-minute flurry of uncertainty among government politicians.

MUDr. Alexandra Horáková ve své ordinaci
Of all the reforms implemented thus far – this is undoubtedly the most controversial. Direct payments for a visit to the doctor, for a prescription or for time spent in hospital – the proposed change has come as a shock to a nation unused to paying for medical care and many Czechs say it is simply unfair since they are already paying medical insurance. The opposition Social Democrats support this view and have filed a complaint with the Constitutional Court on the grounds that payments for medical services are in violation of the law which guarantees medical care for every citizen. They argue that many people – predominantly pensioners and the socially disadvantaged - will not be able to afford health care and have now tabled a proposal to scrap medical fees before they actually take effect. Former Social Democrat health minister David Rath urged the Civic Democrats to abide by their election promises:

David Rath, photo: CTK
“I hope that something will jog the Civic Democrats memory, and remind them of their promise to voters not to introduce fees for medical services. The prime minister even signed a written pledge to that effect. They still have time to make good on that promise.”

Some senators and a number of celebrities recently signed a petition urging Czechs to refuse payments. This led to a storm of controversy, with Health Minister Tomas Julinek expressing outrage that law-makers should urge Czechs to violate the law. He said Czechs who do not pay could find themselves on debtor’s lists and would have trouble getting a loan. The Association of Patients promptly came up with a new form of protest – advising patients to pay in small denominations to make the doctor’s job harder. The crowds of people in their waiting rooms are already doing a good job of that, and at least one hospital has said it would not collect money from under-age children, considering it immoral.

The storm of opposition to the health reform has unsettled the Christian Democrats – one of the three governing parties – who never liked the idea of pensioners and children having to pay. They claim that the impact of the reform should be assessed in six months’ time and if necessary the socially disadvantaged should be exempted from payments. The opposition Social Democrats have greeted this show of uncertainty with enthusiasm, the governing Civic Democrats with anger. But the health minister is standing firm, saying fees for medical services will be introduced since they are vital to better quality health care. People say they will wait to see that to believe it – and many of them are spending long hours in doctors’ waiting rooms in order to save money on health care in the first quarter of 2008.