Selecting one’s surgeon is now possible for a set price

It’s a revolution in Czech health care: as of this month some Czech hospitals are enabling patients to be treated by the surgeon or specialist of their choice on condition that they are prepared to pay extra for his or her services. While the change has only legalized a practice that’s been around for years, critics say it smacks of discrimination.

Photo: Filip Jandourek

It is a practice that has been around for years: people slipping envelopes with cash into doctors’ pockets in an effort to ensure the best possible care for themselves or their loved ones. Those who could afford the best sought someone to introduce them to a renowned specialist assuring them they would not remain in their debt and were ready to pay for above-standard care.

At the initiative of doctors themselves, the Health Ministry has now moved to bring this practice out into the open giving patients the right to select a physician of their choice for a given sum of money - between 5 and 15 thousand crowns. Half of the money will go to the respective hospital or clinic, the other half to the specialist in question. Advocates of the change say that this will not only benefit the medical institutions by giving them more money to invest in the latest technology, but also help them draw the best specialists in the field who know that their skills will not go unrewarded in state hospitals. It would also motivate doctors to improve themselves. The country’s most prominent heart surgeon Jan Pirk is one of those who pushed for the change.

“I think it is perfectly natural that people should have the right to decide who will perform heart surgery on them. People pick their hairdresser, why should they not have the right to pick their heart surgeon?”

It is not only the country’s leading surgeons who are in high demand but also gynecologists and obstetricians. This young woman says she’d certainly make use of the chance to select her obstetrician.

“Of course I would do it to get better care. It helps when you trust the doctor and know he is good. I would most certainly be willing to pay.”

Others are less enthusiastic, fearing that the move will lead to a discrimination of patients who cannot afford to pay for above-standard care and will end up getting treated by less experienced or less capable physicians. The head of the Czech Patients Association Lubos Olejar says it’s simply not right.

“Of course there are patients who will not be able to afford it. They pay health insurance which should get them the best care available especially in serious cases and emergencies and now there’s a risk they will not get it because the best surgeon for the job will be busy performing plastic surgery on a rich client.”

Hospitals reject such claims saying that all patients will be given the best possible care and that complicated cases will automatically go to the most experienced physicians anyway. Rich clients will not be able to jump cue and specialists who are in high demand will have to spend additional time on “paying” patients. Jaroslav Fajrajzl, head of the Podoli Clinic for Mother and Child, says it is the right decision because it will bring under control a practice that is already widespread.

“This was a way of making the practice more transparent. People were paying to be treated by a specialist of their choice anyway and this will legalize the process and make sure that part of the money goes to the respective institution which will use it to provide better care.”

The Health Ministry has left it to individual medical institutions to decide whether or not they want to make use of such an arrangement. Prague’s Vinohrady hospital is the first big state hospital to offer its clients the possibility. Others are biding their time and say they will wait and see how much interest there is on the part of patients.