By Jana Mikotová

The Czech healthcare system is chronically ill. Ask anyone connected with it what the problems are and they'll quickly tell you: 90 percent of public money is spent on this system, yet we see billions in debt accruing with the health insurance giants; there's a huge and growing aging population; there's no gatekeeping to determine whether access to costly medicines, treatments and acute care hospital beds is appropriate; despite the state's claims of openness, there's little transparency in the reimbursement rates set for drugs.

None of these is difficult to fix, of course. But taking action on any one of them would be politically unpopular. It would require a health minister who is a strong leader and who is able to involve the patients in the solution, someone to convey to the electorate that some discipline is finally needed after a long period of abuse of the system.

Ordinary Czechs are accustomed to nearly free hospital stays and medication, though the latter is often of such low quality that many Western doctors would never prescribe it. They are not used to co-payments — nor are they used to seeing a thriving pharmaceutical sector that creates jobs, funds education, research and development of innovative products.

When most Czechs visit the doctor for some minor ailment, the experience is the same — they wait in a long queue, finally get a few minutes of the doctor's time, have a brief chat without any in-depth examination or tests, then are handed a packet or two of pills that cost little or nothing. Sadly, this usually satisfies them.

What they probably don't realize is that they've just witnessed the root of the problem. We need solidarity with chronically ill patients who have serious medical problems and may need expensive drugs: the aged, those who need dialysis, athsmatics, mentally ill and cancer patients.

Because the state spends millions on cheap generic drugs that have little real value, there are no funds left for the drugs and care needed by these more critical patients.

Because hospital beds are so cheap to patients and they are given so much time in them that hospitals become like cheap hotels, there are insufficient facilities available for those in real need.

Because there's no real gatekeeping system, and because it's always politically popular to dispense free pills and beds, the system is abused.

It's easy for politicians to blame big industry organizations, such as the state health insurance juggernaut VZP or the pharmaceutical industry, which it accuses of exploiting people for profits. But in a healthy healthcare system anywhere in the world, doctors, hospitals, insurance companies and drug manufacturers make reasonable returns. If they didn't there would be no development of new treatments and cures.

In short, you'd have a system much like the Czech Republic's.

Politicians are often heard touting the high-quality, low-cost Czech healthcare system and they have refused time and again to consider the kind of co-payment system so common in the West. Since 1992 they have been cutting drug reimbursements and at the same time arguing that co-payments would compromise their mission of looking after the poor.

Yet the Czech Statistical Office indicates that pensioners have been paying proportionally more than any other age group for drugs, and the monthly average of their fees is more than 800 Kč ($31.85).

And anyone with a pharmaceutical dictionary can see that the quality most patients really receive is hardly high. One medications commonly prescribed by doctors in the Czech Republic, Pentoxifyllin, is little more than a placebo and would never be commonly recommended by medical professionals in, say, Sweden or the UK. Yet the Czech Republic spent 260 million Kč on this item in 2004, essentially so it can say it offers affordable drugs to the public.

If the state truly wants to play advocate for the public, it must open its doors to them and initiate the kind of real transparency that it has been claiming to back for years.

The International Association of Pharmaceutical Companies, after working for years to win some kind of consistency and openness in the drug reimbursement prices set by the state, finally appealed to the European Commission this year for a ruling to demand improvements.

The agency responded Oct. 12 by ordering that the Czech Republic produce a timetable, a framework and an appeal process for the setting of reimbursement rates, as other EU member countries have.

It's an odd situation indeed for a pro-EU government to be in; because it has no defined drug policy, the union has now been forced to step in and demand one.

A healthy, transparent health system is something the Czech Republic should be fighting for, not against. Pharmaceutical companies in such a system indeed make reasonable profits, as do doctors, but also fund important studies at universities, if not entire departments that give rise to discoveries and promising young doctors and scientists.

In such a system, new products that are extremely costly to develop are reaching patients. Under the current Czech system, they are not, despite claims to the contrary by the current government administration.

In a healthy system, expensive acute-care hospital beds are available and affordable for patients who need them, but are not assigned without professional oversight. The EU average is 3 to 3.5 such beds per 1,000 citizens. The Czech Republic offers 5.9 beds per 1,000 inhabitants. Meanwhile, these beds are the second-lowest-cost healthcare expense for Czech citizens at 3.6 percent of their expenses, while they are one of the most costly items for the state to provide.

Better oversight and transparency means investment — and an industry with high added value. Czech patients and the public deserve it, and it's worth fighting for.