The fury directed at Health Minister David Rath has reached its climax as healthcare workers prepare for a massive Feb. 24 demonstration that could see as many as 20,000 pharmacists, doctors and patients protesting on Old Town Square.

Some continue to call for Rath's resignation, while others say they hope the protest will at least force the government to reign in some of the cutbacks he has imposed on the country's ailing and cash-strapped healthcare system.

"There needs to be a professional discussion before any changes are made in health care," said Lubomír Chudoba, president of the Czech Pharmaceutical Chamber. "Right now this isn't happening. I hope the protest will change that. We hope the protest will force Rath to realize that he can't go on acting like a dictator."

The Czech healthcare system is mired in debt. Rath blames this on the poor financial management of VZP, the country's biggest state insurer. Estimates put VZP as much as 15 billion Kč ($630 million) in the red.

A painful three months

To help cover this shortfall, hospitals have had to cut services by as much as 20 percent, causing the postponement of elective surgeries and placing a limit on treatments medical centers can prescribe.

Hospital officials say they are having trouble staying under that limit, and consequently have amassed more debt as VZP refuses to cover costs when they exceed it.

On Feb. 15, the Association of Drug Distributors (AVEL), which covers 95 percent of the pharmaceuticals market here, halted deliveries to three hospitals — Bulovka and Thomayerova, both in Prague, and U sv. Anny in Brno — that have failed to pay a total of 400 million Kč owed for drugs.

Pavel Suchý, the director of AVEL, said distribution wouldn't resume until that debt is resolved.

Rath responded by likening the drug companies to Mafia organizations and said he would try to find other companies that could replace the distributors allied under AVEL.

"Something like this wouldn't happen in a civilized country," said Suchý. "That's not how debtors behave toward their creditors."

Another of Rath's most recent cost-cutting measures was to lower the profit margins for pharmacists from 32 percent to 29 percent.

Pharmacists protested outside Rath's window Jan. 26, but their complaints went largely unnoticed. In fact, Rath suggested that he might force the margins even lower this spring. Four days later, pharmacies across the country went on strike for an afternoon. Rath responded by saying there was no need for pharmacies to exist at all: Doctors and hospitals could give out medications directly.

Chudoba of the pharmacists' union said such claims are "very silly."

"Every healthcare system needs pharmacies," he said. "Pharmacists are often more readily accessible to patients than doctors."

According to Vítězslav Klíma, spokesman for the Health Ministry, Rath is still prepared to negotiate with the pharmacists.

But others are starting to lose their patience with Rath as well.

Even Milan Kubek, who replaced Rath as president of the Czech Medical Chamber (ČLK) and has been a longtime supporter of his, asked Rath Feb. 16 to reconsider some of his measures.

Specifically he wanted Rath to give hospitals more leeway when it comes how much they may exceed limits on medication expenses. Rath said such a change would be unlikely.

Kubek refused to comment on his meeting with Rath and on the upcoming demonstration.

Pavel Kubíček, spokesman for the ČLK, said the chamber understands the health workers' concerns but that they are judging Rath's actions only from their own angle. "The demonstration won't resolve anything," he said.

Patients are jumping into the fray for the first time because they worry the cutbacks are beginning to have a serious impact on their care, according to Luboš Olejár, president of the Czech Patients' Association.

"Patients are sending us frustrated letters about how they are volleyed back and forth between different doctors who say they can't treat them because they have exceeded their financial limits," Olejár said. "It's unacceptable."

A polarizing figure

In spite of the severe criticism, even some of Rath's critics admit that he has brought about a few positive changes, namely that he is at least trying to deal with the healthcare deficit.

Rath's unpopularity has nearly as much to do with a style that many describe as abrasive and undiplomatic as with the changes he has imposed.

In one of his most recent statements that many ridiculed as bombastic, Rath lashed out against his critics, asserting that the Civic Democrats (ODS) are behind the demonstration.

Tomáš Julínek, ODS member and shadow health minister, called such a claim ridiculous.