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September 7th, 2008

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Julínek to announce awaited health reforms

Minister says doctors should negotiate their terms for VZP refunds

By Kimberly Ashton
Staff Writer, The Prague Post
February 21st, 2007 issue

Health Minister Tomáš Julínek is expected to propose sweeping changes to the country’s cash-strapped healthcare system in the next week, including a plan to charge patients nominal fees for services that insurance currently covers completely.

Julínek, of the Civic Democratic Party (ODS), wants patients to pay 20 Kč (93 U.S. cents) for each prescription, 50 Kč for each day they spend in a hospital and 50 Kč per visit to a specialist.

Additionally, Julínek wants to put a 3,000 Kč ceiling on the amount patients can be charged annually for drugs and, for the first time, give them the option to purchase supplementary health insurance that will cover above-standard care.

He is also proposing to offer the public stock in state insurance companies.

Julínek, who succeeded the controversial Social Democrat (ČSSD) David Rath last fall, is expected to present a flexible timetable for these reforms Feb. 27, but they might not reach Parliament until early next year.

Julínek’s proposed reforms come as the healthcare system remains bogged down amid fresh opposition from doctors, who went on strike Feb. 14 in several locations nationwide to demonstrate against VZP, the state-owned health insurance company to which most Czechs belong.

They are upset over a contract Julínek finalized with VZP last September. The Czech Medical Chamber wants a new or amended contract with VZP by April that reflects a 10 percent increase in payments to doctors. VZP is balking, saying the terms of the current contract stand.

“The doctors refuse to be the sponsors of the bad financing of the Czech healthcare system,” chamber President Milan Kubek says.

Picking up after Rath
If all this sounds familiar, that’s because VZP has been under fire for years over its financial management and its oft-late payments to Czech doctors and hospitals.

Rath arrived on the scene in 2005 and promptly sacked VZP’s director and put the insurer under forced state administration, an effort to make its management more accountable and to rein in its troubled finances.

But Rath’s reforms had questionable results, and critics charged that the forced administration actually weakened VZP.

“Julínek has dedicated most of his [six months in office] to fixing the errors of the previous minister,” Health Ministry spokesman Tomáš Cikrt says.

Rather than targeting VZP directly, Cikrt says, Julínek has been concentrating on other areas of the healthcare system. He has improved patient access to medical records, Cikrt says, and secured more funding from the European Union.

Cutting costs
Cikrt says the reforms Julínek is proposing will shorten hospital stays, reduce the amount of drugs prescribed to patients and decrease overall visits to doctors — all elements that have contributed to the financial state the healthcare industry has been battling for some time now.

Hospitals are generally paid based on the number of occupied beds, which encourages lingering and flexible recovery times. Czechs often go to doctors for the simplest colds, and doctors respond by writing large numbers of prescriptions for things that could be readily cured over-the-counter.

The Health Ministry, however, is not yet speculating on how much money Julínek’s reforms will save.

Meanwhile, doctors say Julínek could do more to directly go after insurers like VZP.

State officials make up a third of VZP’s board of trustees. Julínek should “take advantage of the fact that the state has some kind of influence in the management boards of the insurance companies and try to reduce the negative impact of contracts,” Kubek says.

Julínek says doctors should “put their energy,” in Cikrt’s words, into negotiating their terms by 2008, when VZP’s contract with the state is up. VZP Director Pavel Horák agrees.

“We understand the doctors’ requirements, but it is too late to change something,” Horák says. “They should have come with their suggestions when the terms were being discussed [last fall]. The only thing left to do now is to negotiate the terms for refunds in 2008. There is still time to change something in 2008.”

But should the government be trying to keep doctors happy? The continued exodus of doctors to West European countries, where they can earn up to eight times as much, at least raises the question.

Each year, 1,000 doctors graduate from the nation’s seven medical colleges. But between 200 and 300 of them ask the Health Ministry for official confirmations of professional competence each year, according to Kubek. These confirmations are necessary to seek work abroad.

Foreign doctors are filling the gap left by the Czechs. “We have 1,300 Slovak doctors here, and I dare say that without them we could close many hospital departments,” Kubek says.

Hela Balínová contributed to this report.

Kimberly Ashton can be reached at kashton@praguepost.com

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