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Hospitals oppose merger proposal

Reforms to combine research and independent facilities

By Markéta Hulpachová
Staff Writer, The Prague Post
November 28th, 2007 issue

Highlights of healthcare reform

Medical services fees to start in January

In addition to the proposed hospital mergers, the healthcare reform package signed into law this October introduces a requirement that patients pay fees for certain services previously covered by insurance.
Health Ministry spokesman Tomáš Cikrt calls these provisions a necessary step toward a more effective system.
"When it comes to wasting healthcare funds, the Czechs are masters," Cikrt says. According to the Czech Statistical Office, an average resident visits the doctor 13 times a year, about twice the norm in France, Austria or Germany. Such a rate, Cikrt says, drains the system's financial resources and diminishes quality of care because, "the doctor can only give a patient a very limited amount of time."
By charging nominal fees for routine services, Health Minister Tomáš Julínek wants to lower the length of hospital stays, cut back on prescriptions and curb the habit of visiting the doctor for minor ailments. Patients will be able to make additional payments to "upgrade" their care.

— Markéta Hulpachová

REFORM HIGHLIGHTS

The four standard fee categories
- Routine doctor's visit 30 Kč
- Drug prescription 30 Kč
- Emergency room visit 90 Kč
- Hospital stay (per day) 60 Kč
Estimated fees for common needs
- Common cold or viral infection 120 Kč (for exam, two prescriptions, and follow-up visit)
- Childbirth 360 Kč (for three days of hospital care)
- Pneumonia 840 Kč (for two weeks of hospital treatment)
Max annual out-of-pocket expenses
- To protect chronically ill patients 5,000 Kč
For the Health Ministry's guide to reforms (currently available in Czech only), go to: www.mzcr.cz

Health Minister Tomáš Julínek has come across some unexpected hurdles while preparing to consolidate the outdated national hospital system.

In an effort to increase the efficiency of state healthcare institutions, Julínek wants to merge teaching hospitals with independent health institutes. As a first step to this reorganization, Julínek plans to fuse the Institute of Hematology and Blood Transfusion (ÚHKT) in Prague 2 with the nearby General Teaching Hospital (VFN).

But the minister’s actions have met with opposition from ÚHKT patients and management, who fear that the larger VFN will siphon funds away from their specialized institution.

Alarmed that the merger will impact the quality of care, about 300 VFN and ÚHKT patients gathered in front of the Health Ministry building Nov. 15 to protest against Julínek’s plans.

“By making the ÚHKT part of the larger VFN, the blood transfusion center would have less funding to successfully develop hematological research,” says former ÚHKT Director Petr Klener, whom Julínek dismissed Nov. 7 after accusing him of spreading false fears among his patients regarding the proposed merger.

While denying these charges, Dr. Klener continues to voice his concern about the future of the ÚHKT. “The cooperation between the two institutions is fine as it is,” he told the daily Hospodářské noviny after his dismissal. “The merger would only make sense if the VFN’s [blood transfusion center] moved to the ÚHKT — not the other way around.”

Faced with criticism from both the research and medical community, Julínek maintains that his actions are warranted, even as Klener continued to campaign against the Health Ministry’s plans through the media and by allowing patients to sign petitions in ambulances. “He acted unethically as a doctor and irresponsibly as a manager,” Julínek says.

Julínek’s plans have also alarmed researchers, who worry that the consolidations will result in a drop in funding.

“Through these not very well-considered changes, we could lose … top research in the field of medicine,” Academy of Sciences Director Václav Pačes told the Czech News Agency (ČTK) Nov. 16.

In response to these concerns, Julínek agreed Nov.19 to collaborate with university experts while drafting a bill on university research institutions early next year.

“The [rectors] will send their specific proposals to the ministry, and we will nominate a team of experts to help us draft the bill,” says Health Ministry spokesman Tomáš Cikrt.

Nevertheless, Julínek’s position on the matter remains rigid:

“What our hospitals will look like in the years to come is solely my responsibility,” he says. “Will they continue to rack up debt, or will they grow to provide quality care?”

While some of the state’s current healthcare concerns, including the high turnover of local doctors, are problematic throughout the European Union, Julínek says the current organizational issues are a specifically Czech problem. “When it comes to health care, the organization that we have here is post-Socialist,” he says.

By centralizing high-cost facilities such as intensive care units within overlapping institutions, the hospitals have a chance to decrease their expenditures.

“When you have one prime state hematology clinic resolving the same issues as an institution that is situated right across the street from it, it’s logical that certain activities within those two institutions overlap,” Julínek says.

The merger would also allow the institution to purchase specialized equipment and medication for lower rates.

“Some of these medications are extremely pricey, and it is possible to get a better price for them,” Julínek says.

To optimize the fusion of the institutions, the Health Ministry has asked both the VFN and the ÚHKT to prepare a plan of requirements that would enable a smooth transition. “If there are problems, we want both sides to identify them so they can be resolved,” Julínek’s deputy Marek Šnajdr says. “But, thanks to this media game, we’ve lost three weeks, maybe even a month of time.”

Markéta Hulpachová can be reached at mhulpachova@praguepost.com

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