Developments in Health Care in the Czech Republic

in 2010 - 2011

MUDr. Zdeněk Mrozek, Ph.D.Vice-President, Czech Medical Chamber

OutlineMain problems of the Czech Health Care

SystemThank you we are leaving – the biggest and

the most successful campaign of the Czech medical doctors

Health Care ReformConclusions

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Main problems of Czech health care

Lack of funds

Lack of qualified zdravhealth careprofessionals

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I am afraid, Dear Colleagues, that this is more serious than we thought!

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Injustice in health insurance payments

Not all really pay 13,5 % from their incomes Payments by state for economically non-active population

Payment by the state for 60 % of inhabitants, who consume 80 % of health care, represents only 24 % of health insurance companies incomes

Increase of payments by state is a political decision

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Monthly insurance premium

Employees 2 865,- CZK

Self-employed persons 1 243,- CZK

Persons with no taxable income 1 080,- CZK

Persons whose health insurance is paid by the state

723,- CZK

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Injustice in health insurance payments

Exodus of Czech doctors

Certificate of Good Standing

Certificate of non-membership

in the CMC

Total

2006 348 3482007 339 3392008 263 50 3132009 272 64 3362010 557 134 691

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Source: CMC Registry

Physicians leaving the Czech Republic – per age

Age 2008 2009 TotalUp to 30 years 22 37 59 11,0 %

30 – 40 135 135 270 50,5 %40 – 50 67 70 137 25,6 %

50 – 60 31 24 55 10,3 %

Above 60 8 6 14 2,6 %

Total 263 272 535 100,0 %

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114 university graduates are to be added to the above figures. They left CRin the years 2008 and 2009 without taking employment in CR as physicians.

Practising doctors are aging

Up to 50 years of age

Above 60 years of age

2000 67 % 11,5 %

2007 56 % 16,0 %

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The share of resp. age groups among practising doctors

Number of foreign doctors working in CR

Number of doctors

2003 8292004 1 0972005 1 1882006 1 6192007 1 8492008 2 0152009 2 129

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Reasons of dissatisfaction of hospital doctors

Low salaries and economic dependence on overtime work

Overburdening – Labour Code and EWTD are not observed

Worse working conditions in comparison to private doctors

Disintegration of the training systemCorruption The loss of hope for a better future

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Thank you we are leaving initiative

Demands of doctors formulated in March 2010Increase of salaries for the basic working time to the

level of 1,5 – 3 times the average salary in CR depending on qualification and experience. The same rules valid for all hospitals

A new system of further education of doctors which should be organised by the medical chamber.

Increase of payments from the health insurance companies to all health care facilities.

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Mass resignations from employment = efficient form of

protest

Genuine strikes are impossible in health care system as doctors have to secure the acute medical care.

Mass resignation from employment is an efficient “strike“, fully legal.Criminal prosecution of participants and organisers of the

movement refused by the courts.

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Action announced in May 2010Doctors will hand over their resignations from

employment on 31 December 2010 and from that date the two months notice period runs.

Announced prior to elections, when it was not clear which party will form the government.

Politicians were given few months time to fulfil the doctors’ demands.

Doctor’s Trade Union Club gained time to mobilise the doctors and to convince the general public.

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13 Reasons for the ExodusUnderfinanced health careLow payment for economically not active

persons by the state Personnel devastation in hospitals –

overburdening of remaining doctorsLow salaries of doctors (100 – 200 CZK/hour)Violation of the Labour CodeDestructed system of further education of

doctorsChaotic medical drug policyStrange hospital management – overpriced

supplies and appliancesUnfulfilled promises of politicians…

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Motto of the campaign“Our exodus, Your exitus?“

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Symbols of the campaign

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“Road show“ running through cities and hospitals

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3 830 doctors gave notice to December 31st 2010

Notice from employment was given in total by 22 % of hospital doctors.

Large regional differences in numbers of noticesDifferences according to specialisation:

Mostly anaesthetists, surgeons, neonatologists, obstetricians, neurologists

Doctors from private hospitals involved only in very small numbers. Several university hospitals did not participate, including the biggest one – University Hospital Motol in PragueIntimidation of employees or preventive increase of salaries

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Compromise has been reached14. 2. 2011

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On 16th February 2011, the regional Doctor‘s Union representatives accepted the agreement.

Signature of the final memorandum 17. 2. 2011

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Minister of Health L. Heger and Chairman of Doctors‘ Union M. Engel.The Czech Doctors‘ Union ended the campaign and called on doctors to return to work.On February 23rd 2011, Government approves the agreement as well as the increase of doctors' salaries.

The victoryThe biggest jump in the salary increases of employed doctors‘ in

the past 20 yearsReached at the same time when the government reduced the salaries in the

public sector by 10 %CR accepted the doctors‘ demand for a salary ranging between 1,5

– 3 times of the average national salary depending on their qualification and length of practice.

CR committed itself to reduce the amount of overtime work of doctors and to respect EWTD.

The ministry committed itself to cooperation on the health care reform with the representatives of doctors, including the Czech Medical Chamber and Doctors‘ Trade Union.

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Conditions for campaign success Great dissatisfaction of doctorsEfficient form of protestStrong organisation (Physicians´ Union Club)Keeping the unity of the majority of doctors

Supported by CMCHelp of professionals – PR agency

Struggle for favourable public opinionBreaking the unity of politicians

Negotiating with the political opposition and with individual members of the coalition government

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Health care reform goals To create a stable and transparent environment for

medical care respecting normal social and economic rules.

To find a fair compromise between the „unlimited“ possibilities of medical science and the limited economic resources.

To create for patients a friendly health care with satisfied health professionals.

To respect EU membership of the Czech Republic and to avoid experiments.

Reform is not made for one electoral term – consensus. 24

Health Care ReformHealth care reform laws passed in the Lower Chamber of

the Czech Parliament in July, August and September 2011Main positive changes: introducing standards of

treatment, possibility to pay for above-standard treatment openly, better definition of lege artis treatment

Main negatives: changes not discussed with opposition parties and health care professionals, transparency of the system remains the same, in some cases even worse, more bureaucracy

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ConclusionsCzech health care = one of the best health care

systems in the world Last 20 years - changes due to not only fast

development of medical science, but also due to vast and profound changes in the Czech society

The main issues in Czech health care: - exodus of Czech physicians- non-transparent financing

Necessary reforms - consensus of all parties, politicians and professionals

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