Czech Republic fears EU membership will lure doctors

The Czech Republic's health insurance system is braced for an onslaught of new claims following the Eastern European country's entrance into the European Union in May.

Generally regarded as practising the highest standard of medical care in the former Eastern bloc, the Czech Republic is expected to be a mecca for patients from EU countries seeking better quality treatment than they can get at home.

“Middle class Russians or Arabs who want good care but can't afford the Mayo Clinic might ... [already] come to the Czech Republic,” says Pavel Hrobon, a Czech physician and health administrator.

In addition, there will be a shift in the physician workforce. Czeck doctors' earn about 35 000 crowns a month (Can$1785) — a quarter of the average income for physicians in neighbouring Germany. Hrobon predicts that 5% of doctors will seek work elsewhere. But David Rath, head of the Czech Chamber of Doctors, estimates the exodus will reach 30%.

Dr. Pavel Machac, an anesthesiologist at Prague's Nemocnice Hospital, says he is among those who will head West. “Here you are forced to work massive overtime even though it is against EU rules,” says Machac. “I want to be in a country where I am treated more fairly.”

Some specialists do work excessive hours due to an uneven distribution throughout the Republic.

Health Minister Jozef Kubinyi has attempted to quash fears of both a doctor shortage and an influx of patients. He points to the offsetting arrival of Slovak and Polish doctors who get paid more in the Czech Republic.

Patients will only be motivated to come to the Czech Republic for elective procedures, such as dentistry and plastic surgery, that they have to pay for out-of-pocket, he says.

The vast majority of Czech citzens are covered by the 9 public insurance companies. Private insurers supplement what is offered.

If patients do arrive from other Eastern bloc countries seeking Western-style medicine, they will also find a country with almost no waiting times for operations. There are only 330 people per doctor in the Czech Republic, compared to 650 people per doctor in Great Britain.

The country's 9 public health care insurers are the entity most likely to be affected by the country's entrance into the EU, since the families of workers from EU countries will now qualify for benefits, even if they are non-residents. Visitors requiring emergency care will also be covered. In addition, the government anticipates an influx of pensioners from Western Europe because of the Czech Republic's lower cost of living.

Ladilslav Svec, director of the Prague-based Center for International Reimbursements, said insurers will have to spend time and money “evaluating the concrete situation of concrete individuals,” to determine if they meet residency requirements that entitle them to benefits.

Perhaps the most pressing problem, Svec says, is the 70 000 Slovaks working in the Czech Republic who will now be covered by Czech insurance companies. Those returning to live in Slovakia, also now an EU member, are entitled to Czech health coverage even after they permanently leave the Czech Republic.

Insurance companies are already infamous in the Czech Republic for not paying doctors on time, so some critics question whether they will have trouble reimbursing foreign hospitals when Czechs get ill while they are abroad.

“It's estimated that international clearing of payments between insurance companies in the enlarged EU will take an average of 3 years,” says Hrobon.

The Czech healthcare sector is running a deficit of 10 billion crowns (Cdn$52 million) and co-payments, as well as a closing of numerous hospitals, may be a necessity.

In such a bankrupt system, foreigners can expect to find well-educated doctors, but preventive care and even toilet paper are not always options. — Dinah A. Spritzer, Prague