czech health care system

Czech Health Care System

David Marx, MD, PhD

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Motto:

Where there is no vision, people perish.

Proverbs, 29,18

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Pre 1989 situation

Centralized systemState owned State employedNo freedom of choiceNo quality incentivesPolitical pressure

head physicians + nursesinvestments

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Basic data – OECD 2009

Acute beds – 7,11/1000 populationNorway 3,35; Germany 8,24; Greece 4,85Long term care beds – 6,5/1000 populNorway 9,3; Germany 10,3Physicians – 3,5/1000 pop.Norway 4,02; Germany 3,6 Nurses – 8,06/ 1000 pop. Norway 14,2; Germany 10,9% GDP : 8,2Norway 9,6; Germany 11,6; Greece 9,6

LEB (OECD 2008)

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Need for reform - General

DemographyTechnologic changesIncreasing No of providersGrowing demand for quality HCInformation assymetryrationing

Cost increases

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Basic problems

StructureQuality

Cost efficiency

Ownership

StateRegionsMunicipalitiesPrivateOther (church, charities)

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Financing

Mandatory public health insurace (Bismarck)13,5 % gross income

Redistribution 100 %risk adjustement

Reimbursement:capitation payment (GP)fee-for-servicebudgets

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Health care reimbursed

in and outpatient care

emergency carepreventiondrugs

spa treatmentoccupational caremedical transport

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Health insurance paid by the state

childrenpensionersmaternity leaveunemployedsocial need

prisoners

Expenditure on health as % GDP

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Problems

Extensive coverageco-payment

Network of HC facilitiesPrimary – Hospital careAcute – Long term careCommunication skills/Bedside manners

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Co-payment

regulatoryoutpatient examination – 30/90 CZKhospital day – 60 CZKPrescription – 30 CZKyearly maximum – 2500/5000 CZK

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Quality

National accreditation body hospitals

International hospital accreditationISO certificationNo direct financial incentives

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Education - physicians

6 years medical school ( 8 medical schools)

5-7 years specialization training84 specialties

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Education - nurses

3 years college/university training3 years of working under supervisionspecialties - optional

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Average salaries in health care 2009Category Salary/

month/year(USD)

Physicians 287034440

Nurses 154518540

Average CR 137016440

QUESTIONS ?

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