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Czech, Slovak health care reforms look similar, but differ

The Czech and Slovak reforms of the health care system may look similar, but they take place in different situations as Slovak reformers had to save a heavily indebted system and introduce radical measures that „hurt” Slovaks, Czech Health Ministry spokesman Tomas Cikrt told CTK.

„We try to prevent such a crisis situation through the reform. Our reform thus can be centered around the patients - their position in the health care system and the services provided will improve,” Cikrt said. Czech health care spends 7.2% of GDP, while Slovak health care spends 6% of GDP. Slovak 2007 health care budget is 90 billion Slovak koruna (€2.7 billion, $3.6 billion) and the debts in the system were 40 billion koruna before the reform. Czech health care has 200 billion Czech koruna (€7.1 billion, €9.6 billion) this year and there is a 2-billion debt in health insurance. Two years ago, its debt was 14 billion koruna.
The Slovak reform had to proceed very quickly because of the threatening collapse of the health care system. The key laws were passed within three years. The Czech reform is to last eight years. In the current election term, the passage of 12 laws is planned that would change the role of the institutions and the environment for the citizens. Financial issues are to be dealt with in the next four years.

Czech health insurance companies are to become joint-stock companies this term, while they are to offer various insurance schemes in the next term. The speedy reforms caused legal problems to Slovakia. But these problems are very unlikely to develop in the Czech Republic, Cikrt said. Czech health care is more differentiated as there is a regional system and a large private sector apart from the state system. There is no need to fear that health care facilities or insurance companies would be gained by a single owner, he said. But former Czech health minister David Rath (Social Democrats, CSSD) has reservations about the reform. Rath claims that Health Minister Tomas Julinek (Civic Democrats, ODS) copied the Slovak reform and that the Czech reform is funded by foreign medicine producers. Rath said that the Czech reform applies the privatization of health insurers and hospitals and in cash payments for prescriptions, visits to doctors and hospital stays by patients that were introduced in Slovakia and „resulted in a tragedy there.”

In Slovakia, the Penta investment group took part in the privatization, taking over two insurance companies, a number of hospital and a network of pharmacies and distributors. „This is a monopoly for the administration of state money and for its spending,” Rath said. Cikrt pointed out that the Czech reform does not want to lead to a dominant owner of health insurance companies or hospitals. Czech health care is covered by public funds by 90%, patients pay 10%. In Slovakia, the ratio is 85:15. As from January 2008, cash payments by Czechs are to be introduced. Slovak patients have paid cash for four years, but the new government cancelled some of the payments last year. Though the Czech reform plans cash fees in order to reduce the abuse of the care, these steps that were introduced in Slovakia are not the core of the reform, Cikrt said.

Both the Czech and Slovak reforms focus on the development of health insurance, competition between insurance companies and purchase of health care services for those insured. The current Slovak government of Robert Fico (Smer-Social Democracy) is canceling some of the reform steps pushed through by the previous right-wing government of Mikulas Dzurinda (Slovak Democratic and Christian Union). The coalition government of Mirek Topolanek (ODS) does not hold a majority in the parliament and it will have to negotiate about the reforms with the left camp, mainly the senior opposition Social Democrats (CSSD). (