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Czech Republic: Clash Looms Between Doctors And Government

Prague, 30 September 1997 (RFE/RL) -- The simmering disagreement between doctors and health authorities in the Czech Republic seems set to break into open conflict.

Many doctors, angered by what they say is their chronically low income, says they will begin from tomorrow demanding direct payment from patients.

Czech Health Minister Jan Strasky has threatened to seek de-registration of any doctor charging direct fees, and he also says he will dismiss any hospital directors allowing doctors in their institutions to levy such charges.

The head of the Czech Medical Doctors' Trade Union Club, Dr. David Rath, told RFE/RL today that the doctors are determined to go ahead. He says he expects "something like war" with the Health Ministry if Strasky's threats are implemented. Rath, whose organisation claims a membership of some 20,000 doctors, warned that there would be a response if the minister move to carry out his threat.

At the heart of the problem is the claim of doctors in private practice that they can barely make a living of what the Czech health care funds pay them per patient. And they say the problem is compounded by very slow payment from the funds, most of which have low liquidity, and some of which have gone bankrupt.

In the Czech Republic's post-communist health system there are more than a dozen health care funds. Most of them are private-sector companies, but by far the biggest is the state-run VZP.

The doctors want to break away from the low fee structure by charging an additional increment averaging about an extra 30 percent of the rate paid by insurance companies. For instance, where a specific type of consultation is covered by the approved health funds at up to 200 crowns, the doctors want to charge 300 -- with the patient paying the difference.

Rath says that doctors in the Czech Republic earn little more than a normal worker, something like $330 a month -- although he concedes that shift work by hospital doctors can increase that sum considerably. He notes a young secretary in Prague working for a foreign company can earn easily $500, and he says a true reflection of the value to society of a qualified medical practititioner would be a salary ranging up to $1,000 per month.

The Czech Doctors' Association (CLK), headed by Bohuslav Svoboda, says it also will give "utmost support" to doctors around the country who demand extra payments.

Svoboda says a solution might be found if a plan backed by Minister Strasky is actually implemented. The Civic Democratic Party (ODS), the leading partner in the governing three-party coalition, at the weekend gave support to the plan, which calls among other things for a series of slight increases in fee payments to the doctors. The ODS said that solving the country's growing health crisis is a top priority. A bill is to go before the parliament in December, but whether it will satisfy the doctors is unclear.

The dispute with the doctors is only one strand of the Czech Republic's health system troubles. The problems are common to many transition economies, in which the medical systems are caught between the old and the new models, with financial collapse looming. Since the fall of communism the Czechs have acted decisively to upgrade their antiquated hospitals with new equipment and medicines, and have also increased salaries. But the new material, mostly imported, is very expensive.

The result: Czech hospitals are deeply endebted, and many are unable to pay their mounting bills for medicines. Reports earlier this month put hospitals endebtedness to medicine suppliers alone at more than $30 million. The Government, which is trying to get the hospitals to manage their affairs more efficiently, has had to step in with special grants to keep a number of the institutions running.

In in the middle of all this, seemingly almost forgotten, are the patients.