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Czech Republic: A Bright Exception In Post-Soviet Medical Decline (Part 5)

Underfunded by Western standards, the Czech health-care system nonetheless manages to provide some of the best treatment in the former Soviet bloc. Its success rests on a highly trained corps of medical personnel and a system that carefully manages limited funds. But while the Czech system offers health-care options comparable to those in Western Europe and the United States, it is struggling with run-down hospitals and the growing problem of "brain drain" as medical professionals look West for better career opportunities. In this final part of a five-part series on post-Soviet health care, RFE/RL correspondent Alexandra Poolos looks at the successes and challenges of the Czech health-care system as the country heads toward accession to the European Union.

Prague, 22 March 2002 (RFE/RL) -- The pediatric-cardiology center at Motol Hospital in Prague exemplifies the best of Czech medicine.

Equipped with the latest technology and staffed by personnel trained in Western Europe and the U.S., the center offers world-class surgical procedures and prenatal care for babies and children with congenital heart problems.

But housed in a decrepit building that has not been renovated in two decades and staffed by doctors paid a fraction of the salaries earned by their peers in the West, the Motol center also reflects the underlying challenges facing Czech health care today. While offering some of the best health care in the former Soviet bloc -- often on a level comparable with Western Europe and the U.S. -- the Czech system still lacks the basic funds needed to reconstruct outdated hospitals and pay its medical personnel competitive salaries.

Doctor Vaclav Chaloupecky heads a team of 20 doctors and 100 nurses at the Motol pediatric-cardiology center. He has been working there since the center's inception some 25 years ago.

Chaloupecky says the level of specialized care in fields such as pediatric medicine has always been high in the country because of its close proximity to the West. Since the fall of communism, he adds, things have only gotten better. Chaloupecky and many of his colleagues have spent time working in hospitals across Europe. They regularly travel to major conventions abroad, and keep track of the latest advances in medical research.

"Changes that have had a strong influence [on the health sector] are the exchange of information, the possibility to travel abroad, the possibility to be trained abroad. This was, I think, crucial for improving health care standards in this country," Chaloupecky says.

The World Health Organization (WHO) has ranked the Czech health-care system 30th in the world out of 191 countries. Life expectancy is higher than in any other postcommunist country except Slovenia, with men and women living well into their 70s. The Czech Republic has a lower infant mortality rate than either the United States or Great Britain, with just 4 deaths per 1,000 babies.

The Czech health-care system is based on a carefully weighted system of targeted financing. The country puts more money into health care -- over 7 percent of the gross domestic product (up from 5.4 percent in 1990) -- than any of its Eastern neighbors. But the money is going mostly to equipment and drugs, avoiding necessary renovations to hospital infrastructure and leaving highly trained doctors with some of the lowest salaries among the country's professional workforce.

Chaloupecky says the careful distribution of funds allows the country to provide the same surgical techniques, drugs, equipment and intensive-care units as one would find in neighboring Western countries: "It's always a question of money. How much do you want to spend on the health-care system and how efficient is the system? Because expenses are rising dramatically in all countries. [But by] traveling abroad and working abroad, the one major advantage is that you can compare your own system with others. And it's always very nice to find out that the level [of health care here] is almost the same [as in the West]."

But while health-care techniques are comparable to those found in Western Europe, the hospital environment is not. At Motol, one of the country's preeminent hospitals, paint chips off the walls and basic necessities like heating and hot water are not always available.

The situation in provincial hospitals is even worse. Less money is allocated to local facilities, which operate more as basic-care outfits. Surgical candidates are more likely to be sent to Prague, where most of the country's specialists are based.

The attempt to keep health-care costs low by underpaying doctors is resulting in potentially one of the worst blows to the Czech Republic's national health care: a "brain drain" of both doctors and nurses.

The average salary of doctors is 28,000 Czech crowns ($700) a month. While this is about twice the national average for workers, the rate is a fraction of what doctors can earn in Western Europe. To boost their salary, many moonlight selling drugs for pharmaceutical companies, or even driving taxis.

Nurses earn around 14,000 crowns ($350) a month. As a result, many have opted to seek employment across the border in Austria.

The brain drain is apparent even in Chaloupecky's small, specialized field. A recruiting ground for Western hospitals, Chaloupecky regularly watches his highly trained colleagues poached for better-paid positions outside the country.

Jan Marek, a prenatal diagnostic expert with 16 years at the Motol center, is now preparing to move to London, where he has been invited to head the prenatal heart team of a local hospital.

Marek says he is making the move not for money, but for the opportunity to work at a respected Western hospital: "It's a big challenge for me. The hospital is among the best pediatric hospitals in Europe. So for me, it's good to stay for even one year to see how such a hospital works. So if you ask me about money, for me, my decision is based on being willing to go to see another place, rather than to earn more money."

Ironically, the Western training that many Czech doctors receive also can act as a gateway, introducing physicians working at home to better-paid situations elsewhere. Chaloupecky says he maintains a policy of requesting doctors in his center to spend at least a year training in the West. He says he is aware of the risks, but maintains hope that Czech doctors will return to what he calls the "excellent camaraderie and situation" back at Motol.

"Of course, we are concerned. But on the other hand there are other people trained [who are ready to work here]. And it's our policy that the doctors from our team should spend some time abroad to gain some experience. But of course, if someone stays forever and if he's an expert, this country is losing an expert," Chaloupecky says.

The westward migration of Czech doctors and nurses is likely only to get worse the closer the country comes to joining the European Union. But entering the European community may also provide the means for the Czech Republic to hang onto its doctors.

Many doctors hope a higher standard of living will arrive with EU accession. More money may mean more citizens will be able to afford private health care schemes, eliminating state insurance companies' current monopoly on the market. State insurers, which cover some 90 percent of the population, set the rates at which doctors and hospitals can be paid for their services. Doctors say this leaves medical services underpriced and also prevents practitioners from accepting contracts with private companies. But if citizens can begin to afford individual health care schemes, doctors will be better able to run successful private practices.