Czech Health Care System David Marx, MD, PhD

2 Motto: Where there is no vision, people perish. Proverbs, 29,18

3 Pre 1989 situation Centralized system State owned State employed No freedom of choice No quality incentives Political pressure  head physicians + nurses  investments

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5 Basic data – OECD 2009 Acute beds – 7,11/1000 population Norway 3,35; Germany 8,24; Greece 4,85 Long term care beds – 6,5/1000 popul Norway 9,3; Germany 10,3 Physicians – 3,5/1000 pop. Norway 4,02; Germany 3,6 Nurses – 8,06/ 1000 pop. Norway 14,2; Germany 10,9 % GDP : 8,2 Norway 9,6; Germany 11,6; Greece 9,6

LEB (OECD 2008)

7 Need for reform - General Demography Technologic changes Increasing No of providers Growing demand for quality HC Information assymetry rationing  Cost increases

9 Basic problems Structure Quality Cost efficiency

Ownership State Regions Municipalities Private Other (church, charities) 10

11 Financing Mandatory public health insurace (Bismarck)  13,5 % gross income Redistribution 100 %  risk adjustement Reimbursement:  capitation payment (GP)  fee-for-service  budgets

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13 Health care reimbursed in and outpatient care emergency care prevention drugs spa treatment occupational care medical transport

14 Health insurance paid by the state children pensioners maternity leave unemployed social need prisoners

Expenditure on health as % GDP 15

16 Problems Extensive coverage  co-payment Network of HC facilities Primary – Hospital care Acute – Long term care Communication skills/Bedside manners

17 Co-payment regulatory outpatient examination – 30/90 CZK hospital day – 60 CZK Prescription – 30 CZK yearly maximum – 2500/5000 CZK

18 Quality National accreditation body  hospitals International hospital accreditation ISO certification No direct financial incentives

19 Education - physicians 6 years medical school ( 8 medical schools) 5-7 years specialization training 84 specialties

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21 Education - nurses 3 years college/university training 3 years of working under supervision specialties - optional

22 Average salaries in health care 2009 CategorySalary/month/ year (USD) Physicians Nurses Average CR

QUESTIONS ? 23