In case of emergency, go public!
Famed for its lager, spas and post-Cold War privatisations, the Czech Republic has one of the best hospital systems in the former Soviet bloc. David Kernek finds out what visitors can expect from its emergency health services
First published in ITIJ 130, November 2011
Famed for its lager, spas and post-Cold War privatisations, the Czech Republic has one of the best hospital systems in the former Soviet bloc. David Kernek finds out what visitors can expect from its emergency health services
Two brains aren’t needed to work out what it was that two Czech towns – Pilzen and Ceske Budejovice – gave the world. But this pint-size country in the middle of Europe also has achievements in the health sphere that, along with its world-beating lagers, cannot be dismissed as small beer.
Complex medical history
Its first university medical school was founded in 1348, and a Czech scientist won the Nobel prize in 1959 for pioneering work on the separation of blood types. It’s the country in which the contact lens was invented, and it’s a leading European manufacturer of high-quality healthcare equipment; at its plant in Bohemia, the Japanese-owned Olympus Medical Systems Company makes endoscopes used in non-invasive surgery. The first-class skills of Czech medics and scientists in the biomedicine field were recognised internationally in 2008, when the US’s Mayo Clinic teamed up with St Anne’s University Hospital (founded in 1784) in Brno to establish a clinical and research centre specialising in cardio and neurovascular diseases.
At everyday ground level, the country wrecked by half a century of ruthless occupation – first by the Nazis and then the Soviet Union – runs acute health services that, although not without serious problems such as over-worked hospital doctors deeply discontented with low salaries, staff shortages, insufficient state funding, and controversial reforms designed to increase the role of the private sector, match in care and expertise most of the countries in the western half of the European Union (EU).
The European Health Consumer Index produced by a Swedish think tank* puts Czech hospital care among the five best in Europe after adjustments for capital spending. It has the seventh-shortest waiting periods, 8.7 beds per 1,000 population – that’s the eighth-best in Europe and more than twice the US score – and its infant and maternal mortality rates are among the lowest in the EU. Life expectancy at 76.8 years compares respectably well with the UK’s 80.5 and the EU average of 78.8**. Whether that is as a result of having the world’s highest per capital beer consumption is open to debate.
For severe illness or injuries, public teaching hospitals offer the most sophisticated care …
In an average year, AXA Assistance Czech Republic, which provides medical and travel assistance services for 37 per cent of the country’s travel insurance market, handles 2,600 outpatient cases, 50 hospitalisations and 110 repatriations. Most of the medical care, reports Dr Cai Glushak, medical director of AXA Assistance Group and chief medical officer of AXA Assistance in Chicago, is concentrated in the public sector, with private clinics and hospitals providing mainly outpatient care and operations during short hospitalisations.
“The quality of care and hygiene and the medical experience of staff and availability of equipment depends on the type of the hospital,” he says. “In large cities, it’s at a higher level than in small regional facilities. In our experience, the overall level of care in Czech public hospitals is comparable with those in Austria. Medical facilities have advanced rapidly, and certainly in the major cities they are equal to those in Western Europe. For severe illness or injuries, public teaching hospitals offer the most sophisticated care. Private clinics often have better amenities, but they do not usually do not handle critical cases.”
Often, where foreign tourists in trouble are taken depends on their health problems, says Marian Hanes, the company’s Czech Republic operations director. “Trivial problems such as common respiratory infections are treated in private facilities, but people with serious conditions that require complex investigations and sophisticated care are treated in public hospitals.” However, there have been over-charging problems, says Ms Hanes, chiefly with local clinics in the country’s mountain ski resorts, but private facilities in the big cities, though more expensive, ‘are very flexible in dealing with assistance services’.
At Mondial Assistance in Prague, medical director Dr Lidmila Vondrakova agrees that the level of the medical care in the Czech Republic is comparable with that in Western Europe. “Medical staff are well trained and have a high level of knowledge. Their medical equipment and technology is modern and widely available. Tourists are normally directed to private GPs, outpatient clinics and public hospitals.”
Mondial Assistance in the Czech Republic handled 8,243 medical cases in 2010, with gastroenteritis and respiratory disease topping the diagnoses chart. Trauma, ENT, and cardiovascular and gynaecology emergencies were also frequent. The vast majority of patients – 7,802 – were treated in outpatient clinics, while 254 patients were repatriated by air ambulance, medical transport and commercial flights.
This year, the company has established a specialised assistance platform staffed 24/7 by trained co-ordinators and doctors to help clients who call with medical problems. The company says that 99 per cent of clients wait on the phone for less than 20 seconds, with an average waiting time of seven seconds. Updated telephony and assistance systems have enabled faster and improved processing of requests, while a new communication system based on its existing Genesys Call Centre system and its proprietary MA Group assistance application will be in operation during the first three months of next year (2012).
In addition to standard medical services, the company offers a domestic health service that provides, by phone, advice and information about local clinics, hospitals, pharmacies and preventive programmes. It is also planning a Second Medical Opinion service, details of which are expected later this year.
Most of the medical care … is concentrated in the public sector, with private clinics and hospitals providing mainly outpatient care and operations during short hospitalisations
Knowledge of the local standards of care and levels of treatment available in various facilities is, of course, key for any assistance company operating in the country. Although both the state and private sectors are used for treating foreign patients, Dr Vondrakova commented: “There are sometimes shortcomings with hotel services in state hospitals. They are better in private sector, but on the other hand the level of the medical care is not guaranteed there in all cases.” The Czech state health service is funded largely by compulsory, wage-based payments to quasi-public health insurance funds, plus employers’ contributions, nominal cash payments by patients for GP consultations, emergency treatment and hospital stays, and direct state financing. The private sector currently accounts for 15 per cent of the country’s hospital beds – a share that is likely to grow as government privatisation reforms kick in.
The relationship between hospital doctors and the government reached crisis point last winter over protests about low pay and long hours, which the doctors’ unions claimed threatened patient safety and breached the country’s working time laws. The basic monthly salary of a newly-qualified doctor stood at £623 – lower than the average national wage – fully-qualified specialists were on £866 and senior department heads were paid £1,400.
“A doctor can work as much as 300 hours a month with all the overtime and double shifts they are expected to do,” said a doctors’ union leader. “They end up being paid the same hourly rate as someone who works in a fast-food outlet.” More than 4,000 doctors answered a union call for a mass resignation protest – known as the Thank you, we’re leaving campaign – and followed up with applications for hospital jobs in the US, Britain, and neighbouring Germany and Austria. The resignations were withdrawn when the government found £73.4 million for salary increases.
The EHIC in the Czech Republic
The European Health Insurance Card (EHIC) covers almost all acute healthcare provided in the Czech Republic. Says AXA’s Marian Hanes: “In the public sector, the card is generally accepted without any problem, and foreigners from EU countries are treated in the same way as Czech citizens. But in the private ambulatory sector, some facilities refuse to accept it and prefer cash payment from patients or a payment guarantee from their private insurance company.”
Along with Czech citizens, patients with EHICs issued by EU governments have to make recently-increased but still nominal payments – known as standard patient contributions for medical treatment: £1.10 for visits to GPs, outpatient clinics and dentists; £3.30 for accident and emergency (A&E) hospital treatment; and £3.67 for each day’s stay in hospital. The card, plus these cash payments, cover foreigners for emergency treatment needed to allow patients to continue their stay until their planned departure date.
Long-term expatriates are required by Czech law to have proof of insurance – minimum cover £20,000 – for emergency hospital treatment, and £20,000 for repatriation.
Top hospitals
These university hospitals are among the best in the country, according to AXA Assistance in the Czech Republic and Mondial Assistance:
University Hospital Motol, Prague – specialises in children’s medicine, and is a major centre for lung transplants;
Hospital Na Homolce, Prague – recipient of the Czech Medical Association’s Hospital of the 21st Century award, its high level hotel services make it popular with expatriates;
Institute of Cardiovascular Medicine, Prague – largest cardiosurgical department in the Czech Republic, performing approximately 1,500 operations annually;
Military Hospital, Prague – best neurosurgical unit;
Charles University Hospital, Prague – best burns department; and
University Hospitals in Brno, Pilzen and Ostrava.
Most of the large public hospitals are classed as trauma centres, but the major ones are in Prague and Brno.
University Hospital Motol has a ‘foreigners’ department’, where English- and German-speaking staff register overseas patients, liaise with medical staff and process insurance documents and payments. Reception staff at Hospital Na Homolce – described by one overseas patient as ‘outstanding … on a par with the best Germany has to offer’ – are fluent in English, German, French and Russian. In fact, English- and German-speaking doctors can be found in most public and private hospitals and clinics.