When the Academy for International Health Studies traveled to Prague in April for its annual trade/study mission, little did
the delegates know they were about to enter a healthcare war zone. Weeks in advance of a contentious national election, the
country's prime minister recently had fired the minister of health and named a successor with a mandate to implement some
quick fixes. Insurers managed their strained cash flows by slowing payments to providers while the new minister, seemingly
arbitrarily, mandated price reductions. The result was a physician-organized strike and thousands of angry, untreated patients.
Managed Healthcare Executive Editorial Advisor Bruce Pollack, MBA, is president of the Academy
for International Health Studies.
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Following a one-week academic program, however, which included discussions with the Czech Ministry of Health, private sector
entrepreneurs and healthcare policy experts, the delegates formulated a far different picture of this nation's system featuring
reasonable quality universal coverage at relative low cost (7.5% of GDP or $1,200 per-person per-annum). U.S. execs and their
Czech counterparts found themselves envying components of the others' system. Universal coverage is a fundamental tenet of healthcare systems in most developed countries. A European's view of the staggering
number of uninsureds in the United States is an image of people dying in the streets. The Czech system maintains a national
insured pool financed predominantly through compulsory contributions unrelated to the individual's health risk with complete
coverage for all. As a holdover from the socialist system, the public has a strong sense of entitlement and the lowest out-of-pocket
expenditure of any European healthcare system (90% covered by insurance and 10% by patients). This has resulted in excessively
high visit rates (12 per-person per-year), some of which may be motivated by the desire to obtain a prescription for simple
medications such as aspirin, which is also covered by insurance. Notably, treatments in Czech spas are included in the national
health insurance benefit plan.
One extraordinary aspect of the Czech system made little sense to the American delegation until its underlying purpose was
explained by Martin Bojar, MD, the first minister of health following 1989's "Velvet Revolution." Citizens are offered a choice
among health insurers, each with the same benefits, price and network of providers. So why bother offering a choice at all?
As Dr. Bojar explained, the system's built-in inefficiencies were intended as a mechanism to help create jobs. The Czech elections in June resulted in a new ruling party; with the center-right Civic Democrats (ODS) narrowly defeating
the left-leaning Social Democrats. Nonetheless, the new rulers intend to take advantage of the multiple payer infrastructure
to gradually introduce managed care sensibilities. Pavel Hrobon, MD, chief health policy advisor to the ODS and Chairman of
HealthReform.cz, says the Czech Republic intends to build upon precedents established in Switzerland, Germany and Holland.
Initial reforms will seek to gradually transform insurers into competitive purchasers of care, beginning with the introduction
of quality measures and DRGs. U.S. delegates cautioned about introducing too much potentially confusing competition among
insurers, benefit plans, premium options and networks to avoid the mistakes, for example, that were made in the introduction
of Medicare Part D.
Managed Healthcare Executive Editorial Advisor Bruce Pollack, MBA, is president of the Academy
for International Health Studies.
