1. MUDr. Zdeněk Mrozek, Ph.D. Vice-President, Czech Medical Chamber

2. Outline Main problems of the Czech Health Care System Thank you we are leaving – the biggest and the most successful campaign of the Czech medical doctors Health Care Reform Conclusions 2

3. Main problems of Czech health care Lack of funds Lack of qualified zdrav health care professionals 3 I am afraid, Dear Colleagues, that this is more serious than we thought!

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5. Injustice in health insurance payments Not all really pay 13,5 % from their incomes Payments by state for economically non-active population Payment by the state for 60 % of inhabitants, who consume 80 % of health care, represents only 24 % of health insurance companies incomes Increase of payments by state is a political decision 5

6. 6 Monthly insurance premium Employees2 865,- CZK Self-employed persons1 243,- CZK Persons with no taxable income1 080,- CZK Persons whose health insurance is paid by the state 723,- CZK 6 Injustice in health insurance payments

7. Exodus of Czech doctors Certificate of Good Standing Certificate of non-membership in the CMC Total 2006348 2007339 200826350313 200927264336 2010 557134691 7 Source: CMC Registry

8. Physicians leaving the Czech Republic – per age Age20082009Total Up to 30 years22375911,0 % 30 – 40135 27050,5 % 40 – 50677013725,6 % 50 – 6031245510,3 % Above 6086142,6 % Total263272535100,0 % 8 114 university graduates are to be added to the above figures. They left CR in the years 2008 and 2009 without taking employment in CR as physicians.

9. Practising doctors are aging Up to 50 years of age Above 60 years of age 200067 %11,5 % 200756 %16,0 % 9 The share of resp. age groups among practising doctors

10. Number of foreign doctors working in CR Number of doctors 2003 829 20041 097 20051 188 20061 619 20071 849 20082 015 20092 129 10

11. Reasons of dissatisfaction of hospital doctors Low salaries and economic dependence on overtime work Overburdening – Labour Code and EWTD are not observed Worse working conditions in comparison to private doctors Disintegration of the training system Corruption The loss of hope for a better future 11

12. Thank you we are leaving initiative Demands of doctors formulated in March 2010 Increase of salaries for the basic working time to the level of 1,5 – 3 times the average salary in CR depending on qualification and experience. The same rules valid for all hospitals A new system of further education of doctors which should be organised by the medical chamber. Increase of payments from the health insurance companies to all health care facilities. 12

13. Mass resignations from employment = efficient form of protest Genuine strikes are impossible in health care system as doctors have to secure the acute medical care. Mass resignation from employment is an efficient “strike“, fully legal. Criminal prosecution of participants and organisers of the movement refused by the courts. 13

14. Action announced in May 2010 Doctors will hand over their resignations from employment on 31 December 2010 and from that date the two months notice period runs. Announced prior to elections, when it was not clear which party will form the government. Politicians were given few months time to fulfil the doctors’ demands. Doctor’s Trade Union Club gained time to mobilise the doctors and to convince the general public. 14

15. 13 Reasons for the Exodus Underfinanced health care Low payment for economically not active persons by the state Personnel devastation in hospitals – overburdening of remaining doctors Low salaries of doctors (100 – 200 CZK/hour) Violation of the Labour Code Destructed system of further education of doctors Chaotic medical drug policy Strange hospital management – overpriced supplies and appliances Unfulfilled promises of politicians … 15

16. Motto of the campaign “Our exodus, Your exitus?“ 16

17. Symbols of the campaign 17

18. “Road show“ running through cities and hospitals 18

19. 3 830 doctors gave notice to December 31 st 2010 Notice from employment was given in total by 22 % of hospital doctors. Large regional differences in numbers of notices Differences according to specialisation: Mostly anaesthetists, surgeons, neonatologists, obstetricians, neurologists Doctors from private hospitals involved only in very small numbers. Several university hospitals did not participate, including the biggest one – University Hospital Motol in Prague Intimidation of employees or preventive increase of salaries 19

20. Compromise has been reached 14. 2. 2011 20 On 16th February 2011, the regional Doctor‘s Union representatives accepted the agreement.

21. Signature of the final memorandum 17. 2. 2011 21 Minister of Health L. Heger and Chairman of Doctors‘ Union M. Engel. The Czech Doctors‘ Union ended the campaign and called on doctors to return to work. On February 23rd 2011, Government approves the agreement as well as the increase of doctors' salaries.

22. The victory The biggest jump in the salary increases of employed doctors‘ in the past 20 years Reached at the same time when the government reduced the salaries in the public sector by 10 % CR accepted the doctors‘ demand for a salary ranging between 1,5 – 3 times of the average national salary depending on their qualification and length of practice. CR committed itself to reduce the amount of overtime work of doctors and to respect EWTD. The ministry committed itself to cooperation on the health care reform with the representatives of doctors, including the Czech Medical Chamber and Doctors‘ Trade Union. 22

23. Conditions for campaign success Great dissatisfaction of doctors Efficient form of protest Strong organisation (Physicians´ Union Club) Keeping the unity of the majority of doctors Supported by CMC Help of professionals – PR agency Struggle for favourable public opinion Breaking the unity of politicians Negotiating with the political opposition and with individual members of the coalition government 23

24. Health care reform goals To create a stable and transparent environment for medical care respecting normal social and economic rules. To find a fair compromise between the „unlimited“ possibilities of medical science and the limited economic resources. To create for patients a friendly health care with satisfied health professionals. To respect EU membership of the Czech Republic and to avoid experiments. Reform is not made for one electoral term – consensus. 24

25. Health Care Reform Health care reform laws passed in the Lower Chamber of the Czech Parliament in July, August and September 2011 Main positive changes: introducing standards of treatment, possibility to pay for above-standard treatment openly, better definition of lege artis treatment Main negatives: changes not discussed with opposition parties and health care professionals, transparency of the system remains the same, in some cases even worse, more bureaucracy 25

26. Conclusions Czech health care = one of the best health care systems in the world Last 20 years - changes due to not only fast development of medical science, but also due to vast and profound changes in the Czech society The main issues in Czech health care: - exodus of Czech physicians - non-transparent financing Necessary reforms - consensus of all parties, politicians and professionals 26