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Czech Health Care System

Czech Health Care System. David Marx, MD, PhD. Motto:. Where there is no vision, people perish . Proverbs , 29,18. 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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Czech Health Care System

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  1. 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

  4. 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

  5. LEB(OECD 2008)

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

  7. Basic problems • Structure • Quality • Cost efficiency

  8. Ownership • State • Regions • Municipalities • Private • Other (church, charities)

  9. Financing • Mandatory public healthinsurace (Bismarck) • 13,5 % grossincome • Redistribution 100 % • risk adjustement • Reimbursement: • capitationpayment (GP) • fee-for-service • budgets

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

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

  12. Expenditure on health as % GDP

  13. Problems • Extensivecoverage • co-payment • Network of HC facilities • Primary – Hospital care • Acute – Long term care • Communicationskills/Bedsidemanners

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

  15. Quality • National accreditation body • hospitals • International hospital accreditation • ISO certification • No direct financial incentives

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

  17. Education - nurses • 3 years college/university training • 3 years of working under supervision • specialties - optional

  18. Average salaries in health care 2009

  19. QUESTIONS ?

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