Saturday, 21 October 2017

A "healthy" compromise?

Prague Daily Monitor |
18 February 2011

The way Radek’s babička told it, Radek’s cousin had walked out of the hospital with her new baby and the doors of the facilities were actually locked behind them. There would be no more births at the recently renovated maternity hospital in the coming weeks in Radek's hometown, as the union-backed hospital doctors' strike that began last autumn finally began to take its toll. As the 1 March departure date for doctors drew closer, medical facilities across the country prepared to either shut their doors entirely or offer limited services. This is likely to mean longer waiting room lines and delayed surgeries. To abate growing public concern, the government has promised an intervention from military medical personnel and has even suggested declaring a state of emergency. According to the news, 3,800 hospital doctors across the Czech Republic, approximately one-fifth of the country’s total, have handed in their resignations since the strikes began last autumn.

The maternity and post-natal care sector is predicted to be hit hard by the strike. Although I have read several reports of maternity divisions closing in regions throughout the country, I didn’t find any data on the particular hospital in Radek’s hometown to support his babička’s claim. Yet another pregnant cousin with a spring due date joked that she’d already wanted to give birth at home, so the anticipated maternity hospital closure wouldn’t bother her. When the subject came up in front of Radek’s grandfather, he declared emphatically, “let them go and don’t take them back.” Regardless of the doctors’ wage dissatisfaction, Radek’s grandfather believed that if the doctors didn’t want to work, then the country was better off without them. When I prodded Radek to discuss the strike with me, he declined, saying that he believed a compromise would be reached eventually.

Although I know it’s typical for strikes to occur regularly in France and other countries, Czechs don’t strike often especially not on such a wide scale as the doctor's strike. Stories related to the strike have been in the news since late autumn. The initial figures suggested that up to 60% of the country’s hospital doctors would depart, recent numbers show around 20% have already resigned. Due to a Czech law that requires an employee to work for up to 90 days after turning in a resignation notice, the doctors were able to create a stir by “resigning” yet still going to work and leaving the doors open for the conciliatory talks.

Back in the fall, I flew into a panic reading the news and wondering what kind of trouble was brewing. I couldn't help but worry about how the strike might affect my family personally. I also wondered if I’d been naïve to praise the socialized Czech healthcare system for the good care we’d received in the past.

The topic stayed on my mind during our US holiday, and when my father asked me to speak to his Rotary Club about life in the Czech Republic I nixed my proposed talk on Christmas traditions and gave a short report on the health system from my perspective as a mother and a non-Czech. Speaking to an audience that included a mix of business and medical professionals, I gave a brief overview of the healthcare system, citing incidents from my own experience, and then turned to the ongoing strike.

My audience was fascinated by the system’s strong benefits for mothers, in particular, the three-year maternity leave, which they joked that I could exist on indefinitely if I kept having children. Since paying for insurance is a significant drain on income in the US, they were also impressed that the government pays for mothers and children. However, when I began to talk about the system of care and the doctor’s average wages I saw a few mouths drop open. A Czech doctor makes an average of CZK 46,000 a month, including overtime, which averages to just over CZK 540,000 a year. The average monthly Czech salary is CZK 22,000. So doctor's salaries are above average, but not by much, and certainly they don't compare to doctor's wages in other western countries. The doctor's union is pushing for a wage increase of over CZK 18,000 a month in order to halt the strikes.

Since doctors aren’t compensated for their time in the same way they are in a privatized system, the volume of patients that filters in and out on a daily basis doesn’t lend itself to personalized attention. Being overworked is another complaint that hospital doctors have voiced. I told my audience about reading an article in the Czech magazine Týden that attempted to survey Czech physicians to find out where they would send their loved ones for different types of medical procedures, ranging from surgeries and hospitalizations to nursing homes and routine dental care. Interestingly, the biggest drawback to the survey in the beginning was the doctors’ lack of interest in participating. No one wanted to publicize a top-notch hospital or skilled surgeon, citing no perceived benefit to the prestige of being well-known, just longer lines and more overworked medical personnel. The survey was publicized shortly before the current strike made news back in the fall.

Talks of a compromise for hospital doctors have been in the works the past week, although it originally seemed that the doctors’ unions would insist on carrying out their strike, even when individual hospitals and medical centers offered to raise doctors’ pay from their own funds. According to a Reuters news headline on Wednesday morning, Czech hospital doctors have finally accepted the wage offer proposed by the Minister of Health Leoš Heger and agreed to call off their anticipated "walkout” on 1 March. The increase of CZK 5,000 to 8,000 in monthly pay would be only the beginning of the overall reform of the healthcare system promised by the government.

In recent years, there has been a growing market in the Czech Republic for private physicians or physicians who accept state insurance but take additional “under the table” cash payments for services like delivering a baby or performing a voluntary surgery. When I first heard about the strike, I wondered if hospital doctors were protesting the system that enables some medical colleagues to earn more by going private or taking “black” money. I’m glad to see that Czech hospital doctors aren’t ready to throw in the towel yet. I hope that their increased wages and the promise of ensuing reforms are good first steps to ensuring that the Czech Republic offers hospitals equipped with appropriately paid staff who are motivated to improve the health of their country’s citizens.