Ing Jaroslava Kunová
Czech Hospital Association
The year 2006 was one of uncertainty and sudden changes for the Czech health system. This stems from long-term instability in the leadership of the health ministry and from the continued postponement of a radical reform of the health service. Some of the changes were triggered by the need to harmonise the Czech legal system with those of other members of the European Union (EU) – in particular, employment regulations.
This prompted the Czech Hospital Association (CHA), which represents, among others, teaching hospitals, specialised health institutions and other hospitals, to start a careful study of the potential impact of the new regulations on the health system. The need for an extensive change to existing employment regulations had already been known at the time the Czech Republic joined the EU in May 2004. However, preparations for their impact on the health system have fallen short despite repeated warnings from the CHA that implementation of the new legislation in its current form would pose considerable difficulties.
A major change is the ruling that, when an employee is not at work but remains on call, this time must be spent outside the workplace. On-call time cannot therefore be served at the employer hospital, even though this is how round-the-clock hospital care used to take place. Therefore, for a hospital to be operational 24/7, continuous shifts must be supplemented by on-call cover outside the hospital.
Workforce analysis using official data suggests that this change will be very difficult to achieve quickly. By the end of 2006 it was already clear that the new legislation would require shiftwork in many hospitals, which would call for a 10–20% increase in medical staff, especially in particular specialties and at certain grades. The increase in staff numbers will also call for a corresponding increase in
funding, but neither this nor the lack of available personnel has been addressed.
Another factor complicating the situation in many Czech hospitals is the need to provide specialised outpatient services out of hours – in the afternoon, in the evening and at weekends. In many regions, this is only possible with the involvement of local hospitals whose prime function is to care for inpatients and outpatients with specific medical conditions, and not to provide out-of-hours care for those with common medical conditions. This situation is a major problem as these hospitals need more medical staff to provide this expanded service. Moreover, reimbursement is inadequate.
The system of healthcare provision and finance was not ready to adopt the new employment regulations at the end of 2006, and the CHA appealed repeatedly, right up to the last moment, to be granted a temporary exemption from the new provisions. It suggested that the implementation of the new regulations be postponed in the healthcare sector until the identified problems had been addressed. Unfortunately, political support was not forthcoming, and neither proposal was adopted. The new employment regulations came into force in their original form in January 2007.
The problems anticipated in healthcare began to appear in the first months of the year. In addition to inadequate staffing levels and funding, other difficulties are caused by a doctor shortage, which calls for a change in the medical education system. New legislation covering postgraduate medical training has exacerbated existing staff shortages because there is a shortage of appropriate training facilities. Urgent clarification is needed on the future form of specialised medical qualifications.
The CHA is still actively working to resolve the issues. Because it represents the largest healthcare providers in the country, we feel a responsibility to find a successful solution.