Major changes to the health care system in the Czech Republic came about this week when the government’s reform package took effect. Called the biggest reform in the last 45 years, the aim is a redefinition of how health care services are provided, and the role of the state, the facility and the patient therein.
One of the main principles of the new health care package is to increase the information patients have, empower their abilities to make decisions about their own treatment and thereby give them more rights. Doctors must now give patients all information related to their medical condition and the treatment they have received, they must explain surgical procedures and their potential consequences, and allow patients to view their files. Patients can then decide for themselves on the circumstances under which they want to be treated, and also on where – the hospital a person visits no longer depends on their place of residence, and hospitals can only reject them in exceptional cases, and never in a life-threatening situation. Conversely, once a patient has opted for a certain doctor at a certain facility and a certain treatment, they have to keep the plan or else risk being dropped by the doctor.
Patients under this system can also decree what they do not want from their doctor, be it information or a type of treatment. It is now possible to have a notary certify what you do not want a doctor to do if you are incapacitated, on life support or otherwise incapable of making a decision independently. Even in such cases however, death is not one of the patient’s options: such wishes will not be respected, the Health Ministry noted, if they were to lead to actively ending the patient’s life, for example by removing them from life support.
Children too are empowered by the new legislation, to a certain extent. Whenever appropriate, doctors must now ask children what they think about a prescribed treatment and record their opinion in their medical file. Serious procedures on children now require the consent of both parents. If that is not possible, or if the child has disagrees with the treatment approved by the parents, the court is informed and a caretaker is appointed. Children can be accompanied by their parents at all times when being treated or during a stay in hospital, and adults too can be accompanied by their friends or family.
Another driving principle of the reforms is to streamline services in the age of austerity. The reforms stipulate, for example, the minimum numbers of doctors to be on hand at hospitals, in an effort to decrease overtime and expenditures. This could mean that where night shifts are concerned, patients may be seen by doctors who are not specialists in their particular problem.
Also, in an effort to decrease mistakes, it is now for the first time possible to seek a second opinion on serious diagnoses and such consultations must be covered by health insurance.
Some forty new emergency rescue stations will be added around the country. Ambulances and rescue services however have more time to reach their destinations – 20 minutes instead of 15. Paramedics now have the ability to enter any building without having to seek permission, and even to demand assistance from passersby. Hospitals must establish contact centres that are in constant communication with paramedic stations.
The controversy that has accompanied the debate and passage of this legislation does not end with its taking effect. Some health care lawyers see the laws as in fact damaging, rather than strengthening the rights of patients, citing for example the fact that it will be more difficult for patients to bring their complaints to court.