Leaving aside the controversy involving the biggest public health insurance provider and a new round of doctor strikes looming on the horizon, the public health insurance system in the Czech Republic is quite a generous one. But unlike some other EU countries, this generosity does not extend to everyone who lives and pays taxes here. Almost 100 thousand foreigners living in this country have no access to public insurance, and in some cases are denied insurance all together. A number of NGOs have been campaigning to include these people in the public insurance scheme, which would ensure better health standards and more money for the state.
In addition to Czech citizens, EU citizens, and foreigners from outside of the EU with permanent residency in this country have access to public health insurance, which covers a large portion of healthcare expenses. Even those foreigners who do not have permanent residency permits, but are legally employed, automatically contribute to public health insurance. Yet, their families have no access to it. Additionally, self-employed foreigners and their families, foreign students, as well as husbands and wives of Czech citizens, who may spend up to two years on temporary spousal visas, have to rely on private health insurance.
Elena Tulupova, coordinator of the Consortium of Migrant Assisting NGOs in the Czech Republic which is leading the campaign for wider access to public insurance for foreigners, told me about the main problems with this type of insurance.
“Private insurance, first of all, does not have the same extent of coverage as public health insurance. Unfortunately, in practice, our clients are also often faced with situations where they were provided with healthcare, but their insurer refuses to cover it, even though it was in their contract.
“It’s a big problem for children whose parents are from outside of the EU and who were born on the territory of the Czech Republic. In case of problems during the birth or if the child has an illness, private insurers may not even be willing to ensure them. This can result in huge debts and even possible bankruptcy for the family.”
The problem is that private health insurance is not regulated by the same laws as public insurance. Although doctors are required by law to provided treatment to anyone in need, private insurance companies can deny payment on the basis of, for example, pre-existing conditions, even if none were declared during initial screenings. All foreigners residing in the Czech Republic are required by law to have a health insurance plan, but private insurance companies can deny contracts without any particular reason.
Robert Kareš, CEO of the private branch of VZP, the biggest public healthcare insurance company, does not feel that including more foreigners in the public health insurance scheme would help this matter.
“The existing scope of [private] insurance has some limits. Our parent company, the biggest public insurance provider [VZP] made a study according to which if all foreigners were transferred from private health insurance to public health insurance, the negative effect on the state budget would be around 10 billion Czech crowns. So my position is to settle all of those problems, including those concerning newborns with the new bill.”
The bill Mr Kareš is referring to is still in the very early stages of development. And although it may in the end stipulate that private insurance companies will be required by law to insure any foreigner without public insurance, it is not clear if it will pass through Parliament, since efforts to pass similar legislation have failed a number of times in the past. Usually they run up against the economic interests, but Ms Tulupova sees a more veiled reason behind this:
“It has been quite openly said that there is a strong lobby of private insurance companies who are trying to resist this change, because this group of people is very profitable insurance companies.”
In fact, representatives of NGOs and healthcare advocates have carried out their own analyses, showing that state coffers would actually profit from a move to wider access to public health insurance, since more than half of the foreigners living in this country, who would be paying for health insurance, are of productive age and average spending for their healthcare needs is at least 1,000 crowns less per year than for an average Czech in the same age group. And in addition to the business side of it, making sure that children of foreigners get maximum, burden-free healthcare coverage will also help the Czech state adhere to important international agreements such as the Convention on the Rights of the Child.
The Consortium is hosting a discussion and a screening of a video on this topic next Tuesday 12 December, at Cross Club. For more information visit the organization’s page: www.konsorcium-nno.cz