The Czech health care system guarantees patients, in return for compulsory monthly health insurance payments, free health care. The insurance companies are then obliged to pay doctors. But this nearly always involves a delay. This permanent cash-flow bottleneck has led dentists to lose their tempers. They are now threatening to make patients pay for dental treatment in cash.
"The situation that's arisen, and has been given so much publicity in the last few weeks is simply a result of past problems which have been bottling up. Neither the present nor the previous government, were able to explain to citizens that free health care may be common in the Czech Republic but not elsewhere in the world. The state is not rich and can't pay for such a luxury. There is simply not enough money and it has all ended up in arguments. Institutions are blaming each other and expect each other to pay the money to doctors."
While the quarrels go on, dentists that have to buy material for their patients are sinking further into debt. The Czech Dental Chamber association has therefore decided to put its foot down. If the Health Ministry and health insurance companies fail to find a satisfactory solution private doctors will refuse to renew contracts with the insurance companies. They will start charging all patients in cash when the old contracts run out. Mr.Ciboch doesn't have high hopes that a compromise will be found.
"All proposals from the Health Ministry are ridiculous. The Ministry would like to restrict our working hours, tell us how much we should pay to our nurses and maybe it will even end up with them saying whether we should come to work shaved or with a beard."
Dental care reforms, which required patients to share the costs of care, were launched in Hungary six years ago. In the short term, many patients left, but they soon returned. If Czech dentists follow the Hungarian example a regular check up will costs about 400 crowns, an amalgam filling 600 and a ceramic tooth about 2 000 crowns. Given prices of fashionable ties or boots it is according to Miroslav Ciboch a good price.
"It all boils down to politics. Politicians are scared to say to their voters that they will have to pay for health services sooner or later."
Jiri Suttner the spokesman of the biggest Czech health insurance company which serves seven million clients says that the threats are a reflection of the bad situation in the Czech health care system.
"We are not in a disagreement with dentists when they urge reforms although they have chosen a rather radical way. They have done it to be seen and heard. We do realize that if you are not radical the government and the Ministry will pay no attention. On the other hand we think that the dentists' decision not to renew the contract might prove to be a double-edged sword. I am afraid that patients would get treated before the contract expires so they would not have to pay, and then they would avoid going to the dentist for the next couple of years. Dentists would lose a big part of their income and some of the private dentists might even go into bankruptcy."
Lack of money goes hand in hand with decreasing numbers of dentists. Five Czech dental faculties annually produce 120 graduates. Many of them are foreigners and return home. Some of the others decide to take up work offers from abroad. Young graduates are often put off staying at home by their battles with Czech insurance companies.
If the present trend is not stopped, there might soon be no more dentists left to take care of aching Czech teeth, and the sound of the dentist's drill could become a rare luxury.