Many Czech people still cherish the idea that healthcare is free of charge and that it is the system that should take care of their health. However, zero responsibility goes hand in hand with low effort to care for our own health. As a result, the burden of lifestyle diseases is in many respects higher in the Czech Republic than elsewhere in Europe. Effective but also very costly therapies have been entering the Czech market and the healthcare system will soon become unsustainable if nothing has changed. According to the director of the General Health Insurance Company Zdeněk Kabátek, we are thus facing a difficult discussion. If a properly informed insured person does not follow recommendations, it will mean a greater financial burden for him or her, said Kabátek at the international panel of the Zdravotnický deník Permanent Conference on Czech Healthcare, which took place on 22 July in Prague.
“In the last few years I have often faced the question on how to ensure the sustainability of the Czech healthcare system as medicine development is fast and new treatment methods, which are very successful but also very expensive, have been entering our reimbursement system. The logic answer is simple. If we manage to influence the behaviour of those participating in our public health insurance system, convince them to approach their health responsibly and involve them in the treatment costs they generate due to a disease which developed as a result of their certain conduct, we will ensure the sustainability of Czech healthcare. Then the costs will be reduced significantly as they are largely a result of the clients‘ behaviour at a certain stage of their lives,” says Zdeněk Kabátek, Director of the General Health Insurance Company (Všeobecná zdravotní pojišťovna – VZP).
Let us recall that VZP reimburses prevention and treatment covered by the public health insurance system from its General Fund. Currently, the annual amount reimbursed is around CZK 200 billion. In addition, the company has a Prevention Fund that reimburses uncovered preventive care and activities paid by the clients. In 2019 (the last year not affected by the Covid-19 pandemic), it distributed over half a billion crowns.
“We have tried to define the main themes and pillars around which we want to promote prevention. We have cardiovascular diseases, which are the biggest killer, oncological diseases, which significantly affect the lives of our clients and are the cause of premature deaths; but we also target psychological diseases and chronic diseases like diabetes,” Kabátek lists the targets at which the company aims.
Changes need political courage
If we succeed in identifying where the client behaviour can be changed and thus costs of future treatment reduced, the latest technologies become also accessible. At the same time, however, a model needs to be found in order to induce insured people to change their behaviour.
“In the future, it will not be possible to maintain a model in which the state or the insurance company is responsible for the health of our citizens. Everyone is responsible for themselves. We should reflect this in the manner we finance healthcare. We should be able to establish a path where the clients are aware that if they have enough information on how to influence their health and cost of their healthcare, they need to be involved financially as well. We are currently working intensively with the Ministry of Health and the Office of the Government on this project,” says Zdeněk Kabátek.
As regards this awareness raising, oncology should come first. This should be followed by a second phase, which will require greater political courage. According to Kabátek, the system should start functioning in such a way that if people do not follow recommendations, it will result in a greater economic burden for them personally.
“It is about being able to convert health insurance in a way where, in addition to the bonuses that insurance companies provide to their clients as part of preventive programmes stimulating a healthy lifestyle, we must also be able to apply penalty fees. It will be a big task. However, if we want to maintain the quality of our system, there is nothing else we can do,” Kabátek believes.
Individual health insurance plans and client involvement in reimbursement need to be discussed
Yet, small fines or penalties for inappropriate behaviour are a course that many experts would rather avoid. Instead, they would prefer positive incentives. And they do not talk just about the aforementioned prevention funds when people have to pay first for their selected activity and only later are reimbursed by the insurance company.
“I myself have been in favour of bonuses and in the current situation, there is no other way. Legislation does not allow us to sanction a client for smoking or using addictive substances. However, the discussion on clients and their share in the costs at the moment when they have the opportunity to be informed and know how to behave to prevent the disease will undoubtedly come up. Paying out bonuses to clients brings no significant results and leads to no changes in their lifestyle. This is also due to the actual availability of resources: if we pay around CZK 200 billion for healthcare and the prevention fund is around 750 million, it is not much to motivate with. In near future, discussion will be held on the application of insurance models that are not yet on the market. Namely on individual health insurance plans and greater or lesser involvement of clients in the reimbursement system,” adds Zdeněk Kabátek.
Michaela Koubová
