czech health care system david marx, md, phd. 2 motto: where there is no vision, people perish....
TRANSCRIPT
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Pre 1989 situation
Centralized systemState owned State employedNo freedom of choiceNo quality incentivesPolitical pressure
head physicians + nursesinvestments
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Basic data – OECD 2009
Acute beds – 7,11/1000 population
Norway 3,35; Germany 8,24; Greece 4,85
Long term care beds – 6,5/1000 popul
Norway 9,3; Germany 10,3
Physicians – 3,5/1000 pop.
Norway 4,02; Germany 3,6
Nurses – 8,06/ 1000 pop.
Norway 14,2; Germany 10,9
% GDP : 8,2
Norway 9,6; Germany 11,6; Greece 9,6
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Need for reform - General
DemographyTechnologic changesIncreasing No of providersGrowing demand for quality HCInformation assymetryrationing
Cost increases
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Financing
Mandatory public health insurace (Bismarck)13,5 % gross income
Redistribution 100 %risk adjustement
Reimbursement:capitation payment (GP)fee-for-servicebudgets
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Health care reimbursed
in and outpatient care
emergency carepreventiondrugs
spa treatmentoccupational caremedical transport
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Health insurance paid by the state
childrenpensionersmaternity leaveunemployedsocial need
prisoners
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Problems
Extensive coverageco-payment
Network of HC facilitiesPrimary – Hospital careAcute – Long term careCommunication skills/Bedside manners
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Co-payment
regulatoryoutpatient examination – 30/90 CZKhospital day – 60 CZKPrescription – 30 CZKyearly maximum – 2500/5000 CZK
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Quality
National accreditation body hospitals
International hospital accreditationISO certificationNo direct financial incentives
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Education - physicians
6 years medical school ( 8 medical schools)
5-7 years specialization training84 specialties
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Education - nurses
3 years college/university training3 years of working under supervisionspecialties - optional
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Average salaries in health care 2009
Category Salary/month/year(USD)
Physicians 287034440
Nurses 154518540
Average CR 137016440