About 20,000 people a year have their gallbladders removed by doctors in Czech hospitals. On average, the patient spends six days in the hospital because of this. Which means, in addition to the performance itself, additional high costs of care. At the same time, a large number of patients do not have to stay in a hospital bed.
Over seven thousand of them could go home after a few hours. Although patients would be interested in this and, according to an analysis based on data from 2019, it would bring savings of over 100 million crowns to health insurance, there was no support for it at the state level for many years.
Until this year. Minister of Health Vlastimil Válek (TOP 09) pushed through a revolutionary change last year, which is gaining momentum this year. In the reimbursement decree, 17 procedures appeared, which medical facilities receive special reimbursement if they take place as part of one-day care. Clinics thus no longer lose so much on them, and they now have not only a medical, but also a financial motivation to engage in them.
In the just approved reimbursement decree for next year, the expansion of one-day care continues. The procedure is still 30 more. Except for gall bladder, hernia or appendix removal, patients can come in for shoulder surgery, finger surgery or tonsil removal and go home the next day.
Take a look at a selection of the most famous procedures that are on the list of one-day surgery and with payment for their performance:
But why is one-day medicine so essential for the future of Czech healthcare? Let’s break down the four main reasons.
1. Benefits for patients
If the doctor offered you to go home the next day, for example, after removing the gallbladder, would you still want to stay in the hospital for the next few days? Abroad, such procedures are quite common and patients praise them. An analysis of seven studies on the subject showed that patients are more satisfied if they undergo the procedure and can go home the next day. For same-day surgery, patients reported 82 percent satisfaction after surgery, compared to 64 percent for inpatients.
“Over time, methods have been developed that are gentler on the human body and allow patients to be discharged faster,” explains doctor Dalibor Štambera from the Association of Day Surgery Providers.
However, the health benefit is also very important for patients. The intervention at a one-day care clinic can be even safer. For patients, the risk of infection during hospitalization is reduced.
The data proves that too. According to German statistics, postoperative wound infection occurred in hospitalized patients in about 16 percent of surgical cases. In contrast, only 3.1 percent of patients underwent surgery at one-day clinics.
Of course, same-day surgery is not for all patients. Doctors assess their health and assess risks. Seniors with other serious medical conditions are almost always kept in bed longer after the procedure. But there is really no reason for a young athlete to remain hospitalized after a simple knee arthroscopy.
2. Approaching modern medicine
Czech patients now go home after a maximum of 24 hours only for a percentage of operations. In Europe, however, the trend has been the opposite in recent decades. For example, in England, over a third of operations are one-day operations.
This is also shown by data from the Organization for Economic Cooperation and Development – OECD. Based on one of the most common procedures in children – the removal of the tonsils – the statisticians compare countries’ access to one-day surgery. Although it is of course impossible to draw a conclusion based on one example, the Czech Republic is one of the four countries where practically no such intervention took place in 2021. At the same time, the average of the developed countries of the world is 37.6 percent of cases, and in Finland, for example, 87.7 percent.
It is similar for other operations. The Czech Republic always belongs to the absolute minimum of countries where one-day care has almost never occurred. The only exception is eye surgery, where, for example, cataract surgery takes place almost exclusively on an outpatient basis in our country, just like abroad.
However, the Ministry of Health is now motivating, through a reimbursement decree, to develop even one-day care in the Czech Republic in a similar way to that in the developed countries of the world.
“I would like one-day medicine to become a strong and integral part of either specialized centers or centers in hospitals by the end of the election period,” says Health Minister Válek.
And medical facilities that see the future in one-day care welcome the department’s efforts.
“It’s definitely a step forward, especially for us, as the Blansko Hospital has been operating one-day surgery for thirteen years, and the whole time we’ve been struggling with the approval of reimbursement for procedures, so we’re glad that it’s enshrined in the decree,” says the director of the Blansko Hospital, Vladimíra Danihelková .
“The stumbling block for one-day surgery was from the beginning that it only had package procedures that did not correspond to the real demands and were not part of the reimbursement decree. In addition, they differed among individual insurance companies. The overwhelming amount of procedures was thus financially undervalued, and therefore medical facilities had no motivation to build one-day care,” adds Štambera.
Reimbursement for procedures in one-day medicine today is roughly at the level of 75 to 80 percent of the value of procedures in ordinary hospital care. For some surgical interventions, this means up to a 100% increase in the original financial assessment.
“It’s a big leap. Reimbursements are starting to be really motivating economically,” adds Štambera.
3. Savings for healthcare
So far, we have discussed mainly bonuses for patients and getting closer to the standards of modern medicine. However, the issue of money is also very important for the Czech healthcare industry, especially at a time when costs in some segments are skyrocketing. Next year, the public health insurance system will have a deficit of 9.2 billion crowns.
But the expansion of one-day care could bring billions in savings. In his analysis, doctor and economist Pavel Hroboň came to the conclusion that the Czech Republic could save 1.2 billion crowns annually. It is a rough model that allows for the transfer of a part of patients to one-day care for suitable procedures.
“Reimbursements have really been a long-term problem for the development of one-day care in the Czech Republic. In fields where reimbursements were set a bit more attractively, one-day care has gradually developed, an example is orthopedics,” says Hroboň, who is also a member of the Government’s National Economic Council.
However, the savings could theoretically be higher in the future, as there will be even more interventions in the next year compared to the model. Of course, the healthcare system will save only when patients are not really hospitalized as often for selected operations – that is, as is usual abroad.
But it’s not just pure savings. Especially after the covid pandemic, waiting periods for planned procedures have been extended by many months, if not by years in some cases. But if the doctors were to investigate the time for one-day procedures, up to a fifth more operations could be done than today.
Even so, the number of one-day care providers is gradually increasing. According to data from the General Health Insurance Company, there were 142 such facilities the year before, and 166 in the first half of this year.
“The number of patients who underwent surgery in the one-day care regime increased by 30 percent between the first half of 2021 and the same period in 2023,” adds the figures for VZP clients, its spokeswoman Viktorie Plívová.
In the first half of 2021, 18,600 VZP patients received one-day care, and 24,800 already in this half year.
4. More doctors, less overtime
In recent months, there has been a big debate about the huge amount of overtime that Czech doctors have to work. Almost six thousand of them refused to continue working extra since December, because such a practice is not even legal, let alone manageable in terms of health.
In this respect too, the development of one-day medicine could help. Night services or weekend work could be reduced in part of the facility.
“If we focus on the surgical departments, even if it didn’t go directly to the one-day care regime, but in short, two doctors wouldn’t always have to be present 24/7, the department can close for the weekend, and that alone saves a third of the staff,” explains Hroboň.
Czech healthcare could go even further when at least part of the regional or district hospitals focus on simpler procedures. Patients would thus receive more appropriate care here, and more complex interventions would be centralized, for example, at the regional level, which would reduce the currently enormous demands on professional staff in each of the health facilities. In terms of availability, compared to other countries, the Czech Republic has significantly more hospitals with round-the-clock service than is needed.
“It is an interesting opportunity for hospitals that feel the need to transform themselves into a model of what is called a community hospital abroad. It is a facility that continues to provide acute care, but not for outside patients in a 24/7 mode,” explains Hroboň.
The Czech Republic is also facing a big debate about the future of the healthcare network through the development of one-day care. And perhaps very fundamental changes in the functioning of hospitals.