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The “raccoon protest” ends. Doctors and union leaders signed an agreement pledging to call on their protesting members and supporters to return to work. The end of the protest, in addition to the understandable relief on the part of the patients, also raises many other questions.
The most important one is whether the entire protest can be used for deeper changes in the health care sector, for changes that would make overtime work a supplement to the medical profession and not a fundamental pillar of the functioning of the entire health care system.
With a bit of optimism, some hope can be read from the text of the agreement. In addition to the complicated mechanism of increasing rewards, it also describes other things. The commitment of the Ministry of Health “to discuss and implement changes in the composition, scope and structure of the network of health service providers” is very important. This means, in translation, that one of the solutions to the amount of overtime in the system will be to reduce the number of workplaces that require a lot of overtime. In terms of the model, these are emergency services and urgent incomes, but it can also mean reducing the number of beds in regular wards or converting acute care beds into follow-up or long-term care beds.
This is undoubtedly the right thing to do and, if done well, could be an effective tool to increase the efficiency of care delivery and reduce the number of hours and services that doctors will have to perform. And it is a pleasant surprise that the trade unionists also signed the agreement with this commitment, and in return they are promised “cooperation” in solving this problem.
Health insurance companies, the Ministry of Health, and the regions should also have their say in the main role in changes to the scope and structure of hospital care.
We have already described here why the final agreement with doctors is inappropriate and dangerous for health insurance companies and the system as a whole. But since it is already signed, we can perhaps optimistically hope that it could also be good for something. On the one hand, the director of VZP reduced his health insurance company to the executor of political will, but on the other hand, he also pulled out a big thorn from the heel of the Minister of Health, Vlastimil Válk, as well as Prime Minister Petar Fial. Such a thing is not usually done “for free”.
Inside VZP, information about the effectiveness and meaningfulness of different workplaces is readily available. Including, for example, detailed data on “occupancy”, that is, let’s say, the use of beds, in individual departments of individual hospitals. The insurance company, especially the largest, has leverage over hospitals through contracts and care ordering, with which it can pressure them to close or limit certain departments or to change the structure of beds. But he rarely does it, because it is always a politically sensitive matter and the fate of the director of VZP is decided by the politically appointed board of directors of the insurance company, in which the current government majority always – even now – has the decisive say.
If the director of Kabátek, with his heavy concession in the agreement with the doctors, had “bought” a freer hand from the politicians and a stronger say in the cancellation of redundant beds, departments, or even hospitals, the whole thing might still make some sense.
However, this optimistic outlook is spoiled by several external factors. First of all, entering the time period, which will again be “chronically pre-election” after a while. A large part of the whole agreement will take place next year, when there are one election (European) at the turn of spring and summer and the other (regional and senate) in autumn. And with the year 2025 comes the period of struggle for voter favor before the most important elections to the Chamber of Deputies.
Few people will want to explain to voters the cancellation or limitation of hospitals before the regional elections, and we can therefore expect great pressure from the governors on the party headquarters to prevent these plans. In such a situation, whether Minister Válk and the entire government coalition will have the courage to support the VZP leadership in its efforts for higher efficiency of the health care sector is a big question. Politics is a tough sport, and Kabátka’s sacrifice and commitment can easily be forgotten in the pre-election rush.
Then it will only be a matter of time when there will be another big surprise over the fact that doctors’ overtime work has practically not decreased and the system has returned to its old ways, only for more money.