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10 Questions

witrh Pavel Horák
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By František Bouc
Staff Writer, The Prague Post
April 25th, 2007 issue

Jan Přerovský/THE PRAGUE POST
VZP Director Pavel Horák says "healthcare access must be universal and fair," but necessary medical care must be defined.
Earlier this month, the government revealed its planned healthcare reforms, along with the rest of its public finance reforms. Among the most significant proposed changes will be the introduction of pay-per-visit fees at doctors’ offices and increased co-payments for medical prescriptions. Pavel Horák, general director of the country’s largest health insurer, VZP, talks to The Prague Post about the reform and the current weaknesses of the healthcare sector.
➊  With the upcoming reforms, what will be more difficult: reforming the healthcare system or people’s perceptions?
The Horák File
  • Job title: Director, VZP health insurance
  • Nationality: Czech
  • Education: Medical faculty of Charles University, Prague
  • Previous job: Director of Bulovka and Thomayer hospitals in Prague
  • Family: Married, two daughters
The reform itself will change people’s perceptions, and the perceptions of healthcare providers. But it will be difficult. The reform’s other changes — to the payment system, the structuring of health care, personal co-financing of health care, among others — will be complicated but doable. It’ll also be difficult to push the reform through Parliament in our polarized political environment. I’m an advocate of all the political parties reaching a consensus.
➋  According to the Constitution, every citizen has a right to free health care. Is this provision an obstacle to reform?
The Constitution says that, but it adds that health care is provided “under the conditions set by the law.” So, as far as the Constitution is concerned, it’s about how its provisions are interpreted. Already, health care is not free of charge. We all pay health insurance and we make extra payments for medicine, and so on. In my interpretation, the Constitution stipulates that healthcare access must be universal and fair, meaning that social situations cannot restrict access to needed health care. But it’s essential to define what needed health care really is.
➌  While the reform would introduce fees for doctor visits and prescriptions, these co-payments would be capped at 5,000 Kč ($240) a year per person. Isn’t this just half of the solution?
A cap of 5,000 Kč can be quite high for a single woman with three children over the age of 3, as she would have to pay 15,000 Kč. On the other hand, the cap can be seen as soft for a well-paid manager like me. The cap is not a half-solution, but its limits should be derived from people’s earnings.
➍ The reform would have people making payments to pharmacists and doctors, along with health insurers. Could the system become less transparent than it is currently?
I don’t think so. All payments will be attached to particular treatments.
➎ Why don’t health insurers provide patients with precise definitions of which treatments and procedures are covered by their insurance?
Based on current legislation, a patient has the right to any possible treatment. There are only a few treatments, such as cosmetic surgery, that aren’t covered. The only limitations placed on patients by insurance are medical. Insurers have standard recommended treatments they make to doctors for various conditions. These standards are set by medical organizations and healthcare providers, and often they’re nontransparent and riddled with exceptions.
Limits also arise in how health care is currently financed. After exhausting standard treatments, patients have no opportunity to pay extra fees for additional treatment.
➏ Will health insurers come up with new plans that will guarantee different standards of treatment?
We’d like to go that way, so that patients can opt for health treatments according to their preferences. They should be able to pay for more comfortable treatment or insure themselves against risks that are not covered by current insurance.
➐  Insurers are often labeled as clearing centers for patient payments into the healthcare system. What needs to be done to involve them in more of a market system?
Insurers should not base their economics on calculations such as “This is what we received this year and the question is how we distribute it.” Instead, they should consider the costs of treatments, the structure of insurance products, the development of health care in the future, demographic risks, etc. They should compete against each other with their products and should not have the features of state institutions.
➑  Is it likely that the number of insurers will shrink in the near future?
Everything depends on whether foreign health insurers are admitted to the market. If so, big changes should be expected. If the market remains closed, we can expect mergers between smaller health insurers as they prepare to compete against larger insurers. But I don’t think a decrease in the number of insurers will be dramatic.
It’s essential that all insurers compete under equal conditions. VZP should remain in the hands of the state, and commercial insurers should compete for more lucrative patients. I know that smaller insurers have a negative view of our large size, but I still think, by European standards, we’re standard.
➒  Is it possible to have an effective market when a state-owned insurer competes with commercial insurers?

I’m convinced that the best status of VZP is as a public service provider. We should remain a pillar of the country’s healthcare system, and the state should strongly regulate both us and the whole sector. VZP guarantees access to health care to a group broader than its own clients, so it should not be privatized. Such a privatization would require a dramatic change of the entire health insurance sector.

➓  What’s the most crucial problem in the healthcare system?
The biggest problem is that the sector has become a platform for political infighting. Instead of rational solutions, it’s become a battlefield for politicians.

František Bouc can be reached at fbouc@praguepost.com


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