Organisation of the System of Czech Healthcare Provision
Outpatient Care
Institutional Care
Accident and Emergency Services
Company Health Services
Pharmaceutical Services
Complaints
Health and Safety at Work
Questions and answers concerned with receiving health care

Receiving Healthcare

Organisation of the System of Czech Healthcare Provision

In the CR there exist both state and private medical facilities. Almost all facilities have concluded contracts for the provision and payment of healthcare with health insurers and provide healthcare to patients insured at the relevant health insurers without direct payment.

Healthcare services are provided by a system of outpatient care, institutional care (inpatient), company preventative care facilities, urgent care facilities, facilities for transport of the sick, injured and women in childbirth, spa care facilities, facilities dealing with medicaments and health aids, and dental products.

Outpatient Care

In cases of falling ill a patient usually turns to a so-called primary care doctor who works in the patient's local area. These are general practitioners, paediatricians, dentists and gynaecologists.

If a patient does not have a doctor or know about medical facilities for any reason, he or she can find out information from local administrative bodies. It is also possible to ask for advice from your health insurer or search for a doctor yourself in the phone book.

When choosing a doctor it is necessary to bear in mind that it is only possible to register with a doctor who has a contract with your insurer for the provision of healthcare.

To be treated by a primary care doctor it is necessary to register with that doctor. The doctor may refuse such registration only in cases where acceptance would mean such a workload for the doctor that he could not provide adequate care to the patient or other patients already in his care. The doctor may not refuse treatment in cases of urgent care (injury, acute illness); however, after such treatment the patient is transferred to his or her own doctor. If the patient is refused, he or she has the right to have the refusal in writing. If you have doubts about this, contact the healthcare department at your local authority with a request for investigation.

When a primary care doctor accepts a patient, he or she becomes the patient's registered doctor, draws up a registry entry and is liable to systematic care of the patient, i.e. ensures basic care (including visits) and, as required, procures specialist care from a specialist or hospital.

Please note that policy-holders of contractual health insurance do not register with doctors. Their treatment is carried out by contractual doctors, as well as VZP contractual medical facilities.

If the patient's state of health requires specialist care which his or her registered general practitioner cannot provide, the latter recommends him or her relevant specialised medical facilities which have contracts with the patient's health insurer. Even in this case the patient has the right of free choice of healthcare facility and doctor. The registered doctor issues a recommendation for specialist care or request for consultant treatment. The specialist then informs the registered doctor of his or her findings and treatments, or makes recommendations about the patient's ability to work.

Patients can visit specialists in the CR without a recommendation from their primary care doctor.

Institutional Care

If the character of the illness requires such, the general practitioner or outpatient specialist recommends the patient treatment in hospital or directly arranges for this admission.

After examination and treatment in the hospital the patient is released, he or she receives required medication for three days and is given a report for the attendant doctor on the methods and results of treatments in the medical institution, with a recommendation for further procedures. The right to a written report by the doctor is not, however, stipulated by law. In practice it is also possible that the attendant doctor sends this report directly to the primary care or outpatient doctor who sent the patient to the healthcare facility.

Inpatient care is provided not only in hospitals, but also in a network of specialist medical institutions. These include institutions for chronic illness, mental hospitals, physiotherapeutic institutions, sanatoria and night sanatoria, institutions treating tuberculosis and respiratory illnesses, and health resorts.

Accident and Emergency Services

In cases of sudden illness or injury, healthcare can be secured outside of surgery hours or in the absence of the attendant doctor. This is provided depending on local conditions - in smaller areas it is usually managed in co-operation with doctors who mutually represent one another, in larger localities there are organised emergency services in special surgeries or in hospital emergency services. Emergency services are also organised for urgent dental conditions.

For case of urgent serious illnesses when the patient cannot get to a doctor alone and where transport to a medical facility and fast treatment is essential ambulance services are organised to avoid a dangerous deterioration of health or threat to life. You can request their assistance by telephoning a special number.

IF REQUIRED CALL FREE OF CHARGE (ALSO FROM A MOBILE PHONE) ON 155.

, where you can also speak English and German and the operators contact the emergency services on your behalf and communicate your problem.

Company Health Services

Company preventative care ensures, in co-operation with employers, prevention and protection of employees' health from work-related illness and other threats to health in the workplace, including prevention of injuries. Company preventative care facilities undertake specialist advisory activities on issues of protection and support for the health and social comforts of employees. They regularly check company workplaces to ascertain the effect of jobs and working conditions on the health of employees, and undertake preventative medical examinations of employees (initial, regular and concluding).

Pharmaceutical Services

Pharmacy services provide patients with medicaments and health aids, either on the basis of a medical prescription or without.

Pharmacies issue patients with medicaments on the basis of prescriptions either without charge, if the medicaments are fully covered by the health insurer, or for a corresponding charge if the insurer only covers a part of the price or not at all.

Validity of medical prescriptions:

• a prescription from the emergency service is valid 24 hours

• a prescription for antibiotics is valid 5 days

• a prescription for opiates is valid 3 days

• other prescriptions are usually valid one week

On the expiry of the period the prescriptions become invalid and the pharmacy cannot issue the relevant medicament on their basis. Conversely when it concerns medicaments which need to be obtained in a special way, the doctor can extend the period of the prescription's validity when he makes it out. If the pharmacy does not have the prescribed medicament and cannot provide it in the prescribed period, even though it is necessary to issue the medicament immediately, it can issue another medical preparation with the same effectiveness and covered in the same way.

Aside from medicaments, pharmacies issue other medical technical resources - health aids. Most specialised workplaces which operate on the basis of contracts with health insurers also issue these aids, and the aids are issued on the basis of medical prescriptions either without charge to the patient or at a partial or full charge.

With some health aids the health insurer can decide on their loan rather than permanent issue to patients (e.g. crutches in cases of injury etc.).

Complaints

If the policy-holder considers that appropriate care has not been provided he or she may, by law (Act No. 48/1997 Coll. § 11 Par. 2) take complaints to several authorities.

It is possible:

• to submit a petition to the management of the healthcare facility, or founder of such facilities, in order that the procedures of its treatment are investigated;

• turn to the Czech Medical Chamber, Czech Dental Chamber, or Czech Pharmaceutical Chamber, should the complaint concern the professional or ethical procedures of the doctor, or, should it concern another employee, turn to the relevant professional organisation;

• turn to the health insurer - in particular when the healthcare worker refuses to carry out a procedure which is part of care covered;

• turn to the relevant state authority where the given medical facility is registered.

In the case of dissatisfaction with the settlement of complaints you can turn to the ombudsman (contact information in Adress Book - “Kancelář veřejného ochránce práv”-The Office of the Ombudsman).

The patient has the possibility of requesting help from one of the organisations representing the interests of patients - particularly when willingness to resolve the complaint is not forthcoming on the part of the healthcare facility. In the CR they are:

The Association for Protection of Patient Rights (Občanské sdružení na ochranu pacientů), Podskalská 24, 120 00 Praha 2; tel: 224 921 617;

Czech Association of Patients (Svaz pacientů ČR), Sokolská 32, 120 00, Praha 2, tel: 224 266 666, 603 720 158; fax: 257 215 757 www.pacienti.cz.

Health and Safety at Work

The CR has a large number of legal regulations concerning health and safety at work, which establish the principles of preventative care and health protection to be ensured for employees by the employer. These concern, above all, the protection of employees' health from work-related illnesses and other threats to health from work and the prevention of injuries. The established principles require the employer to ensure necessary care for its employees, as well as good, safe and suitable working conditions.

For this purpose the employer is liable to check the suitability of the workplace, take measures to minimise risk, and check and evaluate risk factors. The employer is further liable to provide employees with information, especially on regulations ensuring health and safety at work, the healthcare facility where "company preventative care" will be provided for them (in view of the fact that the choice of doctor is limited here), with information on medical preventative check-ups and vaccinations which employees are required to submit to in connection with the performance of their work etc.

The employer is also liable to provide employees with personal protective work aids in certain cases. In circumstances where clothing is subject to unusual soiling and wear and tear the employer provides working clothes or shoes. In the case of adverse work-related effects on employees protective drinks are also provided.

Should the employer not fulfil these obligations, the employee can turn to the sector authority and request assistance in achieving a resolution. The employee can also establish if the organisation in question has a health and safety officer who has the responsibility to resolve the issue.

Aside from general regulations there are also special regulations covering specific requirements e.g. for judging the health eligibility for given professions.

Regulations establish which activities are considered as epidemiologically serious, what work is undertaken at risky workplaces, which tasks performed by employees can threaten the health of co-workers or other persons, or for which special health eligibility is required for certain activities. Before commencing such activities the persons who are to perform them must submit to an examination to confirm their medically eligibility to perform such work (initial examination). The state of health of these persons should be further monitored. Therefore periodic preventative examinations are performed to the prescribed extent and time period. Regulations also establish conditions for the performance of regular, concluding and special preventative examinations and procedures in cases establishing work-related illnesses and ensuring healthcare for these persons.

Questions and answers concerned with receiving health care

What should I do if I feel the need to seek medical care?

Every healthcare facility is required to treat you in the case of acute, urgent care. If your need is not acute get help from a medical facility which is under contract with your insurer. Healthcare will be provided without direct payment in such facilities, to the extent of the given type of your health insurance (public health insurance or long-term contractual health insurance).

With short-term contractual health insurance it is necessary to turn to state-owned medical facilities (e.g. hospitals). Only necessary and urgent care is covered by this insurance.

In the case of serious illness when you cannot get to a doctor yourself and when urgent assistance is required to prevent a dangerous deterioration of health or threat to life, call free of charge (fixed or mobile telephone) 155.

Can I call for an ambulance (line 155) and speak in my own language in the case of sudden serious illness?

If you do not speak Czech, in the case of sudden serious illness it is better to call the emergency services on the central number line 112. Operators on this line speak Czech, English and German and after establishing your problem they contact the emergency services on your behalf. They will remain in contact with you (in a telephone conferencing system with other participants) and interpret for you.

How do I find a doctor who speaks my language?

When concluding contracts for contractual health insurance it is possible to get contact information for contractual medical facilities where foreign languages are spoken. It is possible to solve problems quickly with VZP CR Assistance services.

In the Czech Republic there also exists a central information centre known as H.E.L.P. - the central records of treatment and prevention, which is run by the Medical Information Centre. They can provide information on private doctors, hospitals, pharmacists, health resorts, private clinics, sanatoria and all other medical facilities operating in the Czech Republic.

The system provides basic identification information about all private doctors and medical facilities, including contact information, the medical field in which they carry out treatment and preventative care, and the languages which they speak.

Information in the H.E.L.P. system is publicly accessible and can be obtained in a number of ways. The Catalogue of Medical and Preventative Care in the CR is issued regularly in print and on CD ROM. It contains all necessary data for gaining basic information on providers of medical and preventative care including contact information.

The full catalogue is also located on the site of the Medical Information Centre at www.kataloglekaru.cz or www.doctorhelp.cz or www.help-lic.cz. Here the user can make a criteria-based search for the required doctor or facility.

The Medical Information Centre also operates a free information telephone line +420 296 182 626, where you can get information every working day from 8am to 4pm. You can also request information by email to: help_lic@netforce.cz, by fax on +420 296 181 804, in writing or in person at the address: Lékařské informační centrum, Lékařský dům, Sokolská 31, 120 21 Praha 2.

Mobile phone users can also gain information on doctors and healthcare facilities through their mobile operator or WAP:

• EUROTEL - EUROTEL - ASISTENT and EUROTEL - PORTÁL

• T - Mobile - T-Mobile Asistent 333 (Asistent Navigator) as well as T-Mobile WAP

• OSKAR - OskarKompas, Oskarův WAP

What should I do when I am in distress at night or at weekends? Who can I call?

There is a network of first aid medical services throughout the Czech Republic. Every region has a number of healthcare facilities who can treat you as required, or, if necessary, they can provide you with healthcare outside these facilities.

For urgent medical assistance call 155 - emergency services. If you don't speak Czech call the emergency number 112, where the English and German speaking operators will connect to line 155 themselves and communicate your problem.

What's the procedure when I am injured or in an accident and I don't have my insurance card with me, even though I'm insured?

In the Czech Republic it is still the case that if your situation requires acute and urgent medical care this care will be provided to you with or without handing over of your insurance card. The fact of whether you are insured is easy to ascertain. For participants of public health insurance this verification is possible on the basis of the insurance policy number, which is the birth number based on your date of birth. If you are contractually insured this can be verified on the basis of your name and date of birth from VZP CR assistance services. It's possible that you will be required to produce your card afterwards.

Can I go straight to a specialist if I am experiencing health problems or must I first go to a GP?

If your state of health requires urgent care a GP's recommendation is not necessary. If you are not in an acute state it is better to go to your GP. He will give you a recommendation for expert care if required or an application for examination by a specialist who has a contract with your health insurer.

You always visit a dentist or gynaecologist directly.

Who should I contact if a doctor refuses to treat (register) me even though I have an insurance card?

In the case of refusal contact your health insurer or the healthcare department at the given regional authority. You can also contact the healthcare department if you have a complaint against a doctor whose behaviour seemed discriminatory towards you.

If, even after contacting your health insurer or health department, there is no redress, you can take the matter to the ombudsman (contact given in Adress Book - “Kancelář veřejného ochránce práv” - The Office of the Ombudsman).

Contractual policy-holders of VZP CR do not register with GPs. Treatment is performed by VZP CR contractual doctors and contractual medical facilities.