Česky
How do you perceive the measures that the Czech Republic has introduced in the fight against coronavirus?
In principle, very well. The development has been rapid, so some issues and impacts can only be evaluated in retrospect. During and after the pandemic, there was a lack of better coordination of the outputs of the actors involved in the crisis across the health system. It is now necessary to build on lessons learned to develop a manual for future viral pandemics and similar events. The primary need is to be able to take individual protective measures quickly and to be able to release them just as quickly and flexibly.
You are one of the largest private healthcare providers in the country, how have the coronavirus-related measures affected your facilities?
In the hospitals in Beroun and Hořovice, including Pardubice Oncology, we were forced to immediately reduce outpatient care and surgery by about fifty percent under the pressure of the emergency measures taken. In accordance with a government resolution and in coordination with the Central Bohemian Region, we set up covide beds and introduced so-called triage tents.
What does this mean?
In view of the ongoing pandemic, we have very carefully weighed the patient's indication for surgery on the one hand against the risk of infection, especially for staff, on the other. We decided on the priority of medical procedures accordingly. In the triage system, we simply divided patients into acute and those for whom a short-term or long-term delay was possible. We then informed them that their procedure was postponed. Except, of course, for procedures that could not be postponed.
What is happening with the "deferred" patients now?
We are currently contacting them again and arranging new, alternative appointments. However, we have not refused to treat or schedule any patient during the crisis.
So exactly how many patients were affected by the measures?
Both the Beroun and Hořovice hospitals had to postpone approximately 700 surgical procedures. However, we are still analysing the data. Some outpatient clinics operated without interruption. However, many patients were afraid to come and cancelled appointments themselves, which is still happening.
Can everything be quantified financially? How does all this affect your group's finances?
We will only be able to make a final account when the pandemic and related measures are over. At the moment, we are able to quantify the cost of purchasing protective equipment, the vast majority of which we have secured ourselves and in good time. They are in the millions, and I estimate that they will exceed CZK 10 million.
Let us welcome the fact that insurance companies have not stopped paying the agreed lump sums. However, we have seen an immediate drop in income for procedures covered by the procedure, such as arthroscopy, diagnostics and others. Here again, losses will be in the tens of millions of crowns.
Are you addressing any support for your business or considering applying in some of the programs announced by the government?
So far we have not been able to use any title, due to the size of our facilities. We are currently exploring the possibilities of the Covid III programme.
Apart from your business, the health of the patients itself will also bear the consequences, right? You said yourself that some people were afraid to come in for a checkup.
There's a bit of a confusion between delayed and residual care. You can postpone, for example, the insertion of a total endoprosthesis, but it doesn't make the patient's indications and problems go away. At the same time, the number of new patients who need an endoprosthesis will not stop increasing. The crisis will therefore generally result in longer waiting times, longer periods of discomfort and reduced quality of life for patients, and a greater burden on health professionals as they try to make up for this delay in care.
And other problems?
Some diagnoses are even more problematic from this perspective, as delays in care can worsen a patient's prognosis. In addition, we have unfortunately encountered unjustified requests for testing patients on COVID-19, which we needed to transfer to a specialist department. As a result, everything took longer than usual, even for acute conditions. The whole system seemed to stall at some point.
Fortunately, the epidemic did not reach such parameters that these individual "excesses" threatened the continuity of care. But it is a warning that if we are more papal than the Pope in such a crisis, the whole system will get stuck without reaching its capacity limits. And that's only because of the overzealousness of some care providers in interpreting various regulations and methodologies.
When will what has now been postponed manifest itself in the health of the people?
Only time will tell. But it will certainly show up in a greater burden on the health care system for care that has been provided to a limited extent or not at all. In addition, health professionals also need to rest. They have been banned from taking holidays for some time, and sometimes they will also want to take them. Another wave of epidemics may come in, which would be very unpleasant, but it cannot be ruled out.
Okay, but how big will the impact be?
The impact of the coronavirus crisis on the health of society may not be very noticeable if the health care delivery system can be quickly restored to the necessary scale. Or, on the contrary, they may be very negative if this is not done.
For example, our oncology department in the Pardubice Region was also forced to temporarily limit the care it provided under the pressure of the crisis circumstances and recommendations from professional societies, which were delayed. This means, however, that this workplace will now have to clear the oncology patients who were waiting for care in a short space of time, and at the same time, of course, newly diagnosed patients will be coming to us. We will try to compensate for the described overlap in the need for care by proportionally adjusting the operation of the services provided, i.e. by extending the surgery hours, deploying more specialists, etc.
And the consequences?
If the current situation does not worsen, for example, if there is no further epidemic wave, no further restrictions on operations, if the staff of the facility does not fall ill, etc., the chances are that the impact of the coronavirus crisis on the health of the population will be relatively small.
However, there is still a fairly likely scenario that all will not be rosy. Then there may be further delays in the provision of health care in the context of the implementation of restrictions arising from government regulations. In such a case, the resulting delays will simply not be caught up. Or only at the cost of disproportionate effort and expense. Then it may indeed be that some patients will pay the price in terms of a poorer quality of life, or even life itself. That is why it is also important not to panic in times of crisis and to preserve the throughput of the healthcare system as a whole as far as possible.
What will this mean in terms of your business and, for example, investment in equipment?
In certain circumstances, the crisis may put the brakes on upcoming investments. In this situation, however, the fact that the financing of the Czech healthcare system is not optimally set will become fully apparent. Thinking in terms of the long-term disproportion in public and private sector financing.
The state has declared, and the regions will certainly do so, that it will support its hospitals. We, as private providers of public health services, cannot therefore count on support from state or regional budgets. However, I believe that we will be able to cope with this difficult situation.
So the construction of your mental health centre is proceeding according to plan?
On the contrary, we are accelerating our activities. We are working intensively to secure several billion crowns, which we want to use for further development, especially for the construction of the Mental Health Rehabilitation Centre in Beroun.
Then there is the significant expansion of the capacity of the hospital in Hořovice, the commissioning of the planned polyclinic in Prague - Nové Butovice, aimed especially at paediatric patients, and many others. However, we are reassessing our investments in the light of the pandemic. So that the further planned development of our healthcare facilities does not limit the care provided.
Will the situation surrounding the coronavirus have any effect on relations with health insurance companies?
There will certainly be intensive discussions with health insurance companies about this year's billing and which year will be used as a reference for the following year's reimbursement. We ourselves want to open up the question of creating new capacities in our facilities. On the one hand, the financial situation for their reimbursement will not be ideal, but on the other hand, by using them we can significantly help to improve the quality of healthcare for those diagnoses that have not been temporarily treated because of the crisis. Or because their incidence in the population is accelerating - for example, musculoskeletal diseases, psychiatric diagnoses, some cancer diagnoses or cardiovascular diseases.
Has all of this shown anything positive about the Czech healthcare system or the functioning of the healthcare system?
The experts are doing a top job. The whole system has also been able to rely on excellent and dedicated doctors, nurses and other medical staff, who have also been able to adapt quickly. I think the management was also quick to receive reports from the field and responded flexibly, including from us.
Did the crisis also highlight the difference between the private and public health services? Or has it just reignited the debate on the need to increase salaries for health workers?
We are definitely in favour of raising the salaries of health professionals. We support it. Only in our country we have always had to earn it. However, we are in favour of a systemic measure that gives everyone a raise.
There is a disproportion in the health financing system between the public and private sectors, yet we care for the same patients. If we did not push for efficiency and productivity, we would never be where we are. But efficiency has an elasticity. With our own efficiency and high productivity, we can cover externalities such as pandemics - but only with maximum effort.
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