Meeting with Parliament of Czech Republic delegation

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Health

11 November 2015
Chairperson: Ms. M Dunjwa (ANC)
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Meeting Summary

A delegation from the Czech Republic came to share their experiences and exchange information with the Committee on health care issues, ranging from the effect of an influx of immigrants on the domestic health system, to the functioning of the Czech Republic’s national health care insurance.

The Czech delegation was asked how their country dealt with the diseases they were not used to handling, which were brought in by immigrants,. Were illegal immigrants with uncommon illnesses sent back to their countries or were they treated and accommodated in the Czech Republic? How did they deal with globally threatening sicknesses like Ebola?

The Czech delegation explained that there was compulsory health care insurance in the country, meaning that every citizen had to be insured or the insurance had to be paid for him or her. The responsibility for financing health care insurance went to the health care insurance companies, so it did not matter if the patient went to a state hospital or a private hospital. With 10 million citizens, there were about four million who were economically active, meaning that they could afford to pay for health care insurance, which comprised 12 percent of their income. For the remaining six million, the health insurance was paid by the state. The six million was made up of minors, pensioners and unemployed people, and for those citizens the state paid about R400 per person. There were seven insurance companies which collected the financial means from the state, and also from the economically active citizens.

The meeting was disrupted by the protest that was currently taking place in Parliament. It was adjourned when the protesting workers insisted that the Members and everyone at the meeting should vacate the venue. 

Meeting report

Minutes

The Chairperson officially opened the meeting and asked Members of the Committee to introduce themselves. The delegation from Czech Republic proceeded to introduce themselves as well. As they were not English speakers, they brought a translator along.

The Deputy Speaker of the Czech Chambers of Parliament said the delegation was comprised of members from the Department of Health, the Chambers of Parliament, the Senate and the Chamber of Deputies. One of the main issues that the delegation would like to know about was the health situation regarding immigrants to South Africa. They admitted to having an immigration crisis in the Czech Republic, and as it was a new experience they would like to exchange some information on the matter. The delegation was prepared to answer any questions about the financing of health care insurance, and national health care itself.  They had vast experience with regard to health care insurance. The Committee would be able to ask these questions from the point of view of people who financed it, and the doctors who dealt with patients who were on health care insurance. The basic theme would be left to the chairperson of their committee. They expect the Committee to present its views first and any questions and comments would be welcomed.

The Chairperson of the Portfolio Committee said the Committee would share some questions and concerns. The Committee was comprised of three medical doctors, and Members from various political parties who did not necessarily have medical backgrounds but were activists and persons with an interest in the health sector in the country. She apologized to the Czech delegation, saying that if the Committee had been aware of the composition of their delegation, the Committee would certainly have accommodated them appropriately. However, from time to time the Committee would have representatives from various entities and the Department of Health to report and account on certain issues. The Committee also interacted with the Select Committee on Health in the National Council of Provinces, although this was sometimes difficult because they had a programme of their own.

The Chairperson handed over to the members of the Committee to submit their questions, comments and concerns.

Discussion

Dr W James (DA) said that the fundamental challenge in the country was to provide quality health care to the entire population. In the past, quality health care had been available for white South Africans only, but now it had been made available to all South Africans. There were 50 million people in South Africa, and presently17 percent of the population was on health care insurance, while 83 percent relied on public health care. 41 percent of the health care budget was spent on private health care. In order to provide universal health care, the country needed to get the health care economics right. Regarding affordability, it continued to be a challenge to finance universal health care because of the way the finances were structured.

Referring to the question of immigration, he said he had been the chairman of the green paper task team on immigration for the Department of Home Affairs in 1995. The immigration problem had been principally to develop a refugee protection system, and it was now effective. South Africa’s principal problem was the illegal immigrants, most of whom were economic refugees -- people looking for work or who wanted to trade -- so South Africa by no means had a crisis similar to that of the Czech Republic.

Mr H Volmink (DA) said it seemed, when reflecting on the transition that the Czech Republic had gone through and the changes that had occurred in South Africa over the past two decades, that both could learn a lot from each other.  South Africa’s current challenge was to realise the goal of universal health coverage, and the Committee would be interested to know how the Czech Republic implemented their national health care insurance, and how they had managed to bring the various role players, like the private sector, to the table. Finally, he said people lived in a world where there were global health threats -- recently Africa had suffered the Ebola outbreak -- and he would like to find out more on how the Czech Republic protected itself from such global health threats.

Dr P Maesela (ANC) asked how national health care insurance was working in the Czech Republic. South Africa was also trying to change the accessibility of health care in a manner so that it was available to everyone in the country. Secondly, if the Czech Republic was affected by the influx of refugees and because of the political realignment in Europe that was taking place now, how did it cope with the peculiar diseases that were brought in by the influx? Was there a way to send them back to their countries, or were they accommodated and treated in the Czech Republic?

Responses

The Deputy Speaker said the technical questions would be answered by the professionals. He said that their committees were also proportionally represented according to the political parties. He would like to find out why there was not an act on health care insurance, as the budget showed that about 55 percent of the budget was spent on 83 percent of public health. The critical question was how the health care insurance was going to be organised under those conditions.

The speaker from the delegation said the committee had 24 members from all political parties represented in parliament. The committee was currently sorting out the questions that had accumulated over the past eight years, involving a small portion of the health care system, and in conjunction with this, there was now the issue of the health care crisis in Europe. The health risk in the Czech Republic did not appear to be high -- the mainstream of the refugees in the Republic came from around Europe, like Austria and Germany. However, there were still a few immigrants in the country.

With regard to the systems of organisation the Czech Republic had in place, because the immigrants were illegal, they were placed in detention centres when identified. Immediately, from the beginning, they were examined by doctors and they determined whether further treatment or tests were needed, because they were coming from the countries with diseases that were uncommon in the Czech Republic – such as tuberculosis and HIV/Aids. Everyone was examined and if they needed immediate health care, they would be provided with it. There was not a problem at present, but they were looking into the future because the immigrants would go from the Czech Republic to Germany and other surrounding European countries, so they needed to be prepared for it with their legislation and also with the capacity of their health facilities.

The Czech Republic has 10 million citizens. The health system is very well thought through and it is available to all. At the moment it was concentrating on creating a net to catch of the specialised and super-specialised dangers in the country. For example, the immigrants were hospitalized in the top cardio-surgical centres, and surgeries were performed without requiring financial compensation.

 About Ebola, he said the Czech Republic was not a big country so they had only one centre for these difficult infectious diseases. When the Ebola crisis was prevalent in Europe, there had been a few patients that had been suspected of having Ebola, but none of them turned out to have had it. There was another highly specialised centre, which was for the army, so if needed they to, they could access it and make use of it.

A speaker from the delegation said it was clear that South Africa was in a more difficult situation than the Czech Republic. This was because his country had inherited its health care insurance system from past generations. After the World War, when the Czech health care system had been established, three good fairies come on to the scene-- the first one being availability for all, the second one wished for high quality, and the third one wished for free health care. He said he had forgotten to invite one good fairy and she was angry -- she wished for all those three principles to be satisfied at the same time.  However, it was difficult to satisfy all of them at the same time, because often when health care was free and available to all, the quality suffered, or when it was of good quality and for free, the availability suffered. This was the problem that other countries like the United States of America faced.

The Chairperson said that it would be useful to go back to how the Portfolio Committee was composed. There were members from African National Congress, there were three members from the leading opposition party and from the others, it was one member per party, so the Committee was also composed in a proportional manner. The fortunate part was that the members of the Committee were focusing solely on health. It was also important to reflect on the Committee’s oversight of the executive, which was the Ministry of Health. In the National Assembly, the Committee asks the Ministry questions regarding the issues that need to be dealt with, and calls on the Department of Health to make presentations on their work and projects they undertake. Even the provinces would be called in to the Committee to account for their work, if they were malfunctioning.

As Dr James had highlighted, it was within this context that the government had said the Committee needed to come up with a system that would coordinate the national health care insurance, and a green paper had been developed. The Committee was now awaiting the white paper which would reflect critically on the funding of the national health care insurance.

Acknowledging what had happened before 1994, the government had made sure that that situation would not happen again. The new government had inherited a system where patients were treated based on their skin colour. Even the training and remuneration of health care workers had been on that basis. The health care workers in the country had been trained in a curative system, not in a preventative system, and that was why the focus of the Department of Health was mainly on primary health care, which had never been there before. It was important for the system to be re-engineered, but that was not very easy because the population was increasing, so new hospitals and clinics had been built across the country.

One of the major challenges affecting the country’s human resources was the migration of skills of health workers to other countries. Despite the challenges, the Department of Health was doing its best to ensure that they were circumvented and the health care system was changed for the better. This was why it was looking at a new curriculum for nurses to ensure that it was in line with the new system that was going to be implemented. Due to the high prevalence of poverty, people were easily prone to contracting infections like tuberculosis and HIV/Aids. When the Committee conducted its oversight visits, it was to ensure that the programmes that the Department of Health had put in place were being achieved. The Committee would then make suggestions based on their experiences during the oversight visits.

The Deputy Speaker said that he still had to answer the question about health care insurance. The principle of the health care insurance in the Czech Republic was to separate the money from the state budget. Therefore, the responsibility for financing health care insurance went to the health care insurance companies, so it did not matter if the patient went to a state hospital or a private hospital. This was the difference between the health care insurance, as opposed to the national health insurance, which could be combined in the state budget. The budget was done by the Security Board and the Deputies of the Chambers.

The Deputy Minister of Health Care Insurance said there was compulsory health care insurance in the country, meaning that every citizen had to be insured or the insurance had to be paid for him or her. With 10 million citizens, there were about four million who were economically active, meaning that they could afford to pay for health care insurance, which comprised 12 percent of their income. For the remaining six million, the health insurance was paid by the state. The six million was made up of minors, pensioners and unemployed people, and for those citizens the state paid about R400 per person. There were seven insurance companies which collected the financial means from the state, and also from the economically active citizens. The country’s biggest organisation for health care insurance was the National Health Care Company, which covered about 60 percent of the collections; the remaining insurance companies divided the balance of 40 percent among themselves for coverage.

The meeting was disrupted by the protest that was currently taking place in Parliament. It was adjourned when the protesting workers insisted that the Members and everyone at the meeting should vacate the venue. 

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