Patient Rights in the Czech Republic

1. JUDr. Ondrej Dostal, Ph.D., LL.M. Center for Health Law 3th Medical School, Charles University, Prague Holubova.cz Attorneys Specialized in Health Law, Prague Patient Rightsin theCzech Republic

2. Features of Current System • Czech Constitution, Art.31: • Citizens shall have the right, on the basis of public insurance, to free medical care and to medical aids under conditions provided for by law. • Compulsory insurance coverage, Act 48/1997 Coll.: • Annual compulsory insurance premium set by law • avg. under 1000 USD/year/capita (cca 10 billion USD/yr, 7%HDP) • Paid by employer/employees • State budget pays for non-productive citizens (aged, students…) • Coverage: • Almost all interventions covered (excl. explicit negative list) • Medical aids covered typically up to 75% • Drugs: system of 300 „reference groups“, at least one drug fully covered

3. Bismarck (Potemkin) Model of Public Health Insurance in Czechia Parliament legislation, MoH regulation Fixed premium (<1000 USD/yr) Broad universal coverage No co-payment Health Insurance Funds Early years: fee for service reimbursement Recently: „Historical budget limits“, capitation payments Patients Insured Health Facilities High standard of due care Info.consent, right to know alternatives Almost no payment for covered services

4. Access to Quality Health Care • Very generous promises in insurance law • In fact, problem to access expensive treatments • Physicians „motivated“ not to expend money • Weak enforcement mechanisms • Internal review of insurance company: biased • Court review: lengthy • Other external review (arbitration): non-existent • Problems for cross-border care and insurance reimbursement

5. Patient Rights: Legal Basis • Council of Europe Biomedicine Convention • Since October 2001 • Directly enforceable • Catalogue of rights • Informed consent • Quality of medical intervention • Privacy • Access to information • National laws and directives • NB: liberal rules on reproduction medicine – many incoming patients

6. Informed consent • Condition of legality of intervention • Missing consent, invalid consent = liability • „No valid consent to medical error“ • Disclosure requirements: • Risks • Alternatives • Costs? Doctor experience? • Foreign patient • JCI Accred.: Consent forms in more languages • Interpreter found (not paid for) by provider

7. Informed consent - exceptions • Patients unable to give consent • Minors • Persons with mental disability • Permanent • Temporary • Consent given by legal representative • Exceptions: duty to follow best interest of the represented person • Cases of necessity, where consent cannot be obtained • Exception: Previously expressed wishes

8. Privacy protection • General duty of medical confidentiality • Exceptions: • Patient consent • Needs to be explicit, ideally written • Needed also for communication w/relatives • Exceptions in specific laws • Serious crimes reporting (murder, abuse of child) • Access of medical and other professionals (limited to the necessary level) • Access of medical students (w/consent of patient)

9. Access to Medical Records • 2007 laws: • Right to access all health records • Right to make copies • Right to transfer these rights to other person • Rights of relatives of deceased to access medical records, if the deceased did not prohibit it • Benefits: • Easier to resolve malpractice claims • Problems: • „Retrospective“ - „úplně blbá“ example

10. !!LAWYER ALERT!! Follow the Emergency Plan! Patient N., ischaemic heart disease, died 00:15, 9.4.2008 Attached paper with instructions to the nurse: „Fill in the drinking regime observation!“ „Dr. K....: Record application infusions from 24.03.!“

11. Conclusions • „Explosion of rights, absence of duties“ • Need to balance rights and duties in upcoming legislation • Need to provide motivation to efficient behavior in solidarity-based system • Lack of enforcement • „De iure“ vs. „de facto“ situation • Need to improve legal knowledge between medical workers, patients AND system administrators • Need to establish fast and efficient procedures for dispute resolution

12. Current regulation of cross border health care in CR No domestic legal provision EU regulation 1408/71 coordinating social security systems (directly applicable) Urgent treatment – European Health Insurance Card Planned medical treatment - main „legal regulation“ in the European Court of Justice (legally binding); not respected by the HIFs in pre-auth. decisions New Directive on patient rights in cross border helath care´incorporating case law – to be discussed in the EP in April 2009

13. Thank you for your attention Contact: Holubova.cz Law Firmondrej.dostal@holubova.czCenter for Health Law, 3.LF, Charles University ondrej.dostal@lf3.cuni.cz