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EUROPE: Striking at the Heart of Healthcare

Pavol Stracansky

BRATISLAVA, Oct 5 2011 (IPS) - Almost half of all doctors working in Slovakia’s hospitals have handed in their notice in a mass protest over working conditions and wages which they warn could cause the Eastern European country’s healthcare system to collapse.

They have given two months’ notice but say that if by the end of that time their demands for better wages and reforms of the healthcare system are not met they will carry through their resignations, leaving hospitals having to limit operations, close wards and provide only essential health services.

The mass resignations have been inspired by similar action taken by doctors in the neighbouring Czech Republic.

They also come, though, as discontent among low-paid medical staff runs high in a region where underfunded healthcare systems have struggled in the transformation from communism to capitalist democracy.

“For 20 years there has been discussion about problems in healthcare. But although governments have changed no solution has been forthcoming. Hospitals were always forgotten. The problems have built up and now they have come to a head,” Dr Tibor Sedlak, a union leader at Ruzinov hospital in the capital, Bratislava, told local media.

Following the fall of the Iron Curtain governments, Eastern Europe inherited healthcare systems which were already underdeveloped in comparison with the West.

Successive governments have struggled to overhaul those systems and provide modern healthcare services on a par with the West.

Although health indicators such as life expectancy, infant mortality and the availability of treatments and procedures have risen markedly in the region over the last two decades, many healthcare workers argue that these mask continuing serious problems in health sectors which are grossly underfinanced.

In some states, chronic underfunding has led to hospitals and clinics lacking basic equipment and materials.

In Romania, where state health care spending has regularly been the lowest of any EU member state, there have been a number of protests by doctors and other healthcare workers over the last decade over working conditions.

The situation was so bad, some doctors say, that at times they had to buy vital medicines for patients out of their own money.

State spending on healthcare last year was just above four per cent of GDP compared to the EU average of around eight percent.

In neighbouring Bulgaria, healthcare spending levels are similar to those in Romania and within the last two years hospitals have been so underfunded that they have had to cancel operations and switch to providing only essential medical services.

Slovak doctors point to healthcare spending also below the EU average, at about 6 percent per year.

Low wages and long working hours, which are also among the reasons the Slovak doctors have handed in their resignations, have already prompted industrial action in other parts of the region.

Last year, thousands of doctors in the Czech Republic handed in their notice over wages, claiming newly- graduated doctors earned a basic salary of just over 650 euros a month while the country’s average monthly wage was around 900 euros.

The mass resignations ended in doctors’ wages being raised to above the national average wage and government pledges to reform healthcare. But some of the reforms, including fees for patient hospital stays and certain medicines, have been unpopular.

In Romania, a resident doctor sometimes earns as little as 200 euros per month with the figure in Bulgaria little better. In Hungary some newly qualified doctors have a starting wage of as little as 350 euros per month. In the Baltic states specialist surgeons often earn less than 1,000 euros per month.

But the poor conditions, underfunding and low wages have not just led to industrial action, but also an exodus of specialist and newly-qualified doctors to western European countries and the U.S.

Governments, hospital managers and doctors’ unions have admitted that this brain drain of medical talent will only worsen existing problems in their healthcare systems.

Other doctors have privately told IPS that a lack of staff has actually led to patients being out in danger.

In Slovakia, the striking doctors are demanding their wages be raised to at least one and a half times the national average wage, which currently stands at just under 800 euros per month.

They also want increased funding for healthcare facilities as well as a stop to controversial plans to transform hospitals into state-held companies.

They say that the transformation will negatively affect standards of healthcare and will do nothing to improve hospital financing.

Dr Sedlak said: “There is a basic problem of financing that, for example, for every syringe for which the hospital pays one euro, the hospital gets back from the health insurance company 60 cents.

“This will not change (by transforming hospitals to companies) and it will just mean that the hospital, as a company, will be making a loss. They will try to solve this by reducing treatments and procedures. Less healthcare will be provided.”

Slovak health minister Ivan Uhliarik has said he plans to meet the protesting doctors to discuss their demands.

But he has said that there will be no change to plans to transform the hospitals to companies – a move supporters say will force hospitals to implement sound management practices, cut down on waste and reduce debts – and warned there is no money budgeted for raising doctors’ wages.

Successive cash-strapped governments around the region have repeatedly said that raising funding levels for healthcare is difficult. The financial crisis has also affected spending in the sector in many countries as governments have been forced to make fiscal cutbacks.

In a bid to make up the shortfall a number of controversial measures have been introduced over the years, with varying popular success, to try and raise funds.

In the Czech Republic charges for patient visits to doctors were brought in. Similar charges in Slovakia were dropped amid public opposition. In Bulgaria, mandatory healthcare contributions were introduced some years ago while in Romania recent reforms have included proposed co-payments for patients.

Doctors have said though that such measures have done little to help ailing healthcare systems.

One doctor in Romanian capital Bucharest told IPS that despite various measures and reforms over the years the sector remained beset with funding problems and low morale among medical staff.

Speaking on condition of anonymity, she said: “Healthcare here continues to be very poor despite reform processes.”

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