Marketisation of healthcare: Going back and forth?
The most heated debates about the marketisation of the healthcare systems in the Czech Republic and Slovakia took place very closely in sequence. In the early 2000s, both systems have been quite radically changed in the direction of marketisation by right-wing governments (in the Czech Republic this process was finalized only in 2013). This was accompanied by the implementation of the so-called regulatory fees, payments for above-standard services, or the pressure on the public hospitals so that they are subjected to similar repercussions as private companies if they do not adhere to the market logic of competition and drive for profit.
In both countries, these reforms were met with strong disapproval and further fueled popular backlash, resulting in the victory of social democrats – in Slovakia, this happened in 2006, in Czechia in 2013. New governments tried and, in most cases, managed to reverse many of these new measures, the most symbolic example being the abolition of ambulance fees, which are now not present in either country. The right-wing opposition labelled this step as an act of populism, while the left talked about equal access to healthcare. However, politicians in both countries, for many years to come, found out that citizens are extremely sensitive to any movements towards marketisation and privatisation of health care.
Since then, the subsequent governments on both sides of the political spectrum have been extremely careful about any kind of radical reforms. Nevertheless, that paradoxically does not mean that the tendency to marketise or privatise healthcare has stopped. In fact, much quieter processes have started operating and even though the voters are still aware of them, recognising the political strategy and aims behind them can be very difficult. The main reason is that these new measures are often implemented by centre-left and left-wing parties where citizens are more oblivious to any tendency towards marketisation of healthcare, education or social services.
Since 1 January 2018, if you want to avoid queues, you can pay up to 30 € to your doctor to examine you during the so-called “supplementary hours”. This proposal was put forward by the former Minister of Health Tomáš Drucker and has been changed a few times. Paradoxically, it was criticised by the former Prime Minister Robert Fico, whose government Drucker was part of. Fico, as a then-leader and representative of the government, came across as anti-elitist, while his own government did exactly the opposite move.
In the Czech Republic, the Minister of Health Adam Vojtěch, who used to be a member of the right-wing Civic Democratic Party, took steps towards the marketization of healthcare, which cannot be ignored. In spite of this, he is now nominated as non-partisan by ANO, led by the Prime Minister Andrej Babiš, most of whose electoral base is formed by left-wing voters.
Many Czechs and Slovaks might be against marketisation and privatisation of healthcare, but even if we ignore the question of whether it is a positive or a negative, we must admit that the game the politicians play with the voters is deliberately a very blurred one. A serious debate might start exactly by admitting this. These issues, and much more, will be discussed at the Central European Conference’s panel Public Healthcare Crisis.
Written by Karolina Kasparova