About 100,000 foreigners with long-term visas are required by law to have Czech private health insurance. The group includes foreign students, self-employed people, and the spouses of foreigners working here. But according to the Campaign for Health Insurance for Migrants all foreigners should participate in the public health care system.
The requirement to take out private insurance for these people was part of legislation brought in 2010. The product needed for a visa was comprehensive health insurance (komplexní zdravotní pojištění) which should cover visits to the doctor and hospital care as well as emergencies.
A justification given for new requirement was to ensure that doctors and health professionals would be paid. The implication being that foreign insurance companies didn’t pay or the money was too difficult to obtain.
For some foreigners who are clients of these private companies, this rationale must ring with the bitterest irony. The Campaign for Health Insurance for Migrants has been collecting testimonies from people from Ukraine, Uzbekistan, Australia, and Mongolia. The individuals concerned had complex health insurance from a range of companies. The accounts are cause for concern.
One woman from Uzbekistan followed the regulations and took out insurance with PVZP – the private arm of VZP which provides insurance to foreigners. According to her story, many doctors refused to accept this insurance. A Ukrainian woman attempted to visit doctors on the list provided by her insurer UNIQA. None of the listed doctors would treat her without cash up front, which she eventually had to pay. A fellow countryman of hers was told at Motol that he was “another Ukrainian with the wrong insurance”.
The lack of proper coverage has touched at least one Czech. “Jan”* has a wife from South America. Though they’re married, she still requires private health insurance because she hasn’t been granted residency. Jan has spoken up because of the poor nature of the conditions provided by private insurance, the poor service for foreigners, and the discriminatory nature of the policy.
“We’re scared of a situation in which my wife needs treatment,” he said.
(*He has asked us to not reveal his identity for fear of problems for his partner.)
Maybe irony is the wrong word. Irony (at least in the historical sense) implies an unintended or opposite outcome. Maybe the companies never planned to ensure that medical treatment was paid, at least not by them, or so alleges Linda Janků of SEHNUTÍ, one of the groups who are a part this campaign.
“The reality is that the health insurance companies enter into the contract many conditions so that basically when the migrant needs the health care to be paid, it’s not paid,” she said.
The campaign explains that one reason for the inadequate coverage is the exceedingly high running costs of the private insurance companies. An analysis compiled for the Campaign for Health Insurance for Migrants shows running costs for the five Czech insurance companies averaging 63% with 22% going towards health care. In one instance, an insurer only paid 11% of its earnings toward insurance.
Spokespeople from some of the companies responded to these figures. Maxima didn’t deny the figure but their spokesperson Olga Herko said in an email, “Total operating expenses include a wide variety of items, one of which is commission for the acquisition of contracts.”
Slavia rejected the figure included in the analysis. Spokesperson Aleš Povr said, “Commercial health insurance for foreigners with lower cover but higher rates of claims can’t have a claim amount of 11%.” However, they would not provide the figure of how much their claims came to.
PVZP’s spokesperson Robert Kareš also rejected the figure included in the analysis. He went on to add that PVZP’s mother company VZP doesn’t agree with the inclusion of migrants here on long-term visas to be included in the insurance system.
Kareš added, “The problem of the whole of this campaign is the sheer ignorance about these systems and subsequent erroneous presentation of knowledge.”
Suffer the Children
Age is no guarantee of care. Another case provided by the campaign concerns a young girl who had to have surgery. The surgery was covered by the insurer – until a second doctor changed the diagnosis. The girl’s family had to fight to have the original diagnose recognized in order for the surgery to be covered.
Even when the company covers a child’s treatment, the fact that foreign children don’t participate in the public medical system is a particularly thorny one for the Czech state. The Czech Republic is a signatory to the Convention on the Rights of the Child [http://www2.ohchr.org/english/law/crc.htm]. Article 24 of that document states a signatory’s obligation is regarding the provision of health services to children.
Elena Tulupová, a lecturer in public health at Charles University, is another member of this campaign. She said, “In the questions regarding health it is absolutely inappropriate that in a European state children can’t get proper health care.”
The Ministry of Health interprets the Czech Republic’s obligation differently. “The said obligation does not mean that it has to be borne by public health insurance,” their spokesperson Libuše Bořská wrote via email.
The reasoning is that the health system, in the Ministry’s view, is inherently designed ‘for those who fund it.’
Turning Away Business
The problems with the private insurance system for foreigners affect practitioners as well. Tim Young is from Young and Co. a private medical practice in Dejvice. They have a number of patients from the expat community, and while this should be good for business, they have to turn people away.
“Our problem is that we have about a third of our patients who are non-Czech but who consume maybe half of our time whilst bringing no more revenue than Czech patients (being covered under public health insurance),” he said.
An additional problem is the unreliability of the insurance.
“There are also frequent problems with VZP retroactively cancelling insurance for foreigners after our services have been provided, in which case we do not get paid,” Young added.
According to the campaign, the Ministry of Health’s argument against including foreigners who have long-term visa is that they fear “health tourism.”
Ministry spokesperson Bořská, wrote, “This possibility [medical tourism] must be envisaged and, of course, must be taken into account because it cannot be ruled out.”
Bořská points to the general concern of “social tourism” in the EU as justification for concern. However, she claims that this concern is not “the driving force in deciding on the possibility of extending the personal scope of the law.”
The Campaign for Health Insurance for Migrants counter this argument by pointing out that most foreigners who come are between 18 and 65, the very age group which draws on health care the least.
Are the cases above isolated? One way to find out is from your responses. Are you getting the health care you’ve paid for? Should migrants participate in the state health care system?