Czechs eye "medical tourism" as a way to solve what ails healthcare

23-01-2007

In a Prague suburb full of timeworn old villas, one house stands out like a robin's egg in a nest of straw. It is even painted blue. This is the Alfadent clinic, a private dental center geared towards foreign patients.

Inside, everything is spotlessly clean. All signs are posted in English and German, as well as Czech, and an enormous plasma screen TV is tuned to CNN.

I came here to find out about the growing industry in what's called "medical tourism". In the recovery room, I meet Heidi from Germany sitting in a chair clutching her jaw.

"I had a root canal. And I will get about nine crowns. I came here because one simply can't afford dental care in Germany. And also the care is great - you feel like a king here, even if you're not doing so well after the long dental operation. It really is worth it. In Germany, I would have paid more than twice as much, even with everything included."

Heidi is not unusual. Alfadent sees twelve to fifteen clients for major procedures every day, and dozens of other clinics around the city have started to cater to Germans, Austrians, British, and other western Europeans in need of bridges, crowns, or just a whiter smile. Czech hospitals get fewer foreign patients - not quite 9,000 in 2005. Nevertheless, it's an 85% increase in just four years.

Karel Rubes is the clinic's managing director. He says the key to attracting foreign clients is making them feel at home.

"It begins with our reception, we have bilingual staff who speak English or German, so they are welcomed here in their home language. We arrange to pick them up at the airport. There are also often family members traveling with them. We have for them here TV, wifi extension so they can take their laptop, they can browse the internet, do their emails, whatever they want. So we try to be here very service oriented, kind of a five star hotel."

All this is possible, Rubes says, because of the country's low labor costs.

"The funny thing is that the material is exactly the same as in the UK, the cost savings stem mainly from lower overhead costs, operating in Prague compare to for instance London, and lower wages and salaries, that adds up and certainly we pass it on to the customer, and we create a certain value proposition to customer."

Now some economists say it's time for the Czech Republic to fully cash in on that price advantage, and specialize in medical tourism. Tomas Sedlacek, is chief economic strategist CSOB bank, and a former advisor to President Havel.

Lately he's been talking up the idea of medical tourism, and says there's a great deal of interest - from people in government, from doctors, and from other economists.

"You can make a very nice deal for foreigners. You know if you want a hip replacement you can either wait for 60 days in your home country or we can fly you to the Czech Republic first class. You can spend two weeks after the operation at a spa. We've done in our heads calculations and rough estimates, even if you do this it's still half price of what it would cost in Western Europe. So for local insurance this would be good thing especially at first while prices are still low and people are not used to coming here for their medical care."

You might call it reverse exploitation. It's not simply westerners taking advantage of the low prices in the east, it's the Czech healthcare system taking advantage of how much Western Europe's health insurers, and private clients, are willing to pay.

"If we instead of shipping doctors to foreign countries, ship foreign patients here, we gain in many respects. Firstly, the good doctors stay here, secondly, the economy will profit, not only healthcare but the whole economy - the tourist industry because there will be other services joined to this core business. Thirdly, the quality of our healthcare would not have decrease, on the contrary it would increase because of the influx of new money. Fourthly, it would become a prestigious industry for Czechs to devote to for a couple of years. And fifthly and lastly, research and development which we so much need, would start flowing in the Czech Republic, even more than it does now."

It's a question, then, of finding a way for hospitals to start offering hip replacement, heart surgery, and other major procedures which can be scheduled in advance. At the moment, because of the way the labor market is structured, only dentistry and plastic surgery have drawn many foreign clients.

"It works with the teeth business because that area of healthcare is already reformed, not the other areas of healthcare. You can have private dentists and you can pay them money directly in cash, you cannot do that with doctors or it's very very complicated. And that's exactly where the inspiration came from - dentists and dental care."

Right now, a consensus seems to building that that more "medical tourism" would be a good idea. David Rath, the former health minister, has voiced his cautious support, and Milan Kubek, President of the Czech Medical Chamber, says he sees thinks it could bring badly needed money into cash-strapped hospitals.

The clinic where he works as an angiologist, Poliklinika Prosek, is perhaps typical - a well-run health center with chipping paint and shabby stairwells. Kubek's main concern about "medical tourism" is that there would be enough doctors on hand to see foreign patients.

"It's a question of capacity. What's a major problem here is that we are losing doctors. Many go to Germany, or the UK, and especially in the border areas with Germany there is a serious shortage of qualified physicians. Often they are replaced by colleagues from Slovakia, who unfortunately are less qualified, and in many cases they have come here only as a stop on the way to countries where they can make more money."

In 2006, new overtime rules took effect, limiting the number of hours Czech doctors may work, and further aggravating the situation. According to the Ministry of Health, the country now needs about 2,000 more physicians to fill the gap. Its answer - recruiting doctors from new EU members Romania and Bulgaria. But so far, very few of them have expressed an interest in coming to the Czech Republic. Kubek scoffs at the program - there aren't enough doctors in those countries who speak Czech, and anyway most would rather go to Western Europe, just as about 1,000 Czech doctors have done.

"The basic problem is the chronic under-financing of healthcare system. We only spend about seven percent of Gross Domestic Product on healthcare, which is far below level of old EU 15 who spend more than eight percent of their considerably larger GDP. The Czech healthcare system is not a black hole. If you follow the money spent, you'll see it's actually a miracle of efficiency."

And that, says economist Tomas Sedlacek, is where patients like Heidi from Germany, can make a difference.

"We have always as Czechs been used to having a very high quality of healthcare, from the Communist regime. So you can do two things - downgrade to a car that is lower rank, or invite other passengers to share the costs. That's what I'm suggesting."

23-01-2007