Furore erupts over doctors’ fees

AMONG the six fees which patients will likely no longer pay to doctors as of April, scrapping charges for preferential examinations has led to the most emotional debate. 

(Source: SME)

Many warn that patients may continue doing so off the books.

The changes come amid larger discussion of the common practices of doctors to accept gifts from patients in exchange for improved service, which started after a notable Bratislava-based doctor openly told a TV station that he accepts gifts from his patients amounting to some €5,000 a year.

Parliament passed the amendment to the law on medical care on February 12, scrapping fees for writing a prescription or confirming that a patient has really undergone an examination. It also abolishes charges for booking a specific date and time for treatment, which came as an amending proposal by Smer MP and Žilina Regional Governor Juraj Blanár. According to him, the practice caused several problems and ordinary people often have to wait until paying patients are treated, the TASR newswire reported.

“The amendment contributes to higher transparency in the health service,” Health Minister Vladimír Čislák said in a statement, adding that he hopes the new rules will “contribute to better relations between patients and doctors”.

According to the ministry, there is no reason for patients to pay for services that are covered by the health insurers as part of the public health insurance system.

Under the new rules, every doctor will have to place the list of charged medical services in their consulting or waiting room. They will be allowed to claim fees only for services not covered by public health insurance, like examinations necessary for getting a driving licence or for applying for studies, ministry spokeswoman Martina Šoltésová told The Slovak Spectator.

Doctors will have to send their draft price lists to self-governing regions which will also scrutinise whether they observe the rules. In case of violations, doctors will be fined up to €3,319, Šoltésová said.

However, Medical organisations, including the Association of Private Doctors (ASL) and the Slovak Medical Chamber (SLK), criticised the changes, especially the scrapping of fees for preferential treatment. According to ASL, their patients were satisfied with the fee and often used it.

Gastroenterologist Jozef Klucho from Nové Zámky predicts that people will start appearing in waiting rooms who in order to queue to order, for payment, the Sme daily wrote.

The SLK also warned that new rules may cause several health-care providers to go bankrupt. Tomáš Szalay, executive director of the Health Policy Institute (HPI) think tank, added that scrapping of the fees may mean doctors lose some €2,000 per year, as reported by Sme.

The ASL, SLK and HPI plan to ask the president not to sign the amendment.

“The fees will still be collected,” Szalay wrote in a statement. “They will, however, be less transparent and will not be mentioned in the price list in waiting rooms.”

Corruption discussed

The debate about corruption in the health sector re-opened after two recent scandals connected to well-known doctors.

First, the police accused Viliam Fischer, a well-known cardiac surgeon, unsuccessful presidential candidate and stalwart of the former Movement for a Democratic Slovakia (HZDS) party, of accepting a bribe. The family of a deceased patient filed a criminal complaint in early February stating that Fischer allegedly took a total of €3,000, plus some poultry, for moving the complainant’s mother to an earlier date on the list of planned surgeries. The woman’s condition, however, did not improve after surgery and she later died.

After her death, Fischer allegedly returned €800 to the bereft family members, claiming he did not have more cash on him. The mourning relatives filed a complaint, even though they also face a charges for paying a bribe, the Noviny.sk website informed.

The more intensive debate started after noted Bratislava-based general practitioner Peter Lipták publicly commented on the issue. He told TV Markíza on February 9 that he normally accepts gifts from patients, specifying that he may receive up to €5,000 a year in this way. Lipták said that it is something around €20 a day and that he perceives it as “payment for additional financing”, as the current system of payments through health insurers does not work, Sme reported.

“If someone does not have [the resources] for that – they have simply bad luck,” said Lipták, as quoted by Sme.

He had openly described this in 2013, though his words went unnoticed at the time. However, immediately after the recent TV broadcast General Prosecutor Jaromír Čižnár ordered Lipták’s words to be checked, “as they implied suspicion of corrupt behaviour”, as reported by Sme.

The opposition parties NOVA, Ordinary People and Independent Personalities (OĽaNO) and Freedom and Solidarity (SaS) meanwhile announced at a joint press conference that they are about to file a criminal complaint against Lipták.

In an interview for Sme, Lipták explained his words to TV Markíza, adding that his comments were edited.

“I said that people who have to be treated in a system lacking money and which is not able to offer them what they need have bad luck,” Lipták said, as quoted by Sme, adding that he does not ask for money from people, but when they want to donate, he accepts the money, recording it in a transparent system of evidence.

The gifts are usually small payments, usually €10 or less, but also books, paintings, or vases. The money amounts to about €5,000 a year, Lipták admitted. He does not report it in his tax return, though.

“This would work if I was a legal person, but I receive it as a natural person,” he opined.

Lipták also added that he sees gifts as a means to pay the rental of his consulting room and the new equipment and furnishing he had to buy. The doctor also refuses regular official payments from patients, for earlier visits without long waiting times, for example.

Ladislav Pásztor, head of the ASL, said that if the outpatient departments received enough money from health insurers, the doctors would not need any fees or gifts. Many doctors in these departments have lower salaries than those working in hospitals and the state can be glad that they work there, he said during a political talk show broadcast by the TA3 TV news channel.

Lipták said during the discussion that he would continue to accept gifts, as the Civil Code enables him to do so.

Unofficial payments are a problem

According to Szalay, Lipták described reality, though in a controversial way.

“The Slovak health service is not free of charge,” he wrote in a statement, adding that having no payments is only an illusion with which “politicians cover their own inability or fear to solve the sustainability of financing the health sector”.

The recently published survey carried out by the Focus polling agency for Transparency International Slovensko (TIS) suggests that as many as 95.2 percent of 1,010 respondents said there are bribes in the sector, while 63.5 percent say bribes are widespread, TIS wrote in a press release.

The survey also suggests that as much as 21.8 percent of respondents gave an unofficial payment to medical staff in the past three years, down from 26 percent in the 2012 survey.

Most people (15 percent) offer unofficial payments to medical staff voluntarily, as an expression of thanks. Some 9.1 percent give them as they are convinced that this is how it works or because somebody told them to do so. Less than 3 percent of people were asked for a bribe. As many as 69 percent of respondents said that they gave the staff only official payments, the survey shows.

Of those who gave something to the doctors off the books, 50.5 percent expected better treatment, with some 30.1 percent seeking quicker surgery or examination. About 16.1 percent of respondents pay money to secure a certain doctor.

According to Szalay, to solve the problem it is necessary to make the payments official and set clear rules for them. The official payments can then be registered and taxed, and allow the state to cap the financial exposure of the most vulnerable groups of people.

“In a situation when there are no official payments (and we pretend that we do not see them) we cannot directly help the most vulnerable ones,” Szalay said.

Disclosure: Peter Lipták is the husband of a staff writer at The Slovak Spectator.

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