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  Healthcare
In Europe
Partnership
between public and private sector is changing the face of Czech
ophthalmology
Major
improvements in ophthalmic care and bold partnerships between the
public and private sectors are changing the face of Czech ophthalmology
in the post-communism era. "Since the Velvet Revolution of
1989, the quality and efficiency of ophthalmological services has
greatly improved," observes Pavel Kuchynka MD, President of
the Czech Society of Cataract and Refractive Surgery (ÈSRKCH).
"Well trained surgeons along with modern fully equipped medical
centres throughout the country are fulfilling the public's need
for adequate care."
More than 900 practicing ophthalmologists
In all, more than 900 ophthalmologists practice in the Czech Republic.
Of those, about 170 are cataract surgeons, most of whom are also
phacosurgeons. In addition to practicing ophthalmologists, about
100 residents are in various ophthalmology training programmes overseen
by the Institute for Postgraduate Education.
In parallel with these developments, newly established private ophthalmic
clinics have extended the availability of ophthalmic services generally
and helped the public system to reduce its waiting lists, says Prof
Kuchynka, who heads the Department of Ophthalmology at the Vinohrady
Teaching
Hospital in Prague.
He notes that waiting lists vary from two months to 14 months, depending
on the region.
In all, the Czech Republic boasts 64 eye departments, of which five
are in private hands and three in military hands. Some six private
cataract surgery clinics and nine private refractive surgery clinics
offer care for residents in the country's main urban centres, including
the capital of Prague, Brno, Zlin, Plzen, Ostrava, Hradec-Kralove,
Ceske Budejovice and Olomouc. Collectively, the private ophthalmology
sector offers anything that the public service can, with the exception
of vitreoretinal surgery.
New international postgraduate training centre
Earlier this year, the partnership of the public and private sector
converged in Prague at Prof Kuchynka's hospital with the official
opening of the Lions Educational Centre for Central and Eastern
Europe. The Centre, which combines public and private support, received
most of its funding from the American Lion Club International.
The Centre will provide postgraduate training for doctors and nurses
throughout central and eastern Europe, concentrating on the treatment
of cataracts, glaucoma, diabetic retinopathy and retinopathy of
prematurity.
Despite such concrete developments and long traditions, ophthalmology
in the Czech Republic still has problems. For one, it lacks a fellowship
system to train its best and brightest, Prof Kuchynka says.
"As a result, after finishing the residency program, an ophthalmologist
is trained mostly in general ophthalmology, but not in specialised
areas, such as refractive surgery," he notes.
Specialists shaping future
Prof Kuchynka notes that the specialty remains at the forefront
in shaping the future of Czech ophthalmology. The ÈSRKCH,
which was formed in 1998, is playing its part in developing cataract
and refractive surgery.
And though only four years old, the ÈSRKCH draws on a long
history of Czech ophthalmolgy. That history dates to 1926, when
the country's ophthalmologists established the Czechoslovakian Ophthalmological
Society.
The Society's medical journal, Czechoslovakian Ophthalmology, has
been published continuously for the past 70 years, he adds.
Despite the ophthalmologists' retention of the name of Czechoslovakia,
that country ceased to exist on January 1st, 1993, when the Czech
Republic and Slovakia became two separate, sovereign countries in
a bid to alleviate a political impasse.
The political split, however, has not eliminated the problems that
Czech ophthalmologists face in providing services both within and
outside the public health system.
Basic principles
Those problems in large part stem from basic principles, says Petr
Masek MD, head of the Eye Department at Municipal Hospital in Ostrava
and vice president of the ÈSRKCH.
"There is no definition of 'basic' or 'standard' health service
or care," Dr Masek says. "There is no rule of responsibility
for the patient between the ambulance and hospital. There is also
no definition who should take care of or be responsible for diagnosing
patients overnight and at weekends."
As in most public health systems, money is always in short supply,
Dr Masek adds. In the Czech Republic, the problem is somewhat compounded
because there is also inadequate money in the private medical system.
That is because there is currently no private health insurance available
in the Czech Republic for ophthalmic surgery.
"As a result, there is no possibility to buy better or newer
material like soft IOLs or Healon," Dr Masek says.
Focus
on Czech health CARE
Population: 10.7 million
Percent of GDP spent on health: 7.2%
Life expectancy:
Women: 78.7 years
Men: 72.1 years
Population over age 65: 18.4%
Hospital beds per 100,000 population: 870
Physicians per 100,000 population: 300
Cataract operations 2001 : 55,000
Sources:
Petr Masek, MD; Czech Society for Cataract and Refractive Surgery
(ÈSRKCH);
European Union of Medical Specialists; Organisation of Economic
Cooperation and Development.
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