Česky
Why don't all LDNs in the country look like yours in Beroun?
Because they don't have to. Nothing forces them to. If I exaggerate a bit, anyone can open an LDN and get a contract with a health insurance company today if they chop five or more rooms into a ruin, secure a minimum number of staff and somehow "cheat" the relevant papers for the hygiene and other state control authorities. If someone wants to make money quickly, this is the most efficient way. But I would have to fall into shame if I had to treat patients between four scratched walls, where the smell of urine is already present from the entrance and where the behaviour of the staff resembles a correctional rather than a medical facility.
Although nothing actually forces me to do this, and I do not benefit from it except for a good feeling, I believe that a dignified environment and a humane approach are not just part of, but the basis of, modern medicine.
If you had to say the biggest problem of the Czech healthcare system, which would it be?
There are many problems, they are serious and their solution is complex and lengthy. However, if I have to choose one, I will mention the network of health service providers. I see almost dysfunctional primary care, which at the same time is the cheapest for the state and has the greatest potential to really influence the health of the population, whether through prevention, education (modernly called health promotion) or regulation of access to expensive specialised care. There is a need to centralise specialised and expensive inpatient care in fewer centres and, on the other hand, to strengthen the availability of outpatient and day care, which is relatively inexpensive and efficient.
This would help to resolve the current low cost-effectiveness of the system, but also the problem that is plaguing us much more than money these days, which is the shortage of medical staff. Paradoxically, hospitals today are not facing collapse because of a lack of money, but because they lack doctors and nurses. I do not believe that wages in the healthcare sector are the only reason for this; the organisationally and substantively poorly set up system for training healthcare workers and other, often nonsensical, regulations in the area of staffing healthcare workplaces also play a role in this.
The Hořovice maternity hospital is currently the largest in the Central Bohemia Region. How did you manage to do something like that?
One does not have to be a genius to understand what contemporary mothers demand from modern obstetric care. Childbirth is a physiological process where (ideally, of course) a healthy individual comes into the hospital and two healthy people leave. Certainly this applies to health care in general, but in obstetrics in particular mothers demand a dignified and humane environment, respect for intimacy and their individual needs, and friendly and helpful staff. On the other hand, obstetrics is also an 'adrenaline sport', with unexpected and potentially serious complications occurring quite frequently, and it is therefore necessary to ensure the availability of expert multidisciplinary health care for both mother and newborn.
So we try to ensure quality in both these dimensions, in the subjective and professional component of obstetric care. I am, of course, proud of the beautiful environment we have managed to build, but what I appreciate most is the professional and human qualities of our team, whether it is in the labour ward, the six-week ward or the neonatal ward.
How do you feel about the fact that many mothers no longer want to give birth in traditional maternity hospitals?
Many mothers today are clamouring, for example, for home births or so-called maternity homes. I interpret this as a cry for help. They are basically saying that they are not satisfied with the attitude and environment of today's maternity hospitals. We built the Hořovice maternity hospital and neonatology with the conviction that these conditions can be provided in the environment of a medical facility without having to resign to the availability of specialist care in cases where it is necessary to deal with complications. The current reputation and workload of our maternity unit is proof that this belief is correct.
How is it possible that you invest and make a profit and public hospitals cry?
There is a fine line between economic success and failure in the health sector. A hospital is like a challenging exotic flower. You always have to water it, fertilise it, prune it, provide it with enough light and so on. All you have to do is stop for a few days and it wilts. It's the same with hospitals, we are always looking for ways to set up processes to be leaner (faster, more economical, automated, etc.) while still producing quality and safe care. We try to make the most of our investments, for example in Hořovice we operate scheduled procedures until late in the evening, in Pardubice Cancer Centre we run linear accelerators until 10 o'clock at night. We are looking for ways to save on costs, for example on medicines or materials. On the other hand, we are not afraid to invest in new solutions and technologies, some of which we even develop ourselves, for example in the area of software solutions.
It's the hard work of a whole team of people, where everyone actively tries to add their bit to the mill. To use a now famous expression, we just work.
Do you think that one day we will see a time when the state will stop crying?
I don't want to be unfair to public hospitals, after all I don't even have enough information to make such an assessment or lump them together. But it is a matter of principle. The Czech health system is set up in such a way that political power can fundamentally influence its parameters, where favouring "own" hospitals, for example through various operating subsidies, is an established political strategy, where the Ministry of Health itself is in an outrageous conflict of interest. In other words, as long as it remains the case that he who cries more has more, we will not see change.
Do you think that the state should rather close some hospitals and invest the money saved?
The state of the provider network is certainly one of the most pressing problems in the Czech Republic. Its optimisation is inevitable. We can only choose whether this will happen in a controlled manner or whether the whole system will have to collapse first in order to reform it. Personally, I would like to see the first option, but I am not very optimistic.
You recently set up a holding company. Are you already seeing the positives that this move brings?
It's too early. Officially, Akeso Holding has been in existence since the beginning of this year, but the relevant organisational, personnel and administrative changes will take place throughout 2018. The fiscal effect will still be negligible. We are primarily concerned with simplifying and making the organisational structure more transparent and centralising some common agendas, such as logistics, HR, innovation activities and so on.
You applied for European subsidies for the mental rehabilitation pavilion, which you did not receive in the end. How is it possible that the hotel will receive them and the healthcare facility will not?
That is a question I also ask myself. The vast majority of subsidy titles automatically exclude us because of our status as a "private" provider. So, for example, state and regional hospitals are happily buying, building, innovating with European money, but we cannot, even though we provide the same health services covered by public health insurance.
In the case of the Centre for Mental Rehabilitation, we were exceptionally able to apply, but the project was refused, and we are still trying to get specific reasons from the ministry to this day. Even through a series of complaints and lawsuits, we have still not been able to obtain the information we believe we are entitled to.
Would you ever sell your holding?
In all responsibility, I say never.
