Healthcare and TCM in the Czech Republic

MU Dr. Petra Urikova

 (Health adviser; lecturer, 2018 IATC participant)

In the Czech Republic healthcare is guaranteed for everyone by the Constitution of the Czech Republic, part of which is the Charter of Rights and Freedoms. It states that everyone has the right to health protection and that citizens have the right to free health care and medical care on the basis of public insurance under the conditions laid down by law. Thereby the Czech healthcare system is based on a compulsory insurance model. Working people pay monthly 13,5% of their salary for the insurance and for people who are not gainfully employed it is paid by state. It is solidary system where everyone pay as much as he or she can and take as much care as he or she need. Czech patient has a right to choose an insurance company and doctors of primary care each of which can be changed in stated intervals.

The payments for doctors and healthcare providers are based on fee-for-service system. Payments are issued by the insurance companies after the services are provided. Doctors work in medical facilities which have to have contracts with insurance companies to have the services paid.

The healthcare system is managed by the Ministry of Health, which is also an establisher of some medical facilities. Others are established by regions, towns or private individuals, so the Czech healthcare system has a great degree of decentralisation.

In terms of quality was the Czech healthcare system rated by Euro Health Consumer Index in 2016 13th place from 35 European healthcare systems which is 2nd place from middle and eastern European countries. According to OECD (the Organisation of Economic Cooperation and Development) statistics there are 3,7 doctors and 8,1 nurses per 1000 people in the Czech Republic (in China: 1,8 doctores and 2,1 nurses/1000 people) and health spending per capita and year is 200-2200 dollars (in China 100-500, in USA 2000-10000).

The traditional chinese medicine is in the Czech Republic considered to be one of alternative healthcare methods. It is now a part of the Czech healthcare system, but not for a long time.  It was accepted by the Czech Parliament in 2017 and already in 2018 was cancelled by the Senate and is waiting for decision from the House of Commons about its cancellation. Although TCM has become a part of Czech healthcare, it is not possible to fulfill the conditions stated in the law in this period.

Until 2017 there was no regulation for TCM except of acupuncture. There was no official education and the TCM therapists worked usually as self-employed advisors, masseurs or healers. Acupucture was regulated by statement in journal of Ministry of health published in 1981. There was stated that acupucture can be done only by doctor with specialisation who had passed an official acupuncture course for doctors and who works in medical facility with good cadre opinion. Until 1994 acupuncture was even covered by compulsory health insurance.

The biggest change came in 2017. The Czech Parliament has passed an amendment to the Non-doctor Medical Professions Act which included the two new non-doctor medical professions into the Czech national health system: the „lower“ therapist of the TCM and the „higher“ specialist of the TCM with the specific professional conditions and health educational requirements. Later in 2017 several other rules were adopted, too: the ministerial amendment describing the two new professions concerning the TCM in the Czech national health system in detail and also the amendment to the approbation examination ministerial decree concerning the TCM and the amendment to the governmental decree on the catalogue of labour activities in the public services and administration. Although it seemed to public that the Czech Republic is opening to TCM, the opposite was true. The specific wording of the law was rather restrictive in that time because the amendments were passed with immediate effectiveness and it was not possible to fulfill the conditions stated there: one could be therapeutist or specialist after passing Czech university TCM education – which did not exist and still does not – or a special accredited course of TCM – which did not exist and still does not– or university TCM education abroad but it was not clear which study programmes or universities will be accepted. At the same time duties and activities of both professions has been accurately described and these activities could not be performed by any other profession that the unattainable TCM therapist and specialist. Which in fact meant more of total ban than permission of TCM. Nevertheless in June 2018 a new Act on revocation and cancellation of the 2017 Act on two new non-doctor medical professions in the TCM and in the Czech health system was passed by the Czech Senate and the whole 2017 system of acceptation of TCM in the Czech Republic will be cancelled if the Chamber of Deputies supports the abolition of the rules established, although all these valid recent acts and rules and the Czech governmental health policy were broadly accepted by the patients, lawyers, the public and the former TCM practitioners which standed outside the health system before. From the viewpoint of the therapists, the only problem was in the immediate effectiveness of the rules while missing the education system needed for fulfilling the conditions.

But there are other viewpoints. The only body which has not accepted this new legal situation was unfortunately the Czech Medical Chamber and especially its authorities and also some authorities of several Czech universities, or its medical faculties, respectively, which ultimately resulted in an effort to abolish established rules.

I decided for TCM being my profession when I was 17 years old and I have read first book concerning TCM. When I finished the high school I searched for a school teaching TCM. I found one school in our capital,  Prague, but it was quite expensive for me, was not a university but only a private weekend school and did not answer my application. So I decided to study “western” faculty of medicine. I was prepared to go abroad for TCM studies after finishing my medical studies. Finally everything was different. When I was in second year of medical studies, I found newly opened private TCM school in my town so I signed in and attended both schools simultaneously. I had a privilege that I could visit my teacher’s private TCM praxis regularly and learn from her also there. I passed the official acupuncture course too. In fourth year of my medical studies I got pregnant and then I tookcare of mychild,  finished medical studies, worked as a health advisor and started to teach others what I knew from TCM, as my teacher did. Immediately after graduation I had a second child so it was impossible to go abroad or to start working in hospital for finishing my medical specialisation. According to 1981 statement concerning acupuncture I should achieve a medical specialisation which takes 5 years of full-time job in hospital with some extra time for afternoon and night shifts and then I can use acupuncture within my specialisation. This was impossible for me with 2 small children and husband achieving his medical specialisation. Moreover it would be 5 years without TCM for me because I would not have time for family, let alone TCM which I have chosen to be my profession. 

So I work as a self-employed advisor and lecturer and use all my knowledge I have gained by western and TCM studies and by reading books. My clients are people of all age categories with various health problems and I daily improve their physical and psychical health by using moxibustion, cupping,  phytotherapy, acupuncture and by teaching them this methods, healthy lifestyle and principles of chinese dietetics applied to European conditions and habits. I also sometimes help them to understand what their results of laboratory and imaging methods mean and what possibilities of solving their problem do they have in western and traditional chinese medicine because sometimes doctors do not have time for explanation of the results and patients are then scared, often unnecessarily or, on the contrary, they take a serious problem too easy. All my clients know than I have studied medicine and TCM but I am not a doctor in a medical facility but “only” an advisor. But it is not important for them, the fact that matters is that I am able to help them and, even better, teach some of them how they can help to themselves and maintain their health. 

Besides treating and learning my clients I organise courses for public and for TCM students where I teach them how to understand TCM and how to use it for themselves and their clients in the middle Europe. I teach them the best I know at the moment. I do not know everything of TCM, I am still learning more and I am going to learn during whole life but even the knowledge I have now is helpful for them.

So I work in some “middle space” because the system has not a right category for me. Respectively now it has but it is not possible to fulfill the conditions and it is being on a halfway to its cancelation. I am looking forward to acceptation of TCM as a part of Czech healthcare system under attainable conditions. The established rules are acceptable but at first an official educational system for TCM has to be established and the validity of the rules should be delayed until first students pass the education needed. There should also be any possibility for contemporary therapists to pass some exams or quicker version of the education so that they do not need to start from very beginning and attend a daily school programme. It is very likely that it would be impossible for them with their families and occupation too. Also people who have passed any healthcare education  (nurses, doctors, physiotherapists, pharmacologists) should have possibility to pass only some differential examination of anatomy, physiology, patho(-physio-)logy and first aid - at least - so they can shorten their studies by a year or two.

Instead of this we are now waiting for the cancellation of all the rules and laws established last year and for a draft of a new Healers Act that is being prepared by Ministry of Health. One of the political and legal aims of this draft is based on the political and medical degradation of the TCM and its expulsion from the Czech national health system categorization from "medicine“ to "healing.“ The medical concept and words were also changed from the international well known traditional chinese "medicine“ to the mere traditional chinese "healing“ with its lower standard and significance level. The Czech Ministry of Health is currently in preparation of a draft of the Healers Act which considers the TCM a part of the healing system only, not a part of medicine. A draft has not been published yet. We can now only hope that it will enable TCM therapists to do their profession officially but with no educational system for TCM it will always be only a partial solution.  

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