We spoke with Tom Philipp, MP for KDU-ČSL, head of a clinic at Thomayer University Hospital, and chair of the board of the General Health Insurance Company, during the post-election transfer of power in both the government and the Chamber of Deputies. After four years in the governing coalition, Tom Philipp is moving to the opposition benches.
What condition is the outgoing government of Petr Fiala handing the Czech healthcare system over in to the new cabinet? What went well over the past four years, and what less so?
I would say that we are handing over the healthcare system in fairly good condition, but with several warning signs. We managed the aftermath of COVID, the influx of war refugees from Ukraine, and a period of high inflation and expensive energy without widespread reductions in care. On the other hand, we did not manage to set reimbursement levels in a way that would make the system sustainably balanced in terms of revenues and expenditures – expenditures were consistently slightly higher than revenues. I consider it very important that we succeeded in approving the Strategic Framework for the Development of Healthcare to 2035, known as Health 2035, which clearly defines the direction in which the system should move – emphasizing prevention and healthy living, better care for chronically ill patients, mental health, and long-term care. We also prepared the National e-Health Strategy 2025–2035, which should finally turn scattered digital initiatives into a coherent e-health system, from shared documentation to electronic referrals and online appointment scheduling, and even a digital assistant for patients. I also consider the long-awaited convergence of the health and social care systems to be a major step in the right direction – including comprehensive data collection in the social sector that complements long-running data collection in healthcare. This will move decision-making in both social and health policy to an entirely different level. So, in summary, I see the past term rather positively – the course is correct, but the new cabinet faces a difficult task: turning strategic documents into practice while stabilizing financing so the system does not remain permanently in the red.
You have insight into the finances of the largest health insurer in the Czech Republic, the General Health Insurance Company. What does the situation look like from the insurers’ perspective? Why is it that even as the Czech economy improves, conditions for health insurers continues to worsen?
From the perspective of the General Health Insurance Company, today’s situation is somewhat akin to a household with solid savings but that has been spending more than it earns for several consecutive years. Public health insurance as a whole has been systematically running deficits in recent years, which we cover from previously accumulated reserves. Last year, the deficit at the General Health Insurance Company was roughly five billion CZK, and this year we expect the deficit to be significantly smaller, even though the approved budget assumed a loss of around 6.5 billion. This is not an uncontrolled collapse – these deficits were planned – but it is, of course, not sustainable in the long run. And we must add that the situation at some smaller insurers is even worse, and their ability to cover all necessary care is already quite limited. And why are insurers’ finances worsening even when the economy looks better? The main reason is simple: expenditures on care are rising faster than revenues. In recent years, the Ministry of Health has not managed to sufficiently resist pressure from unions and various provider associations, including the Czech Medical Chamber. It is extremely difficult but at the same time absolutely crucial work – knowing when to say “we cannot go any further.” On the other hand, it is fair to say that concerns raised by providers are often justified. Modern and very expensive medicines and technologies are entering practice, significantly extending and improving patients’ lives. Pressure to increase the wages of doctors, nurses, and other staff is also legitimate – healthcare is a service industry, but a highly specialized one. This work cannot be done by just anyone; it requires years of education and continuous training, and healthcare workers are well aware of their market value. In the coming years, it will therefore be essential to continue the restructuring processes that have already begun – in acute and follow-up inpatient care, as well as in the outpatient sector. Without rationalizing the provider network and improving the organization of care, we will not overcome the financial difficulties.
With his wife Štěpánka.
A recent Constitutional Court ruling approved the principle that smaller hospitals may receive lower payments for the same medical procedure than large hospitals. Can you explain the rationale, and whether you personally consider it fair? Does it not lead to unequal access to care between residents of big cities and those in smaller towns or rural areas?
Let me begin with one point that is often overlooked in this debate: it is not as simple as “the exact same procedure” being paid differently for no reason. The Constitutional Court essentially confirmed that different reimbursement rates are permissible if there is a rational basis for them and if it is not arbitrary discrimination. The principle is roughly this: large hospitals – typically university or regional hospitals – maintain 24/7 emergency readiness across a wide spectrum of specialties, run intensive care units for highly difficult patients, operate specialized centers (oncology, cardiology, stroke centers, trauma centers), and participate in the training of medical students. All of this involves enormous fixed costs that must be paid regardless of whether there were “five extra surgeries today” or not. A portion of these costs is then logically distributed into the payments for procedures, which is why the resulting reimbursement for the same procedure code is higher than in a small district hospital that does not maintain such broad emergency readiness or specialized centers. Is it fair? In principle, yes, provided that the higher reimbursements truly reflect higher requirements for readiness and complex care. It is logical that a trauma center, with a highly trained team and top-tier facilities on permanent standby, has a different cost structure than a small hospital that mostly performs standard planned procedures. Reimbursements must, however, be set fairly – and thanks to the project I initiated years ago at the Ministry of Health, namely DRG Restart, this is now much more feasible. In acute inpatient care, we can now determine quite precisely what the costs are based on location and procedure type. This is the essential precondition for ensuring that differences in reimbursement reflect real costs, and not merely a hospital’s address.
You were re-elected to parliament on the SPOLU coalition ticket. How do you see SPOLU’s performance, and that of KDU-ČSL within it? Is there anything that the governing coalition or SPOLU should have done differently? And how do you explain the fact that voters chose the opposition even though the Czech economy is in good condition?
We did not win the election, and in my view that is a pity above all for the country. The SPOLU coalition did an enormous amount of work during a difficult period, but this time voters decided differently, and we must accept that respectfully. From the perspective of KDU-ČSL, I consider the result to be very good. We fielded strong candidates, we were visible during the campaign, and we conducted it respectfully and substantively – and that helped us. It turned out that long-term work in the regions matters, being close to people and not showing up only a few weeks before the election. Of course, both for myself and the entire governing coalition, I see things that could have been done better. Clearer communication of unpopular measures, more empathy for people affected by inflation and high energy prices. We often made reasonable decisions, but explained them poorly – and that is a mistake in politics, one the opposition used very effectively. And why did voters prefer the opposition even though the Czech economy is doing well? I think it is a combination of public fatigue – after COVID, the war in Ukraine, and a period of rising prices – and the appeal of attractive but unrealistic promises from parts of the opposition. But we are not populists. We try to say and do what we believe is best for citizens in the long term, even when it is not the most popular option. In politics, that does not always pay off in the short-term electoral result, but in the long run it is the only honest path.
The author is a European editor of Deník
CV BOX
Tom Philipp (born December 26, 1968, in Prague) is the head of the Rheumatology and Rehabilitation Clinic of the Third Faculty of Medicine at the Charles University and the Thomayer University Hospital, MP, chairman of the Board of Directors of the General Health Insurance Company (VZP), member of the Prague 12 Municipal Assembly, and former vice-chair of the KDU-ČSL.
Following his graduation from the Second Faculty of Medicine at Charles University in 1993, he started working as a physician at the rheumatology ward in the Thomayer Hospital, later becoming the deputy director (2005–2014). From 2014, he worked as deputy minister of health for four years. From late November 2018, he worked at Agel, a.s., as the first vice-chairman of the board and director of the Jeseník Hospital. He never fully severed ties with Thomayer Hospital and eventually returned there full-time.
He has been a KDU-ČSL member since 2002 and an MP since 2021. After eight years of serving as a member of the VZP board of directors, he became its chair in February 2022.
Philipp lives in Prague. He is married and has five children. He enjoys hiking, cycling, cynology, and fishing. Politics remains his primary hobby, however.
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