Do we live long and, more importantly, well? Do we have an excess of health insurance companies? Does our healthcare system respond flexibly enough to the rise in addictive substances? And what about euthanasia? It’s hard to find a topic in our healthcare system that doesn’t spark controversy. On the contrary, with the upcoming parliamentary election, these issues are becoming even more pressing and could become a major point of contention. How does Tom Philipp, MP for KDU-ČSL, chairman of one of the clinics at Prague’s Thomayer Hospital, and chairman of the VZP board, see it?
One of the long-standing, unresolved issues in our country is the length of (active) life. Compared to our western neighbors, adopting a healthy lifestyle remains a challenge - why?
The number of years lived in good health in the Czech Republic lags behind the EU average by approximately ten years. A sedentary lifestyle, poor diet, smoking, excessive alcohol consumption, high levels of stress from work overload, and an imbalance between work and personal life are persistent problems. More than twenty percent of the population is obese. Although awareness of a healthy lifestyle is growing, we still have a lot to catch up on compared to our western neighbors, particularly the Nordic countries. The main causes lie in differences in cultural habits, health literacy, and attitudes toward preventive care.
Can you illustrate this with numbers?
Czechs are among the world’s largest alcohol consumers, averaging 12.4 liters of pure alcohol per person per year, compared to 8.8 liters in Sweden. About 25 percent of the population smokes, more than twice the rate in Norway (9%). Only 40 percent of adults engage in regular physical activity, while in Sweden, the figure exceeds 70 percent. We might find inspiration in Scandinavia, where there is a long-standing emphasis on promoting physical activity, preventive care, and regulation of unhealthy habits. Thanks to these measures, Swedes live an average of ten years longer in good health than Czechs. Investments in awareness campaigns and similar measures could help improve the quality of life and extend its healthy portion in our country as well.
Should there be penalties for those who neglect preventive check-ups?
Preventive care is the key to good health. That’s why the discussion about penalties for those who neglect it and incentives for those who take care of their health is justified. However, health is complex and influenced by many factors, not just personal responsibility. If people ignore prevention, their health can deteriorate, putting a strain on the healthcare system and reducing access to care for others. Some health insurers, such as VZP, already motivate clients with financial contributions or bonuses for attending preventive check-ups, vaccinations, or participating in screening programs. I consider these positive incentives more effective than penalties, which can face ethical and practical challenges. Not everyone has the same access to preventive care – for example, people in remote areas or those with lower incomes. Therefore, penalties should be the last resort if positive motivational measures fail. The ideal goal is to create a system where preventive care is not only a natural choice but also rewarded – through better health, easier access to care, and attractive benefits.
We have seven health insurance companies in this country. Isn‘t that too many?
The current number of seven health insurance companies repeatedly raises debates about the efficiency of the public health insurance system. I believe that fewer insurance companies would suffice, similar to Israel, where there are four. Fewer insurance companies could reduce administrative costs – each insurer today manages its own bureaucracy, IT systems, and marketing, which increases operating expenses funded by public money. Additionally, seven insurers place a significant burden on healthcare facilities, which must negotiate contracts and amendments multiple times. Hospitals have entire teams dedicated to this administrative process, whose work could be used more efficiently. Israel’s system, with fewer insurers, still provides effective and high-quality public insurance. A smaller number of entities means easier organization, lower costs, and still ensures competition and quality services.
The public health insurance system deficit is growing. What solutions do you see?
The 2024 health insurance deficit, exceeding ten billion CZK, and similar projections for 2025 present a serious issue that cannot be ignored. This trend is a warning sign that the current healthcare financing system is unsustainable in the long run. Addressing this situation requires a fundamental discussion about priorities. One option is to reduce the entitlements of insured individuals, but this risks limiting the availability and quality of care that citizens expect.
And the other option?
The alternative is to increase system revenues – whether through higher contributions from employees and employers or by raising payments for state-insured individuals. Any step in this direction will have a direct impact on citizens, either through increased financial burden or reduced healthcare services. Therefore, this debate should be conducted openly, involving experts, policymakers, and the public, with the goal of finding a fair and sustainable long-term solution. Health insurance is not just about money; it reflects the values we uphold as a society – especially the right to dignified and accessible healthcare. That’s why it’s crucial to act quickly but thoughtfully to minimize the impact on the most vulnerable groups and ensure the system’s stability for future generations.
The public debate on addictive substances continues - kratom, HHC, and CBD products have recently been added to the mix. In reaction to that, last December‘s amendment to the Act on Addictive Substances presented three new lists. Do you think they‘re sufficient?
The amendment to the Act on Addictive Substances, effective January 1, 2025, introduces significant changes in their regulation. There are now three categories of these substances: banned substances, psychomodulatory substances, and psychoactive substances. The list of banned substances, containing thousands of items, remains the foundation of regulation. Two new lists have been introduced: one for substances that can only be studied but not sold and another for substances that can be sold under strict conditions. This system was designed by experts to ensure better control while avoiding the criminalization of citizens using less dangerous substances. A crucial aspect of the amendment is protecting children from exposure to these substances, including strict advertising regulations and a ban on sales to individuals under eighteen. How well this system works in practice remains to be seen, but it is expected to contribute to a more effective approach to addressing substance use and reducing its societal impacts.
Euthanasia is a controversial topic. Some countries already allow it - Belgium, Luxembourg, and the Netherlands, while Switzerland permits assisted suicide. Would you support it in the Czech Republic?
I approach the issue of euthanasia with great caution. As a doctor with over thirty years of experience in a hospital, I have witnessed many situations that force deep reflection on this option. However, I firmly believe that our primary duty is to use all available methods of modern medicine to minimize patient suffering and ensure that their illness does not become an unbearable burden. Euthanasia can easily turn into a shortcut for solving complex problems. Any decision regarding human life requires deep respect for its value and dignity. Instead of assisted death, we should focus on strengthening palliative care, psychological support, and assistance for those facing the most difficult moments.
The author is an 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.
