Almost all healthcare-related topics are becoming increasingly contentious in connection with the 2025 parliamentary election, and the term “healthcare reform” is loudly echoed by all political parties. Tom Philipp, MP for KDU-ČSL, head of one of the clinics at Prague‘s Thomayer Hospital, and chairman of the board of VZP (General Health Insurance Company), also acknowledges its necessity.
When we spoke in June, you mentioned anticipating further unrest among doctors. What do you make of the planned strike that eventually didn‘t occur?
During spring and summer, I participated in meetings between the Ministry of Health, representatives of inpatient facilities, the Czech Medical Chamber (ČLK), and the Medical Trade Union Club (LOK). ČLK and LOK‘s demands for unified remuneration in private and state hospitals met resistance from employers. I must admit that I, too, did not consider this demand the right path. From the meetings, it was already apparent that ČLK and LOK would initiate protests if their key demand was not met. However, it is important to note that all other demands from the autumn of 2023 were fully addressed. The protests by hospital doctors ultimately did not take place, citing the aftermath of the floods in Moravia. Personally, I believe the union leaders assessed that the demand for pay and wage unification did not have as broad support among doctors as expected. As for the looming protests by general practitioners and specialists, they represent the typical annual pressure tactics by certain groups of doctors seeking the largest possible share of funds distributed by the reimbursement decree. The issue, however, is that the ministry has only limited funds at its disposal – what is given to some must be taken from others. This time, general practitioners benefited the most, while field specialists received at least partial increases.
Isn‘t there an issue in that patients don‘t need referrals for outpatient specialists - or at least for some specialties - and often seek a second opinion?
The problem of repeated examinations, some of which are genuinely unnecessary, is just one example of the inefficiencies in our healthcare system. On the one hand, the demand for a second opinion is understandable, especially in the case of more severe health issues. On the other hand, repeated examinations for the same problem lead to inefficient use of healthcare resources, increased administrative burdens, and potential delays that can negatively affect the availability of care for other patients. From the perspective of the chairman of a health insurance company‘s board, repeated examinations primarily highlight the challenge of balancing care accessibility with sustainability. Direct access to some outpatient specialists without a referral from a general practitioner does increase patient comfort but often leads to overutilization of care. Solutions could include requiring referrals from general practitioners, improving electronic sharing of medical reports and examination results, and fostering better communication between GPs and specialists. Such measures are already being gradually introduced into the system, and I believe they will help mitigate inefficiencies of this type.
VZP‘s finances for this year are expected to show a deficit, according to director Zdeněk Kabátek. How can potential financial problems be prevented in the future, and what measures is the insurance company planning?
The General Health Insurance Company expects a deficit just under five billion crowns for this year, which will be covered by its financial reserves. This deficit is planned and does not jeopardize VZP‘s stability, meaning patient care is not at risk. The same applies to other health insurers. Next year, a system-wide deficit of 10-15 billion is expected. However, moving forward, a balanced financial approach is essential. That means aligning reimbursement decrees with this approach and introducing cost-saving and rationalization measures to ensure the long-term financial stability of VZP and the sustainability of the public health insurance system.
If the entire public health insurance system ends up in deficit, isn't it time for a major healthcare reform?
The system-wide deficit, projected at 11 billion crowns for 2024 and approximately 10-15 billion crowns for 2025, clearly highlights the unsustainability of the current setup. While insurers‘ financial reserves can still cover the shortfall for now, this approach cannot continue indefinitely. It is evident that without structural changes, the healthcare system will face serious challenges, particularly concerning an aging population, rising costs of modern medical technologies and medications, and ever-increasing demands for quality of care. Fundamental healthcare reforms, however, remain a highly sensitive political topic.
Shouldn‘t the governing coalition leaders seek consensus across all parliamentary parties?
Unfortunately, the current situation shows that reaching an agreement with the opposition, which often takes a populist stance, is very difficult. This is evident in other key reforms, such as pension reform. The unilateral rejection of any systemic changes and attempts to score political points at the expense of addressing long-term issues only deepen the stagnation. Nevertheless, we continue to strive for dialogue – this is about the future of healthcare, which affects every citizen. Reforms are inevitable, not only for insurers and the state but also in terms of regulating demand from patients themselves. Without these changes, the system will face increasing challenges, potentially leading to severe consequences for both patients and healthcare providers.
Some hospitals, particularly smaller ones, are dissatisfied with next year‘s reimbursement decree and are considering filing a constitutional complaint. Is the reimbursement system designed differently from previous years?
The reimbursement decree for the upcoming year essentially builds on the principles established in previous years, with the Ministry of Health also aiming to harmonize payments to ensure equal pay for equal work, regardless of the type of healthcare facility. Complaints from smaller hospitals reflect long-standing issues in healthcare financing. These hospitals often struggle with higher operating costs, significant personnel expenses, and sometimes underutilized capacities – factors the reimbursement system cannot ignore. However, it cannot be said that the decree is discriminatory – it is a tool aimed at balancing the needs of all providers within limited financial resources. As for the possibility of filing a constitutional complaint, healthcare facilities naturally have the right to do so. The question remains whether complainants can prove their rights are being violated or that they are subject to discriminatory treatment. This will depend on the interpretation of specific aspects of the decree. Regardless of the outcome of any legal proceedings, it is clear that without broader reforms and changes in healthcare financing, which better reflect differences between types of hospitals, pressure to adjust the reimbursement decree will remain constant.
As we approach an election year, do you think Petr Fiala‘s government will pass the test with voters, and do you believe in another electoral success for the SPOLU coalition?
We have signed a memorandum of cooperation within the SPOLU coalition, and our goal is to win the election again. We recognize that this will not be an easy task, but we build on what we have accomplished during this term. And there‘s a lot to highlight – we have one of the lowest unemployment rates in the European Union, we reduced the state budget deficit, eliminated energy import dependence on Russia, completed pension reform for the first time, opened 207 kilometers of new highways, introduced mail-in voting, finalized a major overhaul of social benefits, simplified the tax system, boosted the labor market, and restored the country‘s international respect. At the same time, we are preparing a clear plan for the next term, offering concrete solutions to current challenges.
What do you think about polls suggesting that if KDU-ČSL ran independently, it wouldn‘t surpass the 5-percent threshold? Will the new leadership elected at the October congress help?
As already mentioned, KDU-ČSL is not running alone but within the SPOLU coalition, which many polls haven‘t accounted for. Of course, we monitor polls, but historically, these have underestimated KD????-ČSL compared to actual results. This year‘s congress expressed confidence not only in experienced leaders but also in a new generation of politicians with great potential. I believe their enthusiasm, combined with the experience of the chair and first vice-chair, will bring KDU-ČSL renewed energy. Key topics such as family support, affordable housing, and quality education will now be communicated more clearly, focusing more on voters‘ needs. This is how we aim to attract new supporters and reinforce trust in our responsible and conscientious policies. KDU-ČSL is not a catch-all party; we are a centrist conservative party aiming to appeal to parents with children and people in rural areas. We need to win back those who chose not to participate in the last election.
MEASURES
Tom Philipp identifies several key cost-saving and rationalization measures. These include:
Reducing operating expenses: optimizing energy, rent, and personnel costs, and implementing a more efficient medication policy
Changing healthcare financing: gradually transitioning from a fee- for-service system to a model that emphasizes the quality and efficiency of care provided
Promoting prevention: expanding bonus programs for clients to encourage regular preventive check-ups and responsible health behaviors
Digitalization and electronic processes: improving cost management and communication between healthcare facilities and insurers
More efficient use of inpatient capacities: converting underutilized departments to long- term care, developing day surgery and outpatient facilities, or introducing mixed-use bed funds
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.
