I met with Tom Philipp, chairman of the board of directors of VZP (General Health Insurance Company), head of the Clinic of Rheumatology and Rehabilitation at the Third Faculty of Medicine of Charles University and the Thomayer Hospital, vice-chair of KDU-ČSL, and MP, in the Chamber during negotiations about the pension reform. Meaning a topic that resonates throughout society.
What is the reform based on?
First and foremost, I would like to emphasize that the pension reform does not affect seniors today, although the opposition likes to say otherwise. There are numerous changes, including smaller ones, but I will list the most fundamental ones. Pensions will increase at a sustainable pace so that in the next ten years they will reach a sum of thirty-one thousand crowns. The retirement age will change depending on the projected life expectancy, from which the projected length of pension payments of 21.5 years will be deducted. Every citizen will know their retirement age when they turn fifty. The time spent caring for children will count as time spent in employment, and a new feature is that spouses will be able to voluntarily share their bases for calculating pensions. Early retirement for demanding professions will include professions classified in Category 4 and partially in Category 3. The insurance rate for working pensioners will be reduced by 6.5 percent, increasing their net income. For example, if they earn twenty thousand crowns gross, their net income will increase by 1300 crowns per month. The reform we are implementing is for the younger generation so that they too will have a dignified retirement one day. However, it still holds true that everyone should prepare for retirement on their own as well.
You mentioned life expectancy, but the bigger issue is healthy life expectancy. How does Czechia stand in this regard?
In recent years, healthy life expectancy has been a topic of intense discussion not only for experts but also for politicians. Unfortunately, this issue has been neglected for a long time, so compared to other countries, especially in the Nordics, we are lagging far behind. According to European Union statistics, the healthy life expectancy in the Czech Republic is 62.3 years for men and 64.6 years for women. For comparison, in Sweden, the healthy life expectancy is 73.7 years for men and 71.6 years for women. This difference is due to several factors, including the level of healthcare, lifestyle, prevention, and timely disease diagnosis. Living in health is important for citizens – everyone wants to be fit, self-sufficient, and independent – but also for the state and its expenditures. Therefore, emphasis on prevention and screening needs to become a priority not only for individuals but also for healthcare systems and public health policy. Important tools to improve this are regular preventive check-ups and screening programs, which support the early detection of various diseases (lung, breast, cervical, colorectal, rectal, and prostate cancer).
How do you motivate those who only seek medical attention when the disease breaks out?
If we had true health insurance negotiated with the insurer and bore the insurance risks, the situation in this regard would be somewhat easier. Is your cholesterol level 10 mmol/l, are you skipping check- ups, and not getting treatment? Then you pay extra. But in our world, this is still a utopian way of thinking. On the other hand, we are not completely empty- handed. If I may speak for the VZP, we have prepared a bonus system where only those who have had preventive check-ups in the last two years can achieve certain types of bonuses. For example, those who participate in cancer prevention screening programs can receive contributions for vaccinations, sports activities, or the purchase of medical devices. Specifically, these contributions include vaccinations against tick-borne encephalitis, influenza, or meningococcus. Furthermore, policyholders can receive contributions for physical activities such as swimming or gym visits, as well as for the purchase of glasses or contact lenses. In this way, we want to motivate citizens to take better care of their health and regularly attend preventive check-ups.
Similar to the pension system, healthcare is in dire need of reform. What direction should it take?
One thing that has been achieved in the past fifteen years, and could be one of the ways forward, is the concentration of care in specialized centers. Oncological, stroke, cardiological, traumatological, and burn as well as other highly specialized care centers have been established, which I feel represents significant progress. Patients with these diseases have a better chance of recovery and survival thanks to highly specialized care, and in practice, we are seeing tremendous improvements. For example, stroke centers have significantly increased the likelihood of survival after a stroke. Due to the centralization of care and the availability of modern treatment methods such as thrombolysis and mechanical thrombectomy, the survival rates of stroke patients have improved by more than twenty percent. Timely and specialized intervention in stroke centers significantly reduces mortality and improves the long-term prognosis for patients. What currently troubles us the most is the large number of acute care beds for which we do not have enough staff. In other words, there is not enough personnel for the amount of hours worked by doctors. This was also the cause of the unrest we experienced in autumn, and I expect more to come soon. The situation is truly unsustainable under the current setup.
How does VZP perceive the situation?
VZP, as a market leader, strives to be active in this regard and serve as a partner for the management and sponsors of hospitals and acute care wards. We regularly publish statistics and use them to demonstrate what each figure means. The problem truly lies in the low occupancy rates of acute care beds and sometimes excessive hospitalization of patients, which usually happens for economic rather than medical reasons. VZP supports, for example, the possibility of using free capacities to establish single- day care units. We also see a way forward in mixed-bed funds and single-day care.
Let‘s also touch on the topic of addictive substances – how has the bill progressed, and how do you feel about Germany relaxing its rules and legalizing cannabis? Is such a scenario conceivable here?
It could very well happen that our society will eventually reach this point. The bill on addictive substances, which has gone through public consultation and is currently awaiting notification from the EU before going to the Senate, is actually the first step towards a more liberal approach to addictive substances in general. On the other hand, I see no reason to rush. We can wait and observe the impact of deregulation in Germany. From what certain friends have told me, I know that in countries where cannabis has already been legalized, the feelings about deregulation are subjectively rather negative, and even the overall impact on society is not perceived as particularly positive. I am essentially a liberal person. Let everyone do what they want as long as they do not endanger or restrict others and are willing and able to take responsibility for their behavior. However, let us rather be at the forefront in areas such as science, research, sports, and similar fields rather than in deregulating cannabis and other substances.
There was also a report in the media about plans to increase the tax on sugar in certain products. Isn‘t such an approach a little too patronizing?
Statistics show that more than 60 percent of adults in Czechia are overweight, and 28 percent suffer from obesity. Also alarming is the increase in childhood obesity – in 2021, 16 percent of children were obese, which is one-third more compared to 2016. In children aged 13 to 17, the proportion of overweight individuals increased from 10 percent in 1996 to 25 percent in 2021. The prevalence of obesity is thus still on the rise in our country, both among adults and children. Add to this a sedentary job or inactive leisure time, and we have the makings of a major population-wide problem. The aim of a higher tax on sugar is to support the reduction of the consumption of sugary beverages and regulate things such as the consumption of energy drinks. Experience with similar measures from other countries shows that manufacturers naturally respond to tax increases by reducing the amount of sugar in their products. Of course, one such measure will not save the world. Education is certainly important, although we must not overestimate its role either. Rousing a sense of responsibility for their health in citizens living in an environment of 100% entitlement and free care, where the policyholder bears not even a minimal financial risk is, as we have already touched on, truly difficult. However, this is a topic for a more extensive discussion and a different platform.
HOSPITALS
The issue of possibly closing down hospitals is discussed in the public quite frequently. “We do not want to close down hospitals in the regions, but we want to offer solutions to the problems of underutilized departments, lack of medical staff, and non-profitable operations to hospital management and sponsors,” counters Tom Philipp. “Our goal is to ensure that patients still have access to the care necessary for routine procedures near their residence. At the same time, we would like to ensure that patients with serious diagnoses can be treated in facilities specializing in such treatment and using modern approaches and technologies, which significantly increases the likelihood of recovery. The saying ‘practice makes perfect’ applies not only in medicine. And I believe that hospitals will start gradually transforming, rather than closing down.”
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), vice-chair of the KDU-ČSL party, and former Deputy Minister of Healthcare.
Following his graduation from the Second Faculty of Medicine at Charles University in 1993, he started working as a physician in the rheumatology ward in the Thomayer Hospital, later becoming the deputy director (2005-2014). From 2014, he worked as the Deputy Minister of Healthcare for four years. “Then came Adam Vojtěch and the ANO movement, and they did a clean sweep across all the different ministries,” he points out.
In November 2018, he started working at Agel JSC, where he was appointed first vice-chair of the board and director of the Jeseník Hospital. “It was a very interesting time in my life, I learned a lot, both as a person and as a manager,” he says.
Philipp always maintained ties with the Thomayer Hospital to some degree and eventually came back full-time. He is married and has five children.
He enjoys hiking, cycling, cynology, and fishing. Politics remains his primary hobby, however.
