Oldřich Šubrt (Health Plus): Českému zdravotnictví chybí efektivita, aby mohlo zařídit pro lidi zdravý život

Our health system is the first in the world, depending on the health, on the workers. I don't understand how it is possible that after 30 years there is no news that we have been living for 8 years since the revolution, but we have been living healthily for 8 months. And now, after COVID, it has decreased in 3 years. If we had decreased in the Czech Republic by 10%, if we had continued living healthily for 1 year, so that we would increase our GDP by 11.3%. PICCZ, PICCZ, PICCZ, your message from the world of business. The Czech health system will be the end of 2020 in Horki. Minister Válek has called on the doctors over time to refuse the PICC health system, which has provided a number of thousands of doctors on protest against the minister. How is the current situation? What will be the health system in 20 years? How much will the technology change? In the podcast I will tell you about Polcik Schubert, the founder and also the director of Clinica Health Plus. PICCZ, PICCZ. Welcome to the microphone. Good day, thank you for your invitation. Ladies and gentlemen, you have experience in the animal sphere. 15 years ago you were in the demonstration at the home, and now you are in the hospital. How do you look at the current health system and the responsibility of the doctors with Minister Válek? I have been doing the health system for 32 years. I finished medicine 20-30 years ago, and I took care of it. I think there are two problems that arise. One is that we have some basic mistakes, the attitude of the entire health system or the lack of this attitude since the 90s, and it does not change. And the other thing is that we are in a post-COVID situation with two other crises. The war and the economic one. And that means that if we have some things wrongly set up, then when you get into the crisis with them, then it will start to fall apart somewhere where you did not even realize that it can happen. That means that I can start from COVID, which is very interesting when you look at it whole-worldedly. I travel every year to London every year for such a whole-world conference for health care at Business International. And the Rothschild Bank has a large department for health care and has a whole additional seminar there, what is happening in health care in the world, and then people from various continents come up to it. And it was fascinating that all of them said the same thing. Even if they were from Japan, or from Brazil, or from the United States, or from Qatar. And they said, when COVID came, then all politicians, because today all politicians are populists, took one to two to calculate health care, and put them into health care, so that they could know that they do not know what to do. It is not a joke that they do not know what to do, but it is better that they pay for it. By the way, the money was distributed in the health care system. And health care was used to receive twice more money at once. Of course, that something was still waiting, something was still going on, all the bonds and so on. But those are not important investments, or investments, because there was no complete health care. So you had a lot of money at once. Everyone got used to it. The second thing is that a lot of health care was not carried out. Even today, when you look at the mortality rate in the Czech Republic, in the summer of this year, it is higher in those months than before COVID. But COVID was no longer in the summer. That means that we have postponed some health care, health care is no longer like before the pandemic. Some operations that should have been planned in 2021, are still okay. That means you have a deficit of work. But you have lost twice more money. And you got used to it. And inflation came into play. That means everyone expects that they will be given a lot of money. But they are not, because the States no longer have it. And if they do, they have to go to war. And people don't have money, because there is inflation. And that is always harming people. So we got into the situation that everywhere in the world, health care is worse than before COVID. Not because of COVID, but because of the way we managed COVID. And that is a big problem. It turns out that the only one who will be able to save it, will eventually be citizens, who are sure that when health care is worse, and they don't give in to the money they don't have anymore, they will have more powerful facilities. They will have facilities that will go further into work. And so on. And these are of course major losses. In the world, these problems, that would be discussed by the local authorities, which is the state in the first place. They mentioned the cross-sphere. So in the world we don't see these problems from the table. Yes, and now we are going to the present. Why is it worse for us, more than anywhere else? In the last four years, we have increased by 50% health care. It is no longer possible. Yes, what happened to it? We were the country that had, it was the fourth from the bottom, in the GDP percent, in the European Union. Now we are the third from the bottom. This means that we are saving money, but it is not enough, because our health care is the first in the world, depending on the sources, on the workers. In our health care, 87% of all the money that are in the system is created. About 4% is given by the Ministry of Health, the Ministry of Health of a person who doesn't have any money. All the money has been saved. And the expenses, which are the salaries for the doctors, so let's pay our own money. And nowhere in the world is there such a measure, that 87% paid for it, how high the salaries are, and how many people are paid for it. This means that the higher the health care, it is very volatile, depending on the inflation, and how quickly the salaries are paid. We were before that, when we did not increase the efficiency of the economy, but we increased the salaries, when we were before the covid, so it was obvious. Every year, 12% increased the health care, because the salary increased in their cities. But the salaries started to decline, the inflation was faster than the salaries. So it quickly decreased. And this is a big problem. The second problem is that the current Czech economy, that we do not have any objective system, access to the health care system. That is, who will become a doctor who has a salary? Who will become a shareholder who has a salary? Who will be the new orthopedist who earns a salary with a higher health care system? There are various choices, such as the treatment that will be done in our city, but it is not quite transparent. I am not talking about corruption at all. I am talking about the fact that it is not decided what is more effective from the result of treatment and prices, and that there is no system for this, which is usually led by the OECD in Poland, in Hungary, in Romania and in Ukraine. We are defending it a bit, and it is such a human creation between the health care system, a bit of ministry and a bit of all of us, which we want to get the most money from. And now it's all the same. And if we want to talk about the reason that is now that doctors are talking to the minister and they say this is a party and so on, have you ever heard that some salesmen or some local people, or some people with a car, went to demonstrate the industry before the ministry and wanted other dreams? It doesn't make sense. The minister doesn't manage these dreams. Especially when he has to take care of the ministry, it is only two and a half percent, which he can manage. He can manage the laws, but before the day they are under the law. And we have supported and ministered both socially democratic or leftist, or populist when there was a woman, or conservative when, for example, I don't know, someone stepped nine, and it's conservative. So they all let themselves into the past. I will help you. I will assume that there will be other tariffes. Why? Besides the fact that I support, I run a school, an academic management, where we teach young managers of health care, we have MBA there and such things. Is that something else? Yes, and when we have fun with young doctors, so we say at the beginning, I always have the first module and the last module, that is the year and a half. And in the first module, everyone says, how is the system scary, and how is the ministry impossible, and how can you not live here at all. And in the last module, I have a decision in health care. And in the year and a half, the people say, it's good that it's a bit of a mess here. We are actually doing our own order, and we are doing it. It means wanting to do things in a creative way. And when I'm having fun, now that it doesn't make sense to you at all, but if you start a camp or start a medical chamber, be a volunteer club, I said to myself, don't go after that minister, but learn those young doctors, in Motol, in Brno, in Ostravje, in Vesnice, to be able to count what is worth. Go after your prime minister, and make the reflector young, I'm already very old, so I still remember communism, but make the reflector and say to the minister, we know how to do this operation differently, we know how to start in the morning, and how to do it in three days. The incompetence has seen more than 20% of it. Give us 5%. Does it mean that doctors should absolve some kind of economic and social distribution? But the main thing would be to think about that there is some money on the town before the ministry. There are no there. The incompetence, you see, these are huge goods. Today the faculty of the incompetence doesn't know who it is. These are tens of billions. In every city, in every part of the republic, where there is an incompetence, there is an incompetence in the company with the greatest brother, who is still young, Boleslavio. And by the way, this is a subordinate, which is supposed to be called subordinate, by the way, only one is state, but two are also state. We completely resigned from that. And I don't understand why the minister doesn't stand up and doesn't say to his friends, come help me. Go to your incompetence, and you will find the effectivity there. Well, the sport, which I also take part in, is actually about those over time. At that moment, the doctors had some kind of pension over time, thanks to the novelization of the law of work, the pension over time increased to twice the amount, which the doctors don't like. And that's the primary sport, which is then transferred to those departments and to those health providers, in any case. You see, this is the first plan, and I don't even compare it at all. I think that this is a problem of modern media, which is the deepest. The problem doesn't disappear like that. The problem disappears. I recently wrote it in a article. When you come to the US emergency room, in the size of, for example, Motola, so we all know him, he will serve in it eight times less doctors than in the Czech emergency room, but it's just that they have it set up like that. Today in the US, it's important that those doctors have to serve a little more, because then they won't be able to do everything at night. But they have them eight times less. And when I was managing the emergency room, whether it's state, or for a Czech or for a German worker, I just said this, as I said, here I have 200 doctors, or good, so I'm in Motola, but I don't want to be the manager of the emergency room, because it's an incredibly complex problem. But let's say we have, we have 200 doctors, or 70 doctors. For me, three of them are very important. And I give you a high salary. And I say, I don't want you to serve. You have a salary here. And if you need help at night, don't sleep here. Don't go after those shots. But before that, if you need to serve the decision, or after the video, or after the phone, or before anything else, we gave a little higher salary. And those people who served were killed. It's only the manager's decision how to organize it. You just have states where they serve half, half, third, fourth people, than in the Czech Republic. Why? Because the whole time we got used to, and this is not a problem in Czech, it's in German. We are used to that doctors serve more for the services. I hide it with a simple object. The law was changed in which you speak, and in which you moved over time. I came to one dermatologist who I treated. And I met my colleagues there. And they came up to me and said, "Oldo, that's bad. What have they done to us?" And I said, I will say that they will have to serve. They gave them 800 hours. Before that, it was unlimited. We will come in 30,000 months. We want to serve. I didn't hear this news in any news. I heard news of the same five people. They say the same thing. And these are rebel things. But the rebel things to the subordinate look after the rebel reunification. But it didn't work. What is the effectivity problem? You know, and I think that when we said some serious problems and some specific problems about COVID-19, it is the most important word that when someone comes from another industry or from the economy to health, he looks at it like a bull. Where is some measurement, some valuation, some contribution, where is the effectivity? Not at all. Because in the past, we were watching how we were able to win a fight with a diagnosis. You were not interested in us. You were interested in the number of the diagnosis and the numbers that show on the invoice to cure the diagnosis. But the meaning of health is not that they will win a fight with a diagnosis, but that I will help you with a happy and healthy life. And it doesn't look good at all. But now, when you said at the beginning where we will finish, we will finish so that we will be okay, because for us it is beneficial for our health. We will support that we want to be paid for the fight with a diagnosis and for the performance. We will make as many performances as possible. If you give us 100 billion more, we will need it next year and we will have decent payments. We will say that. Or we will start doing some valuation of what it brought. I don't understand how it is possible that after 30 years there are no full news about it. We have been living for 8 years since the revolution. But we have been living a healthy life for 8 months only. And now after Covid it has decreased in 3 years. Why is it not written about it? If someone wants to serve him he doesn't want to serve him. It is not interesting. You don't care about it, do you? It is not a positive thing. Yes, but if you take it so that we can connect it for example, an emotional and healthy relationship to society, which would not be a problem. One small mistake at the beginning. When the fact that I heal and go to work, I have 3 non-economic benefits. So it would be one effectivity. The fact that the locals could sing for their locals to have better preventive procedures or something like that, so that they could keep it well. Because they can buy a Japanese-made robot. But they can't buy a doctor and give him to the hospital because it is a front of local practice. Yes. And if these things come to that, we do it in our school because we have such a team that the economy and other things. So we have been doing calculations recently. If we would reduce in the Czech Republic by 10% the non-economic share and if we would continue a healthy life in one year so that people would go to work in one year. So we would increase the GDP by 1.3%. Try to increase it just by 1.3%. And we would definitely be able to do that. But it would have to be someone who wants to be healthy. And it would have to be controlled. And this is the thing that I see now in Scandinavia, in Rakauska, in Canada and in Brazil that they are starting to look at it not as much as we have undergone in the heart. But how did we continue a healthy life? How many people have a long absence? How many people return to work after some operations? How, when they are diagnosed for a long time, the Czech Republic has one of the best specters for all the patients who exist. For example, we are the third generation in Europe between the diagnosis of your patient which takes about 3 months. Why? These are different small problems and it would be important to talk about them what is the meaning of health and what we want. I am very happy that there could be a discussion between health workers because we have populist politics. We have democracy, but populist. Politicians will do only what they want. And people would like to do, to do effective value based health. And people will go to the city and say why, when in my child after a child's neurology it is even half a year, why do we have the most heart surgery, but at the same time so many people die here for heart failure of cardiologists. And we will talk about these questions maybe then the politics will say it is too hard. My personal opinion is that at the moment when I want to be alone or with a child who has a problem with something I don't know where I should be so it is my personal opinion but I will find someone who will look at it. I don't know who the cat is. I will come to the doctor I will come there with a hard problem but then I sit there for 3 hours and wait and wait until something happens. And I understand that it is just that the child is with older people who have to wait there for half a year before getting married. And why do I have to wait here? What do I have to do with it? Who doesn't want to come here? There are many of them. Why? Is it the ineffectivity? Is it ineffectivity? And then it is interesting in Central Europe and especially as a Catholic Central Europe when we are all as we are not believers then it is a Catholic space. So here I am very free in comparison with the Protestant world and the Jewish world and the Arab world. Being free here is digitalizing far smaller even in Germany, in Austria, in Switzerland and in France too. And there is great hope because in a moment where society will want how the doctors don't have all the documents that are submitted how you don't know everything in me when I will agree with that. So that you don't make unnecessary research so that you can find your confessions and you don't have to even look when you make artificial intelligence then everything will tell you why it is not all because it is in all other Catholic communities but it is not in health care and it is not because it is not in health care and it is not in Central Europe because at the moment you can increase the effectiveness by 30-40% because you will spread the data we are now in our health care system where there are about 15,000 people so actually because we give all the data to society we pay them so that we can get all the data that was sent to us so that we have all the data in you in those 15,000 people and today we say when we know you for two years when we have your two preventive researches we will make you genetics and we have everything what happened to you in those two years and we have seen you a few times that we know what life is in the next 20 years we will take everything and that is what medicine is in the next 10-20 years when it will be in the right way that is predictive medicine today in Estonia in Finland in Denmark in Israel you will get a note where it says next three months get to your cardiologist get to the infarct and you will feel nothing and you will go there You ran a bit ahead of me and I wanted to ask you that the help to improve the effectivity because the modern technology and digitalization should be reasonable and in the second place as you present it then you will be able to guess how many modern devices are in the Czech Republic because from my point of view this solution is not a question of the exceptions it is a question of the setting of the whole connection today we have some places the Czech Republic the north Morava there are three big elevators but some have been added or some places we have which are completely digitized but it is only from 3 pktp which means that the laboratories are different some diagnostic centers are different all practices and some specialists are not included in it I am just saying if someone wants to improve the Czech healthcare and if someone pays for it to make a huge amount of money then they connect regionally all healthcare companies and all healthcare companies because at the same time as I say you don't have to do 30% of the training and you have all the diagnoses far too fast and you have to go far too fast that means the problem is not digitization but it is not information connection some states like when they are in the faculty or in the government which are very good but they are not connected that means you only have the piece that today when you are in the end they write to us and you will come to Prague so they see there they just pull out from old issues some important full text which would not be possible in the huge amount of information but it all runs but we need to connect it now and we actually did the only thing that we connected is the ERECET and EN but we are still not going we are still defending it why are we defending it we will connect it so you will see the effects and the imperfections because you say the data is connected it is not about health it is just about big data showing how the world works this is not a connection it is not a problem of health when you look at the history in the religious sphere hundreds of thousands of organizations each has its IT system it runs on something else and the problem with this connection is also how I perceive it so basically it is getting closer to better times in Czech Republic and you have the chance to help the campaign minister of local development Mr. Bartoshe who basically gave himself digitalization to the cloud because he is not determined on health he is determined on the business sphere I am not an expert I can not say I am just looking at the open piece that many countries who wanted to speed up allowed the bank identity maybe they knew a little bit about the bank maybe a little bit too much that we will show the bank identity because it is absolutely right because it did not happen to you in the last two years with all the money from the bank everywhere in those states where it has become a bank identity we make a state identity I just go back to the 90s and say who knew it are there any other states how much it has become more than 5 billion probably 7 and we do not have it maybe it would be a faster solution for our health care workers in the last 20 years? now an interesting term started I hope that no one will bother me or the doctor's colleague will not bother me but in the last three months in the care of the manager or the health care organization use the "hospitalization of health care workers" what is happening now because the availability has worsened because it is a health care worker who is used to spending money and they are not satisfied so he is not satisfied so there is a reason for a place where you have to pay cash what is a stomatology? the stomatology has been replaced by the health care organization and today even if your mother or someone from older people goes and spends 3,000 per hour on stomatology it does not look strange even if you cannot find how much money will be and you spend the most money today you go to the orthopedic and then you go to the control and after that you do not want to wait for 3 hours so you go to others or it will be a failure so there will definitely be such a bubble which we see in Poland which we see in Hungary in those 30 years of post-communism that there will be a lack of health care but with that in the future or in the next minister there will be a big bubble because at the end of the day people really came to the city and said "I am going to break my leg" "I will not go to the orthopedic and pay 15,000" that's what you think and at that moment things will start to change and get better but it will be the lack of health care which will rise according to my view if you do not become something worse than such a hospital it will happen that we will have to pay more and we will ask why? People do health care when I take 100,000 I will take 45,000 I give a lot of money and my employer too and where is it? what kind of 400 billion do I have? and I will start the discussion "I will give you a better access to the doctor" "you will continue your life" and then it will be good in 20 years it will be good I am happy that you have experienced it also because our generation our generation is old and will be old that is such a bonus but I am quite excited about it because I organize health care for 32 years and so I have a lot of friends who are older I have a client who is 15 years old and when you go through these two categories one of them is around 55 years old when these hidden emotions are coming start and now they will be found at the beginning so the secondary prevention begins and the health care will pull you out into the normal world and then there will be such a category it should be a bit different when there will be some importance and you have a good access to the doctor or you have a whole history who is old, there are some chronic disease management and so on and they will tighten you up again even if you are a little sick and you have to take some pills so I know a lot of people in the 80's and I always say when you enter into the business class of Lufthansa there will be 80 years of people who go to conferences in Boston and are completely healthy and when you look at these two things such a category and you have a good team I think that in good condition when you don't come to an agreement unpleasant thing but it happens in 10% in 90% beautiful, 87, 2, 90 years and it's okay and he says thank you for your time and have an interesting conversation and good luck