Category making in discourses of health policy reforms: the case study of the Czech Republic

Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care

“…So too has been the issue of shifting patients’ rights and responsibilities, both in terms of the focus on building patients’ capacities to take greater control over their health care (Čada ), and the need for more respectful (‘caring’) attitudes towards patients on the part of healthcare providers (Hrešanová , Read ). Both developments are facets of the move towards a more consumer‐focused healthcare system that not only enables, but requires patients to make their own choices about their care, for example, no longer being assigned a primary‐care physician based on their area of residence, but being able to choose one themselves.…”

“…After 1989, some spas went into private hands, while others remain publically funded institutions, though like most “free” public services, patients must pay a small daily subsidy (Čada ), resulting in spa care becoming less accessible to the wider population. That said, biomedical physicians continue to refer patients suffering from a wide range of (chronic or acute) problems for spa treatment.…”

“…Both medical traditions are currently at the crux of debates over how to assess efficiency, effectiveness and equality in a post‐socialist society that has spent the last 28 years moving away from a healthcare system ostensibly focused on providing equal care for all, towards an increasingly stratified model with the introduction of “nadstandards” or “above‐standard” care paid for by patients in ever‐increasing areas of medical care. The post‐socialist promotion of patients as self‐responsible healthcare consumers has also shifted more decision‐making onto patients (Čada , Hrešanová , Trnka 2017a), requiring a new understanding of what we might mean by equality of care. Both CAM and spa care are, moreover, marked by debates over how to demonstrate and rationalise efficiency and effectiveness.…”

Efficacious Holidays: The Therapeutic Dimensions of Pleasure and Discipline in Czech Respiratory Spas

“…Medical care is still seen as a citizen's right, and all citizens are covered by health insurance. However, even ostensibly free public services, such as hospitalization, incur small daily payments from patients (Čada ).…”

“…“It was miserable,” she remembers, “as in those days you went without your mother and I was terrified.” Her account is echoed by Jaroslav, who was sent to a respiratory spa as a young boy in the early 1980s, and remembers “horrible nurses who beat the children and didn't care about us at all.” Both of their recollections reflect the general understanding that while authority, expertise, and, all too often, authoritarianism remain significant elements of physicians’ relationships with patients (see Heitlinger and Trnka ; Hrešanová ; Read ; Trnka ), a more caring ethos has begun to permeate through the medical profession since the end of state socialism. Some of this shift is due to the growing consumer ethos in health care (Read ), though there is also increasing recognition of the desirability of having patients who are better informed and more responsible for their health (Čada ; Hrešanová ; Trnka ).…”