A Basic Guide to Czech Healthcare for English Speakers
How to maximize your experience when you’re sick, injured or need a doctor’s advice
Maybe you’ve blown your knee out on your second day of your new resolution to get fit. Or you’ve got a child with a wintertime strep throat infection. Regardless of the precipitating circumstances, one of the most difficult aspects of life in a foreign country can be learning how to use its healthcare system.
From finding a doctor to filling a prescription, getting emergency care or having cosmetic surgery, sometimes the hardest part of health insurance abroad is figuring out what is required, which resources are available and how much it’ll cost you.
Public health insurance vs. commercial health insurance for foreigners
The Czech Republic by law (Act No. 326/1999 Coll. E Territory of the Czech Republic) requires foreigners to have medical insurance for the duration of their stay in the country, although coverage can vary based on length of stay, type of visa and other factors. Issuance of temporary and long-term visas is contingent upon having health insurance that meets the approval of the Czech foreign police.
The largest public insurance company in the Czech Republic is the Všeobecna Zdravotní Pojištovna known as VZP (General Healthcare Insurance) which provides full coverage health insurance to all Czech citizens, permanent residents of the Czech Republic and those with long-term working permits (i.e. self-employed or those operating on a Živnostenský list (trade business license). Family members of non-EU citizens who are working here may be covered under the public healthcare system or might require commercial insurance. For those participating in the public system, monthly insurance contributions are deducted from your salary or sent by bank transfer for those who are self-employed.
VZP’s subsidiary company, PVZP offers different levels of commercial insurance policies to foreigners who are ineligible to be covered within the state system. According to EU regulations, a state health insurance company cannot sell commercial insurance. PVZP’s insurance policies meet the requirements of Czech law regarding the stay of foreigners in Czech Republic. In cooperation with VZP, there are 4,500 medical facilities and specialists for use by PVZP and VZP clients. According to the Ministry of Foreign Affairs, of the 430,000 – 450,000 registered foreign residents in the Czech Republic, approximately 88,000 foreigners currently require a commercial insurance product.
Other private companies, such as BUPA International, Alliance Partnership, Maxima, AIG and Uniqua also offer commercial policies for expats.
Buying a commercial insurance policy online
Like many new residents in the Czech Republic, figuring out the healthcare system took me a bit of time, due diligence and trial and error experience.
When I arrived in the Czech Republic 14 years ago, I waited in line at a commercial branch of the VZP office with other new English teachers and used hand gestures to communicate with an insurance representative. At the time, all the forms were in Czech; no one in the office spoke English, and my Czech was non-existent. I handed over a couple thousand Czech crowns for the upfront premium for a short-term commercial insurance policy that I hoped matched the requirements of the one-year working visa I was also in the process of applying for.
Flash forward a decade plus.
A few days ago, I did a preliminary scan on PVZP’s website which provides information in Czech, Russian, English and Vietnamese. When I called PVZP’s 24-hour English hotline +420 225 354 940 (press 2 for English), a representative speaking impeccable English explained the application process. By plugging personal details (age, sex, length of stay, number of persons, etc.) into their online insurance calculator, you will receive a specific health insurance offer in response either by email or phone. There is no need for a personal visit to the office, nor are you required to sign any forms. Your insurance becomes valid as soon as the premium is paid.
Perks of the online process include potential discounts (up to 10% for basic and up to 20% for family comprehensive coverage). For those who’d prefer to do their insurance in person, PZVP will open a new office (as of February) in Palace Broadway – Na Příkopě 988/31 Prague 1. Hamilton Hudson is another firm offering VZP commercial insurance for foreigners. Visit their website at www.vzpforforeigners.cz for details on how to register.
Commercial insurance is priced on a sliding scale, so a 1 month basic policy for an individual costs 900 CZK while you pay only 4970 CZK for the same coverage for 12-months. PVZP offers basic (up to 90-day tourist stays), basic with superior standard (short term working stays), comprehensive (necessary for stays beyond 90-days) and exclusive (the only policy on the market that fully covers pre-existing conditions). Exclusive requires a complex doctor’s examination for acceptance.
Although there are complaints about insurance companies that do not validate foreigners’ commercial insurance policies and loopholes that allow insurers to refuse payment for services provided, the PVZP official assured me their clients have access to the same extensive database of medical personnel that VZP’s public clients do. Since the vast majority of foreigners living here fall into the category of being eligible for public VZP coverage, concerns about the system (beyond language requirements) are likely similar to those of Czech citizens.
For more detailed information about what to do upon arrival to Prague as a foreign citizen in order to comply with Czech regulations, check out the PVZP help site at infocizinci.cz/en. Information is provided in Czech, English and Russian.
Once you’ve received your insurance card in the mail, carry it with you. The card contains your date of birth, your personal identification number (rodné číslo) and your insurance policy code. You must present this card at the doctor’s or specialist’s to prove that you have coverage. Without it, you may be refused treatment (with the exception of emergencies). Each family member receives his or her own different card whose validity corresponds to the length of your visa or residency permission. A copy of your child’s insurance card will be kept on file at your children’s school, summer camps and any after-school activities.
Finding a general doctor or medical specialist
Under the Czech healthcare system, you are allowed to choose your own primary care doctor (praktický lékař) or specialist. If the doctor participates in the public Czech system (most doctors accept VZP), your appointment and subsequent treatment should be free of charge. This includes all care deemed as necessary or essential. If you choose to see a doctor outside of your insurance system, you will pay for the appointment and have the option of filing for reimbursement. There is a small charge for prescription medicines purchased at a lékárna (chemist’s shop) and a regulatory fee of 90 CZK for after-hour urgent care at hospitals or clinics. By and large, however, the cost for medical care in the Czech Republic is minimal compared to prices paid in other countries.
Use a database or scope out your neighborhood
Today, most doctors have their contact information online. Although I am not aware that a centralized online database of medical Czech professionals exists, contact your insurance provider to ask them for a list of participating doctors and specialists. There are also individual online resources like the website www.znamylekar.cz that allow you to type in the kind of doctor or specialist you need and the region where you live. On this site, you can read patient reviews (in Czech only) and doctors are graded on a star system. For online searches, you can also trying typing praktický lékař followed by listing your neighborhood. When I did this for Prague 1, I came up with a catalog of medical professionals with doctors’ names, addresses and telephone numbers for practices in Prague 1. Some sites state that they offer care in English or other languages.
Since many doctors’ offices are located in residential neighborhoods, you may be able to scope out the nearest medical facility on foot and ask in person. Larger clinics and in hospitals also provide facilities where general care doctors conduct their practice. See our Prague.TV article for a list of English-speaking medical services in Prague.
Once you’ve chosen a doctor, call to find out if he or she is currently registering new patients. If the doctor is full, ask for a recommendation of another doctor nearby who has space available. If your situation is critical, you can be seen by any doctor without an appointment as long as you are willing to wait (even if you are registered with a different one or not registered with a specific doctor yet).
The same process works for finding a pediatrician. While your child should be registered with one primary pediatrician in order to receive all the necessary information on immunizations, vaccinations and yearly health check-ups, registration with one pediatrician does not prevent you from seeing a different pediatrician if your child is sick while traveling or if you would like to get a second opinion.
Going to see a specialist does not generally require a referral from a primary care physician. Specialists, like ORL (ENT – ear, nose, throat surgeons) often do not take appointments, but provide care on a first-come-first serve policy during their regular working hours. This may meaning waiting in a line in order to be seen. However, once you’ve waited a few times, you’ll figure out what time to arrive to avoid the rush.
Downsides to the system (aesthetics and bedside manner)
The Czech healthcare system is sometimes criticized by Czechs and foreigners alike for its downsides. If you’re used to Western standards, you might be surprised by some of the differences here, at least at first sight. Formerly, the system was known for less than pleasing aesthetics – long waiting room lines or the shabby exterior of medical facilities. Doctors had the reputation of being gruff and authoritative, despite having reputations as well-trained, skilled physicians.
Doctors working in the public system are not compensated for their time, as they are under a privatized healthcare system, and the volume of patients that filters in-and-out on a daily basis doesn't lend itself to personalized attention. I'll never forget the day I walked into a doctor’s office to be greeted by a gruff, "Co Vam je?" Basically, "What's wrong with you?" My husband said the greeting was customary and not as rude as I had interpreted it, but he agreed that the doctor wasn't sending a very customer-friendly message, even if she was competent. Yet, whenever I mention my dissatisfaction with the bedside manner, or lack thereof, prevalent in the Czech medical system, my husband reminds me that if I don't voice my dissatisfaction, nothing will change.
For the most part, I've found Czech doctors who are willing to answer my questions and to consider alternative treatments when I refuse to accept the traditional one. Over the years, I have learned, if you don’t want something done, be firm to get your way.
Signs of modernization
Signs of modernization are apparent across the system, both in the quality of facilities and treatment available as well as the attitude of medical personnel. When my daughter was an infant, we waited to see our Czech pediatrician in a hallway. Ten years later, the pediatrician shares a sky-blue colored waiting room that she has rented with another doctor and painted herself. Children can play with toys and books while they wait; pictures from patients adorn the walls; information about necessary and optional vaccinations as well as a link to her website is displayed. Treatment options in the system have also expanded, mostly in the range of high-end services for above standard treatment at a specialist (see Paying more below). A younger generation of physicians, many of whom speak multiple languages, is also replacing the image of the gruff Czech medical professional.
One of the highlights of the Czech healthcare system is that it offers free healthcare for children from birth through the end of their university school studies. Regardless of their income, parents are not required to pay into the system for their child’s healthcare, and necessary treatment is provided for children free of cost. Parents are still responsible for prescription medicines and preventative treatment, or treatment above the standard.
Women’s Health (Gynecology & Obstetrics)
Since our first daughter was born in the US, we had a barometer for comparing maternity care and delivery costs when I became pregnant with my son after we moved back to Prague. Although my daughter's delivery was smooth and our stay at a birthing center was short (no doctor attended the birth), we ended up paying about 1,200 USD out-of-pocket in addition to our insurance coverage for routine hospital costs. A similar delivery in Prague with VZP public insurance does not cost the family a penny, unless you request additional “above-standard” services (like having a particular doctor deliver the child or paying for English-speaking prenatal care). With my sons, I did pay out-of-pocket so that I could see an English-speaking doctor during my pregnancies and a delivery fee. I also paid a small fee to the hospital in order to have a private room after delivery.
Routine gynecological exams are free of charge, although gynecologists can charge minimal amounts for writing prescriptions and other services.
Paying more for high-end care and premium services
Increasingly, many specialists (such as OBGYNs, orthopedic surgeons, dentists and orthodontists) accept public insurance for basic medical services but also offer additional privatized services at a higher standard. Private services run the gamut from a small surcharge for surgery performed at a private facility at an earlier date than waiting for availability at a public facility to expensive rounds of cutting edge treatment. When I blew out my knee while running, I visited a series of sports-oriented orthopedic surgeons (all of whom accepted my VZP insurance but offered a range of extra treatment – from arthroscopic surgery at a minimal cost to expensive plasma injections).
At the dental office, special services could mean a more modern treatment method such as invisible braces or a consultation in English. On a recent visit to the orthodontist with my children, I was asked by the receptionist if I wanted the consultation for braces in Czech or English. For English, I’d need to pay 800 CZK. For Czech, I’d pay 360 CZK. I chose the Czech and got by with help from my kids.
Low cost for excellent treatment
In the Czech Republic, my family has experienced a level of care that has equaled or surpassed that which we could have received in the US (and barely touched our wallets). I've gotten excellent care during two pregnancies and deliveries. My three children have been treated for their share of childhood illnesses with minimal antibiotics by competent doctors. Despite a few negatives (which to some extent exist in any healthcare system), I have nothing but praise for way the Czech healthcare system has treated my family’s needs for more than a decade.
So, if you’ve pulled a muscle on your first new year’s run, or you’ve just moved here and your daughter has come down with a case of strep throat, don’t panic. You might not like going to the doctor (who does), but it’s better to know what you need to get yourself there, just in case.
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