Pátek, 1. července, 2022

The Range of Contributions from Prevention Funds Is Wide But Their Benefits on Health May Be Doubtful, Says Head of the Association of Outpatient Specialists


Today, health insurance companies offer a whole range of contributions as part of their prevention funds: from those for physical activities to vaccinations to more thorough preventive check-ups. However, taking advantage of these financial bonuses also has shortcomings. Some contributions have doubtful benefits on health, others could offer higher amounts or could be provided more frequently. The main problem remains that today, many insured people do not heed the word “prevention” and they do not take advantage of the options, whether covered by standard means or supported by prevention funds. The aforementioned was stated by Zorjan Jojko, the Head of the Association of Outpatient Specialists, at the international panel of the Zdravotnický deník Permanent Conference on Czech Healthcare, held on 22 July.

According to Zorjan Jojko, insured people today have much to choose from in terms of the prevention funds of health insurance companies. “The extent of each preventive check-up is rather wide even according to the field. The contributions are often generous, and it is a shame not to take advantage,” Jojko emphasised.

Today in the field of oncology, health insurance companies offer not only the three regularly covered national screening programmes that target colorectal cancer, breast cancer, and cervical cancer, but also birthmark screenings, mammogram screenings outside of the regulated compensation for the given risk group, complex oncological examinations in specialised offices, or the prevention of prostate, gut organs, or oral cavity cancer. Contributions supporting efforts to quit smoking can be categorised as both preventive measures in oncology and cardiology, and aside from this, when it comes to cardiology, health insurance companies, for example, contribute to purchasing digital tonometers.

“As a cardiologist, I am saddened by the lack of contributions in this field. On the other hand, I am glad that health insurance companies offer finances for the purchase of digital tonometers. I myself promote the saying of a tonometer for each family, and now I also say an EKG for each family,” Jojko said.

Zorjan Jojko’s lecture is listened to by (from the right)  the editor-in-chief of Zdravotnický deník, Tomáš Cikrt, President of the Czech Society of Atherosclerosis, Michal Vráblík, President of the Czech Society for Oncology, Head of the Department of Oncology, Second Medical Faculty of Charles University and Motol Faculty Hospital in Prague, Jana Prausová, Deputy Director, General Health Insurance Company, Ivan Duškov. Photo: Radek Čepelák

In the field of psychiatry, there are contributions for cognitive aids, for psycho-social interventions, or for brain activity screenings. Contributions for voluntary vaccinations, for example tick-borne encephalitis, hepatitis, pneumococcus, measles, the flu, HPV, meningitis, shingles, or diseases associated with travel, are often included too.

“Vaccinations have an unequivocal priority. This is prevention that should be supported, and we do not understand why anyone would not let themselves be vaccinated against any disease if there is no evidence that it causes any harm and on the contrary, there is more and more proof that vaccinations help,” stated Zorjan Jojko.

Aside from this, health insurance companies contribute to interdisciplinary screenings beyond standard preventive check-ups, e.g., lab tests of urine, blood lipid levels, blood sugar levels, renal functioning, or thyroid gland hormones. Furthermore, there are contributions for the screenings of prothrombotic mutations or of osteoporosis, examinations of the optic nerve, or a podoscope assessment.

An area that is gaining in importance, especially during the Covid-19 pandemic, is telemedicine. Thus, health insurance companies support the distance monitoring of heart failure, arrhythmia, diabetes, sleep apnoea, or the ITAREPS system, which can detect worsened states of people with schizophrenia.

A ten-thousand crown contribution for a watch with an EKG

On the other hand, Jojko believes that health insurance companies sometimes contribute to things that have doubtful health benefits. An example is free admission to aqua parks, but only one day is set aside for this benefit, meaning that facilities are overcrowded, and one cannot consider this to be beneficial for health. Even some spa stays are questionable, as the curative procedures are often overshadowed by entertainment, and the benefits of some children’s stays are also debatable.

“We wonder why some health insurance companies contribute finances to buy Nordic walking poles, but perhaps this could be meaningful. What I do not understand at all is why one health insurance company contributes a sum of ten thousand crowns for purchasing a watch that also measures EKG, when today you can easily purchase a small EKG for three thousand. For me, this is a senseless squandering of funds, and the pertinent health insurance company should give this a thought,” Zorjan Jojko considered.

Panel participants are listening to the presentation of Slovak Deputy Anna Záborská. From the right: President of the Czech Society of Atherosclerosis, Michal Vráblík, President of the Czech Society for Oncology, Head of the Department of Oncology, Second Medical Faculty of Charles University and Motol Faculty Hospital in Prague, Jana Prausová, Deputy Director, General Health Insurance Company, Ivan Duškov, Head of the Association of Outpatient Specialists, Zorjan Jojko, Director of the National Institute of Health, Barbora Macková, founding member of the Association of General Practitioners Czech Republic, Zdeněk Hamouz, and Director of the National Institute of Mental Health, Petr Winkler. Photo: Radek Čepelák

According to Jojko, aside from the fact that health insurance companies sometimes contribute to not entirely meaningful activities in terms of health, the very structure of each contribution could be improved – for example, some are too low, whereas some do not have a sufficient frequency. Other times the interpretation of some screening results is debatable, such as a resting EKG or occult bleeding tests during colon cancer screenings – the results can be satisfactory, yet the patient has a problem.

The approach to prevention is unbalanced

Taking advantage of preventive activities can also be complicated by the fact that they are covered using several modes. We have standard covered prevention, such as national oncological screening programmes or regular preventive check-ups at one’s general practitioner. Then, there are additional insurance company programmes, such as VZP Plus, which focus on hypertension or diabetes. The aforementioned examples are covered from the prevention funds, when the patient first pays for the given screening, activity or aid, and then the health insurance company retrospectively pays the contribution based on the receipt presented by the client. However, every health insurance company contributes to something else and has its own methods, thus often, even physicians do not know how to advise their patients.

“The problem that we primarily face in the Czech Republic is the disinterest of patients. There is no pressure to alter this situation. We need to think about why this is so, whether we should introduce a system of rewards and punishment, so that the client is motivated to attend check-ups,” underscored Jojko, who also believes that physicians having less and less time for prevention and explanations is a problem.

Prime Minister Andrej Babiš during his videomessage to the participants of the international panel of the Zdravotnický deník Permanent Conference on Czech Healthcare. Photo: Radek Čepelák

When putting through preventive measures, the fact that the returns are more long-term is a problem, as many stakeholders are put off. Also, the question remains who should support, cover, and analyse preventive measures. According to Jojko, not only the government and health insurance companies should participate, but employers as well.

“But this is problematic. In my experience, when we approached companies with the offer of prevention programmes, all the managers signed up. But they did not sign up their drivers. However, these drivers are at a significantly greater cardiovascular risk than the managers. Thus, it should be balanced,” Jojko added. According to him, it would be ideal if every person around forty years of age falls slightly ill so that they are forced to visit their general practitioner. The GPs would then be able to carry out a preventive check-up, thus detecting any problems that could otherwise continue to quietly develop.

Michaela Koubová