History and Role

In 1891, the Austro-Hungarian Monarchy issued a law on the establishment of medical chambers. In the Kingdom of Bohemia a Medical Chamber was founded in October 1894 after the establishment of the Imperial and Royal Governor´s Office in Prague. At the time, a bicameral chamber was establish with Czech and German subdivisions. The Medical Chamber continued to be active in the newly established Czechoslovak Republic, the underlying principles of its operation being similar to those applied by medical chambers at present. Its main tasks included supervision of medical ethics and the quality of health care. All physicians engaged in private practice were members of the Chamber.
Even the Nazi occupation did not interrupt the Chamber´s activities. The Medical Chamber continued until 1950, at which time its activities were suspended by the Communist government. After the major socio-political changes accomplished in our country in 1989 the Medical Chamber was re-established in 1991 on the basis of Act No. 220/1991 Coll. concerning the Czech Medical Chamber, the Czech Chamber of Dentists and the Czech Chamber of Pharmacists.

The Czech Medical Chamber is an independent, non-political authonomous professional organisation responsible for the interests, the professionalism, the ethics and the honour of the medical profession.
The law prescribes obligatory membership in the CMC for all physicians providing diagnostic and/or therapeutic treatment in Czech Republic.

The first President of CMC, MUDr. Miloš Štejfa, DrSc., was elected by the Constituent Assembly of CMC that was held on November 17-19, 1991. In November 1992, Doc. MUDr. Miroslav Svoboda, CSc. succeeded to the Presidency and in 1998 MUDr. David Rath. The incumbent President is MUDr. Milan Kubek, who was elected by the CMC Assembly in January 14, 2006.

CMC´s duties have to be viewed from two different perspectives. The public puts its faith in the Chamber to guarantee that doctors will use the highest medical standards and ethics in their dealings with patients. To the physicians, CMC plays the role of a democratic representative of the medical profession in their contact with society, government authorities and health administration bodies. Throught its power to award licences to doctors, the Chamber determines the conditions under which its members engage in private practice and act as expert representatives and head physicians in non-governmental health care facilities. Furthermore, CMC lays down the professiona lrequirements for the performance of diagnostics and therapeutic methods and supervises Continuing Medical Education (CME). These activities, too, serve to promote the use of the highest professional standards by CMC members. The Chamber thus guarantees to the patients that health care is provided in accordance with the latest knowledge of modern medical science.
The Chamber is non-profit organisation. Its expenses are covered exclusively by membership fees, donations and proceeds from levied penalties. CMC does not receive any government subsidies.

Organs of CMC

The basic units in the CMC´s structure are the District Associations of Physicians or, in the City of Prague, the Municipal District Associations.

Organs of CMC on central level are:
The General Assembly of the Czech Medical Chamber
(The supreme authority of the Chamber)
The Presidium of the Czech Medical Chamber
(The managing and executive body)
The President of the Czech Medical Chamber
(Represents the Chamber in external relations)
The Vice-President of the Czech Medical Chamber
(Stands in for the President)
The Honorary Board
(exercises disciplinary powers)
The Review Committee
(The supreme organ of scrutiny)
The Scientific Board
(Advisory Working Body)
The Ethical Commission
(Advisory Working Body)

Organs of CMC on district/municipal district level are:
The District/Municipal District Assembly
The Presidium of a District/Municipal District Association
The Honorary Board of a District/Municipal District Association
The Ethical Commission of a District/Municipal District Association
The Review Committee of a District/Municipal District Association

Positions within the Chamber are honorary. For completion of such services, officials of the Chamber receive only compensation for the loss of time and reimbursement of out-of-pocket expenses.
In accordance with Act No. 220/1991 Coll. CMC issues its Professional Ordinances, which are binding on the activities of its bodies as well as on all individual members.

Among the most important Professional Ordinances are:
· The Organisation Order;
· The Election Order;
· The Rules of Procedure;
· The Disciplinary Order;
· The Ethical Code;
· The Licencing Order;
· The Functional Licences;
· The Code of Continual Education.

In addition to its Professional ordinances, the Chamber also issues Binding Statemnets, which are valid for all members of CMC practicing medicine within the teritory of the Czech Republic.
The subjects addressed in the Binding Statements include, for example: the system of Continuing Medical Education (CME); use of medical products in health care; assessment of the level of staff in contracting health care establishments; definition of the Complement; definition of STATIM investigation, etc.

The Rights and Duties of CMC under the Law

The Czech Medical Chamber:

· Sees to it that its members exercise their profession in conformity with the highest professional standards, as well as with the principles of medical ethics and with the law;
· Serves as the guarantor of professionalism an the part of its members and certifies satisfaction of the requirements for the practice of medicine;
· Reviews and defends the rights and the professional, social and economic interests of its members;
· Defends the professional honour of its members;
· Maintains the register of its members.

The Chamber is allowed to:

· Participate in negotiations concerning the tariffs for individual medical procedures and the price lists for pharmaceuticals;
· Take part in competition proceedings to fill leading positions in the health care sector;
· Lay down requirements for the practice of medicine by its members in their own private establishments;
· Investigate malpractice complaints field against its members;
· Issue opinions on the conditions and forms of CME;
· Participate in specialisation exams.

Each member of the Chamber has the right to:

· Elect his/her representatives, and be elected, to the organs of the CMC
; · Resort to the assistance of the Chamber in the field of CME and in legal matters.

Each member of the Chamber has the obligation to:

· Exercise his/her profession at a high level of expertise, in accordance with the principles of medical ethics and with the valid legislation;
· Abide by the Rules of the Chamber;
· Pay the membership fees.

Journal CMC - Tempus Medicorum

CMC issues a monthly journal entitled Tempus Medicorum, which is distributed free of charge to all its members. Besides articles on current CMC activities, the journal also publishes information on developments in the field of medicine and on the organisation of health care in the Czech Republic as well as in foreign countries. A weekly form of the journal, called WebTempus, appears on the Internet.
The Chamber's website can be found under http://www.lkcr.cz, publishing the most recent information on the Chamber's activities as well as papers that are too extensive for inclusion in the printed journal.

International Cooperation

Since 1999, the CMC has expanded its relationship with partners in foreign countries. Fruitful cooperation is being pursued especially with our neighbours in Slovakia, Germany and Austria. Very close cooperation is with the General Medical Council in United Kingdom and other medical chambers and association in the European Union countries.

CMC is a member of:
CPME - Standing Committee of European Doctors
PWG - Permanent Working Group of Junior European Doctors
CEOM - European Conference of Medical Chambers.

Social Activities and Services of the Chamber

In addition to its professional tasks, the Chamber also fulfils a social role. Every year, pursuant to Professional Ordinance No. 14, the Chamber awards the title "Knight of the Czech Medical Profession" to one Czech doctor. This award honours physicians for their outstanding life-long activities that have contributed to the advancement of medicine, medical ethics and humanity.
The Chamber also co-hosts the annual Czech Medical Doctors' Ball - a major festive occasion organized in cooperation with the Medical Trade Unions´ Club. Close collaboration with other medical organizations that unite physicians on a voluntary basis is an inseparable component of the Chamber's activities.
There are also the traditional annual CMC Christmas concerts which always bring together the most important representatives of the Czech health care community.
Professional Ordinance No. 6 governs the establishment of the Social Fund of the Chamber and sets forth rules for its use. The fund is meant to support members of the Chamber who, through no fault of their own, run into financial difficulties; to help CMC members to further their medical education; and, to give assistance to families of deceased members.
In view of the current low level of membership fees, based on poor financial compensation for physicians in the Czech Republic, this fund can be used on a limited scale only at the present time. For the same reason, CMC is not yet able to offer its members additional pension insurance in the same way as this is done in the neighbouring countries such as Austria and Germany.

Basic Information on Health Care in the Czech Republic

In the past ten years, the system of health care in our country has undergone major changes. The centralized way of planning and managing health care and financing it from the state budget was abolished. The law now prescribes obligatory health insurance under which every employed person contributes to his/her health care coverage (the health insurance premiums for employees, which constitute 13.5% of salary, are paid partly by the employees themselves and partly by their employers, the ratio between the employer and employee contribution being 2:1). The state covers health insurance for the unemployed, as well as for children and students, women on maternity leave, retired persons, etc.
Many health insurance companies were initially established, but some of them soon went out of business. Eight health insurance companies are currently in operation, the most powerful of them being the General Health Insurance Company, which covers more than 80% of the Czech population. Contemporary legislation does not permit individual insurance companies to offer their clients more advantages, lower fees or an above-standard package of service, thus preventing real competition in the health insurance sector. This system enables the General Health Insurance Company to dictate the terms of its contracts with physicians.
Health care in the Czech Republic is offered by different types of providers. Health care establishments belong either to the State, to municipalities or they have private owners. Most hospitals are state-owned, while most of the outpatient facilities are in private hands.
Health care providers sign contracts with insurance companies for five-year periods. On the basis of these contracts, the insurance companies provide remuneration for services rendered. The initially applied fee-for-service system has been gradually replaced by a rather non-transparent and complicated pattern of financing. Private general practitioners are paid under a mixed system combining fee-for-service and per capita fees. Specialists in outpatient establishments have their remuneration limited by standard times for individual procedures and by historical precedents. Hospitals operate under a partly budgetary system reflecting the performed services and the level of payments to individual hospitals in the previous term. In several facilities the DRG (Diagnosis Related Groups) system of payments is being tested. Rather strict limits are imposed on individual health care establishments for the purposes of remuneration as regards the volume of prescribed medications and of requested examinations.
Private Establishments
Establishments supervised by district authorities
Establishments supervised by the Ministry of Health
In the last decade, major headway has been made in equipping health care establishments with modern technologies. However, payments from insurance companies do not reflect depreciation of the equipment and the necessity to upgrade it. Consequently, the health care sector witnesses a growing disparity between increasing demands of the patients and increasing costs of modern health care on the one hand, and the lack of financial resources on the other.
Improvements in the quality of health care have helped in the last few years to bring about a significant prolongation of life expectancy, as well as substantial decreases in the number of abortions and in the death rate of infants. In respect to infant mortality, with 5.9 deaths for every 1000 live births, the Czech Republic has reached one of the foremost places in Europe.
CMC has 40,823 physicians registered. Out of this number, 31,652 are active (figures as of June 30, 2000, excluding 5,841 dentists). 72% of all physicians work in outpatient establishments. With a total population of 10.5 million, the ratio in the Czech Republic is 1 physician per 324.9 inhabitants, or, 30.8 physicians per 100,000 inhabitants.
Independent out-patient establishments
Hospitals - in-patient treatment
Hospitals - out-patient treatment
Special therapeutic institutions, incl. balneologic institutions
Special health care establishments
Other
The title Doctor of Medicine (Medicinae Universae Doctor - MUDr.) is conferred on every graduate from a Medical Faculty after completing six years of studies. This title allows a graduate to practice medicine in a hospital as an assistant physician (resident) or in an outpatient establishment under the supervision of another qualified doctor. There are seven Medical Faculties in the Czech Republic, graduating a total of 1,100 - 1,600 medical doctors per year. The contemporary system of postgraduate medical education is based on a two-step specialisation - the compulsory first degree of specialisation for every doctor practicing medicine and the second specialisation degree that is mandatory only for physicians in leading positions.
Supplementary specialisation exams also exist for individual medical branches.
The current system will have to be transformed in the future into a system valid in the countries of the European Union - one standard specialisation exam completed after approx. five years of practice. Growing emphasis is being placed on Continuing Medical Education, which is an important component of the responsibilities of the Czech Medical Chamber.
The average monthly income of Czech physicians, as well as other health care personnel, is only slightly above the intermediate salary in the country, and is far behind the rewards of doctors elsewhere in Europe, even in other post-Communist countries.

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