3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
On March 17, the MoH ordered providers to delay all planned care and non-urgent treatment to open capacity for expected COVID-19 patients (1); this measure was relaxed in the second half of April in an effort to bring care provision for non-COVID patients back to standard levels (2). The government also prohibited all medical workers to take regular leave during the state of emergency; this resolution was revoked on April 10, 2020. In general, redeployment from other specialities to deal with COVID-19 patients did not occur (for details on physical infrastructure and workforce, see section 2). A plan was prepared to transfer standard beds into ICU ones along with staff redeployment in case the epidemiological situation worsens (as of beginning of May, there are approximately 300 hospitalized COVID-positive patients in the CZ (3)). Starting on April 8, inpatient care facilities were obliged to report any change in their ICU bed capacity and occupancy on a daily basis (4). On April 29, the MoH announced plans to concentrate COVID-19 patients requiring hospitalisation to selected bigger hospitals on regional level, aiming to free smaller hospitals to focus on non-COVID patients only (5). In mid-September, COVID-19 patients are primarily taken care of in university and regional hospitals. Bed capacity continues to be reported daily and closely monitored. With the rapid increase of positively detected cases, hospital beds have started filling up as well. As of September 18, the MoH declares there is still enough capacity, while some medical experts express worries about it. No limit on non-urgent care has been imposed from the government so far (September 16).
General Practitioners (core primary health care providers; each person should be registered with one who, however, does not have the gatekeeping role) were initially advised to treat patients by phone and only accept physical visits with appropriate PPEs (many GPs did not have this in the beginning, so many were unwilling to actually see their patients in the first weeks of the outbreak). Prevention and other care was postponed during March and April. The use of e-Prescription as well as other electronic tools (e.g. a new system to issue medical certificates for fitness to work/sick leave) increased. On April 9, GPs were ordered by the MoH to perform tests at the end of patients' quarantine; later, GPs are still responsible for terminating a quarantine or isolation, but tests are not necessary in all cases any more (see section 1.3 for details).. Primary care providers or Regional Public Health Authorities are the first point of (telephone) contact for suspected cases, mandated to require testing and to order the 14-day quarantine or isolation. Besides, GPs decide on the end of quarantine and isolation given 2 negative PCR tests or a negative speed blood test (Rapid RT tests for presence of IgM a IgG in RT.) – details on current quarantine and isolation termination testing are provided in Section 1.3.
Regarding distanced medical consultations: the health insurance funds widened providers’ reimbursements to include these arrangements (telemedicine, email, phone) for most outpatient specialists. General practitioners have reported making a majority of contacts with their patients over phone, with the average daily number of contacts for those who did not close or limit their office hours substantially being down only by less than 15% (6). According to the temporary reimbursement rules, even dentists were able to perform telemedicine consultations with their patients (see also section 4). Most of these reimbursement rules were temporary and in force till June 30 (7). In the beginning of September, health insurers introduced new code for GPs’ phone consultations to avoid confusion with spring phone consultation coding. The new code is activated by health insurers only in “crisis” times and as a temporary measure; it was activated on September 1.
(1) Ministry of Health Extraordinary Measures issued on March 16, 2020 (MZDR 12066/2020-1/MIN/KAN) and March 19, 2020 (MZDR 12312/2020-2/MIN/KAN)
(2) Ministry of Health recommendation for healthcare providers, issued on April 14, 2020 https://koronavirus.mzcr.cz/doporuceni-poskytovatelum-zdravotni-pece/
(4) Ministry of Health Extraordinary Measure on intensive care capacity reporting, issued on April 8, 2020 (MZDR 15190/2020-6/MIN/KAN)
(6) information provided by the CZ Association of General Practitioners