PUBLIC HEALTH IN CZECHOSLOVAKIA

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP82-00457R008600260006-7
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 5
• Document Creation Date: December 14, 2016
• Document Release Date: January 5, 2001
• Sequence Number: 6
• Publication Date: September 21, 1951
• Content Type: REPORT

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Approved For ReferEgAIONNWOCIMAGIRIM82-0045EZEM861002
INFOR ATION REPORT CD NO.
CONFIDENTIAL
aMir7RY Coechoslovakia
SUBJECT Publie Health in Czechoslovakia
RACE 25X1A
ACQUIRED
DATE OF
INFO.
Tim:kV?
DATE DISTR, 32.
NO. OF PAGES 5
NO. OF ENCLS.
(LISTED BELOW)
SUPPLEMENT o.
MNENT TO
REPORT 25xix
In addition to the clinics attached to university medical faculties, two
types of hospitals are to exist at the completion of the current reorgani-
zation: district hospitals (okresni nemocnice) and regional hospitals
(oblastni nemomice). (1) These hospitals, which are subject to the
administration of the Public Health Office (zdravotni oddeleni) of their ap-
rropri.Ao District or County National Committee and are located wherever
such National Committees are established, consist of the following
sections g (2)
a. District Hospitals p surgery
internal diseases
onecology and obabetrics
pediatrics
b. Regional Hospitals: surgery
internal diseases
gynecology and obstetric
pediatrics
ophthalmology
otologr
x-ray
dermatology
infectious diseases
neurology
Psychopathology
te.
Document No. _ ------------- ________
No Change In Class,
O Declassified
Class, Changed To: TS S
Auth.: HR 713-,2 ,
Date:
By: -Olt
2. It is intended to establish Health Centers (zdravotni stredisko)? some of
which are already in operation, directed by a medical manager who is to be
an accredited physician and an administrative manaLpr elected from among
the ranks of the non-medical personnel. These Health Centers will be
formed by amalgamating the functions of the medical consulting offices of
the National Tnsurance Offices., the Institutes of National Health (Ustav
sarodniho zdrev31 and the appropriate hosnitalq district or regional as the
case may be. (3) The Health Centers may also have branch consulting offices
outside of the hospitals. The National Insurance consulting offices may
be abolished, their functions being transferred to hospital departments.
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3. All hospital wards, especially those for internal diseases, are currently
ovororowdeea There ia a variety or reasons for this condition* among
which is the fact that the general practitioners are overburdened with
patients and are therefore prone to send ambulatory cases to the hospital
to lighten their own load, and that many people attampt to become admitted
to the hospital in order to obtain a legal excuse for absenteeism from
work. One of the major causes, however, is that there are insufficient
institutions for the incurably diseased and the aged. Such patients rho
have no one to care for them have therefore glutted hospital wards, internal
disease wards particularly. ?law patients who have a justifiable elaim to
hospital aaMitzsnee must be turned away.
4, !lost phyniciaris still maintain a private consulting practice, :.athouish a
small minority have given up private practice and entered a physicians'
cooeerative Privately sracticinc physicians are paid for their services
only in accordance with the number of National Insurance certificates
received from patients in the quarter for which they are valid. The doctor
15 furthernore paid only for one visit oven thouell the patient requires
further treatoent. (4) A physician's trave3ine expenses when creatinc
bedridden patients in their homes are also mot throueh standardized, lump
sum allowances* regardless of the number of home calls the physician may be
required to make.
5. Physicians* all of whom are required to keep the number of patients unable
to mirk at on absolute minimum and to prescribe the cheapest and smallest
quantity of drugs eossible, also act as factory doctors for about two hours
each morning. (5) In the latter part of the morning each physician holds
his private consultations, seeine an averaee of 70 patients. During the
hours from noon to 8 P.M. the doctor visits bedridden patients at home, con-
tributes several hours working for a dispensary or public consulting office
performing public health inspections, and again holds private consultation
for an average of 70 more patients. After 8 P.n he makes evening house calls.((
In addition to these normal duties, each physician is also liable to emergensy
eall, ehich also includes any surgical stitching required after delivery since
midwives nay not perform surgery in any form. (7)
Any general practitioner can be enployed as a factory doctor, for which he
receives 1.500 Kos monthly for about 6 hours a week's attendance at the
plant. A factory doctor is expected to perform two medical functiona.
preventive ana curative. Hie preventive activities are the
more heavily stressed by the regine and consist of supervision of aealth
conditions in the plant, hygiene and research on the materials with which
the workers must come in contact in order to determine and olimtnate or
otherwise naturalize harmful characteristics. This duty suffers because his time
iarcely consumed by his curative functien. The factory doctor's curative
activity ie conceraud with:eepitic, the workers from visiting a doctor of
their awn choice an order to keep absenteeism at the lowest possible level. (8)
Plant medicines are purchased collectively throueh the District Uational
Insurance Offices.
7. Chief hospital physiciansi the so-called Primariue 'who are generally the
older physicians in the hospital and, in addition to the hosaital director,
are those in charge of departments and sections, receive a salary of about
13,000 Kcs to 114000 Kes month3y. (9) Assistant hospital physicians, the
ao-ealled Secondarius? received a gross salary of 5,000 Kos monthly plus
bonuses for specialized or extreme: prior to July 19500(10) Shen the 500
Kc s physicians salaryrvase nas introduced in Julys, hooever, all bonus pay
was abolished. This actually- had the effect of a salary cut since most
hospital assistant physicians now earn less than before the raise. A second
raise of 500 Kc s for the assistant physician depends upon the recommendation
of his chiof physician.
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Fun and exclusive specialization is permitted, only
in key fields such as pediatrics, eye, nose and throat, gynecology and nerve
diseases, which fields are considered medical bottlenecks. (11) Permissian
to epecialize requires an application subnitted to the rinistry of Health
plus the recommendation of the Employeest Council, the hospital trade union
creme comparable to the Factory Workers, Councils* In emetic? such permission
is granted only to politically reliable applicants* (12) Except for surgeons,
gynecologists and internal disease specialistswho must have to years of
hospital works the succeesful aeplicant is not required to fulfill the full
hospital internship requirements demanded of the potential general prac-
tit-ioner. (13)
9. There are 'dill many very capable Czech and Garman nuns doing hospital
nurshig, although their nembers are imadequate, but they are thbe replaced
by civilian ner8es0 (14) Expulsion of German nuns is again under consider.,
tion deepite e. lack of nurses in some areas &Ida shortace of really skilled
skilled nurses almost everywhere. However, it is anticipated that
should that be done those mem uneciai cepalirications such as operative
nmrses will nevertheless be retained. The present civilian nurses, who are
eenerealy unskilled becauee of too short and rapid a trainine course, are
selected from the domestic servant clam and Oxen six moralist ward training.
This sort of training reflects itself in many ways, but esnecially in the
new-born infant mortality rate, particnierly amene premature infants. Further-
more, the ill-trained civilian nurses have been the cause of neu-born infant
injuries and infections, in mazer cases, due to ignorance and nom hygienic
habits in the nursery.
(1)
(2:
(3)
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_coriment: pt for emereency cases, patients are admitted to
olFiarr after connultine a nhysician and receivinc his recom-
mendation for hospitalization. The university clinics are at Charles
university in Prague, which also has branches at Pilsen and Ifradec
Krelove? at Brno University and at the university in Bretislava. At
present there are also several other typ.s of hospitals not mentioned
hero or in the text, but they are merely of a transitional nature and
are ultimately to be abolished.
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IIIIILgozmt: The Public Health Office, which is one of those organs
of the National Committees authorized to perform the myriad functions
allocnted to the Netional Cormittees, is ultimately subordinated to the
Ministry of Health in medical matters, but in matters of personnel the
Public Health Office is responsible to the Ministry of Interior.
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111111111.22nerentst
The Institutes of national Health consulting offices for pregnant
women, children, tuberculars and venereal diseases, which offices are
nau established in the district and reeional hospitals, may be ex-
panded, to include sections for dipsonania?
hormone disorders and cardiology. Comment: It is unclear what
the present relationship is between the c ions of the consulting
offices of the national Insurance Offices, which is a public sickness
insurance institution, membership in which is now believed to be
obligatory, and the consultine offices of the Institutes of national
Health, a public health institution. Doth are apparently under the
jurisdiction of the rehlic Health Offices, and it is believed that the
institutes of national Uealth consulting offices are fundamentally
concerned with social work and problems in their medical imelications?
whereas the national Insurance Offices t consultine offices concentrate
on diseases of a noneeocial nature. It mieht be noted that the 7:ational
Tnsurance Offices Imre fornerly called t'ao &".11.0!moss Ins-Lnince r:fftec.-;/
U1 1:_dc:i tItie 1.1uy are still (.)tun ?E):Allarl( desicnateda)
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(4) It has been rumored physicians will soon be paid set salaries by the
state for services in private practice in lieu of the present practice
Vetere income varies according to- the number of patients. Honevere a
patient may choose the physician he wishes to have attend him, but may
not thereafter seek medical attention from any other doctor within any
given quarter except under special circumstances such as removal to a
neu city, The patient is issued his national Insurance certificate by
meane of 'which the physician collects his fee by his factory doctore
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(5) there is a trend to prescribe patent drucs produced Vy
the Czechoslovak pharmaceutical industry:, Spare* uhich in 1951
became the elle Czech pharmaceutical corporation havinc absorbed the
East Bohemian Plants at Ribitvi (051 /169)? and Slovakofarma at
Bratislava (P49 X99) --rather than compounded drucs :prepared by druggists.
(6) A physician must be on duty each nicht at each of the District national
Insurance Offices also* for which service he is not allowed any
compensatory tiirie. off the followiec day. Ile is supplied with an
automobile and driver durinc thin nicht duty.
(7) Prior to the end of 1950 midwives received 500 Kos for each delivery
from the rational Insurance Office, the pregnant mother choosing the
midwife he preferred. Since 1 January 1951, honever, each rd4wite
receives a set 3.000 Kcs a month, is assigned an area of responsibility
out of which she may not practice* and is required to work a stipulated
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presumably she eorks in the room)
Foxner1y the midwife was paid -additionally for service rendered at an
OB consultant's office.
(6) It is often the practice amonc the workers to take off the whole day
whenever thoy are able to visit a private physician of their awn
choice and plead that a lonc vaitinc line at the doctors office pre-
vented tlicm from returninc in time to vork.
(9) Decause of taxes these chief hospital physicians (Primarius) are on
the whole givinc up private practice.
(10) Before July 1950 surgeons and x-ray specialists received an additional*
non-taxable 300 Kos monthly, while nicht duty netted an acklitional 100
Kcs and Sunray duty 200 Kc s (only half of which was taxable) amounting
to an average of 400 to 600 Hes additional each month. In such yards
an OB and pediatrics, hevever? where constant, special nicht service
is maintained, tie physician vas able to earn up to 1,$00 Kos monthly
Lor extra vork.
(21) Only on the recomnendation of a cpneral practitioner after consultation
may a patient visit a specie:1in% exceptinc for the pediatrician, the
oculist* the unecolocist and for venereal treatment.
(12) redical students are also subjected to strict political reliability
control; students are organized into nstudy circles!' for the pureose
of political indoctrination* must pass rarxiem-Leninism examinations
at the end of each term to be permitted to continue the next term, and
must serve on labor brigades durinc each term to secure admission to
the next term.
(13) For example, because of an acute uhortace of pediatricians* craduate
physicians havinc six months to one year 3s clinical experience are
betnr trained in pediatrics for only six memths and assigned to reeional
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. (1h) A recent general order (prier to !arch 1951) required all physicians
as men as all the nurses to work in surgery wards for at least two
months in order to familiarize themselves with the treatment of 25X1X
- abdominal wounds and fractures. 111=111.1.11 the
main purpose of this measure is to create as large a group of medical
personnel as possible capable of treating war casualties. Further?
more, all physicians mire required to attend bleed transfusion courses
prior to April 1951.
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