Health-care reform is everywhere. Although different countries are moving at different speeds, using somewhat different means and different routes, they are all trying to arrive at the same place. The place is called "better value for money in health care". Presents details of the health-care reforms taking place in the Czech Republic, identifying and discussing the main strands of Czech reforms: the dissolution of the regional health authorities; the reorientation of district health authorities; the move to a pluralistic semi-competitive insurance-based system; hospitals receiving funding by winning contracts with purchasers; contracts becoming more sophisticated and being based on cost, volume and quality factors; changes in the incentives and rewards for GPs; the drive towards a primary-care-led health-care system; and privatization.

• MeSH
• ekonomické soutěžení MeSH
• poskytování zdravotní péče ekonomika   organizace a řízení   trendy   MeSH
• privatizace MeSH
• programy národního zdraví ekonomika   organizace a řízení   MeSH
• reforma zdravotní péče organizace a řízení   MeSH
• regionální zdravotnické plánování organizace a řízení   MeSH
• rodinné lékařství ekonomika   organizace a řízení   MeSH
• sazby - stanovení a přezkoumání MeSH
• státní lékařství organizace a řízení   trendy   MeSH
• veřejný sektor MeSH
• všeobecné zdravotní pojištění MeSH
• výdaje na zdravotnictví MeSH
• zdravotní pojištění * MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: The main aim of the study was to investigate the quality of life and the medicinal and social needs of patients hospitalized with schizophrenia in the Czech Republic to uncover potential issues in these areas. METHODS: Relevant self-evaluating questionnaires (SQUALA for quality of life; CANSAS for medicinal and social needs) were used in a cohort of hospitalized schizophrenic patients undergoing rehabilitation before discharge from the mental hospital. RESULTS: Two hundred and forty-four patients (women N=115) aged 18-58 years were involved in the study. The quality of life of hospitalized patients with schizophrenia was subjectively assessed as universally worse in comparison with the general Czech population (p<0.05 in most cases; two-sample Student's t-test), but patients were not wholly critical of their own health status and overestimated its quality (arithmetic mean 63.79 in the patients vs the range of 45.5-59.8 as the norm in the general Czech population). Intimate relations, financial matters, treatment of psychotic symptoms, and sexual life were among the most pressing medicinal and social needs in our study subjects. CONCLUSION: The results of our study should stimulate psychiatric nurses in their effort not only to detect but also address the problems of schizophrenic patients concerning quality of life and unfulfilled needs. This can be done via education, guidance towards a healthy lifestyle, or providing patients with adequate exercise. Overall this issue is of significant importance in the Czech Republic due to the fact that legislative reform of mental health care emphasizing community care and psychiatric nursing has just been implemented.

• MeSH
• dospělí MeSH
• hospitalizovaní pacienti psychologie   MeSH
• kvalita života psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• schizofrenie terapie   MeSH
• zdravotnické služby - potřeby a požadavky normy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

This article describes policy processes that have led to the re-organisation of stroke care in the Czech Republic since 2011, which has been part of a broader process of care concentration in several medical fields. Currently, stroke care is provided by 13 Comprehensive and 32 Primary Stroke Centres. The paper explains factors that supported the reform implementation, reviews implications, and discusses future challenges. Mandatory reporting of quality indicators, the introduction of a benchmarking system, integration with pre-hospital emergency care, and the introduction of countrywide patient triage have supported more timely treatment for stroke patients and better quality of care. Data from the Stroke Care Quality Indicators of the Czech Stroke Society show positive trends in many areas: the number of patients treated with intravenous thrombolysis quadrupled in eight years, with 26.4 % of all acute stroke patients receiving thrombolysis in 2018. Czech Republic now ranks third in Europe in the number of thrombolysis per population and second in the number of mechanical thrombectomies per population. The Czech experience provides an example of positive outcomes of concentrated stroke care, while highlighting the importance of proper implementation processes. In particular, it is essential to involve stakeholders and to provide reputational incentives through continuous benchmarking.

• Klíčová slova
• Benchmarking, Highly specialized care concentration, Quality monitoring, Recanalization therapy, Stroke,
• MeSH
• benchmarking MeSH
• cévní mozková příhoda * terapie   MeSH
• kvalita zdravotní péče MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Evropa MeSH

BACKGROUND: The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia. METHODS: The health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society). RESULTS: The social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. CONCLUSIONS: The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet.

• MeSH
• duševní zdraví * ekonomika   MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• služby péče o duševní zdraví ekonomika   organizace a řízení   MeSH
• všeobecné zdravotní pojištění MeSH
• zdravotní politika * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Bulharsko MeSH
• Česká republika MeSH
• Maďarsko MeSH
• Moldavsko MeSH
• Polsko MeSH
• Rumunsko MeSH
• Slovenská republika MeSH

BACKGROUND: In hospitals, decisions are often made under time pressure. There is, however, little evidence on how time pressure affects the quality of treatment and the documentation behaviour of physicians. SETTING: We implemented a controlled laboratory experiment with a healthcare framing in which international medical students in the Czech Republic treated patients in the role of hospital physicians. We varied the presence of time pressure and a documentation task. RESULTS: We observed worse treatment quality when individuals were faced with a combination of a documentation task and time pressure. In line with the concept of the speed-accuracy trade-off, we showed that quality changes are likely driven by less accuracy. Finally, we showed that while documentation quality was relatively high overall, time pressure significantly lowered the latter leading to a higher hypothetical profit loss for the hospital. CONCLUSIONS: Our results suggest that policy reforms aimed at increasing staffing and promoting novel technologies that facilitate physicians' treatment decisions and support their documentation work in the hospital sector might be promising means of improving the treatment quality and reducing inefficiencies potentially caused by documentation errors.

• Klíčová slova
• Laboratory experiment, Physician incentives, Time pressure, Work motivation,
• MeSH
• časové faktory MeSH
• dokumentace * normy   MeSH
• kvalita zdravotní péče * MeSH
• lékaři * psychologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH