Decalogue of Patient Rights

This article outlines the ten basic rights of patients from the perspective of the Health Ombudsman's Office. It was published in Zdravotnické noviny (Healthcare Newspaper).

A patient—i.e. an individual provided with healthcare services—is guaranteed a wide range of rights. These rights are enshrined both at the international and national levels, most notably in the Convention on Human Rights and the Dignity of the Human Being in relation to the Application of Biology and Medicine (the Convention on Human Rights and Biomedicine), in the Charter of Fundamental Rights and Freedoms, in the Act on Healthcare Services (Act No. 372/2011 Coll.), and in the Act on Public Health Insurance (Act No. 48/1997 Coll.).

Below is the decalog of the most important rights, compiled by the Health Ombudsman's Office based on daily patient feedback.

1. Equal Care for Everyone, Wherever They Are
   In the Czech Republic, all patients are guaranteed the same healthcare. No one can be denied treatment that is indicated for their diagnosis while other patients receive it elsewhere. The Charter of Fundamental Rights and Freedoms guarantees everyone, without distinction, the right to health protection and free healthcare provided under public health insurance. Equal treatment and the prohibition of discrimination in access to and provision of healthcare are further defined by the Anti-Discrimination Act.
   Example:
   Mr. M. is HIV-positive and complained about his dentist’s conduct—she refused to treat him in the outpatient clinic and performed the procedure in the corridor in front of other waiting patients. Her actions violated his right to dignified treatment and privacy, even though she claimed it was due to the excessive time required for disinfecting her office. A healthcare professional may only refuse to provide a service if doing so would directly endanger their own life or cause serious harm to their health. In this case, the dentist could have referred Mr. M. to another provider who specializes in treating HIV-positive patients under appropriate hygienic and safe conditions. It is completely unacceptable to provide healthcare under such undignified and discriminatory conditions.
2. The Patient Must Understand Their Illness and Treatment
   The healthcare provider is obliged to ensure that the patient is informed in a clear and comprehensive manner about their health condition and the proposed individualized treatment plan. They must also allow the patient to ask follow-up questions and provide understandable answers.
   Example:
   Patient N. was scheduled to undergo a complex knee operation but was not properly informed about how the surgery would proceed—she was given only a form to sign. According to the Act on Healthcare Services and the Civil Code, healthcare may only be provided with the patient’s free and informed consent. The doctor must clearly explain the procedure, including the risks, possible consequences, and alternatives.
3. Everyone May Freely Choose Their Healthcare Provider
   A patient may freely choose not only their general practitioner, dentist, or gynecologist, but also any other doctor, provided that the doctor operates independently. They may also choose the healthcare provider and the specific medical facility (if their health condition allows it).
   However, the Act on Healthcare Services also sets exceptions to this right, such as emergency medical services, occupational health services, mandatory isolation, quarantine, or protective treatment. For example, individuals in police custody, those serving prison sentences, or soldiers on active duty do not have the option to choose.
   Example:
   Mr. P., who had been undergoing long-term treatment for migraines with no improvement, requested that another doctor in the same hospital take over his care. The provider, however, refused due to the high workload of other specialists. It is important to note that while a patient may choose a provider, they cannot select a specific doctor employed by that provider—unless the provider has contractually committed to doing so.
4. A Patient May Refuse the Treatment Proposed by the Provider
   The Act on Healthcare Services allows patients to refuse treatment and the provision of information about their health status. The only exception is for infectious diseases that pose a threat to others. A patient may also withdraw their consent for receiving healthcare services; however, such withdrawal is not effective if the treatment has already started and its interruption would pose a serious risk to the patient’s health or life.
   Example:
   Mrs. K. called the Health Ombudsman's Office to ask whether she was entitled to receive sedatives free of charge after refusing treatment for her cancer.

   Even in cases of so-called negative reverse—where a patient initially refuses treatment—the patient is still entitled to free hospitalization and any other treatment appropriate to their condition, should they decide to proceed.

5. The Medical Record Is About the Patient, So They Should Know It
   Every patient has the right to inspect their medical records and to obtain excerpts, summaries, and copies. This right also extends to other individuals defined by the Act on Healthcare Services, which divides them into three categories: the patient; the legal representative or guardian of the patient (or a person designated by them, such as a foster parent or caregiver); and persons close to a deceased patient.
   Although the law does not mandate a written request, providers usually require one. Access to the records, or obtaining copies, is permitted only in the presence of an authorized employee of the healthcare provider. The law clearly states that the patient has the right to all information in their records, except for certain restrictions related to records of authorized psychological methods and descriptions of psychotherapeutic treatment.
6. Must the Insurance Company Cover Every Prescription Prescribed by a Doctor?
   Health insurance companies cover medicinal products and medical devices based on a prescription issued by a contracted provider, a doctor providing emergency care, a contracted doctor in a social care facility, or a contracted doctor providing services to the patient, their spouse, parents, grandparents, children, grandchildren, or siblings. Thus, any doctor can issue a prescription; however, if the doctor does not have a contract with the patient’s insurer, the patient will have to pay for the medications themselves. This does not apply in cases of necessary and emergency care, when insurance companies are obliged to fully reimburse the prescription costs.
   Example:
   Two patients visited a doctor’s office over six months, and the doctor issued a total of seven prescriptions marked “Acute Care.” The pharmacy dispensed the medications, but later the patients’ insurer refused reimbursement, as the doctor was not a contracted provider with the insurer. The pharmacy then sued the doctor, concluding that he caused them damage by issuing prescriptions for which the patients had to pay in full, and he must have known this. (This incident occurred before the introduction of e-prescriptions.)
   It was suggested that this might be a case of a “doctor providing emergency care to an insured person” because the doctor always marked “acute care” on the prescriptions. However, given the nature of the medications and the time at which they were collected, the court ruled that it was not emergency care and that the pharmacy should have sought payment from the patients. The pharmacy appealed, insisting that the doctor was at fault for not indicating on the prescription that the patient was to pay. The appellate court confirmed the lower court’s decision. In a genuine case of emergency care, the insurer would be obliged to pay for the medications; otherwise, the cost falls on the patient. Only a court-appointed expert can assess such a situation.
7. Children and People with Limited Legal Capacity Do Not Have to Be Alone in the Hospital
   An underage patient has the right to the continuous presence of a legal representative or a person designated by the legal representative, foster parent, or another court-appointed caregiver. For a patient whose legal capacity has been restricted regarding decisions on healthcare provision and its consequences, a guardian or an appointed person may be present. This is subject to compliance with other legal regulations, the internal rules of the healthcare provider, and the presence of these persons must not disrupt treatment.
   Example:
   Mrs. K. complained about the hospital’s procedure in providing care for her four-year-old son. She wished to stay with him, and although the hospital agreed, they later charged her 390 CZK per night. She argued that the presence of an escort for children under the age of six is covered by public health insurance. The attending doctor decides whether the stay of an escort (for example, a parent) for a child under six is covered by insurance. Reimbursement for continuous presence—including accommodation and meals—is dependent on the child’s health condition and subsequent care. For children over six, approval from an insurance review doctor is required. Even if the doctor does not explicitly accept a parent as an escort, the right to the continuous presence of a parent remains; however, such a stay is then not covered by public health insurance, and the provider may set its own price.
8. The Ambulance Must Reach the Patient Within 20 Minutes
   The Act on Emergency Medical Services stipulates that the availability of emergency services is determined primarily by the region’s coverage plan for emergency bases. This plan sets the number and locations of emergency bases based on demographic, topographic, and risk factors in the territories of individual municipalities and districts of Prague, ensuring that any incident site can be reached from the nearest base within 20 minutes.
   Example:
   Mr. D. suffered a laceration on his right hand accompanied by massive bleeding. According to his wife, the emergency service (155) arrived only after 45 minutes following the call. The 20-minute response time must be maintained, except in cases of unforeseen adverse traffic, weather conditions, or other circumstances warranting special consideration. Each case must be individually assessed, and any reasons for delay, which the emergency service provider will undoubtedly cite, must be taken into account.
9. If the Patient Has to Pay for Treatment, They Must Be Informed in Advance
   The patient must be informed in advance, if their health condition permits, about the cost of healthcare services that are not fully or only partially covered by public health insurance and about the method of payment. It is solely up to the patient whether to agree to proceed under those circumstances.
   Example:
   Mr. T. visited his dentist, who, among other things, demonstrated proper tooth-brushing techniques. Without any prior notice, she then charged him 350 CZK. According to the Act on Public Health Insurance, the insurer is required to cover certain healthcare services fully, partially, or not at all. Although the details of the case are unknown, the doctor is obligated to inform the patient of the cost before providing the service and to issue a bill unless another regulation specifies otherwise. The price list for services not covered (or partially covered) should be displayed in an accessible manner (this does not apply to pharmacy services).
10. Everyone Can Check Their Account with Their Health Insurance Company
    The insured person has the right to receive information from their health insurer regarding the covered services provided to them.
    Example:
    Mrs. A. wanted to know what healthcare services her doctors had billed to her insurer, so she requested an account statement. She was shocked to find that a dentist, where she had been treated only once, was charging her insurer 1,000 CZK every year. Following her complaint, the insurer determined that the dentist had indeed billed costs improperly and deducted the entire amount. However, Mrs. A. was not satisfied with how her case was resolved, considering it to be systematic exploitation, and felt that the insurer should have taken stronger action.
    In such cases, insurers rely on prompts from the insured, except when it is indisputable that care could not have been provided. The insurer will reclaim improperly billed services retroactively from the doctor. If repeated instances occur, a physical audit of the doctor may be conducted, and in extreme cases, the contract may be terminated. Some cases also lead to a criminal complaint against the doctor who billed for services that were not provided. Information about fraudulent practices by some doctors is mainly disseminated through online projects by health insurance companies.

M.Sc. Jana Kunstýřová, M.Sc. Kristýna Pintová
Health Ombudsman's Office
www.ombudsmanprozdravi.cz