Paediatric care in the Czech Republic

Short Review of Child Health Care in Former Czechoslovakia and Czech Republic since 1993

We provide an overview on child health care in Czech Republic, including a historical background. Child health care has substantially improved in Czech hospitals during the past 20 years. Eight pediatric departments are located in university hospitals. The technical background of pediatric services meets high international standards. Inpatient and outpatient care is offered on a 24-hour service, and all pediatric subspecialties are usually provided. The different pediatric subspecialties are organized in the frame of the Czech Pediatric Society, and all of them have developed dynamic international scientific collaborations. From the organizational point of view, the formation of specialized centers of competence at university departments of pediatrics followed a mixture of a "bottom-up and top-down strategy" of all opinion and decision makers.

Demography of pediatric primary care in Europe: delivery of care and training

OBJECTIVE

The Union of National European Pediatric Societies and Associations recognized the lack of information regarding demography of delivery of care and training for the doctors who care for children in Europe. Therefore, the Union of National European Pediatric Societies and Associations studied factors and explanations for the variation between countries regarding pediatric primary care (PPC) and community pediatrics (CP) as well as the extent of formal training provided for those who take care of children at the community level.

METHODS

An explanatory letter and a questionnaire with 12 questions regarding delivery of PPC and CP and training was mailed to the president of each of 41 national pediatric societies in Europe. Statistical data about population, country's income, and infant mortality rate (IMR) were also obtained from World Health Organization data. Statistical analysis using multivariate and linear regression was conducted to ascertain which variables were associated with IMR. Descriptive statistics regarding demography and training are also reported.

RESULTS

In 1999, a total of 167 444 pediatricians served a population of 158 million children who were younger than 15 years and living in the 34 reporting European countries. The median number of children per pediatrician was 2094; this varied from 401 to 15 150. A pediatric system for PPC existed in 12 countries; 6 countries had a general practitioner system, and a combined system was reported from 16 countries. Pediatricians did not work at the primary care level at all in 3 countries. In 14 of 34 countries, pediatricians worked in various aspects of community medicine, such as developmental pediatrics, well-infant care, school physicians, and so forth. IMR was lower in countries with a higher income per capita. In addition, a pediatric system of primary care had a protective effect when looking at IMR as the outcome. In 75% of the countries, some form of training in pediatric care for pediatricians was reported; the corresponding data for general practitioners was 60%. Community-based teaching programs were offered to pediatricians and general practitioners in a minority of countries only.

CONCLUSIONS

At the end of the century, Europe showed a considerable variation in both delivery of PPC and training for doctors who care for children. This study identified 3 different health care delivery systems for PPC, as well as 2 types of pediatricians who work in community-based settings. Formal training in PPC or CP for both pediatricians and general practitioners varied from established curricula to no teaching at all. Economic and sociopolitical issues, professional power, and geographical and historical factors may explain the differences in pediatric care among European countries.