Smokers damage their health themselves and so should pay more for health care.

Such is the suggestion of Miloslav Zámečník, a member of NERV, the cabinet’s team of economic crisis experts.

“Insurance companies should focus on motivating their clients to care for their health, especially during times of crisis when the system is short on money and less insurance payments are collected. Those who smoke damage their health by their own choice and so should pay higher health insurance,” he said.

Money – the best motivator
Basic blood testes could be used to distinguish a smoker from a non-smoker.

Everyone who would want to pay lower insurance would apply for the discount and have a test done by a GP. If the test would prove that the person is a non-smoker then the health insurance payment deducted from the salary every month would be lower. The discount would last half a year, and then the client would have to pass the test again.

“It would be profitable for both the client and the insurer. The client would be motivated by the insurance discount not to smoke, the insurer would only pay CZK 300 for the test and save future hundreds of thousands for lung cancer treatment,” said Zámečník.

Doctors welcome NERV’s idea, but insurance companies claim it is impossible to implement.

A blood test is enough
“It would be great if insurers had some way of influencing patients’ behaviour,” said Jan Jelínek from a GP association.

Financial motivation is the best weapon. “I can very well imagine a smoker quitting to lower his taxes.”

He said that it is easy to identify a smoker. All it takes is testing his blood for the presence of the metabolites that are created by inhaling nicotine. Whether or not the patient smokes can be discovered for some six months in retrospect.

“I would personally go even further,” Jelínek addeed. If the patient fails to stop smoking even after a heart operation he would make the patient cover the cost. “The operation is expensive, it costs half a million crowns. A patient undergoes the operation, gets a bypass, doesn’t quit smoking and so completely destroys the result of the doctors’ work,” he said. There is nothing at the moment to force people observe a healthy lifestyle.

Better increase tobacco tax
“I do not think something like this would be technically possible. How do you distinguish between an active smoker and someone who only works in a smoky environment?” said Jiří Rod, VZP insurance company spokesman.

If something like that was introduced, sanctions would have to be aimed also at drug and alcohol addicts. Obese people and diabetics not following the treatment could also pay more. “And what about sports injuries and what about melanoma in people who sunbathe without protection?” Rod asked.

Jaromír Gajdáček, head of the Interior Ministry insurance company, chose a different approach. “In principle, it is correct,” he said. He thinks that to increase taxes on tobacco and alcohol and put the money collected into the healthcare would be better. He would also offer health education a greater space.

Health Minister Daniela Filipiová (ODS) wants to leave the decision making concerning the healthier lifestyle motivation of patients solely up to the insurers. “Insurance companies are independent organisations, and it is only up to them to decide on the contracts they offer their clients,” she said.

She added that some of the insurers have already adopted similar motivation measures.

Not to pay twice
Miroslav Zámečník not only wants to introduce bonuses for people following healthy lifestyles, but also something called eHealth. “The effectiveness of health care will increase when all the information on healthcare spending will be published in one spot online. Surveys show that 30% of healthcare is offered unnecessarily,” he said.