Procedure for filing a complaint against healthcare received

A person has an absolute right to file a complaint against any healthcare services received – if they feel that the level of care was inadequate, unreasonably delayed, of an inadequate quality or if care was denied. If a person is dissatisfied with the conduct of a physician or with his/her approach, if the patient feels they were given insufficient information or if there is a suspicion of malpractice or misconduct during an operation, a complaint may also be filed.

How to File a Compliant

Filing a complaint is usually one of the last steps to be taken by an individual in a situation in which they are dissatisfied with the way health care services were provided or with the outcome. Before filing a formal complaint, it is recommended that a patient exhaust all other options. The cause of the complaint may be a minor case of misunderstanding, a lack of ability or, in the worst case, a reluctance on the part of health workers to explain something in sufficient detail. It is best to handle minor problems with a personal visit and to do so as quickly as possible after the problem arises.

If you are not satisfied with the healthcare you have received, it is advisable to discuss your objection / complaint with the doctor. Complaints must also be heard by the respective chief physician – the head of the department and senior management personnel (the director or a deputy director).

In the case of a more serious problem, it is more effective to file a complaint in writing. After investigation and in due course, a written complaint will receive a written reply. The filing of a complaint may also be done ​​by phone, fax or email.

Under “The Act on Healthcare Services”, a complaint is submitted to the respective provider – which could be a doctor or the management of a healthcare facility. If the person who filed the complaint doesn't agree with the way in which the complaint is resolved, the complainant may file their complaint with the responsible administrative authority that granted the provider with permission to offer healthcare services. In most cases, this is the regional authority in whose administrative district the respective facility is located.

In a case of any suspected professional misconduct or unethical conduct on the part of a doctor or dentist, a complaint can be submitted to the Czech Medical Chamber or to the Czech Dental Chamber or, as applicable, to another relevant professional organization. The Czech Medical Chamber, the Czech Dental Chamber and these other professional organizations act as guarantors of the professionalism of their members and they are required to look into any complaints received.

“The Act on Healthcare Services” does not expressly provide for the ability to file a complaint with a health insurance company, but it also doesn’t preclude the filing of such a complaint. A health insurance company can look into allegations of misconduct, if it has a contract with the respective hospital, clinic or doctor. A health insurance company uses one of its supervisory or review physicians (care assessment personnel) to certify the appropriateness of a treatment process. Particular attention is paid to the course of treatment, to the use and prescription of certain drugs and to other health care services provided and to whether the care provided was the same as that billed to the health insurance company, whether only necessary procedures and services were billed and whether the type of healthcare provided was appropriate to the patient's medical condition.

Competent Authorities – Where Complaints Can be Filed

I.     Healthcare Services Provider – i.e. a physician, head physician, hospital director, etc. The provider will look into the complaint and send the patient a response. The complaint must be processed within 30 and no later than 60 days after its receipt.

II.   Responsible Administrative Authority – i.e. the administrative authority that issued the respective healthcare provider with an authorization to offer its healthcare services (this would include Regional Authorities, the Prague City Hall and the Ministry of Justice, Ministry of the Interior and  Ministry of Defense – if responsible for establishing the healthcare provider). If a person filing a complaint is unhappy with the initial resolution of the complaint (see above), the complainant should file their complaint (effectively an appeal) with the respective responsible administrative authority.

III. Czech Medical Chamber, Dental Chamber or other professional organization. These bodies look into complaints about courses of treatment, unethical behavior and professional misconduct.

It is possible to submit a complaint against a physician for unethical behavior or professional misconduct within one year of the incident (i.e. there is a 12 month statute of limitations). The complaint does not have to be submitted by the affected patient – it can be filed by anyone (such as a relative). The complaint must be in writing and it should be responded to within six (6) months of its receipt.

If a patient does not agree with the resolution of their complaint, they have fifteen (15) days from the date on which they received a decision from the review committee to submit an objection, which will be decided upon by the Honorary Board of the Czech Medical Chamber. Any decision reached by the above parties can also be appealed by the affected doctor or by an authorized member of the review committee.

IV.  Health Insurance Company. The respective health insurance company needs to have a contract with the respective hospital, clinic or doctor against which a complaint is being lodged. Complaints are filed with an insurance company in situations in which it is necessary to examine the rationale for the treatment received (with particular attention being paid to the course of treatment, to the use and prescription of certain drugs and other health care services provided), whether the care provided was the same as that billed to the health insurance company, whether only necessary procedures and services were billed and whether the type of healthcare provided was appropriate to the patient's medical condition. It is also possible to contact the health insurance company in situations in which a physician or other healthcare staff refused to carry out a medical procedure that falls within the covered care.

The handling the complaints is governed by the “Administrative Procedure Code”, which provides a maximum period of 60 days for a resolution or decision.

Page info

Published: 11.12.2012

Last change: 24.06.2014, 15:26