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the two state ministries is provided by the federal Ministry of Labor and Social Affairs.

Health care, including hospitalization and medication, is provided to all citizens, with only a nominal fee paid for medical insurance. In general, the quality of medical personnel and health care provided is good and has helped to provide a level of public health which is second to none in Eastern Europe. Nevertheless, there are a number of problems existing in the health services, some of which are associated with the rigid state-controlled system of health administration. Deterioration of the traditional physician-patient relationship has been, according to Czechoslovak public opinion, one of the more regrettable developments. By imposing heavy administrative duties on doctors, encouraging overspecialization of practitioners, and establishing relatively low pay scales, the regime has contributed to an increasingly impersonal physician-patient relationship and to a general lessening of prestige for the medical profession. Dissatisfaction with the existing state of affairs was voiced by doctors and the general public in a survey conducted by the Dubcek regime in 1968. Specific criticism was leveled at the government's disposition to treat the sick more as temporary incapacitated units of "productive society" than as human beings who are ill.

As of December 1971 there were 31,426 physicians in Czechoslovakia, or one for every 460 inhabitants. This is the highest ratio in Eastern Europe, where the average is over 1:600, and one of the most favorable ratios in the world. Since the 1930's there has been a substantial increase in the size of the medical profession. As a consequence, the number of physicians increased from 7.9 per 10,000 inhabitants in 1937, to 10.9 in 1960, and to 23.9 in 1971. Other health professionals and paramedical personnel in the country, in the year indicated, were as follows:

The distribution of professional medical personnel is regarded as satisfactory, although there have been reports of shortages of doctors and dentists in some of the outlying border regions. Of much greater concern is a chronic shortage of nurses and other paramedical personnel which has resulted in reports of inadequate nursing care.

Contrasting to practice in Western nations, the Czechoslovak medical profession has a large proportion of women; over four-tenths of all practitioners were women in 1971. Women doctors dominate such specialities as infectious diseases, allergies, pediatrics, ophthalmology, and dermatology, but are a minority in such fields as surgery, orthopedics, urology, and prosthetics.

Czechoslovakia has 10 medical schools and 9 dental schools offering degrees in medicine and dentistry. All of these facilities operate under the authority of the Czech and Slovak ministries of education and receive their financial support from the government. Nursing education is conducted in hospitals throughout the country, while other paramedical training is offered at specialized secondary schools.

Health facilities are inadequate both quantitatively and qualitatively. There are an insufficient number of hospitals to adequately treat the sick, and many of those that exist are old and without modern medical equipment. The existence of poor medical facilities has affected the length of stay in the hospital, which on the average is roughly double that in the West. In an attempt to remedy the situation, new hospitals are being constructed and modern equipment is gradually replacing the old. In 1971, Czechoslovakia had 249 general hospitals with a total of 114,706 beds, or a ratio of roughly 8.0 beds per 1,000 persons. Additional medical facilities included specialized clinics, sanatoriums, and maternity homes (Figure 12).

The bulk of public health services are rendered on an outpatient basis, either through hospital departments established for that purpose or through networks of polyclinics, district health centers, and medical stations. By 1971 there were 416 polyclinics,

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APPROVED FOR RELEASE: 2009/06/16: CIA-RDP01-00707R000200110015-7