"The involvement of patients and their families in healthcare policymaking has been a general trend in recent years. This tendency can be observed also in the process of the current reform of psychiatric care in the Czech Republic, which should gradually shift the focus of psychiatric care from large facilities to community care. Organizations representing patients and their families are among the key stakeholders in this reform. The present study analyses semi-structured in-depth interviews and documents with the objective to map and evaluate the process of patient involvement in the reform from its launch to its implementation in 2012-2019. The study identifies the major barriers to patient involvement – on the part of the patients and their organizations, professionals (healthcare professionals, care providers, administration, policymakers), as well as the whole society. It becomes clear that the reform encourages patient involvement, with a palpable shift from consultation to involvement. Still, there are many obstacles to patient involvement in the Czech Republic: the mental state, social and economic situation of the patients, paternalism on the part of care providers, tokenism or stigmatization of mentally ill people."
This article analyses the politicisation of public health debates by focusing on vaccination and mental health care in the Czech Republic. The mainstream understanding of politicisation commonly refers to politics-as-sphere, linked with the political instrumentalisation of health care controversies as part of electoral campaigning and power struggles. In our analysis, we conceive politicisation more broadly, as politics-as-activity, which encompasses the role of civic engagement and the involvement of patients in these processes. We thus view politicisation as a process which encompasses a plurality of political actors and, in addition to politicians, includes patients, users, carers, citizens, and experts. Our analysis draws on extensive empirical evidence, consisting of observations, semi-structured interviews, and a review of available documents. The study took place in the Czech Republic from 2017 to 2019. We conclude that politicisation takes place alongside four dimensions: (1) contingency, (2) agency, (3) a plurality of opinions and approaches, and (4) visibility. We further argue that the contingent nature of biomedical controversies is articulated in three different, possibly interconnected layers. Thus, the politicisation of the two Czech analysed cases refers to (a) uncertainties and problematic aspects of biomedical objects of controversy; to (b) social rights, economic needs, and legal aspects as well as social representations of illness and vaccinations in the public debate; and to (c) the political processes which determine the previous two layers of politicisation, labelled as meta-politicisation. Last but not least, we stress the dynamic and non-linear nature of politicisation processes, the varieties of connections between the third sector and expertise, and the necessity to analyse the politicisation of public health controversies hand in hand with its connection to depoliticisation and repoliticisation.
Many countries aim to strengthen patient and public involvement (PPI) in healthcare decision-making. This article discusses the institutionalisation of PPI in the Czech Republic from 2014 to the present based on a review of available documents as well as interviews with policymakers and representatives of patients’ organisations. Important steps that contributed to the institutionalisation of PPI were the establishment of the Ministry of Health's (MoH) Patients’ Council and the MoH's Patients’ Rights Support Department. The institutionalisation of PPI was facilitated through the bottom-up engagement of patients, top-down policy developments, transnational pressures, the support of statutory insurance funds and the pharmaceutical industry, and macro-societal developments. Compared to other post-socialist countries, the institutionalisation of patient involvement in policymaking is amongst the most developed. Although the pharmaceutical industry enhanced PPI, its involvement raised ethical concerns. Various stakeholders called for public funding of patients’ organisations to provide them with a stable income and more independence. In summary, the role of patients has been strengthened through macro-institutional involvement. Further progress will demonstrate whether these changes at the macro level of policymaking will stimulate more profound transformations at the meso and micro levels and, therefore, contribute to more profound cultural changes in doctor-patient relationships.
This paper analyses the contemporary public debate about vaccination, and medical knowledge more broadly, in the context of social media. The study is focused on the massive online debate prompted by the Facebook status of the digital celebrity Mark Zuckerberg, who posted a picture of his two-month-old daughter, accompanied by a comment: “Doctor's visit -- time for vaccines!” Carrying out a qualitative analysis on a sample of 650 comments and replies, selected through systematic random sampling from an initial pool of over 10,000 user contributions, and utilising open and axial coding, we empirically inform the theoretical discussion around the concept of the reflexive patient and introduce the notion of multi-layered reflexivity. We argue that the reflexive debate surrounding this primarily medical problem is influenced by both biomedical and social scientific knowledge. Lay actors therefore discuss not only vaccination, but also its political and economic aspects as well as the post-truth information context of the debate. We stress that the reflexivity of social actors related to the post-truth era re-enters and influences the debate more than ever. Furthermore, we suggest that the interconnection of different layers of reflexivity can either reinforce certainty or deepen the ambiguity and uncertainty of reflexive agents.