Pink discrimination: Why Czech gynecologists get away with charging illegal fees

Being a woman in the Czech Republic can cost you. 

And I am not talking about the wage gap which is, in fact, one of the widest here across the EU. Neither am I referring to the cost of feminine-branded products being higher than their identical versions marketed for men. 

I am talking about the "pink discrimination" faced by thousands of women in the Czech Republic as they enter obstetrics and gynecology clinics. To many, the extra fees they pay every year may come across as obligatory and unavoidable. Given that these visits are covered by state insurance, are the fees legal? 

The “registration” or “annual” fees in Czech gynecological offices have been an unwritten rule for a long time. These fees are not covered by insurance and can climb up to several thousand crowns, even if a woman visits the office just once a year.

Meanwhile, foreign patients may be charged even more for English-speaking doctors. 

Beula was one of the women to start questioning the fees with her gynecologist. The first year that she signed up, she paid around CZK 400. But then the cost began to increase throughout the years: first to CZK 600 and then to CZK 800. 

“I first thought it was a usual practice,” says Beula. “But when I lived here for a couple of years, I started hearing from other women that this is not something that they pay.”

Once she confronted her gynecologist, he made it clear that it was a take-it-or-leave-it situation. 

For many women, finding a gynecologist with whom they feel comfortable and who would effectively address their concerns is not an easy undertaking. Having found the right doctor, they may feel like they have to put up with the extra charge to be secure of the service. 

In fact, the clinics do not make it mandatory to pay the fee. But if you don’t, they may simply tell you that they are no longer accepting new patients.

As I began to ask around among my friends, most of them reacted in sheer disbelief that the fee they pay is not universal and varies from doctor to doctor.

“As if being an expat woman living in a foreign country is not hard enough, we need to be constantly on alert of not being taken advantage of,” said one of them.

“Why am I being charged for being a woman? My husband has never told me of any fees he pays upon his medical visits,” raged another woman. 

Only few said they do not have to pay anything. They also happened to be fluent Czech speakers. 

As for the rest, the fees were ever-present since their first visit. Their range varies from CZK 500 to 3,000. One woman told me that to her it seemed like the clinic personnel were coming up with the number based not just on the language capacities but also on their biases.

From a legal point of view, the insurance must cover any additional fees, making it illegal for hospitals to charge their patients. 

However, many women feel cornered as they fear they will not receive proper treatment unless they comply with the charges.

“The way clinics do it is very clever,” explains Elizabeth Spacilova, a translator and co-admin of the Expat Women in Prague group. “They write it off as providing an extra service.” 

At some gynecology offices, women are told that the fee covers blood tests, ultrasounds, and any additional expenses. Others say that the fee is for e-services and online portals.

Spacilova sees that move as a doctor’s way of selecting patients. “They basically tell women: you may not pay the fee, but we are not taking any more patients,” she says. 

During pregnancy, women are charged even more. “They find a way to justify it, for instance, saying that more administration is involved with a pregnant person,” says Spacilova.

Karola Bozdioch was registered with a doctor whose annual fee for pregnant women was CZK 4,000. As she switched to another doctor, she found out that the former one changed the prices and started to ask for an additional CZK 1,000 six weeks after childbirth. 

Although Karola’s new gynecologist asks for a lower fee and is more transparent about what it covers, she admits it was not easy to find a doctor accepting new patients.

The high demand and the low supply of gynecologists seem to be an incentivizing factor for clinics to rachet up their prices and for women to put up with them. 

But it does not have to be this way. 

A Czech activist group Podpoříte mne v osvětě? (which roughly translates as "Will you help me enlighten others?") focuses on hospital rights and the handling of complaints. 

One of the main rules for joining their Facebook group is to make a promise to never pay any extra fees. In turn, they provide detailed instructions on how to stand up for your patient’s rights, build a convincing argument and file an official complaint.  

“I don’t know how realistic this is in Prague,” notes Elizabeth Spacilova. 

While additional fees at gynecology offices are technically illegal, extra fees for communication in a language other than Czech are not. 

In 2019, Spacilova reached out to the City (Magistrát hlavního města Prahy) and was told that communicating with a patient in a foreign language is not considered a health service. They suggested contacting the Prague Integration Center and asking them to provide an interpreter. The City noted that the questions of ethics are handled by the Czech Medical Chamber.

Spacilova then reached out to a lawyer from the Chamber. She asked whether it is ethical for a medical professional who is able to communicate in a language understood by the patient to refuse to speak the patient's language unless they receive a payment from the patient. 

However, the question of ethics was dismissed, and she once again was told the legal argument that interpreting is neither mentioned in the healthcare law nor is it covered by insurance. 

“I can speak from experience: I have accompanied foreign women to the Ministry of the Interior, which also insists on all communication being in Czech. On only one occasion, I actually interpreted. All the other times, immediately after I introduced myself as the interpreter, the Ministry staff person just spoke in English directly to the client,” says Elizabeth Spacilova. 

For many women, standing up for their rights at gynecology offices can come across as an intimidating and rather hopeless undertaking. On the other hand, the more women openly disavow this practice, the higher the chances of driving a positive change.