By Jan Lopatka

PRAGUE, May 28 (Reuters) - Czech patients will have to pay for doctor visits, the country's top court ruled on Wednesday, upholding the cornerstone of the centre-right government's plan to reform the public health system and cut waste.

The 30-crown ($1.87) fee and other planned reforms have rankled many Czechs accustomed to free health care after decades of communist rule, sparking unrest in the ruling coalition and drawing a strike threat by labour unions.

The Constitutional Court struck down a petition backed by the Social Democrat opposition against the fees, saying the payments -- just a little more than the cost of a metro ticket -- were a political matter.

"If the court proceeded, in relation to any reform, with too much activism, it would create (a precedent) which would close the door to any reform efforts," judge Stanislav Balik said.

The fees, an element of the government's wider fiscal, welfare and pension reforms, reduced the amount health insurers spend on prescriptions by 20 percent, or $104 million, in the first quarter. Many Czechs used the state-organised system to get easily available drugs like aspirin for free.

The payments also significantly cut doctor visits since their introduction in January. The Health Ministry said savings generated by the new system would be channelled toward patients requiring expensive care.

But like elsewhere in central and Eastern Europe where governments are trying to overhaul public services designed in the communist era, the fees have met widespread resistance from the public and caused deep divisions in the ruling coalition.

The Christian Democrats, a junior member of the three-party coalition, have demanded children and pensioners be exempt and have threatened to block further reforms like the transformation of health insurers into for-profit companies.

Unions have called a general strike for June 24 and the country's top university threatened to close its medical schools unless the proposed steps are changed.

The court ruling was eagerly anticipated by the government, which had previously criticised the court for striking down a law which withheld sickpay in the first three days of illness, a measure aimed at cutting absenteeism.

In neighbouring Hungary, doctor fees were struck down in a referendum which halted reforms and broke up the ruling coalition. In Slovakia, the leftist government of Robert Fico cancelled fees introduced by the previous administration. (Reporting by Jan Lopatka; Editing by Michael Winfrey and Jon Boyle)

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