Czech Republic

Background

In 1993/94, the Czech Republic moved to a multiple insurance system. Since then people have been able to freely choose between several public sickness funds, as well as of GPs and specialists. Funds are paid from employee and employer contributions. Wage and price negotiations between insurers and providers take place on a collective level. The state remains the major care provider: hospitals and clinics are state property, and so are many GP surgeries. The latter is rather unusual in the CEE region, where most GPs are no longer state employees.

High rates of economic growth permitted the establishment of a generous statutory health care system in 1997. This remains today even after numerous changes of government. Spending increased quickly while medical staff and equipment were expanded. As a result, health indicators in the Czech Republic were well ahead of those in neighbouring countries. The Czech health system has achieved high quality healthcare, but the financial basis of this success is very unstable. The health system is heavily indebted: 10% of its turnover consists of borrowed money. Hospital remunerations are based on extrapolations of historic formulas rather than performance, and hospitals on the verge of bankruptcy are usually bailed out, which encourages financial slackness.

Current situation

In January 2008, the Civic Democratic Party introduced user fees with the aim of limiting consumption of medical services. Fees are charged whenever a patient visits a doctor or spends a day in hospital. The move has been highly controversial because even though the fees are minimal, they represent a break with the political consensus that all healthcare should be free. As a result of mounting public opposition, the Social Democratic party gained power in 13 regions in October on an anti-health fees platform and the government replaced former Health Minister, Tomas Julinek, the architect of the fee system. In February 2009, the fees were abolished for children under 18 and lowered for citizens over 65 years old. Legislation to fully abolish healthcare fees is set to be debated in the near future. Nevertheless, the currentt Health Minister Dana Juraskova from the Civic Democratic Party (ODS), along with opposition party, the Social Democrats, claim that if fees were completely abolished, it is uncertain how the healthcare budget would be maintained especially in the current financial crisis.

In response to the financial crisis, Juraskova’s predecessor Daniela Filipiova made proposals whilst in office at the beginning of 2009 to (i) increase compulsory state insurance (covering students, children, pensioners and other groups), (ii) cancel insurance payments ceilings, (iii) lower "insurers' operation costs", and (iv) improve the "control of the correctness of insurance payments".

At the same time, Filipiova introduced policies to improve the working conditions of healthcare providers so as to tackle problems caused by a shortage of nurses in both the public and private healthcare sectors. For example, all hospital nurses are to receive a 15% salary, as well as better training in order to stabilise the nursing situation.

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