“In an effort to contain costs, a system of user fees was introduced in 2008. These fees are intensely discussed by the Czech public and the exact design of the fee system is subject to constant changes (see sections 3.4.1 and 6.1). Additionally, in 2008 the administrative structure of the regional public health authorities was consolidated, with the aim of increased economic efficiency (see sections 2.3 and 5.1). In the late 1990s research started on introducing a DRG-based hospital payment system in the Czech Republic. Since 2007 case payments based on an adapted version of the AP-DRG system have accounted for an increasing share of total hospital revenue (estimates of 55–60% in 2013) (see section 3.7).”

Source: Alexa J, Rečka L, Votápková J, van Ginneken E, Spranger A, Wittenbecher F. Czech Republic: Health system review. Health Systems in Transition, 2015; 17(1):1–165.

“The future fiscal context of the Czech SHI [Social Health Insurance] system primarily depends on political decisions regarding an acceptable share of private expenditures. Despite the fact that the Czech Republic has one of the lowest shares of private health expenditures among OECD countries (OECD, 2013), it is unlikely that this share will rise in the short term due to lack of political consensus. To keep the current standard of health care, additional (financial) resources will thus have to be mobilized through other channels such as rising SHI contributions or more efficient delivery of care. If not, access may effectively be reduced because of increasing waiting times or limited availability of modern treatment options. The main political parties are aware of the necessity for reform. Yet they propose different solutions, ranging from more centralization with fewer or possibly only one health insurance fund on the left side of the political spectrum, to a more liberal and market-oriented approach on the right side of the political spectrum. The lack of consensus on a vision of the future Czech health system has prevented some key structural problems being addressed, such as mobilizing sufficient funds during economic downturns. This has led to recurring problems with financial instability, inefficiencies in care delivery, high transaction costs and an inability to benefit from reforms in the medium and long term.”

Source: Alexa J, Rečka L, Votápková J, van Ginneken E, Spranger A, Wittenbecher F. Czech Republic: Health system review. Health Systems in Transition, 2015; 17(1):1–165.

“Vaccination for some vulnerable groups of patients is covered by SHI [Social Health Insurance] (for example, vaccination against influenza for patients aged 65 years and over or for patients recovering from organ transplantation). In terms of financing, the vaccinations as well as the vaccines have been paid through SHI since 2010. This was a change from previous arrangements when the state paid for the vaccine through general taxation. It has added to the financial strain on health insurance funds as the additional responsibilities for vaccination were not matched by rising rates of health insurance premiums. Estimates suggest that this shift led to savings from the state budget of approximately CZK 850 million (€31.2 million) per year.”

Source: Alexa J, Rečka L, Votápková J, van Ginneken E, Spranger A, Wittenbecher F. Czech Republic: Health system review. Health Systems in Transition, 2015; 17(1):1–165.

“In the OECD Health Benefits Basket Questionnaire, 19 OECD countries reported systematic use of HTA [Health Technology Assessment] to decide whether a new medicine should be covered. Only nine countries did so for decisions regarding new medical procedures, and eight for new medical devices. Five countries reported systematic use of HTA to inform coverage for all technologies: Chile, France, Israel, Korea and Poland. Only a minority of countries, such as the Czech Republic, Japan and the United States, never or rarely use HTA as a formal part of decision making, but rather use HTA to determine reimbursement level or price-setting for new technologies (OECD, 2016b).”

“Relatively high prices of pharmaceuticals and other medical supplies may reflect organisational structures of the procurement system that hinder building market power through bulk purchasing. For example, this occurs when small insurers or providers contract separately for limited volumes of the same products. Indeed, in many OECD countries, individual hospitals, pharmacies and local government units and insurers carry out procurement separately (e.g. Belgium, the Czech Republic, Germany, the Slovak Republic, Slovenia, Sweden and Turkey). This not only precludes volume-related discounts but also creates unnecessary task repetition by each buyer.”

“Health care systems in which coverage is provided by a single entity generally have lower administrative costs than multi-payer systems, partly because they enjoy more economies of scale (Mossialos et al., 2002). Enrolment, collection of contributions, claims processing, benefits management, sales and marketing, and insurance funds’ compliance with government and non-government regulations and accreditation need only a single accounting and processing system in single-payer schemes, whereas multi-payer systems by their nature multiply the same functions (Bentley et al., 2008). The same holds true for purchasing and contracting, which creates an additional burden at the provider level.

“Moreover, in multi-payer systems, costly and technically demanding risk-equalisation and resource transfer mechanisms are frequently required to counter issues of patient selection, ensure equal basic benefit packages, or indeed avoid budgetary difficulties of payers. Such systems exist, for instance, in Belgium, the Czech Republic, Germany, Japan, the Netherlands and Switzerland (Paris et al., 2010; van de Ven et al., 2013) but are not required in single-payer systems.”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Feb. 6, 2023 by Doug McVay, Editor.