Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%

*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“For individuals with permanent residence or those who are not permanent residents but are working for an employer based in the Czech Republic, opting out of the SHI [Statutory Health Insurance] system is not possible. Similarly, the health insurance funds must accept all applicants who have a legal basis for entitlement; risk selection is not permitted. Individuals may choose freely among the health insurance funds and may switch insurance funds annually provided they have applied before 1 July the previous year. In reality, however, the percentage of insured individuals who switch is very low (1.4% in 2012), as there are only small differences between the funds (VZP, 2013a). They may differ very slightly in bonuses provided to their members (for example, contributions for sporting activities) and in the amount and type of contracted medical facilities. Yet most GPs, ambulatory specialists and hospitals have contracts with all the relevant health insurance funds in their region. Children and pensioners may register with any health insurance fund, but for historical reasons most pensioners are registered with the VZP [General Health Insurance Company of the Czech Republic] (see section 2.8.1).”

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.

“Entitlement to coverage in the Czech Republic is based on permanent residence rather than on direct SHI contributions. Individuals who are not permanent residents are also covered if they are working for an employer based in the Czech Republic. Because health insurance is compulsory, non-EU nationals who do not fulfil these conditions must purchase private health insurance if they wish to remain in the country. EU nationals who do not fulfil these conditions and who stay for longer than 90 days in the Czech Republic have the option of participating in the Czech SHI system; if they choose not to participate, they must be insured through their own national insurance company or system, or have private health insurance. It should be noted, however, that virtually 100% of the population is covered by SHI at the time of writing.”

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.

“Health insurance in the Czech Republic is compulsory, and there is no provision to allow individuals to opt out of the system. Insured individuals do, however, have the right to choose their health insurance fund and may switch to a new fund once every 12 months. Applications have to be filed before 30 June of a given year in order to swap insurance funds in the next year. All health insurance funds are obliged to accept any applicant; risk selection is not permitted. Patients also have the right to choose their primary health-care provider every three months. General practitioners (GPs) can refer patients to ambulatory care specialists, but patients are also free to obtain this care from a provider of their choice without a referral, and frequently do so (see section 5.3). A government decree enacted in 2012 further specified the obligations of health insurance funds and postulated maximum waiting times for certain procedures and maximum geographical distances to certain services.”

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 Czech health system the introduction of formal user fees in 2008 reduced the depth of coverage, because health providers’ remuneration was adjusted downward to take into account the revenues of user fees directly paid to providers. User fees for prescriptions and certain health services (for example, emergency care or hospital stays), as well as co-payments for pharmaceuticals, were introduced in 2008. The system of user fees and co-payments has been changed several times since its introduction. User fees for hospital stays were abolished by the Czech Constitutional Court in 2013. In mid-2014 there were user fees for doctor visits – CZK 30 (€1.20); the use of ambulatory services outside standard office hours – CZK 90 (€3.60); and per prescription – CZK 30 (€1.20). (For further information see section 3.4.1.) Co-payments other than those specified by law or top-up payments are legally prohibited.”

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 range of benefits available to individuals covered by SHI in the Czech Republic is very broad and includes inpatient and outpatient care, prescription pharmaceuticals, rehabilitation, some dental procedures, spa treatments and over-the-counter pharmaceuticals (if prescribed by a physician). This is in accordance with Czech law, which stipulates that insured individuals are entitled to any medical treatment delivered with the aim of maintaining or improving their health status. In practice, however, benefits are rationed by a combination of means, including: (a) legislation, (b) formularies, (c) an annual negotiation process between the health insurance funds and providers aimed at defining specific conditions of reimbursement and (d) a fee schedule known as the List of Health Services.”

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.

“For a number of treatments, such as spa therapy and some types of dental and cosmetic procedures, patients must obtain permission from a review doctor working for their health insurance fund in order to qualify for coverage. In 2013 the guidelines for spa therapy prescriptions were fundamentally modified and the possibilities of prescription severely limited. With the exception of pharmaceuticals, medical aids and – from 2012 to 2013 – above-standard care, partial coverage is not permitted – that is, patients cannot top up their statutory coverage by choosing a treatment that is more expensive than that normally covered and paying only for the difference. In practice, around 1500 prescribed pharmaceuticals (approximately 55% in terms of the numbers of packs distributed) do not require any co-payment beyond a CZK 30 (€1.20) fee per prescription. There is a trend of exclusion of common over-the-counter pharmaceuticals from the benefit package – more than 120 pharmaceuticals were excluded in July 2012 (for example, certain wound disinfectants and allergy drugs).

“Additional benefits may be offered by the funds only in the field of prevention (such as safety helmets for children, vitamins and health promotion activities).”

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.

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 Nov. 12, 2022 by Doug McVay, Editor.