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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.

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“Entitlement to SHI [Statutory Health Insurance] coverage is based on permanent residence, not on SHI contributions themselves. All people residing in Czechia are subject to compulsory SHI enrolment, including Czech citizens and permanent residents. Individuals who are not permanent residents are also covered if they are working for a Czech-based employer. EU nationals who do not fulfil these conditions and who stay for longer than 90 days in Czechia have the option of participating in the Czech SHI system; if they choose not to participate, they must be insured through their country’s insurance system or be privately insured. As health insurance is compulsory, non-EU nationals without permanent residence and not working for a Czech-based employer must purchase private health insurance (PHI) if they wish to remain in the country (see Section 3.5). These provisions result in virtually 100% population coverage. Czech nationals living abroad who do not wish to contribute to SHI must explicitly deregister from their Czech HIF [Health Insurance Fund], and EU regulations on coverage apply for Czechs located in other EU countries.

“For permanent residents and those working for Czech-based employers, opting out of the SHI system is not possible. Similarly, HIFs must accept all applicants who have a legal basis for entitlement; risk selection is not permitted. Individuals may choose freely among HIFs.”

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“The range of benefits covered by SHI [Statutory Health Insurance] in Czechia is very broad and includes inpatient and outpatient care (including homecare), prescription pharmaceuticals, some dental procedures, rehabilitation, spa treatments and over-the-counter pharmaceuticals (the last three 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 legislation, formularies, an annual negotiation process between HIFs [Health Insurance Funds] and providers aimed at defining specific conditions of reimbursement and the LHS [List of Health Insurance Services].”

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“The first mechanism by which benefits are rationed is the Health Insurance Act, which excludes procedures and services either implicitly or explicitly. Examples of implicitly excluded services are voluntary abortions, examinations requested by employers and various medical certificates, as these do not meet the requirements of maintaining or improving health status. Examples of explicitly excluded services are cosmetic surgery, acupuncture and some dental treatments, which are specified in a negative list contained within the first Annex of the Health Insurance Act. This also defines exceptional cases in which items on the negative list may be covered by SHI [Statutory Health Insurance]. Other annexes contain: a list of substances for which at least one pharmaceutical should always be fully covered (the second Annex); the categorization of MDAs [Medical Devices and Aids], including prescription, indication and volume reimbursement limits (the third Annex); dental aids and procedures that may be reimbursed under the SHI system (the fourth Annex); and an indication list for spa treatment covered by SHI (the fifth Annex) (Health Insurance Act, 1997).”

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“The following details the most important services that are fully or partially covered by SHI [Statutory Health Insurance]:

“ƒ Preventive services (such as examinations, screening, vaccinations)
“ƒ Diagnostic procedures
“ƒ Curative ambulatory and hospital care, including rehabilitation and care of the chronically ill
“ƒ Some dental treatments
“ƒ Pharmaceuticals and medical aids
“ƒ Psychotherapy
“ƒ IVF under certain conditions
“ƒ Medical transportation services
“ƒ Spa treatments (if prescribed by a physician)
“ƒ Emergency health services

“Several treatments, such as spa therapy and some types of dental and cosmetic procedures, necessitate patients obtaining permission via prior authorization from their HIF [Health Insurance Fund] to be covered. Above the statutory benefits package, additional benefits may be offered by HIFs only in the field of extra prevention (for instance, for reimbursements for voluntary vaccinations not covered by SHI like tick-borne encephalitis, extra screenings, mammography for younger women, safety helmets for children, vitamins and health promotion activities). Sick pay, maternity benefits and social care allowances are not covered by SHI, but are part of the state social security system, which is also responsible for pensions, unemployment compensation and other social benefits. This system is financed through social security contributions and general taxation.”

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“Most health services covered by SHI [Statutory Health Insurance] are provided free of charge at the point of use (see Box 3.1). Except for pharmaceuticals and MDAs [Medical Devices and Aids], partial coverage is not permitted – that is, patients cannot top up their statutory coverage by choosing a treatment that is more expensive than one normally covered and paying for the difference. Patient co-payments are only permitted for above-standard hotel-like services in hospitals and for accommodation during spa treatments. This applies also to dental care, for which only some treatments are covered by the HIFs [Health Insurance Funds]; treatments not covered are paid in full directly by the patients based on prices set by the dentists.

“There have been almost no user fees applied since 2015, though one remaining user fee (CZK90) is for accessing out-of-hours outpatient care. A wider range of small user fees introduced in 2008 proved politically divisive and were gradually removed and fully abandoned. An annual ceiling for pharmaceutical co-payments, also introduced in 2008, continues to be applied; exemptions from the out-of-hours outpatient care fee apply for people living below the poverty line.”

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World 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 July 26, 2023 by Doug McVay, Editor.