“The Velvet Revolution in 1989 led to democratization and reforms that had far-reaching effects on health care in Czechoslovakia and, later, Czechia. The principle of free choice of provider was introduced, and the Regional and District Institutes of National Health were dismantled. Primary care, outpatient (ambulatory) specialist care, the pharmaceutical industry, pharmacies and spa facilities were almost completely privatized, though hospitals remained publicly owned.”
“In the early 1990s, several key laws relating to the new health system were approved, including the General Health Insurance Act (1991), the Act on the General Health Insurance Fund (1991) and the Act on Departmental, Professional, Corporate, and Other Health Insurance Funds (1992). These shifted the health system towards SHI [Statutory Health Insurance], with quasi-public, self-governing HIFs acting as payers and purchasers of care, primarily financed through mandatory, wage-based contributions. The first established entity was the General Health Insurance Fund (Všeobecná zdravotní pojišťovna, VZP) in early 1992, which remains the largest HIF in Czechia, followed by others shortly after. The number of HIFs [Health Insurance Funds] operating in Czechia peaked at 27 in the mid-1990s, though their numbers decreased dramatically in the following years and stabilized at nine in the early 2000s. One new HIF has since been established, and, after several mergers, the number of HIFs settled at seven in 2012, where it remains at the time of writing.
“As a result of these reforms, HIFs contracted an increasing number of state and private health care facilities on a fee-for-service (FFS) basis, leading to unsustainable costs. In 1997, FFS payments were replaced by capitation fees for primary care and by fixed, prospective budgets for hospitals. The FFS scheme was also modified for outpatient specialists by introducing prescription limitations, followed later by pharmaceutical budgets and limits on the volume of services to be fully reimbursed.”
“Following governance reforms in 2003, ownership of approximately half of the hospitals was transferred from the central government to 14 newly formed, self-governing regions. Some regions later decided to change the legal incorporation of their hospitals from entities directly subordinate to regional authorities to joint-stock companies (see Section 2.3). A system of user fees was introduced in 2008, though due to popular opposition it was gradually dismantled and abolished by 2015 (with a few exceptions, see Section 3.3.1). Fees for some defined higher-standard health services were introduced in 2012 and quickly abolished (Constitutional Court of the Czech Republic, 2013).”
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Page last updated August 22, 2023 by Doug McVay, Editor.