1. The Czech Health System – its Presence and Future
Pavel Hroboň
L.Dittrich

2. BASIC FACTS ON THE CZECH HEALTH SYSTEM
Financing
Payor and provider structure
Access to care
Statutory insurance - 13,5% „payroll tax“ on economically active citizens,
ca 30% of sources supplied from the state budget
Private spending amounts only to 10% of total
7,2% of GDP translates into 1118 USD per capita (in PPP in 2002)
One-off state subsidies needed each 2-3 years to cover debts
9 (competing) payors (VZP has 60% of the market)
100% of premiums subject to risk adjustment
Payors limited in their efforts to purchase care
High number of hospitals, acute hospital beds, patient-physician
interactions and drug prescriptions
Most outpatient practices in private hands
Teaching hospitals managed by the central government, regional and
district ones by regional governments, 10% of hospitals beds private
Low specialization of providers, provision of care fragmented
Generally very good access to physician and hospital services
Until recently very good access to some modern technologies
Some health indicators belong to the EU top, some to the bottom
Quality and accessibility of services varies between providers

3. CHALLENGES Low efficiency Low patient-friendliness Variable quality
High public spending
Population ageing – Czech Republic belongs to countries
with biggest expected impact

4. IMPACT OF POPULATION AGEING

5. EXPECTED STATUTORY HEALTH INSURANCE PREMIUM RATE
Rates required to cover the increasing healthcare costs with
public resources
Rate of total
tax burden on healthcare
In % of basis of assessment
Rate of
insurance
premium
2003
2050

6. AGENDA Current status of the Czech health care system
Proposal for change

7. WHAT IS THE SOLUTION SPACE
Preserve access to health care for the whole population
Cap public contributions on the current level
Ensure choice for citizens

8. REFORM OF INSTITUTIONS
Health insurers
Enable purchasing and management of care
Introduce legal status enabling responsible management
Support competition in price and quality of services
Health care
providers
Support modern methods of care provision
Pay providers according to volume and quality of provided care
Support competition leading to growth of efficient high quality providers
Government
Strengthen legislative and regulatory roles
Ensure access through redistribution of public sources and support the citizen through provision of information
Ensure urgent pre-hospital care and public health
Regulated competition in health insurance and health care provision will lead to substantial efficiency gains

9. REFORM OF FINANCING
Define scope
of statutory
coverage
Define scope of services covered by statutory health insurance, including their geographic accessibility and maximum waiting times
Introduce regulatory copayments on drugs, physician visits and hospitalization days
Enable choice for
citizens
Let citizens choose scope and conditions of complementary insurance
Let citizens decide for managed care plans or health plans with higher coinsurance
Increase flow of
private money
Enable legal combination of public and private money:
For a single health care intervention
In the same insurance institution
In future on citizens personal health accounts
These measures will help the system to cope with financial impact of population ageing, increasing demands and new technologies

10. MAIN LEGAL CHANGES PLANNED FOR 2007 - 2008
New law on reimbursement of pharmaceuticals
Establishment of an independent Health Insurance Regulatory Office
New law on statutory health insurance:
Definition of coverage and guaranteed access
Changes in payor – provider relations
Transformation of health funds into joint stock companies
Establishment of University hospitals
New law on medical education, change in the role of Medical Chamber