The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems. They also describe the institutional framework, process, content, and implementation of health and health care policies, highlighting challenges and areas that require more in-depth analysis.

Since the early 1990s, the Czech Republic has had a system of social health insurance (SHI) based on compulsory membership in one of a number of health insurance funds, which are quasi-public, self-governing bodies that act as payers and purchasers of care. Eligible residents may freely choose their health insurance fund and health care providers. The health insurance funds must accept all applicants who have a legal basis for entitlement regardless of age or health status. SHI contributions are mandatory and take the form of a payroll tax split between employers and employees; self-employed individuals must contribute a fixed percentage of their profits.

As of 2009, the Czech health system is characterized by relatively low total health care expenditure as a share of gross domestic product compared to western Europe; low out-of-pocket payments; plentiful human resources, albeit with some significant regional disparities; and good results for a number of important health indicators. The population enjoys virtually universal coverage and a broad range of benefits, and some important health indicators are better than the European Union (EU) averages (such as mortality due to respiratory disease) or are even among the best in the world (in terms of infant mortality rates, for example). On the other hand, the standardized death rates for diseases of the circulatory system and malignant neoplasms are well above the average for all EU Member States (EU27). The same applies to a range of health care utilization rates, such as outpatient contacts and average length of stay in acute care hospitals. In short, there is substantial potential in the Czech Republic for efficiency gains and improved health outcomes. This has been recognized by the Czech government, which has attempted to reduce inappropriate demand by increasing cost sharing and to improve the quality of specialized care by identifying high-performing health care facilities and allowing for special contractual arrangements between them and the health insurance funds.

Many of the recent reforms to the Czech health system have attempted to address the chronic financial instability that has marked the system since its inception. Others have focused on the issue of hospital ownership and management structures, or on improving purchaser–provider relationships, compliance with EU law, and coordination between the systems of health and social care. The key challenge to health reform in the coming decades will be to keep high-quality care accessible to all inhabitants of the Czech Republic while taking into account economic development, demographic ageing and the capacity of the SHI system. Future reforms will focus on codifying patient rights, clarifying the purchaser–provider relationship and refining the SHI system. As of 2009, the system for defining and rationing benefits is fragmented, ad hoc and unwieldy. One of the most important pieces of proposed legislation would provide a more explicit definition of SHI benefits and redesignate them as entitlements, thus increasing transparency and strengthening the legal rights of all relevant actors to enforce them.

http://www.euro.who.int/Document/E92968.pdf [2]