Abstract
Abstract Transformation of the health care system was a task faced by all formerly socialist Central and Eastern European countries. The years of changes revealed a large number of problems, including those induced by the limited capacity of governments to formulate and implement health care reforms. The goal of this article is to reflect the Czech situation. We start by summarizing the historical development of the Czech health care system in the context of government capacity for implementing health policy. In the core parts of this article, we highlight the main features of Czech health policy making and implementation and present an in-depth analysis of two selected country-specific issues - a low level of patient co-payments and a pluralistic insurance-based financing of health services.
Highlights
All Central and Eastern European (CEE) countries implemented large-scale health care reforms after 1989, trying to convert a “socialist” health care system into a “modern” one
The years of changes revealed a large number of problems, including those induced by the limited capacity of governments to formulate and implement health care reforms
Afterwards, a description of the development of Czech health policy after 1989 is provided. This historical discourse shows that reforming health care in the Czech Republic is connected with many problems, and especially with limited capacity for health policy making and implementation, discontinuity and politicization
Summary
All Central and Eastern European (CEE) countries implemented large-scale health care reforms after 1989, trying to convert a “socialist” health care system into a “modern” one (see, for example, Shakarashvili, 2005; Rosenbaum, Nemec & Tolo, 2004; or various WHO and OECD studies). Access would be partly dependent on willingness to pay, and services would no longer be entirely free at point of use: two clear changes to the previously guiding principles of social policy in this area This was intended to be the key change to the system of health care, a clear shift away from its pre−1989 étatist origins and towards a mixed-type system with state and societal regulation, societal financing and mixed state-societal-private provision (Wendt, Frisina & Rothgang, 2009). The new government proclaimed the same programme of public service reform, and it managed to pass a series of health care bills in the summer of 2011 These bills introduced into health insurance the distinction between basic and supplemental coverage, increased the powers of insurance companies, and confirmed the shift from citizens as patients of the state to citizens as clients of insurance companies. The following years of debate led (in 2015) to abolition of all fees excluding that for visiting an emergency unit in cases when general practitioner is not available
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