Individual Payment Research Articles

Cost Shifting in Lung Cancer Inpatient Care Under Diagnosis-Intervention Packet Reform: A Pilot Study in China.

China has developed and widely implemented an innovative case-based payment method for inpatient services under a regional global budget, termed the "Diagnosis-Intervention Packet" (DIP). This study aims to examine cost-shifting behaviour in lung cancer inpatient care under the DIP reform. This study examines the impact of the DIP reform in Zunyi, a national pilot city, using double machine learning (DML). Specifically, we analyze the effects on the total health expenditures (THS), individual payments excluding reimbursement (IPER), proportion of IPER, copayments for category-B, proportion of copayments for category-B, copayments for category-C and proportion of copayments for category-C per case for LC inpatients in tertiary hospitals. The results indicate a significant reduction in THS per case after the DIP reform (β = -0.0778, p < 0.001). Following the reform, there was a significant increase in IPER (β = 0.0689, p < 0.05), copayments for category-B (β = 0.1682, p < 0.01), and the proportion of copayments for category-B (β = 0.0039, p < 0.05). Conversely, the proportion of copayments for category-C significantly decreased (β = -0.0108, p < 0.001). Notably, significant heterogeneity in the cost-containment and cost-shifting effects was observed across different hospital categories, teaching types, and insured classifications. The DIP reform significantly reduced the THS per case for LC inpatients, while shifting in-policy expenditures to IPER. The cost-shifting primarily occurred through the redistribution of copayments from category-C to category-B. It is imperative for policymakers to establish differentiated regulatory policies tailored to various cost categories, hospital types, and insured classifications to optimize the effectiveness of the DIP reform.

Estimating Policy Functions in Payment Systems Using Reinforcement Learning

This paper uses reinforcement learning (RL) to approximate the policy rules of banks participating in a high-value payment system (HVPS). The objective of the RL agents is to learn a policy function for the choice of amount of liquidity provided to the system at the beginning of the day and the rate at which to pay intraday payments. Individual choices have complex strategic effects precluding a closed form solution of the optimal policy, except in simple cases. We show that in a stylized two-agent setting, RL agents learn the optimal policy that minimizes the cost of processing their individual payments—without complete knowledge of the environment. We further demonstrate that in more complex settings, both agents learn to reduce the cost of processing their payments and effectively respond to liquidity-delay trade-off. Our results show the potential of RL to solve liquidity management problems in HVPS and provide new tools to assist policymakers in their mandates of ensuring safety and improving the efficiency of payment systems.

Tax Systems Of Ukraine And The USA: Evolution Of Approaches To Buildings And Reforms

The scientific article summarizes scientific approaches to building and reforming the tax systems of Ukraine and the United States. The reform of the tax system of Ukraine after gaining political independence is analyzed. The reasons for rethinking the theoretical achievements of Western scientific thought in taxation and studying the experience of building tax systems in the USA are identified. The approaches to tax legislation reform in Ukraine and the USA are described. Attention is focused on the normative sequence of development in both countries of individual regulatory legal acts, which were later integrated into a codified document. The similarity of approaches to regulatory work in adopting and amending tax codes in the two countries is emphasized. It has been proven that the assessment of tax reforms carried out must be approached carefully their consistency and continuity must be ensured, and factors that influence the reform process must be taken into account. The tax reform carried out in Ukraine in late 2014 — early 2015 is characterized by the need to complete fiscal decentralization. Its main shortcomings are identified when combining individual taxes with different objects of taxation and individual payments under one name as a prototype of the physiocrat theory. It is emphasized that the practice of tax pooling was used in the USA as early as the first half of the 19th century and had consequences for local budgets. It is argued that in the conditions of Ukraine, preference should be given to modern economic theories, to adhere to the consistency and continuity of tax reforms as in the USA, without diminishing one’s achievements. A difference was identified in the application of tax benefits as optional elements of taxes in the domestic tax system and their systematic use in the USA for innovation and investment stimulation. It is summarized that for economic activity in reforming the tax system of Ukraine during the Russian-Ukrainian war, a symbiosis of military and commercial Keynesianism was used, and the effectiveness of the Keynesian concept was confirmed.

Pharmaceutical Industry Payments to Patient Organizations in Poland: Analysis of the Patterns, Evolution, and Structure of Connections.

Drug company funding can create conflicts of interest that compromise the integrity of patient organizations, a problem studied primarily in Western Europe and North America. To address this research gap, we conducted a case study in Poland, a Central European country. Between 2012 and 2020, 33 companies reported payments worth €13 729 644 to 273 patient organizations in Poland. The funding was highly concentrated, with the top ten recipients amassing 46.2 percent of the total amount. Cancer patient organizations were the primary recipients, receiving 37.5 percent. The funding focused on patient organizations' educational activities, constituting 40.4 percent of the total. For the ten companies reporting payments consistently from 2012 to 2020, we detected an increase in both the value of individual payments and the overall value of the funding. Additionally, some patient organizations formed exclusive, or nearly exclusive, ties with single companies. Overall, our study reveals important similarities between Poland and Western countries in the reported distribution of drug company payments to patient organizations. It also highlights priority areas for further research, including the evolution and structure of the financial connections.

Motivational drivers and the effectiveness of conservation incentives

The debate about how external incentives (e.g., payments for ecosystem services) and internal motivations (e.g., intrinsic values) interact in producing conservation outcomes is still unresolved. This paper examines the role of personal values (biospheric and egoistic) as intrinsic motivational drivers for conservation and their potential to affect conditional payments to enhance conservation behavior. We used a lab-in-the-field experiment with rural farmers in two ecological corridors of Tanzania to assess their conservation behavior under two payment modalities, namely a fixed individual payment and a fixed individual payment with an agglomeration bonus. In addition, a post-experiment survey was conducted to determine the levels of personal value endorsement for each individual participant. We consistently found that biospheric values increased conservation behavior, while egoistic values decreased it. The positive effect of biospheric values was higher than the negative effect of egoistic values. Both payments do not seem to affect the conservation behavior of farmers with high biospheric value endorsement. Heterogeneity in personal values thus likely has economic implications for the design of real-world PES schemes. Our results suggest that educational investments in training future generations of farmers with strong pro-environmental values can reduce future pressure on the environment and the costs of associated policy action. Areas for further research are discussed.

How significant is cost-shifting behavior under the diagnosis intervention packet payment reform? Evidence from the coronary heart disease market.

Controlling the growth of inpatient costs presents a major challenge in China's healthcare system. China introduced a new case-based payment method, the "Diagnosis Intervention Packet" (DIP), to address the surge in hospitalization expenses. However, the influence of DIP payment reform on cost shifting among coronary heart disease (CHD) inpatients remains unclear. This study focused on Zunyi, a national pilot city for DIP, utilizing inpatient claim data to assess the effects of DIP payment reform. We analyzed the influence on total health expenditures (THE), individual payments excluding reimbursement (IPER), proportion of IPER, copayments for category-B, proportion of copayments for category-B, copayments for category C, and proportion of copayments for category C per case for CHD inpatient. Results indicate a significant reduction in THE per case for CHD inpatients after the DIP reform (β = -0.1272, p < 0.01). Increases in cost shifting were observed in IPER (β = 0.1080, p < 0.05), the proportion of IPER (β = 0.0551, p < 0.01), copayments for category B (β = 0.2392, p < 0.01), and the proportion of copayments for category B (β = 0.0295, p < 0.01), along with the proportion of copayments for category C (β = 0.0255, p < 0.01). However, the copayments for category C did not significantly change. Notable variations in the effects of cost control and shifting were observed across different hospital categories, teaching statuses, hospital grades, and ownership types. The DIP reform significantly reduced the THE per case for CHD inpatients, while shifting in-policy expenditures to IPER, particularly with a greater shift intensity in the proportion of Class B compared with the proportion of Class C.

Demographic changes, technology growth, and retirement policy reform: Implications for U.S. housing dynamics

As the population aging process continues, concerns about how this situation impacts the housing market and social security rise. To address this question, this paper presents a developed and calibrated general equilibrium life-cycle model incorporating two production sectors to analyze the impacts of demographic structure changes and retirement policy reforms on housing price fluctuations and household choices. The model calibrated to the U.S. macroeconomic data between 1968 and 2018 suggests that in an economy with unlimited land supply, the housing supply curve exhibits perfect elasticity, rendering demographic changes insignificant in housing price fluctuations, while technological advancements lead to decreased prices. A 1% growth in productivity in both sectors results in a 2.6% decrease in house prices. Furthermore, a 1% decrease in population and a 5-year early retirement led to significant reductions of 25% and 30% in individual social security payments and 9% and 18% in interest rates, respectively. This suggests that during a recession caused by demographic structural changes, households become more conservative and prioritize precautionary saving strategies, increasing savings and investing more in housing assets. Consistent with empirical findings, during an economic boom, a decline in the capital-output ratio and the real housing price suggests a decrease in savings and housing asset investment. The rise in consumption drives the capital demand of the non-housing sector to increase, stimulating business expansion and labor inflow.

The equity road ahead for financing non-national immunization program vaccines in China: challenges and opportunities from a qualitative study

BackgroundIn China, national immunization program (NIP) vaccines benefit from robust financial support and have achieved high coverage. Non-NIP vaccines rely on fragmented funding sources, mostly out-of-pocket payment, and face sub-optimal and inequitable coverage. Sustainable financing needs to be secured for addressing equity in non-NIP vaccine delivery. However, discussion and understanding of this issue remain limited. This study aims to analyze the current situation, comprehensively identify challenges and opportunities in non-NIP vaccine financing, and offer suggestions to enhance vaccine uptake and improve public health.MethodsBetween July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Bureau, Centers for Disease Control and Prevention, Medical Insurance Bureau, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data.ResultsNon-NIP vaccine financing sources include out-of-pocket payments, government fiscal, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination.ConclusionRelying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines.

AD|ARC (Administrative Data | Agricultural Research Collection): Characteristics of farm households participating in agri-environment schemes in Wales, UK.

Objectives Describe the sociodemographic and farm business characteristics of farming households in Wales that have agri-environment contracts (voluntarily opting-in) without primary farm subsidies (voluntarily opting-out). Investigate the sociodemographic and farm business characteristics of farming households in Wales by the number and type of farming subsidies received. ApproachWe utilised the AD|ARC dataset comprising of Census 2011 variables, linked to agricultural and business variables for all farming households in Wales. We analysed variables relating to the individual (e.g. age, gender), household (e.g. household size, structure), farm business (e.g. farm type, diversification activities) and rural payments data (subsidy type, amount paid). We conducted comparative analyses between three groups of farming households: households engaged in agri-environmental schemes but not primary subsidies, households engaged with both subsidy types, and households claiming primary subsidies only. ResultsWe will present a detailed description of the sociodemographic and business characteristics of farming households by the number and type of subsidies claimed and engagement with agri-environmental schemes. Using business, personal, and household characteristics, we will discuss different farming household typologies in relation to participation in agri-environmental schemes, and outline the relationship between farming households and positive environmental action. Full findings will be presented at the conference but are currently subject to information governance restrictions. With an increasing interest in climate change and supporting the natural environment, our findings provide insight into the characteristics of farming households and their relationship to engagement with agri-environmental schemes. Our results will inform policy-makers seeking to support farming and the rural environment.

Industry payments and implicit bias in cardiothoracic surgery: Difference in industry payments to cardiothoracic surgeons by gender

Industry payments and implicit bias in cardiothoracic surgery: Difference in industry payments to cardiothoracic surgeons by gender

Market Structure and Extortion: Evidence from 50,000 Extortion Payments

Abstract How does gang competition affect extortion? Using detailed data on individual extortion payments to gangs and sales from a leading wholesale distributor of consumer goods and pharmaceuticals in El Salvador, we document evidence on the determinants of extortion payments and the effects of extortion on firms and consumers. We exploit a 2016 nonaggression pact between gangs to examine how collusion affects extortion in areas where gangs previously competed. While the pact led to a large reduction in competition and violence, we find that it increased the amount paid in extortion by approximately 20%. Much of this increase was passed through to retailers and consumers: retailers experienced an increase in delivery fees, leading to an increase in consumer prices. In particular, we find an increase in prices for pharmaceutical drugs and a corresponding increase in hospital visits for chronic illnesses. The results point to an unintended consequence of policies that reduce competition between criminal organizations.

Trend Analysis of Industry Payments to Dermatologists in the United States from 2015-2022

Background: Open Payments, established in 2013 to address concerns about industry-driven healthcare influence, aims to enhance transparency regarding financial relationships between industry and physicians. This study investigates trends in industry payments to dermatologists between 2015 and 2022, a topic that has not been explored since a prior characterization in 2014. Methods: We conducted a retrospective review of United States dermatologists appearing in the Open Payments database between 2015 and 2022. A Joinpoint analysis was performed to calculate the average annual percentage change (AAPC) across study years. A sensitivity analysis excluding 2020-2021 data was conducted. Results: This study reviewed 2,616,289 payments totaling $494,271,790 made to dermatologists during the study period. The average annual percentage change (AAPC) across these years for the number of recipient dermatologists, total value of payments, and total number of payments were 1.5%, 5.5%, and 3.9%, respectively, with confirmed positive growth when excluding data from 2020-2021. Conclusions: Payments per dermatologist have increased over the years, even when adjusting for inflation, but this growth is likely attributed to the overall expansion of the specialty. Most individual payments to dermatologists were less than $50. However, a substantial proportion of dermatologists (60%) received total payments exceeding $1000 during the study period. These findings suggest a longitudinal nature of industry-dermatologist relationships and emphasize the financial significance of payments over time. Notably, the impact of physician-industry relationships on patient care in dermatology remains debated but may influence medical decision-making and engender patient distrust.

Long-term transformation of fiscal instruments under sanctions pressure: Iran's experience and its relevance to Russia

The subject of this study is the Iranian tax system and its changes in the context of international sanctions that have been in effect against the country for several decades. Given that Iran's fiscal system has undergone a number of significant changes during the period of sanctions pressure, the experience of this country is relevant for Russia both in terms of possible tools aimed at stabilizing the economy and in terms of forecasting trends in the transformation of the tax system. The analysis and characteristics of Iranian tax system is carried out through the prism of its adjustment and changes necessary to ensure the country's fiscal stability in the face of sanctions pressure. Data published by the World Bank and the Central Bank of Iran are used as sources. The purpose of the study is to characterize and identify Iranian positive experience in changing the tax system under the conditions of sanctions pressure and to develop recommendations for its application in Russia. The research methods used are analysis, synthesis, induction, and classification. The following indicators are used: the tax burden, the share of taxes in the total amount of state budget revenues, the share of individual tax payments in the total amount of tax payments. The data are analyzed in dynamics for the period 1972 – 2020. A graphical way of presenting data is used to visualize the results of the analysis. As a result of the analysis, it is concluded that taxes under the conditions of sanctions become an alternative source of income for the state budget of Iran. Meanwhile the structure of the country tax payments has undergone significant changes, as a result of which the role of insurance premiums and indirect taxes (primarily VAT) has significantly increased. Iranian experience is relevant for Russia. Thus, the result of the analysis demonstrates that due to the fact that sanctions are a significant barrier to foreign trade, taxation becomes, in fact, the only source of government revenue, and the fiscal function of taxes becomes dominant. In this regard, an increase in the nominal corporate profits tax rate by 5 percentage points while maintaining the existing preferential mechanisms, as well as progressive five-stage taxation of personal income, becomes a logical and justified tool for replenishing the state budget, which allows achieving the task.

Industry Payments to Foot and Ankle-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019.

Introduction The authors examined if the transparency in industry payments to foot and ankle-trained orthopedic surgeons resulted in the following changes to the (1) median general payments to surgeons, (2) trend in median payments to surgeons across all subcategory payments, and (3) trend in median payments to surgeons in 11 regions of the United States. Methods A retrospective review of the Centers for Medicare and Medicaid Services (CMS) and Open Payments Database (OPD) was performed to identify all industry payments made by drug and medical device companies to orthopedic surgeons (N=3,835) between January 1, 2014, and December 31, 2019. Descriptive statistics were calculated, and trend analyses in annual payments, number of paymentsto surgeons per year, payment subtypes, and regional distributions were analyzed. Results A total of 53,280 payments totaling $53,454,850.56 were made to orthopedic foot and ankle surgeons between 2014 and 2019. Mean and median payments were $1,003.28 and $60.19, respectively. Statistically significant differences in mean payment amounts were observed by year (p= 0.001) with a highly statistically significant, strong increase in the number of payments made over the six-year period (r= 0.97,p< 0.001).The greatest increases in median individual payments were observed forgifts (277.1%;r= 0.18,p= 0.05), education (250.6%;r= 0.17,p< 0.001), and royalties and licensing (72.1%;r= 0.05,p= 0.04). Statistically significant increasing trends in median payments over time were observed for the Northeast (p< 0.001) and South regions (p< 0.001). Discussion The results of this study demonstrate the increase in payments made across the six-year time period. The study demonstrates that there is a shift in the type of payments from speaker fees, entertainment, and lodging to education, gifts, honoraria, royalties, and consulting. Conclusion Since the OPD release, no significant decrease wasidentified in the financial relationship between foot and ankle surgeons and the industry; rather, an increase was observed. This increase in education, royalties, and consulting shows that more foot and ankle surgeons are getting involved in the industry, contrary to expectations. The partnership between industry and physicians can help to improve innovation and bring new ideas to the future of orthopedics.

Motivation attitudes of managers and ordinary employees of anti-tuberculosis organizations

The purpose of the study was to identify differences in the level of general professional satisfaction and motivational preferences of the managers and ordinary personnel of tuberculosis institutions. Materials and methods. An anonymous sociological survey of 75 employees of medical institutions of phthisiatric profile using the developed questionnaire was conducted. The level of satisfaction with occupational activity and motivational attitudes of medical workers was studied, and recommendations for improving the complex system of motivation of medical personnel were developed. Results. Managers are more likely to be dissatisfied with the key incentives compared to doctors. The priorities for doctors are loyalty to occupational duty, financial well-being and stability, for managers — self-realization, professional growth and social status. For doctors, the main motives are material, managers believe labour efficiency to increase due to developing a system of individual incentive payments and maintaining interpersonal relationships in the team. Conflict situations with a manager occur due to the imposition of additional responsibilities according to ordinary employees, to the managers’ opinion — their failure. The degree of employee satisfaction with work can be characterized as high, which is confirmed by the desire of a large number of employees to continue working in their previous position. Limitations: truthfulness, hasty and rash answers, distortion of results due to socio-psychological influence, small number of respondents, belonging to a narrow sphere of activity. Conclusion. When developing a motivation system for employees of anti-tuberculosis institutions, it is necessary to agree on satisfaction with working conditions of all occupational categories, improve incentive methods while maintaining existing favourable factors, create an individual incentive system based on investments in human resources, manage the motivational environment taking into account group affiliation, individual characteristics, preferences and personal qualities of employees, as well as assessment of employee satisfaction with innovations through regular questionnaires, sociological surveys

Industry Payments to Orthopedic Surgeons Among All Subspecialties: An Analysis of the Open Payments Database From 2014 to 2019.

Introduction Since the passage of the Physician Payments Sunshine Act in 2010, the Centers for Medicare and Medicaid Services (CMS) started the National Physician Payment Transparency Program and Open Payments Database (OPD), which allowed for public access to financial disclosures between physicians and industry. Although orthopedic surgeons receive the highest average payments when compared to other specialties, there has been limited data evaluating these payments among the different orthopedic subspecialties. The purpose of this study was to analyze all industry payments made across all subspecialties among orthopedic surgeons. Methods A retrospective review of the CMS OPD was performed to identify all industry payments made by drug and medical device companies to orthopedic surgeons (N = 28,475) between January 1, 2014, and December 31, 2019. Descriptive statistics were calculated for the number, individual value, and total value of industry payments, stratified by payment type and orthopedic subspecialty. Results A total of 1,048,573 payments (approximately $1.6 billion) were made to orthopedic surgeons between 2014 and 2019. The average orthopedic surgeon received 6.14 payments per year (SD = 29.39), with a mean individual payment amount of $1,542.32. Royalties or licensing comprised the greatest proportion of open payments, followed by consulting fees. Adult reconstruction (M = $225,131.10) and spine (M = $197,404.74) received significantly greater total payments when compared to all other subspecialties (all p-values ≤ 0.001). Differences in total payments made to trauma (M = $73,789.65), sports medicine (M = $60,988.09), foot and ankle (M = $45,007.45), pediatric orthopaedics (M = $35,898.54), general orthopaedics (M = $28,405.81), and hand (M = $14,027.76) were all found to be statistically equivalent (all p--values > 0.20). Discussion Increased collaboration between physicians and industry has resulted in the rapid advancement of innovation that can have sizeable financial implications among orthopedic surgeons. There exists significant heterogeneity in open payments made to orthopedic surgeons when stratified by subspecialty. Adult reconstructive and spine surgeons were the most compensated whereas hand and general orthopaedic surgeons received the least.

Conflict of interest disclosure by US cardiothoracic surgeons.

Surgeon-industry collaboration is a key driver of advancement in surgical technology and practice. Disclosures of financial relationships between investigators and industries are important to ensure transparent and critical evaluation of literature. All American cardiothoracic (CT) surgeons who published in three major CT surgery journals in 2019 were identified. Whether these surgeons disclosed any conflicts of interest was recorded and compared to actual payments received within 5years of publication as reported by the Centers for Medicare and Medicaid Services data. In the study period, there were 1079 unique manuscripts involving 885 American CT surgeons as authors, which combined for 2719 author instances. Of these, 96.2% of authors (851 of 885) received payments from companies. The authors who received payments produced 2651 author instances (97.4%). Financial disclosure was reported in only 11.4% (301 of 2651) of these instances. In total, 851 surgeons received more than $187 million over 5years, with the highest-paid surgeon receiving an average of over $5.9 million per year. The largest individual payments were from "Associated Research Funding," with over $115 million being paid to 277 surgeons over 5years. The top paying company issued over $96.5 million to American CT surgeons over 5years. Nearly all the reviewed publications in three top CT surgery journals were by surgeons who received payments from companies, but very few of these payments were recorded as potential conflicts of interest. A more consistent and robust policy of COI disclosure is needed to reduce perceptions of bias.

Effect of modified income assistance payment schedules on substance use service access: Evidence from an experimental study

Effect of modified income assistance payment schedules on substance use service access: Evidence from an experimental study

Income composition inequality of Chinese residents and fiscal redistribution effect: An empirical analysis on individual income tax and transfer system.

Based on the data of China Family Panel Studies (CFPS), this paper decomposed Chinese residents' income into labor income and capital income by income source, and measured the income inequality and income composition inequality of Chinese residents during 2010-2018. We take the Gini coefficient as a measure of inequality and, by decomposing it by income source, analyze the absolute and relative marginal effects of capital income and labor income on the overall income inequality. On this basis, this paper discusses the redistributive effect of financial instruments such as personal income tax and transfer payment on income inequality and income composition inequality. The results show that capital income is not only the main driving factor for the increase of overall income inequality, but also its influence on inequality is gradually increasing. The results of the redistribution effect of fiscal instruments show that although individual income tax and transfer payment both help to reduce the overall income inequality, only individual income tax can reduce the inequality of income composition, while transfer payment will exacerbate it. In the background of the rising share of capital income, it may widen the income distribution gap in the long run. Hence, future fiscal redistribution efforts should consider the income composition inequality. This includes further promotion of individual income tax reforms, optimization of the tax rate structure, enhancement of relevant tax laws governing capital income like property income, and continuous improvement in the redistributive impact of fiscal instruments.

State Insureds in the Czech Republic as a Ball and Chain of Future Public Budgets

Czech healthcare is financed through a system of universal and compulsory health insurance based on solidarity. In last years, due to the covid-19 pandemic, there has been an unprecedented expansion of fiscal space for health services through increased payments for state-insured individuals. The article aims to highlight this increasingly important part of the Czech health insurance companies’ revenues and the possible implications for the shape of the Czech health system and for ’he country's future budgets. The significant increase in financing health services through tax redistribution is gradually shifting the Czech health system back toward a national health system model. The existence of (several) health insurance companies is thus slowly but surely losing its key importance thanks to the described mechanism of constant increase of direct payments to the state.