The Czech Health System – its Presence and Future

Pavel Hroboň

L.Dittrich

BASIC FACTS ON THE CZECH HEALTH SYSTEM

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

Financing

Payor and provider structure

Access to care

CHALLENGES

Low efficiency

Low patient-friendliness

Variable quality

High public spending

Population ageing – Czech Republic belongs to countries with biggest expected impact

IMPACT OF POPULATION AGEINGIMPACT OF POPULATION AGEING

EXPECTED STATUTORY HEALTH EXPECTED STATUTORY HEALTH INSURANCE PREMIUM RATEINSURANCE PREMIUM RATE

Rates required to cover the increasing healthcare costs with

public resourcesRate of total

tax burden on healthcareIn % of basis of assessment

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Rate of insurance premium

2003 2050

AGENDA

Current status of the Czech health care system

Proposal for change

WWHAT IS THE SOLUTION SPACEHAT IS THE SOLUTION SPACE

• Preserve access to health care for the whole population

• Cap public contributions on the current level

• Ensure choice for citizens

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

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

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