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 AGEING

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

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

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

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  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