On what basis does the Czech healthcare system work?

How the Czech healthcare system works

The Czech healthcare system is based on the principle of public health insurance. This means that citizens (and other persons who fall within the scope of the insured under the law) are obliged to pay for health insurance and in return are entitled to health care to the extent provided for by law.

In the case of employees, the employer pays part of the premium and the employee pays part, self-employed persons pay advances according to their assessment base, and persons with no taxable income have a minimum price for health insurance. For some groups (e.g. children, pensioners, people on parental leave or on the register of the employment office) the state pays the premiums.

Healthcare in the Czech system is provided through a network of contracted healthcare facilities. Each health insurer has contracts with a number of providers – general practitioners, specialist clinics, hospitals, spas, etc. The patient has a choice of doctor and healthcare facility, as long as the provider has a contract with his/her insurance company and accepts new patients.

In addition to public health insurance, there is also voluntary commercial supplementary insurance, but this does not replace public health insurance under the Public Health Insurance Act. It is only used to cover extra costs (e.g. better hospital rooms, extra material, certain procedures or shorter waiting times).

What the law regulates

In practice, you will most often come across the term Public Health Insurance Act. This sets out who participates in the public health insurance system, what the obligations of insured persons, employers and health insurance companies are, what is covered health care, what the standards of care are and under what conditions care is reimbursed. It also defines the so-called state insured, i.e. groups of persons for whom the state pays premiums.

The Public Health Insurance Act is also key because it defines exactly what is covered by insurance and what is paid for by the patient. Not everything your doctor offers you is “covered by the insurance company”. Sometimes a procedure is only partially covered or not covered at all – in such situations it is advisable to have it explained in advance what is a standard covered by public health insurance and what is a voluntary supplement. If you are in doubt, you can also check the information directly with the health insurance company.

Health insurance: who pays, when and how much

For most people, the most important practical question is: what is the health insurance payment, who pays it and how is the amount of health insurance calculated. The rules vary depending on which group you belong to.

Employees

For employees, the employer pays the health insurance premiums. The Public Health Insurance Act sets out the assessment base on which the amount of health insurance is calculated and the percentage to be paid. The employee is therefore obliged to be insured and to report changes (e.g. change of insurance company), but the employer takes care of the actual payment.

SELF-EMPLOYED

The situation is more complicated for the self-employed. The self-employed pay advance payments of insurance premiums, the minimum amount of which is set in relation to the average wage. After the end of the year, the insurance premiums are settled according to the actual assessment base. The amount of health insurance for the self-employed may therefore be higher than the sum of the minimum advance payments.

Persons without taxable income (PIT)

A specific category is persons without taxable income who are not state insured, employed or self-employed. Typically, these are people who are not currently working and are not registered with the employment office. They have to pay their own premiums, at the rate set by law – again, the price of health insurance for the PWD is often mentioned. This is not an optional amount, but the legal minimum.

If the health insurance payment is not made as it should be, a premium debt is incurred. The health insurance company can charge penalties, collect the debt and, in extreme cases, file for foreclosure. A health insurance debt is therefore not something that “just goes away”. On the contrary, it pays to deal with the situation early, negotiate with the insurance company for repayments if necessary, and check that the health insurance amount has been calculated correctly.

Health insurance companies: how to choose and what to watch for

There are several public health insurance companies in the Czech Republic. Health insurance companies in the Czech Republic have to provide all their insured persons with the statutory scope of covered care. The basic framework is provided by the Public Health Insurance Act and related regulations.

However,differences do existbetween insurance companies. These relate mainly to the offer of bonuses and preventive programmes (allowances for vaccinations, rehabilitation, spectacles, maternity care, etc.), the range and availability of branches and client centres, the quality and clarity of online services (electronic communication, overview of reported care in the client zone) or marketing promotions, loyalty programmes and other “benefits”.

When choosing an insurer, it is wise to look not only at the current premiums offered, but also at the network of contracted providers in your area. If your general practitioner or key specialist is not contracted with a particular insurance company, it may mean more difficult access to care or having to pay for some procedures in full.

Health insurance companies in the Czech Republic also differ in the way they communicate with insured people to resolve problems – claims, requests for payment for procedures, debt resolution. If you are dealing with a dispute with your insurer or have doubts about the procedure, legal consultation is often in order.

What am I entitled to as a patient?

Just because you have valid health insurance does not mean that everything is settled. Another important pillar of the system is the Health Services Act. This mainly deals with the relationship between the patient and the healthcare provider, i.e. how healthcare facilities should operate, what rights and obligations patients have and what medical records should look like, for example.

Key patient rights include:

• the right to accessible and professionally correct healthcare,
• the right to understandable information about their health condition and proposed treatment,
• the right to give or refuse informed consent,
• the right to inspect and make copies of medical records,
• the right to protection of personal data and confidentiality.

The Health Services Act also regulates how complaints can be lodged against a provider’s practice, how disputes about the quality or scope of care provided are resolved and what control mechanisms exist. If you believe that you have received incorrect or inadequate healthcare, it is important to follow a systematic approach: first ask for an explanation from the provider, if necessary file a complaint, contact the health insurer or the competent administrative authority. In serious cases (e.g. suspected malpractice leading to personal injury), legal representation is also appropriate.

Healthcare facilities: where to look for care

There is a wide network of healthcare providers in the Czech system. A healthcare facility is not just a hospital – it is an umbrella term for different types of entities that are authorised to provide healthcare services.

Typically you will come across the following categories:

• GPs for adults and children – first contact for common health problems, prevention, vaccinations, basic diagnostics.
• Outpatient specialists – e.g. internist, cardiologist, gynaecologist, ENT, neurologist, psychiatrist, etc. Usually a GP referral is needed (but not an absolute rule).
• Hospitals and clinics – inpatient care, surgery, acute and intensive care, follow-up care.
• A&E and urgent care – for acute conditions that cannot be delayed.
• Spa and rehabilitation facilities – follow-up and rehabilitation care, sometimes partly covered by public health insurance.

In terms of reimbursement, it is important whether the facility has a contract with your health insurance company. You can usually find a list of contracted facilities on the insurance company’s website or directly in its client area. If you visit a provider who does not have a contract, the cost of your healthcare may be entirely up to you. This may not be a problem for one-time procedures, but it makes a significant difference for more expensive treatments.

So it’s always a good idea to check whether the doctor or facility you want to see is in your insurer’s contracted network. If not, we recommend that you find out in advance what the cost of your care will be and whether there is a possibility of at least partial reimbursement.

Summary

The Czech health care system is based on public health insurance, which must be paid by the majority of persons residing in the Czech Republic (or otherwise defined insured persons), whereby the employer pays the premiums for employees, self-employed persons pay advances according to the assessment base, persons without taxable income pay the statutory minimum, and the state pays the premiums for state insured persons (e.g. children, pensioners, parents on parental leave, unemployed persons on the register of the Social Insurance Office). The Public Health Insurance Act determines who participates in the system, what is covered care, what are the obligations of insured persons, employers and insurance companies, and defines precisely what is covered by insurance and what the patient pays for, while the Public Health Insurance Act and related regulations regulate the calculation and payment of premiums in individual situations. If premiums are not paid correctly, a debt is incurred, for which the insurance company charges a penalty and can even enforce it, so arrears must be actively addressed. In addition to compulsory public insurance, there is also voluntary commercial supplementary insurance, but this only serves to cover the above standard (better conditions, material, comfort) and does not replace public insurance. There are several health insurance companies in the Czech Republic, which must provide the same legal scope of care, but they differ mainly in bonuses, prevention programmes, quality of services and network of contracted doctors – so it is important to check whether your doctor or health care facility has a contract with the insurance company, otherwise you can pay for the care yourself. The network of providers includes general practitioners, outpatient specialists, hospitals, emergency rooms, as well as spas and rehabilitation facilities, and reimbursement for care depends on the contract with your insurance company. The Health Services Act then protects the patient’s position – it guarantees the right to accessible and professionally correct care, to understandable information about health and treatment, to informed consent or refusal of treatment, to access to documentation and protection of personal data, as well as regulating the complaints and dispute resolution procedure, where legal assistance is worthwhile in more complicated cases.