Information about public health insurance in Czech Republic
Until 1948, Czechoslovakia had a Bismarckian health protection system. Following the fall of the Communist regime in 1992, a new Bismarckian (social security) system was introduced.
The legal basis of the compulsory protection system in the Czech Republic consists of four laws, which cover the health insurance system, health insurance Premium, the General Insurance Company and employee’s insurance companies. These laws were passed by Parliament in 1991 and 1992.
The compulsory protection system is the responsibility of both the Ministers of Finance and Health. However, with the exception of teaching hospitals and several highly specialized centres, they have no direct executive power. Except in a few specific cases, their responsibility is limited to the obligation to introduce a system or regulations governing the financing of health care institutions and the way in which insurance companies operate.
All those insured are free to choose their insurance company. There are 9 health care insurance companies; the General Insurance Company covered 6 535 00 people by the end of 2007, i.e. 63 % of the total insured population.
The financing system is of the contributory type, based on health insurance contributions. Insurance companies have to balance their income and expenditure.
Everyone who is permanently resident in the Czech Republic is obliged to participate in the health care insurance system. Foreigners working for companies incorporated within the Republic are also covered. In total, the central register of those insured included 10 381 130 people by the end of 2007.
Health services covered
Compulsory health care insurance includes provision of most types of health care. Only certain cosmetic and acupuncture treatments as well as homeopathic products are excluded from coverage.
A system of third party payment is in force. In general, health care services provided by contractual physicians are free of charge at the point of use. The patient is free to choose a GP and the care provided by GPs is free of charge at the point of use.
Health care delivery
Patients have free choice of GP and hospital. Private Doctors must obtain a licence issued by the Medical Chamber and they must also registered with their regional government authority.
GPs are considered as the point of entry into the healthcare system. A patient therefore registers with the GP of his choice. He is free to change his GP. In this case the previous doctor sends the patient’s medical file to his new GP.
The GP’s do not act as gatekeepers. They refer patients to specialists, but patients are also allowed to consult a specialist without any referral.
Role of mutual health funds
The compulsory health care insurance system consists of 9 not-for-profit health insurance companies. Those insured are free to choose their health insurance company and can change it once a year. The largest health insurance company, the General Insurance Company of the Czech Republic, covers 63 % of the population.
There is a fund reinsuring health care insurance companies (except for the General Health Insurance Company) for the case of bankruptcy. The insurance companies have to contribute into this fund 0,5 % of their average annual basic fund expenditures.
Citizens of European Union countries can obtain the necessary information on public health insurance and healthcare in the Czech Republic through the Centre for International Reimbursements. The Centre for International Reimbursements (CMU) is the Czech Republic’s liaison body for healthcare. It associates all Czech public health insurers and makes sure that international social-security treaties and European Community law are applied. The CMU also provides an information service and consultancy, for example, on entitlements to non-financial healthcare benefits from public health insurance during a stay (residence) of foreign insured persons in the Czech Republic.
Those who do not participate in the Czech public health insurance system and are not from EU countries are obliged to take out commercial heath insurance. Health insurance for foreigners that covers comprehensive care guarantees them healthcare to the extent that is comparable to the extent of the Czech public health insurance, and guarantees them cash-free use of healthcare. This insurance meets all the conditions of the Act on a Foreigners’ Stay in the Czech Republic, and is recognised by the Aliens Police. People staying in the Czech Republic for a short time are recommended to take out foreigner’s health insurance to cover urgent healthcare. Both of these types of insurance are provided by Pojišťovna VZP, a. s., a subsidiary of Všeobecná zdravotní pojišťovna (General Health Insurer).