Introduction

The Czech healthcare system ranks 20th overall in the 2022 World Index of Healthcare Innovation, down from 16th in 2021 and 8th in 2020.

The Czech Republic ranked 4th for Fiscal Sustainability, achieving universal coverage with a relatively low level of public healthcare spending. Czechs enjoy a decent number of choices for coverage and care (ranked 8th for Choice), thanks to its German-style system of universal private coverage.

The Czech Republic scored toward the bottom of the Index on Science & Technology (28th) and Quality (27th), driven by low marks for scientific discoveries, acute care, and cancer survival rates. In addition, the Czech Republic scored near the bottom of the Index on its response to COVID-19.

Background

The Czech region was part of the Austro-Hungarian empire in the late 19th century, and accordingly, adopted a healthcare system modeled after that of Otto von Bismarck in Germany. As in Austria and Hungary, the Czech region first installed compulsory private health insurance for blue-collar workers in 1888. By 1918, hundreds of private sickness funds existed throughout Austria-Hungary.

When Czechoslovakia gained its independence in 1918, following the dissolution of the Austro-Hungarian empire, the new country expanded its health insurance system to all wage earners, including agricultural workers, and familial relatives of blue-collar workers. In 1924, these private funds were consolidated into a single regulator, the Central Social Insurance Fund (Ústřední sociální pojišt’ovna, or ÚSP). In 1948, under communist rule, the ÚSP was replaced by the Central National Insurance Fund (Ústřední národní pojišt’ovna, or ÚNP), and ultimately in 1952 with a Soviet-style socialist system, which in today’s terms is similar to that of the British National Health Service.

After the 1989 Velvet Revolution, the Czech Republic privatized its health insurance system, and reintroduced the principle of patient choice. After a wave of consolidation, today there are seven private, self-governing sickness funds in the country, the largest being the General Health Insurance Fund (Všeobecná zdravotní pojišťovna České republiky, or VZP). Universal coverage is financed through a 13.5% payroll tax, with a minimum monthly premium contribution of CZK 2,187 in 2022 (approximately $100 USD).

The State Institute for Drug Control (Státní ústav pro kontrolu léčiv, or SÚKL) regulates drug prices by setting the maximum end-customer price at the level of the average of the three lowest prices in the European Union.

Quality

Like other eastern European countries, the Czech Republic struggles with the Quality dimension, ranking 27th. While it initially handled the COVID-19 pandemic well, the virus eventually surged amidst a low vaccination rate, resulting in the 4th highest fatality rate among Index countries. On top of this, Czechs have struggled to manage chronic diseases like cardiovascular disease and cancer. On a positive note, the Czech Republic does a reasonably good job preventing hospitalizations for conditions such as asthma and diabetes.

Choice

The level of Choice in the Czech Republic is high, ranking 8th overall. The Czech Republic’s universal healthcare system prioritizes affordability of health coverage (1st) over freedom to choose healthcare services (19th). Despite the focus on limiting healthcare costs, access to new treatments is improving in the Czech Republic, where the use of biosimilars is encouraged.

Science & Technology

The Czech Republic is weak in Science and Technology innovation, ranking 28th overall. The country lags in health digitization (25th), and relies on other modern countries for medical advances (21st) and scientific discoveries (27th) because it lacks research and development capacity across the health sector and academia.

Fiscal Sustainability

The Czech Republic remains near the top of the Index for Fiscal Sustainability, ranking 4th overall. While its ranking on national solvency is 11th due to an aging population, it ranks only behind Germany in public healthcare spending as a percentage of GDP (2nd). While the Czech Republic ranks 23rd in growth of public healthcare spending in the last 10 years, such growth reflects similar scores among countries with lower baselines of public health spending.