Introduction

After a decade of reform efforts in the health care sector, the Czech Republic has experienced both successes and failures in its transition from a Soviet-imposed system of public financing and provision of care under a centralized command-and-control structure to a decentralized, market-driven system of compulsory health insurance and fee-for-service reimbursement. On the positive side, Czech health care reform has brought increased access to new medical technology, updated medical protocols and guidelines, and higher quality of care, all of which have translated to greater clinical efficacy, as indicated by the dramatic improvements in population health status measures such as male and female life expectancy, rate of infant mortality, and rate of premature death from cardiovascular disease ("Chaotic Growth Period...." 1997; Robbins, 1995). Reform has also elevated the voice and stature of consumers with respect to choice of providers and treatments. On the negative side, inefficiencies and misallocations of resources wrought in part from poor management practices and excess capacity in physicians and hospital beds--all legacies of the Soviet model-continue to plague the Czech health care system (Lewis, 1999; Massaro, Nemec, and Kalman, 1994; Scheffler, 1999; Uldrichov, 1996; Vyborna, 1995). These old problems, coupled with reform-based disincentives to control the volume and costs of services, have rendered the system vulnerable to rapid inflation. In this article, we provide a thumbnail sketch of the core elements of the reforms and the underpinning national policies as initiated in 1989, the major outcomes of these efforts to date, and the key challenges that lie ahead for Czech policymakers as they develop and implement further midcourse corrections in the financing and delivery of health care.

Full Article [PDF]