Health system and governance

Political Will

The Czech Republic is ranked 18th (a low performance) based on the assessment of political will. This is based on indicators of spending in the healthcare sector, and institutional development. The country is ranked 12th based on a metric of magnitude and growth of health expenditure (out of total government expenditure) in the past 10 years. It is ranked 16th based on the change of out-of-pocket health expenditure (out of current health expenditure) in the past 10 years. The Covid-19 emergency creates new funding priorities. “There is a national plan for renewal, but healthcare is only about 11 percent of this plan. So there are not enough funds in healthcare,” notes Dr Prausová. “However, it is also about using the money that we have meaningfully.”

As cancer treatments become more sophisticated, it is expected that investment should continue to grow. Professor Bartunkova notes: “What I can see from the hospital budget is that the expenses for oncology care are increasing substantially in the past years. Especially as a result of the introduction of new treatments such as checkpoint inhibitors, other monoclonal antibodies, CAR-T; one treatment is worth several million crowns.” Dr Dolezal highlights the value of better cancer planning: “As there is no mid-term plan for investment in cancer care, we don’t know what the budget for cancer is, even for next year.”

Based on data from WHO, the country achieves 76% of universal coverage of essential health services (ranked 16th). Professor Bartunkova notes:  “Generally, healthcare in the Czech Republic is at a very good level; access to healthcare is good, the majority of healthcare is free of charge. Of course, we pay taxes, but it is free [at point of use]. It is comparable to France, Italy, etc.”

An indication of institutional development, there is a Health Technology Assessment (HTA) mechanism independent from payers and providers. However, assessment is limited only to outpatient medicines. Medicines for hospital use and medical devices, for example, are not included in the HTA process by the State Institute for Drug Control (SUKL). Dr Dolezal notes: “we have an HTA process for new drugs but not for other technologies. This is a long-term weakness”

Infrastructure

Infrastructure is a strong area for the Czech Republic as it’s ranked 2nd out of the 29 countries, just below Germany. It is first globally based on surgeons per 1,000 population (0.80) and 9th on density of skilled health professionals (physicians, nurses and midwives); 121 per 10,000 population. Professor Bartunkova sees cancer centres as one area of success: “the most important achievement is the establishment of about 10 Complex Oncology Centres (COCs) in the country with a population of 10 million inhabitants, which is enough in terms of density of treatment facilities for a country of this size.” Dr Prausová notes: “we are very good  in our organisation of oncological care. We have several regional and two national centres. The national centres specialise in more atypical cancer diagnoses, or in paediatric oncological diseases.”

Dr Dolezal stresses the need for greater coordination across care levels: “the focus is on top-level specialised cancer care, and this seems to be fine; but top-level specialists are taking care of a portion of the patients, the rest of the patients are in different outpatient clinics, in primary care, and so on.” Dr Prausová notes the state of facilities is not always the best. “Prague hospitals are not in a good state of repair and new buildings are not being built here for some reason.”

Intersectoral Action and Governance

 There are national policies for health that address at least two priority determinants of health and the Czech Republic is ranked 11th in the intersectoral action and governance indicator. Although there is no national framework for intersectoral cooperation on health, there are programmes for ministerial collaboration addressing disease prevention.[1] For instance, the Czech Ministry of Healthcare and the Ministry of Education have a collaborative programme addressing lifestyles of children and adolescents, specifically lack of physical activity.  The programme is designed to educate children and teenagers on how to adapt their lifestyles so as to prevent obesity and diseases stemming from it.[2] The Ministry of Healthcare has also collaborated with the Ministry of Education on other projects, such as a series of seminars on obesity among children and adolescents, and healthy eating habits.[3]

A measure of government effectiveness, the country is ranked 13th for control of corruption based on public perceptions. Even though the country is in the top half of the global scale, performance is one of the weakest among high-income countries included. Transparency and accountability are important factors needed to undertake effective health reforms that benefit patients ultimately.

Notes:

[1] Alexa J et al.,Czech Republic: Health system review. Health Systems in Transition, 2015; 17(1): 1–165. Available from: https://www.euro.who.int/__data/assets/pdf_file/0005/280706/Czech-HiT.pdf

[2] Ministry of Education, The Ministries of Health and Education Want to Make Children Move (Ministerstva školství a zdravotnictví chtějí rozhýbat děti). Available from: https://www.msmt.cz/ministerstvo/novinar/rezorty-zdravotnictvi-a-skolstvi-chteji-spolecne-rozhybat

[3] Ministry of Education, The Ministry of Education Wants to Intensify the Trend of Healthy Eating Among Schoolchildren (Ministerstvo školství chce zintezivnit trend zdravého stravování školáků), 2012. Available from: https://www.msmt.cz/ministerstvo/novinar/ministerstvo-skolstvi-chce-zintenzivnit-trend-zdraveho