Faculty of Social Sciences, Charles University.
Institute of Economic Studies, Faculty of Social Sciences, Charles University.
Health Syst Transit. 2023 Mar;25(1):1-216.
This analysis of the Czech health system reviews developments in governance, organization, financing and delivery of care, health reforms and health system performance. Czechs have enjoyed a statutory health insurance system with a high level of financial protection, a broad benefits package and universal membership for over 30 years. The central level of the state, mostly represented through the Ministry of Health and its subordinated bodies, takes on the various roles of legislator, steward and even owner of various providers of care, while also making insurance contributions for the sizeable part of the population classified as economically inactive. Health insurance funds are responsible for contracting sufficient care provision for their members. The Czech health system has traditionally derived a majority of its financing from public sources, which stood at 81.5% of current health expenditure in 2019, as the latest available year of reference, with the rest coming from private sources. While health spending in Czechia is below the European Union (EU) average, the densities of acute care beds and primary care physicians are above respective EU averages. Ageing and a lack of qualified staff (for example, nurses in hospitals) are already putting pressure on the Czech health workforce, a bottleneck further exposed by the COVID-19 pandemic. Additionally, Czechia has embarked on a reform process to modernize and centralize specialized tertiary care and psychiatric care. Patients enjoy free choice of primary and specialized outpatient providers, though there are signs that accessibility is limited in some regions and for some specialties. Overall, health outcomes in terms of life expectancy, mortality and survival rates of stroke and cancer have improved in recent years, though these improvements have been slower in Czechia than in other countries. However, life expectancy dropped considerably due to heightened mortality resulting from the COVID-19 pandemic in 2020 and 2021. There remains considerable room for improvement in strengthening disease prevention and health promotion, particularly for dietary habits and health literacy. Various efforts to advance evidence-based interventions in the health system, such as the initiation of health care quality monitoring and health system performance assessment, will assist in further analysing Czechia's health outcomes.
本文分析了捷克的医疗体系，对其治理、组织、筹资和医疗服务提供，以及医疗改革和体系绩效等方面的发展情况进行了综述。捷克实行法定医疗保险制度已有 30 多年，参保人员覆盖面广，保险水平高，保障全面。国家的中央层面，主要通过卫生部及其下属机构，承担着立法者、管理者，甚至是各类医疗服务提供者所有者的各种角色，同时也为大部分被归类为非经济活动人口的人缴纳保险费。医疗保险基金负责为其成员提供足够的医疗服务。捷克医疗体系的资金传统上主要来源于公共资金，在可获得的最新参考年 2019 年，公共资金占当前卫生支出的 81.5%，其余来自私人资金。虽然捷克的卫生支出低于欧盟（EU）平均水平，但急症护理床位和初级保健医生的密度高于欧盟平均水平。人口老龄化和合格员工（例如医院护士）的短缺已经对捷克医疗体系的劳动力造成压力，而新冠疫情则进一步暴露了这一瓶颈。此外，捷克已经启动了一项改革进程，以实现专门的三级护理和精神科护理的现代化和集中化。患者可以自由选择初级和专科门诊服务提供者，但有迹象表明，在一些地区和一些专科领域，服务的可及性有限。总的来说，近年来，捷克在预期寿命、死亡率和中风及癌症存活率等方面的健康结果有所改善，尽管这些改善速度比其他国家慢。然而，2020 年和 2021 年由于新冠疫情导致死亡率上升，预期寿命大幅下降。在加强疾病预防和促进健康方面，特别是在饮食习惯和健康素养方面，仍有很大的改进空间。为了在医疗体系中推进循证干预措施，已经采取了各种努力，例如启动医疗保健质量监测和医疗体系绩效评估，这将有助于进一步分析捷克的健康结果。
