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Health Care

Public Health Insurance

The public health insurance system in the Czech Republic is based on three entities:

  • Insured person (the recipient of health care services)
  • Healthcare services provider (certified to provide healthcare services)
  • Health insurance company (an entity or institution, where the insured person is covered by health insurance)

Types of healthcare services

Outpatient Care

Outpatient care is health care when hospitalization or one-day-care institution admission is not necessary. It is provided by primary care physicians and various types of medical specialists. In case of illness or sickness the patient usually first sees a primary care physician, i.e. general practitioner (for adults), pediatricians (general practitioner for children and young), dentist or gynecologist. For this type of care, it is usually necessary for the person seeking care to have previously registered with that physician.

A doctor may refuse to accept a patient for treatment:

  • if accepting the patient would result in such a workload for the doctor so that he/she could not provide adequate care of the patient or other patients already in his/her care,
  • if the distance of the patient´s residence makes visiting to provide health services unfeasible
  • if the patient is not insured by a health insurance company with which the provider of medical services has a contract; this does not apply to persons with insurance who are insured in another member state of the European Union, a state that is a part of the European Economic Area or the Swiss Confederation, or persons from a country with which the Czech Republic has entered into a social security agreement, which includes within its scope a substantive right to healthcare.

In case of refusal, it is the right of an insured person to get a written confirmation of refusal. In the case of an emergency (i.e. an accident or sudden acute illness), no doctor can refuse to see a patient; however, after the emergency care the doctor can transfer the patient into the care of his/her attending physician. The patient can see a specialist without a primary health care physician referral. The following types of outpatient care are provided:

  • Primary Outpatient Care: to provide preventive, diagnostic, therapeutic and assessment care and consultations. It also includes the coordination of the continuity of healthcare services being provided by other providers (specialists, medical facilities). Primary outpatient care also includes any necessary home visits to a patient.
  • Specialized Outpatient Care: provided within particular health care specializations,
  • Stationary Care: to provide health care to those patients whose health condition requires repeated daily outpatient care provision.

Inpatient Care

If the illness requires, a primary care doctor or outpatient specialist can recommend the patient´s treatment in the inpatient care institution or can directly arrange it. There are the following types of inpatient health care facilities: acute standard, acute intensive, follow-up and long-term.

The Health Services Act defines inpatient care as healthcare which cannot be provided on an outpatient basis and which requires the patient to be hospitalized. Inpatient care must be provided in a medical facility with 24-hour operating hours.

There are following four types of provided inpatient care:

  • Acute Standard Inpatient Care: provided to a patient
    • with a sudden illness or the sudden deterioration of a chronic condition, which seriously threatens his/her health, but does not lead directly to a failure of vital bodily functions, or
    • for the purpose of performing medical procedures that cannot be done on an outpatient basis,
    • for the purpose of providing an early therapeutical physiotherapy,
  • Acute Intensive Inpatient Care{/b:} provided to the patient in case of a sudden bodily failure or a sudden threat to basic vital functions or in situations when these conditions can be reasonably expected,
  • Follow-Up Inpatient Care: provided to the patient who was given a basic diagnosis and whose health condition has been stabilized, a sudden illness or a sudden worsening of a chronic condition was dealt with, and whose health condition requires follow-up care or some type of physiotherapeutical care; then the patient who is partially or totally dependent on vital bodily function support,
  • Long-Term Inpatient Care: provided to the patient whose health condition cannot be significantly improved by medical treatment and without a continuous provision of some type of nursing care is worsening; then to the patient with impaired basic bodily functions.

Medical Rescue Service and Emergency Service

The Medical Rescue Service is used in case of a sudden severe illness or accident when the patient can not see a physician by himself/herself and when the immediate care has to be received in a place of an accident or during his/her transport to the medical facility to avoid any other health condition worsening or threating of his/her life.

Emergency phone numbers free of charge:

  • 155 - a nationwide emergency call number to solve medical problems
  • 112 - the pan-European emergency call number to get a help in emergency situation involving large number of injured persons and to activate an integrated rescue services system (the police, Medical Rescue Service and fire brigades).

Health services covered by health insurance can be used also in a less severe sudden illness, including injury, a dental problem outside of normal working hours and in the absence of an attending physician, depending on local arrangements - doctors either cover for one another or the care is provided in special offices of the emergency medical services or dental emergency services.

These emergency services are usually provided also by inpatient medical care service providers (i.e. hospitals).

More information can be obtained from the Department of Health of the local Regional Authorities or from the dispatching department of Medical Rescue Service.

Occupational and Work Related Medical Services

These are preventive healthcare services which evaluate the influence of working activity, working environment and working conditions on the health and they include preventive examinations and health condition assessments. They are aimed at assessing the patient's eligibility to work, to provide consulting on occupational health and safety issues, occupationally-related diseases and work-related illnesses, at arranging first aid training and regular supervision of workplaces and working or service performance. These services are covered by the employer.

Dispensary Care

The aim is active and long-term monitoring of health condition of the patient threatened or suffering from an illness or a state of health deterioration in which the illness development and early diagnosis of the health condition change can affect another treatment and further illness development.

Spa and Health Resort Physiotherapeutical Care

It can become a necessary part of the therapeutical process. It is recommended by the patient´s attending physician and comfirmed by a supervising physician. The prescription for this type of care is submitted by the patient´s general practitioner or attending physician when the patient is hospitalized.

Providing of Medicines and Medical Devices

There is an extensive network of pharmaceutical dispensing facilities (pharmacies) in the Czech Republic, which provide the distribution of drugs, medicinal products and medical devices, both based on a doctor-provided prescription and without it (i.e. an over-the-counter sale).

Validity of a medical prescription:

  • 1 day following the issue date if issued by emergency department,
  • 5 days if antibiotics and antimicrobial chemotherapeutics are prescribed,
  • 14 days for any other type of a prescription unless not specified in other way by a prescribing person

Preventive Care

A primary care physician performs preventive check-ups and vaccinations against infectious diseases.

Health Care Covered by Public Health Insurance

Health care services are mostly provided on compulsory public health insurance in the Czech Republic. In case of employed people, the employer pays for the health insurance at the rate of 13.5% of the calculated base income (of which one third is paid by the employee and two thirds by the employer). In certain cases, the insurance premiums are paid for by the state (dependent children, retired people, etc.). A foreign person participates in the public health insurance program if he/she has a permanent resident status in the Czech Republic. If not, then if working as an employee of an employer with a registered address or a permanent resident status in the Czech Republic. Then he/she obtains the same rights to receive health care services covered by public health insurance (hereinafter as "covered healthcare services") as any other insured person.

It concerns:

  1. preventive, dispensary, diagnostic, therapeutic, physiotherapeutical, spa physiotherapeutical care, including examinations, nursing and palliative care (care for the dying which should provide the treatment and care adequate to the health condition which will not burden the patient and will allow him/her to live with quality and dignity until the end of his/her life), care for the donors of blood, tissues and cells or organs in relation to their removal – pursuant to its provision of the Health Services Act,
  2. provision of medicinal products, foods for special medical needs, medical devices and dental products,
  3. transportation of the insured people and reimbursement of travel expenses,
  4. blood taking and tissue, cell and organ taking for transplantation purposes and any necessary handling (preservation, storage, processing and testing),
  5. transportation of a living donor to and from the place of removal and the providing of healthcare related to the collection and reimbursement of travel costs,
  6. transport of a deceased donor to and from the place of removal,
  7. transportation of removed samples of tissues, cells and organs,
  8. the examination and autopsy of a deceased insured person - including transportation,
  9. the stay of a person accompanying an insured person to a medical facility for inpatient care,
  10. health care related to pregnancy and the birth of a child where the mother has asked for confidentiality in connection with the childbirth; this care is covered by health insurance, where payment is requested by the provider based on the identification of the insured person.

Covered health care services are provided by medical professionals and other medical specialists on the basis of their specialized medical qualifications.

Covered health care services are provided in health care provider facilities and they are paid for by the health insurance company on the basis of a contract between the provider of the healthcare services and the health insurance company of the insured person.

This does not apply to pharmacies because the insured person can pick up the prescription at any pharmacy, irrespective of the pharmacy’s contract with the respective health insurance company. However, the prescription must usually be issued a doctor who has a contract with the health insurance company through which the patient is insured.

Only on an exceptional basis, covered health care services can be provided in a different location or through a facility that does not have a contract with the insured person's health insurance company.

The patients is asked to make a co-payment towards the cost of certain drugs. Drugs are categorized into groups, where at least one drug in each group must be fully covered by health insurance (i.e. the drug has no co-pay required).

During hospitalization, an insured person does not pay any of the cost for medicines or medical devices. These costs are fully covered by the health insurance company.

Source: http://www.mzcr.cz

This project has been funded with support from the European Union. The author exclusively is responsible for the publication content. The publication does not reflect the views of the European Commission and the European Commission is not responsible for usage of the data contained therein.

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