Czech Health Profile 2012

HEALTH & DEVELOPMENT

Czech Republic has achieved almost universal coverage of its population with mandatory health insurance.
Health insurance is the main source of public funding for the health sector. Participation in health insurance scheme is mandatory foreveryone who works in the Czech Republic. A large section of the population does not contribute but is nevertheless covered. Due to high unemployment rate, tax evasion, cost inflation, ageing, and low co-participation of patients, the universal coverage and the comprehensivebenefit package are difficult to sustain, resulting in continuous budget deficit. The government is attempting to introduce measures to increase efficiency benefit package and increase co-payments.

Sustainability of health care system. Since the beginning of 2003, a reform of public administration has been under way in the  Czech Republic. This reform consists of decentralizing the execution of public administration and transferring it to a regional level and of transferring a large volume of competencies to self-governing regions. Those changes have significant consequences for the provision and management of the health services and the public health services. Regions are responsible for health care provision. Role of the Ministry of Health could be strengthened, in the sense of the outputs of the Tallinn Ministerial Conference on Financial Sustainability of Health Care Systems.

Noncommunicable diseases are the leading causes of morbidity and mortality. The three most frequent causes of death - diseases of the circulatory system, neoplasms and external causes - consist 83% of all deaths. The most feared diseases are malignant neoplasms (MN), the second most frequent cause of death. The negative trend of increase in MN cases remains and with regard to certain types of MNs, the Czech Republic is a country with the highest incidence in the region. This increase is partly influenced by ageing of the population and by earlier and more accurate diagnostics but it is apparent that malignant neoplasms affect gradually more and more people. The most often diagnosed oncological disease for men is colorectal carcinoma, followed by MN of trachea, bronchus and lung and of prostate. The most frequent diagnosis for women is MN of breast. Selected screening programs of early detection were introduced in 2005.

Lifestyle related risk factors are prevalent, particularly smoking, unhealthy diet and insufficient physical activity. Although public health and disease prevention have featured high on the agenda of the health sector reform process, throughout the last decade less attention has been given to systematic efforts to address disease prevention and health promotion. The situation was improved but health promotion policy continued to be ineffective especially in its primary health care and also multi-sectoral context. Some progress was made in settings initiatives such as healthy schools and healthy cities. The Government adopted a long-term programme for improving the public health status of the Czech citizens based on the strategy – Health21 at a multi-sectoral approach. Smoking has decreased significantly over the last decade although the problem persists amongst the young and should be addressed as a priority of action.
Communicable disease incidence is very low. Compulsory vaccination programmes with high coverage and an effective alert and response system for outbreaks have kept most diseases under control. Exceptions in the latter group were tick-borne viral encephalitis and viral hepatitis, which both slightly increased although vaccination was offered. No significant changes we registered in respect to the numbers of reported cases of venereal diseases in spite of considerable migration of persons occurring. HIV/AIDS incidence is low compared to other EU countries and it remains stable. So is the status of reported incidences of tuberculoses in the Czech Republic (less then 10 per 100 000), however it should be noted that cased of mycobacterium tuberculosis have bee observed in special risk groups of the population – homeless, drug addicts, asylum seekers, ex-prisoners. Environmental health – Around two thirds of the Czech population live in areas with severe air pollution. Air and water pollution in areas of northwestern Bohemia and in northern Moravia were important health risk factors, but the situation is improving. With regard to nitrates, the designation of vulnerable zones is ongoing and the main sources of pollution from dangerous substances have been identified. Concerning protection of the natural environment, further efforts are needed to keep up with the foreseen timetable. Some progress has been made with regard to strengthening of the administrative, monitoring and enforcement capacity at the national and regional level.

OPPORTUNITIES

• Joining the EU in May 2004 has created new opportunities for strengthening public health services and scaling up investment in the health sector.
• The Czech economy has been growing as a result of higher foreign trade investment, industrial production and household spending.
• The Government adopted a long-term programme for improving the public health status of the Czech citizens based on the strategy – Health21.
• Abundant accessible health information which, if used effectively, can provide valid evidence for policy-making in various areas.
• Universal health insurance coverage provides the opportunity to deliver cost-effective, evidence-based interventions and address major public health challenges.
• Infant mortality decreased to the level 3,9 per mille in the year 2005 and the rate is one of the lowest at the world; high immunization coverage rates between 95% and 98% for all
(obligatory) immunization programmes.

CHALLENGES

• Precarious long-term financial sustainability of the health insurance system.
• Ageing population and related increases in resources needs for the health system.
• High expenditures on pharmaceuticals and health care service.
• Weak stewardship role of the MoH in policy development and sector regulation.
• Developing and implementing a comprehensive national policy and strategy.
• Health care reforms with a focus on health financing, quality of care and human resource development.
• Strengthening public health functions and capacity at the regional level