NCPA - National Center for Policy Analysis


May 28, 2008

Countries rich and poor struggle with how best to provide affordable health care to their citizens without breaking the bank.  In the beginning of 2008, the Czech Republic began imposing modest fees, $1.85 for a prescription as well as a doctor's visit, and twice that for a day in the hospital, for some health care services in an effort to improve the health care system. 

Thomas Julinek, the Czech health minister, says the government is trying to "take out some of the costs that people can pay for themselves from the health care system."  There is a cap on payments, set at just over $300 for the year, which Julinek said would also protect the seriously ill.

The fees are clearly having an effect on Czech behavior:

  • The Health Ministry said the number of prescriptions fell 40 percent in the first quarter, though some of that may have been a result of stockpiling at the end of last year.
  • The government estimated that public insurers had saved more than $100 million in the first quarter compared with the previous year, while providers collected $62 million in fees.

The region has been a laboratory of health care reform in recent years.  The effort has been led by free-market advocates from booming Slovakia, which sports a flat tax and scorching economic growth, at a rate of more than 10 percent last year.  However, health care reform has also led to rapid reversals in policy in several Central European countries:

  • In the Czech Republic, which began imposing the modest fees at the start of the year, the prime minister himself was forced before the constitutional court in Brno to testify as the court weighs overturning them. It is scheduled to rule on Wednesday.
  • Slovakia introduced modest payments for doctors' visits and hospital stays in 2003. However, the left-wing government that came to power in 2006 rolled them back later that year, within just a few months of taking office.
  • Low fees for certain health care services were also introduced in Hungary, but these were also eliminated.

Source: Milan Jaros, "$1.85 Fee to See a Doctor?  Some Say It's Too Much," The New York Times, May 27, 2008.

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