Czech medical care fees toughest in Europe

Petr Holub
16. 4. 2008 17:00
Czech medicare combines two common EU approaches
Foto: Ondřej Besperát

Praha - The Czech medical fees are not very high compared with the rest of Europe. The usual fee in developed countries is EUR 10, i.e. CZK 50 with regards to the average wages. 

However, Czechs have to pay much more often. In Germany for instance, it is sufficient to pay EUR 10 one in every three months when visiting an outpatient doctor. Then, patients pay no more when visiting the same doctor again or another doctor with the outpatient doctor's recommendation.

In Sweden, patients have the certainty of not paying more than EUR 90 a year for outpatient clinic services. Austria has a similar system.

Czechs pay CZK 30, i.e. slightly less than in other countries. However, they pay for each visit even when visiting the same doctor in a week or if the practitioner sends them to a specialist. 

In all of Europe, children under 18 years of age generally do not pay the fees; in Sweden it is under 20. In the Czech Republic, everybody has to pay.

In hospitals, Europeans also pay EUR 10 a day but for 30 days a year at most. In the Czech Republic, the CZK 60/day fee is not temporarily limited.

The Swedish, German or Austrian system is more logical: the fees should only deter from unnecessary visits. Their purpose is not to increase citizens' participation as these pay insurance premiums anyway.

Within this decade, also Slovaks and Hungarians implemented a similarly tough system. But the Hungarians did not collect fees from children. Both countries have already cancelled the fees, Hungary at the beginning of April.

Dissatisfaction with the state

The whole Czech payment system is unique.

Each European country has a different approach but each sticks to several principles. In case of public health systems, patients pay nothing for seeing a doctor. However, some medical services are not covered by the state, e.g. dental or ophthalmological in Italy and Spain. In Britain, people pay extra money for these services.

People pay a lot of extra money for cheap drugs, Italians sometimes pay the whole price.

Public systems usually strictly regulate the service offer. Italians, Spaniards, Britons, Irishmen and Poles therefore often use and pay to private doctors and clinics to avoid long waiting lines.

Those using public systems are the least satisfied.

Popular insurance companies

In Austria and Germany, doctors are paid by public insurance companies and medical care is much more available. These countries use the fees to deter people from abusing the wide offer. The same applies for Sweden and other Scandinavian countries.

France and Belgium are unique examples of a system of state-owned public insurance companies. People in these countries pay directly to doctors or druggists and then get the money from their insurance companies. However, they generally do not receive the whole price and therefore most people have some extra insurance.

People are usually satisfied with this system, according to Eurobarometr.

No fees at private insurers

Two countries only (Holland and Switzerland) use private insurance companies. These can offer services for various insurance rates. As each insurance plan limits the service offer in some way, fees are usually not collected. 

Julínek´s health reform seems be tough especially for pensioners
Julínek´s health reform seems be tough especially for pensioners | Foto: Ludvík Hradilek

There are practically no fees in Holland, in Switzerland patients pay for hospitals stays but the total sum is limited. For example, the limit at some insurance companies is EUR 200 a year.

The private insurance companies' basic premium does not cover dental and some other services. However, their clients generally have extra insurance.

Double regulation in East

The Czech reform combines both approaches.

Fees reduce the demand for medical services as in Germany or Sweden. The other phase of the reform, however, follows the Dutch model and implements private insurance companies. 

It is clear from the reform drafts that insurance companies plans will regulate the offer of medical services. A mechanism incorporated in the drafts allows whole medical branches to be deleted from the offer.

Slovakia and Hungary chose a similar way but the reformers failed. The Slovaks are now strengthening the position of two public insurance companies and head for the system that exists in Poland or Spain.

The failure of the Hungarian fees cast a doubt on the plan for the division and privatisation of the only public insurance company. 


See comparison of doctor´s visitation fees in some of EU countries:

o Italy
The health system is financed by the state. Patients have to follow the instructions of family doctors. In addition, patients can visit private doctors where the entry fee is EUR 12 and common charges range from EUR 40 to160. Hospital stays are free, luxurious rooms are available for extra EUR 60 to 75/day. Additional drug fees range from 10 to 100 % depending on efficiency and price.

o Spain
The health system is financed by the state. Dental and ophthalmological services are not defrayed by the state. Patients have to follow the instructions of family doctors. Hospital stays are free, patients defray 40 % of the cost of cheaper drugs. 20 % of Spaniards prefer private insurance with a limited contractual network of doctors and hospitals. If they want to be examined somewhere else, they defray 20 % of the price.

o Great Britain
The health system is financed by the state. Only some drugs are partially defrayed by patients. Dental and ophthalmological services are also defrayed by patients. The well-of pay private insurance premiums so that they do not have to wait for surgeries and specialist's examinations.

o Poland
The health system is financed by the state. Dental care not covered by insurance. Hospital stay is provided for free, ZL 3.20 (approx. CZK 23) is paid per recipe. One tenth of Poles pay private insurance premiums so that they do not have to wait for surgeries and specialist's examinations.

o Sweden
The health system is financed by the state. Patients have to follow the recommendations  of family doctors or general practitioners (approx. EUR 10 per visit, annual limit EUR 90), visiting a specialist without a recommendations costs EUR 25. Drugs up to EUR 10 are fully defrayed, limit is EUR 50, a hospital stay costs approx. EUR 8 a day.

o Austria
The health system is financed by public insurance companies. Visiting a doctor costs EUR 3.60 with a three-month limit. A hospital stay costs about EUR 10 a day, one prescription item costs EUR 4.70.

o Germany
The health system is financed by public insurance companies. Visiting a doctor costs EUR 10, paying once in three months is sufficient. Visiting a specialist costs EUR 10 provided the patient has no recommendation. Patients defray EUR 5 to 10 of the cost of drugs. As for the hospital stay, EUR 10 is paid per one day, maximum is 28 days a year.

o France
The health system is financed by public insurance companies. Visiting a doctor is paid directly, usually EUR 25 to 30, insurance companies return up to 70 % of the sum. The same percentage applies for dental care and a slightly lower one for labs. Additional drug fees range from 0 to 100 % depending on efficiency and price. 80 % of the sum paid for a hospital stay is returned, a stay exceeding one month is free. 85 % of French are privately insured against fees.

o Holland
The health system is financed by private insurance companies. They can offer various insurance rates. They also offer supplementary insurance covering dental care, logopaedics and rehabilitation. These services are not covered by the basic insurance. Clients have to visit specialists and hospitals with family doctors' recommendations. However, they can do so even without a recommendation but then they have to pay directly and later ask their insurance company for the money. 

o Hungary
The health system is financed by the state. By the end of March, visiting a doctor had cost FT 600  (CZK 60), visiting a specialist with a practitioner's recommendation FT 300 only, visiting an outpatient clinic FT 1,000. A hospital stay had cost FT 300 a day if the patient had no practitioner's recommendation. Without a recommendation, the stay had cost FT 800 a day. A 20-day stay was paid at most. The fees were cancelled by a plebiscite. 

o Czech Republic
The health system is financed by public insurance companies. Visiting a doctor costs CZK 30, visiting an outpatient clinic CZK 90. Annual maximum is CZK 5,000, some drug fees are included in this sum. One prescription item costs CZK 30, a day in hospital CZK 60.



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