Changes to the Public Health Insurance Act

The Chamber of Deputies has successfully passed an important amendment to the Public Health Insurance Act, introducing a wide range of changes across various areas. Some of the proposals sparked controversy, with several ultimately being rejected by lawmakers.

The most discussed topic was the “patient choice” proposal, intended to allow patients to pay the difference between standard reimbursed care and the above standard variant of care. For instance, when undergoing an examination, a patient could choose a more advanced MD and only pay the price difference compared to the basic MD covered by insurance. However, after debate, the proposal was rejected. Concerns were raised mainly about the unclear distinction between what qualifies as standard care and what is already above standard, as well as fears that co-payments could lead to inequality in access to care.

MPs also turned down the proposal for insurance companies to reimburse hospitals based on real tendered prices of medicines instead of their maximum prices. Critics argued that such a change would weaken hospitals’ motivation to negotiate more effectively. Indeed, the introduction of a system whereby hospitals could keep the difference between the maximum price and the tendered price had in the past led to hospitals trying to tender the prices of medicines efficiently.

On the other hand, the amendment introduces HTA assessments for vaccines to better evaluate their efficacy and costs. The continuation of funding for children’s health institutions, enhanced rights for former soldiers in choosing insurers, and new rules on insurers’ financial management was also approved.

One proposal, requiring pregnancy tests to feature information about support for women with unexpected pregnancies, triggered strong criticism and was eventually withdrawn. Similarly, proposals to cover midwife services or increase transparency in subsidiary companies of insurers did not gain sufficient support. Another defeated proposal was to maintain tenders for providing outpatient healthcare, which was rejected by a tied vote of 84 to 84.

From a systemic perspective, the approved changes bring greater transparency. Upholding equal access to care and promoting efficient insurance spending remain key to long-term sustainability. Yet, the rejection of the “patient choice” model highlights the Parliament’s continued caution around healthcare financing reforms.

Author: Alžběta Frýdlová