Health Care in the CR
29. 6. 2012 | Source: BusinessInfo.cz
The public health insurance system of the Czech Republic is based on three interconnected pillars – insured person (person insured under the Act on public health insurance) – health care facility (authorized to provide health care) – health insurer (institution with which the insured person is insured). Health care is largely provided on the territory of the Czech Republic on the basis of compulsory health insurance.
- Participation of Foreign Nationals in Health Insurance
- Travel Insurance and Insurance Contract
- Health Insurers
- Covered Health Care
Participation of Foreign Nationals in Health Insurance
Foreign nationals participate in public health insurance when they have permanent residence in the Czech Republic and, if it is not the case, when they are employed by an employer with registered office or permanent residence in the Czech Republic.
In some cases the state pays the insurance contributions (for example, for children without means of subsistence up to the age of 26, old-age pensioners). Concerning employment, the employer pays in health insurance contributions 13.5 % of the employee’s gross wage and the employee contributes one third of this, that is 4.5 %. Those who do not satisfy the conditions for participation in public health insurance and have no arrangement for reimbursement of medical expenses must obtain travel insurance.
Categories of Foreign Nationals
There are special categories of persons regarded by law as foreign nationals with a permanent residence permit:
- foreign national with a long-term residence permit for scientific research is considered for the purposes of reimbursement of health care a foreign national with a permanent residence permit;
- person enjoying subsidiary protection for the purposes of the provision of health care and employment is regarded as a person with permanent residence on the territory of the Czech Republic;
- an asylee has permanent residence on the territory of the Czech Republic for the period of validity of the decision on asylum;
- foreign nationals enjoying subsidiary protection are considered, for the purposes of the provision of health, foreign nationals with a permanent residence permit;
- foreign nationals born on the territory of the Czech Republic whose legal guardian resides on the territory of the Czech Republic on the basis of a permanent residence permit. The legal guardian is obliged to apply to the police within 60 days of the birth on behalf of the newborn foreign national for a permanent residence permit. If the application has been filed, the residence of the newborn foreign national is considered permanent residence from the moment of birth to the time when the decision on the application comes into force;
- persons seeking international protection and their child born on the territory of the Czech Republic and foreign nationals granted a tolerated stay visa and their child born on the territory. These persons are provided free health care within the scope of the care reimbursed from health insurance under Act 48/1997 Coll., and health care in connection with a compulsory quarantine or another measure related to the protection of public health; this does not apply if health care is assured according to Act 326/1999 Coll. on the stay of foreign nationals on the territory of the Czech Republic, as amended;
- foreign nationals who have been granted permission to reside in the Czech Republic to be provided temporary protection (Act 221/2003 Coll.), if they have no income from employment or self-employment.
Participation in the public health insurance system terminates on the day of:
- termination of permanent residence on the territory of the Czech Republic,
- death of the insured person or his/her being declared dead,
- termination of employment in the Czech Republic (persons without permanent residence in the Czech Republic).
Travel Insurance and Insurance Contract
Foreign nationals are obliged to supply proof of their ability to pay medical expenses. This obligation can be fulfilled by a foreign national with travel insurance, if health care is not covered under an international agreement or by public health insurance or if the foreign national proves that health care is paid by other means.
Proof of Insurance
If a foreign national comes to the Czech Republic to take up an employment, this condition is satisfied on the day when he or she becomes an employee of an employer with registered office or permanent residence in the Czech Republic. Under other circumstances one must have travel insurance or supply proof that the payment of medical expenses is assured in another way.
Staying on the territory of the Czech Republic without insurance is a violation of Czech law and the person doing so faces prosecution. If he or she then needs health care, payment is demanded in cash, which in case of health care exceeding the extent of necessary and urgent health care can reach rather high amounts.
No need to proof
Proof of travel health insurance is not demanded from foreign nationals from Cuba, Yemen, Libya, Morocco. Necessary and urgent health care is reimbursed to nationals of these states from the state budget under a bilateral agreement. Proof of travel health insurance is not demanded from foreign nationals from countries, with which the Czech Republic has concluded a social security agreement (Montenegro, Croatia, Macedonia, Serbia, Turkey and Bosnia and Herzegovina).
Foreign nationals without permanent residence in the Czech Republic who are not employed in the Czech Republic cannot participate in public health insurance and in most cases must have travel health insurance cover, which is independent of public health insurance and is based on a contract between the insured person and an insurer. This insurance is not administered by health insurance companies but by insurance companies under Act 277/2009 Coll., on insurance. Unlike public health insurance, non-payment of contributions invalidates one’s entitlement to reimbursement of medical expenses.
Travel health insurance means assurance of payment of treatment costs in connection with an accident or an acute illness on the territory of the Czech Republic, including costs of transport of the sick to a country whose travel documents he or she holds, or to another country in which he or she has permitted residence, up to EUR 30,000 during the stay on the territory.
The amount of the insurance payout depends on the specific terms of the insurance contract. One should pay close attention to the terms when negotiating an insurance contract, as follows:
- insurance coverage does not usually apply to the treatment of a disease contracted before the insurance contract was signed;
- a limit is usually set for the insurance cover, over which medical expenses are not paid;
- this scope of health care covered by the insurance contract is limited (dental care is often excluded, for example)
Delivering a Baby
It is necessary to buy travel health insurance for a child born in the Czech Republic to a foreign national without permanent residence. The contract can be usually concluded after the child’s birth and no insurance payout can be demanded in arrears from the date of birth. In anticipation of such cases some insurers offer products applicable to pregnant mothers and to health care provided to the child in the first days after birth.
A child born to parents who are foreign nationals and participants in public health insurance merely through employment is not a participant in public health insurance, and it is therefore necessary for him or her to contract travel insurance. It is recommended to a pregnant mother in this case to conclude an insurance contract that covers health care provided to the child in the first days after birth.
If a foreign national is a participant in public health insurance, he/she has the same entitlement to health care reimbursed from public health insurance as other insured persons. He/she must register at one of the health insurers listed below. Health insurers are obliged to accept as an insured person every person satisfying the conditions for participation in public health insurance with permanent residence or employment in the Czech Republic.
The largest health insurer is Všeobecná zdravotní pojišťovna ČR (VZP ČR).
Codes and Names of Insurers
- 111 Všeobecná zdravétní pojišťovna ČR (VZP ČR)
- 201 Vojenská zdravotní pojišťovna (VoZP ČR),
- 205 Česká průmyslová zdravotní pojišťovna (ČPZP),
- 207 Oborová zdravotní pojišťovna zaměstnanců bank, pojišťoven a stavebnictví (OZP),
- 209 Zaměstnanecká pojišťovna Škoda (ZPŠ),
- 211 Zdravotní pojišťovna ministerstva vnitra ČR (ZPMV ČR),
- 213 Revírní bratrská pokladna, zdravotní pojišťovna (RBP),
- 217 Zdravotní pojišťovna METAL–ALIANCE (ZPM-A),
- 228 Zdravotní pojišťovna MÉDIA (ZPM).
Covered Health Care
Health care provided on the basis of public health insurance and reimbursed from this insurance covers:
- outpatient care
- institutional (inpatient) care
- emergency and ambulance services
- industrial health care
- dispensary care
- balneological care, care in specialized children’s hospitals and sanatoria
- supply of medicaments, medical supplies (e.g. hearing aids, bandages)
- preventive care
- transport of the sick, reimbursement of travel expenses
- forensic examination and post-mortem
Health care is provided in health care facilities. If a situation so requires, it may be provided elsewhere. Health care is provided by health personnel within the scope of their qualification. The essential condition for the provision of reimbursed health care is that it must be provided in a health care facility which has a contract with the patient’s insurer. If essential and urgent health care is needed, it may be provided in exceptional circumstances by a health care facility which does not have a contract with the patient’s insurer.
An exception to this rule is a pharmacy because an insured person can ask for a medicament at any pharmacy regardless of the existence of its contract with the insured person’s insurer. A prescription must be issued, however, in case of other than urgent health care by a physician who has a contract with the insured person’s insurer. Within the public health insurance system, health care is reimbursed by the insurer on the basis of its contract with the health care facility.
There are many procedures which insured persons co-finance. These are procedures or medical devices provided outside the legal framework. Some cases in point are dental procedures, some balneological care and some medicaments. Some medicaments are reimbursed in full by insurance companies whereas some are co-financed by the patients. In every category of medicaments there must be at least one reimbursed in full by an insurer. Costs of medicaments and medical devices during hospitalization are reimbursed in full by the insurer and the insured person does not pay directly.
Some health care to which public health insurance does not apply and which patients must pay directly is defined by law. Some examples of this are:
- plastic surgery for aesthetic reasons at patient’s request
- selected dental procedures
Outpatient care is provided by primary care physicians or specialists. If a person is taken ill, they usually contact a primary care physician working near their home. These are general practitioners for adults, general practitioners for children and young people, dentists and gynaecologists.
When choosing a physician, one should bear in mind that he/she can only register with a physician who has concluded a contract with his/her insurance company.
If health care is to be reimbursed from public health insurance, the insured must first register with a primary care physician (the local basic health care provider). A physician may only refuse to register an insured person if the registration brought to the physician so much work that it would not permit provision of quality care to the patient or other patients in the physician’s care.
A physician cannot refuse treatment in the case of essential and urgent care (accident or sudden acute illness). After the treatment the patient is referred to his or her family physician. If refused, an insured person has a right to have the refusal confirmed by the physician in writing.
A patient can visit a specialist physician in the Czech Republic without a referral from the primary care physician.
Institutional (inpatient) care
If the nature of an illness demands this, a primary care physician or outpatient specialist can refer a patient for hospital treatment or arrange for their admittance. Inpatient care is provided in hospitals and specialized institutions, such as psychiatric hospitals and rehabilitation centres, hospices, sanatoria, long-term care hospitals.
Ambulance and emergency rescue service
Emergency rescue service is available to deal with cases of acute illness or accident when a patient cannot get to a physician and immediate treatment is needed and transport of the patient to a health care facility under permanent care to prevent further aggravation of their health conditions or threat to the life. It can be called on the national emergency number 155. Number 155 can only be used to call for assistance with health problems, whereas the single European emergency number 112 is intended to call help when more people are affected and to activate the integrated rescue system whose core elements are the police, ambulance service, and the fire brigade. Both numbers can be dialled free of charge.
Provision of health care is assured in the event of a less serious acute illness or accident outside physician’s hours or in the absence of the attending physician. This functions according to local conditions: it is usually collaboration of physicians who stand in for one another, or are emergency services in special consulting centres or in hospital emergency departments. Emergency services are also available for acute dental complaints. Insured person can address information to the health department of the regional council and centre of medical emergency services.
Industrial health care
Industrial health care aims to protect employees’ health and to prevent, in cooperation with the employer, occupational diseases and other damage to health, which includes prevention of accidents. Industrial health care staff counsel employees in matters involving protection and promotion of health. They regularly inspect workplaces, determine the effects of work and working conditions on employees’ health, and perform preventive health examinations of employees (incoming, ongoing, outgoing).
It is the provision of consistent specialist patient care.
Balneological care can be regarded as an essential part of the curative process. It is recommended by one’s attending physician and confirmed by a reviewing physician. Entitlement to balneological care is claimed on a pre-printed form by the registering general physician or attending physician in case of hospitalization.
Dispensing medicaments and medical devices
In the Czech Republic, there is an extensive network of pharmacies dispensing medicaments and medical devices, both on prescription and over the counter.
Validity of prescriptions:
- a prescription from an emergency service is valid for one day after its issue,
- a prescription for antibiotics and antimicrobial chemotherapeutics is valid for 5 days,
- other prescriptions are valid for 14 days unless the prescribing physician decides otherwise.
Preventive examinations and vaccination against infectious diseases are performed by primary care physicians.
The document was prepared on the basis of information provided by the Ministry of Health.