Policy responses for Czech Republic - HSRM

Czech Republic

Policy responses for Czech Republic

4.2 Entitlement and coverage

All healthcare costs regarding testing (if recommended, see below), treatment, transport etc. of COVID-19 patients are paid by the statutory health insurance (SHI). Universal coverage is based on citizenship and permanent residence, including prisoners, asylum seekers, etc., and is not a condition of paying SHI contributions.

Tests for COVID-19 are covered by SHI only if recommended by a physician (general practitioners, paediatricians, pneumologists or attending physicians in hospitals) or by the public health authority (for recommendation details, see section 1.5 and 1.3). The Compensation Reimbursement Directive introduced special reimbursements for hospitals and outpatient facilities for running sample collection points and taking the samples.   

Private testing for other individuals has been allowed since the second week of March, however people must pay out-of-pocket. Private tests may be requested in some private laboratories and their prices differed (between 1 000 – 3 000 CZK; EUR 37-111).  Since May 15, the maximum price for a PCR test had been regulated at CZK 1756, but starting on January 1, 2021, the maximum PCR test price (including the sample taking) was decreased to CZK 1309 for private testing and to CZK 1276 when covered by SHI funds (MoH directive No. 563/2020, Coll.). Since December 16, 2020, people can also get voluntarily tested (i.e. without the necessity of getting a GP’s or public health officer’s referral) using antigen testing every five days (later shortened to every 3 days) and it is covered by SHI funds and the price (including sample taking) is regulated at a maximum of CZK 352 [13]. 
In spring, the HIFs widened benefit entitlements and providers’ reimbursements to include telemedicine (phone calls) for most outpatient specialists, including the GPs, who were newly able to claim these procedures without further conditions. For example, even dentists could perform telemedicine consultations with their patients with add-on reimbursement 55 CZK (2 EUR) [7]. Most of these reimbursement measures were temporary and were withdrawn by June 30 [12]. In the beginning of September, health insurers introduced new code for GPs’ phone consultations to avoid unclarity in spring phone consultation coding. The new code is activated by health insurers only in “crises” times as temporary measure; it has been activated on September 1.

In spring, an Extraordinary Measure of the Ministry of Health ordered the hospitals to free up beds and make health workers available for COVID-19 treatment, as part of the effort to increase capacity. This changed the structure of beds, which was contracted by the HIFs. The HIFs officially accepted such changes as “contracted capacity”, otherwise providers would face a penalty clause [8]; this measure was called off by June 3 [12].

VZP, the largest HIF with a 60% market share, offered monthly advance payment of 50 000 CZK (1 850 EUR) to its contracted dentists who continued to provide services and operate at least 17 hours per week during the state of emergency. VZP also increased the reimbursement for dental care to COVID-19 positive patients by 3 000 CZK (111 EUR) per treatment [9]. This measure was called off by June 30 [12].

Since November, regular antigen testing of clients and staff at LTC facilities and senior homes (including home care services) was ordered (see section 1.4). Financing of these tests was delegated to the health insurance funds. An amendment to the law was needed for health insurers to be able to directly reimburse the test distributor for costs. In early December, the government launched voluntary testing using the antigen tests open at first to teachers and later (Dec 16) to the whole population. The cost of the antigen testing is paid for from the SHI funds; entitlement to coverage was originally once every five days, On February 1st it was shortened to once every three days.

The distribution and administration of vaccine doses are covered by SHI funds, while the state budget pays for the vaccines themselves based on an agreement with the Commission. Still, the final vaccine bill will be settled by the health insurance funds, who will reimburse the central state budget for all administered doses (i.e. not only for the administering itself as was originally intended).

Employers are reimbursed CZK 60 (EUR 2.3) per POC antigen self-test/per employee/per week by the SHI funds; tests administered by healthcare providers are covered directly by the SHI funds.   

[1] Ministry of Healthcare website, accessed April 11, 2020 https://koronavirus.mzcr.cz/parlament-schvalil-opatreni-na-podporu-platcu-pojistneho/
[2] Government Resolution No. 263, issued on March 19, 2020, and Government Resolution No. 286, issued on March 23, 2020. https://apps.odok.cz/attachment/-/down/IHOABMVAVX1D https://apps.odok.cz/attachment/-/down/IHOABMZANK1C
[3] https://www.mfcr.cz/cs/aktualne/tiskove-zpravy/2020/vlada-schvalila-novelu-zakona-o-statnim-37959
[4] Government Resolution No. 296, issued on March 23, 2020. https://apps.odok.cz/attachment/-/down/IHOABMZAP9TY
[5] Ministry of Health, Guidelines for testing Covid-19 patients, issued on March 25, 2020. https://koronavirus.mzcr.cz/wp-content/uploads/2020/03/Doporu%C4%8Den%C3%BD-postup-k-testov%C3%A1n%C3%AD-na-COVID-19.pdf
[7] https://media.vzpstatic.cz/media/Default/dokumenty/covid-19/organizacni-opatreni_15_2020-kontakt-u-stomatologa.pdf
[8] https://media.vzpstatic.cz/media/Default/dokumenty/covid-19/organizacni-opatreni_21_2020-zmena-akutniho-luzkoveho-fondu.pdf
[9] https://media.vzpstatic.cz/media/Default/dokumenty/covid-19/organizacni-opatreni_20_2020-stomatologie_stabilizace.pdf
[10] https://www.ceskatelevize.cz/porady/1126672097-otazky-vaclava-moravce/220411030510426-otazky-vaclava-moravce-2-cast/
[11] https://www.mzcr.cz/tiskove-centrum-mz/ministerstvo-zdravotnictvi-odeslalo-kompenzacni-vyhlasku-do-sbirky-zakonu/
[12] https://www.vzp.cz/o-nas/aktuality/postupne-rusime-nouzova-organizacni-opatreni
[13] https://www.ceskenoviny.cz/zpravy/pojistovny-budou-od-ledna-hradit-za-pcr-test-a-odber-1276-korun/1977107