Tuesday, June 25, 2013
2.22 (Binnengasthuis)
The Czech health care system witnessed major transformations since 1989. At the beginning of post-socialism, healthcare in Czech Republic was facing a deep crisis. Long history of constant shortages and underfunding, coupled with deteriorating health status, created an alarming situation in the sector that asked for prompt policy solutions. In response, early democratic governments embarked on a path of systemic and radical reforms. Transforming Czech healthcare system from Beveridge to Bismarck type, they introduced insurance mechanisms, which significantly changed the system’s institutional architecture. Simultaneously, they initiated market building in healthcare provision focused on privatization, competition and decentralization. An analysis of distributional outcomes of the Czech health reforms demonstrates that they almost consistently favored a specific group of actors, private healthcare providers. How did different Czech governments create the system favouring this specific group, and working at the disadvantage of both citizens as users, and insurance funds as purchasers of care services? What was the role of private actors and medical professionals in shaping the reform initiatives? In this paper, I argue that the outcomes of market reforms in Czech healthcare cannot be explained through sole reference to interests, and interests groups involved in the process of health policy making. Rather, ideas over which specific market elements should be introduced, as well as formal institutional arrangements of the state and the party system, shaped particular policy decisions and gave rise to these outcomes.
