Data on the health status of the population and on activities of the health service providers are obtained from the National Health Information System (hereinafter only referred to as the NHIS). The NHIS is defined in the Act on Health Services and Conditions of Their Provision. The NHIS is determined for keeping national health registers and processing of data kept therein. The administration of the NHIS has been delegated by the Ministry of Health to the Institute of Health Information and Statistics of the Czech Republic (IHIS CR)

The Czech Statistical Office in cooperation with the Czech Social Security Administration (CSSA) ensures data on new reported cases of incapacity for work due to disease or injury.

Information on health care expenditure pursuant to the System of Health Accounts is derived from data of the Ministry of Health, the Ministry of Finance, the Ministry of Labour and Social Affairs, the National Register of Reimbursed Health Services (Národní registr hrazených zdravotních služeb – NRHZS), which is part of the NHIS, and data sources of the CZSO.

The data about healthcare and incapacity for work uses the breakdown of diseases and related health problems according to diagnoses and chapters of the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).

Besides the aforementioned sources, the chapter uses structural (employee) wage statistics, namely in the case of data on the average gross monthly wage of medical doctors (physicians) and nurses.

Data on students of and graduates from health fields of education at universities in the Czech Republic were obtained from data sources of the Ministry of Education, Youth, and Sports, namely from the SIMS database (i.e. Union Information from Students’ Registers).

Another source of data is the System of Health Accounts (SHA), which is compiled according to the OECD unified methodology (therefore, they are internationally comparable). In 2022, data for 2017–2019 were revised and data for 2020 processed while using a new data source. For the first time, the CZSO for an analysis of expenditure on health care did not use data handed over directly from individual health insurance companies – it used data sent by health insurance companies during the year to the National Register of Reimbursed Health Services (abbreviated NRHZS in Czech) and to the Ministry of Health of the Czech Republic. An effort to reduce the administrative burden of individual health insurance companies and to unify the input source was the main reason for the revision. In addition, a revision of data from the general government (budgets), voluntary health insurance, and non-profit organisations has been made.

Only current expenditure is included in the total health care expenditure within the System of Health Accounts. The following items financed directly from the state budget are excluded from surveyed data:

i) expenditure on construction and reconstruction of health establishments,

ii) investment expenditure on purchase and modernisation of instrumentation/equipment,

iii) expenditure on health research and development,

iv) expenditure on education of medical staff (health professionals).

Expenditure of health insurance companies includes reimbursements from the obligatory public health insurance on health care reported by health establishments and recognised by health insurance companies. Revenue of health insurance companies comes from the public health insurance in which every person with permanent residence in the territory of the Czech Republic is obliged to participate.

State budget expenditure mainly includes support to long-term care establishments (e.g. retirement homes). Administration of the sector of the Ministry of Health is also covered from the state budget, i.e. operation of the Ministry of Health, health departments of individual regional authorities, public health authorities, the National Institute of Public Health, the State Institute for Drug Control, and the Institute of Health Information and Statistics of the CR. In 2020, the following were covered from the state budget: payment of hospitals’ debt and purchase of personal protective equipment in relation to the COVID-19 disease pandemic.

Regional/local government budgets include financial means on health care from budgets of Regions and municipalities and relating, for example, to operation of the ambulance service.

Household out-of-pocket payment (direct expenditure of households) includes direct expenditure of health care recipients (patients) and their co-payments. It includes the population expenditure on medicines (co-payments for prescribed medicines and full payments for over-the-counter medicines), for medical devices, payments for above-standard services at dentists, for spa treatment stays, above-standard rooms in hospitals, and payments for various certificates.

Voluntary health insurance only comprises travel insurance. Except for additional travel insurance, the population of the Czech Republic cannot use other voluntary health insurance to cover health care.

Non-profit organisations include expenditure on health care covered by non-profit non-state institutions (e.g. the Red Cross). Activities of these institutions are financed from voluntary contributions of households and from government transfers or subsidies/grants.

Company-funded preventive health care (enterprise financing schemes) includes costs for performed routine check-ups and medical examinations of own employees, provided that they have not been covered from the public health insurance.

Curative care is a summary of health services to patients that especially include making a diagnosis, making corresponding medical examinations, determining how to treat a disease (eliminate pain and health problems), providing treatment by means of necessary procedures including using of medicines and corresponding healthcare products, and following observation of the health status.

Inpatient curative care includes formal reception to a health establishment for treatment, rehabilitation, or long-term care for which an overnight stay is expected. Inpatient care is not limited as for the type of provider. Most often, the provider is a hospital, but it can also be nursing care facilities/establishments or establishments classified as providers of outpatient care, which provide occasional procedures requiring inpatient care and therefore they are able to provide overnight accommodation.

Outpatient curative care includes medical and ancillary services provided to a patient who has not been formally received to an establishment and does not stay in the establishment overnight. Outpatient care can be provided in hospitals or by general practitioners and specialists in private health establishments or in individual surgeries.

Day curative care includes planned medical procedures performed by physicians and paramedical personnel (non-physicians) provided to patients formally received to a health establishment for diagnosis to be made, for treatment or other types of health care. A patient is received and released on the same day; the length of stay is 3–8 hours.

Home-based curative care includes medical services, ancillary services, and nursing services (care services), which are provided to patients in their homes and include physical presence of a provider. They include, for example, home obstetric services, home dialysis and all other health care services consumed in a home-setting, regardless of the provider, which may be, for example, a relative or a health professional. Assisted living facilities are not included in this category.

Rehabilitative care is a summary of health services provided in rehabilitation establishments (including balneological ones) aimed at elimination of health limitations and health problems experienced by a patient and at repeated achieving of a corresponding health condition (usually after medical care has been provided).

Long-term health care comprises a range of services of medical care and personal care that are consumed with the primary goal to relieve pain and suffering and to reduce or manage deterioration of health condition of patients with a level of long-term dependence.

Ancillary services include laboratory diagnostics and medical imaging diagnostics (X-ray imaging, computerised tomography (CT), magnetic resonance, etc.) and also transport of patients (it also applies to the ambulance service).

Medical goods (non-specified by function) are determined to be used for diagnostics, mitigating a disease’s effect, or treating a disease including prescribed medicines and over-the-counter medicines. Expenditure on medicines consumed in inpatient health establishments is not included.

Preventive care includes immunisation programmes (vaccinations), programmes for early detection of a disease (e.g. screenings of malignant tumours), regular routine check-ups/examinations (e.g. examinations during pregnancy, check-ups of growth and development of children, regular check-ups at the dentist, and general routine check-ups). Preventive care also includes expenditure on information and counselling programmes such as information about health consequences of smoking, drinking of alcohol, unhealthy diet, or insufficient physical activity. In 2020, this category also includes costs for PCR tests and antigen tests for the COVID-19 disease. 

Health care system administration focuses on the health system rather than direct health care; it is considered to be a collective service since it is not allocated to specific individuals but benefit all health system users. It directs and supports health system functioning. These services are expected to administer and enhance efficiency and performance of the health system. Included are, for example, formulation and administration of government policy, setting standards, or licencing.

Data about subjective subjective health status come from European Health Interview Survey or Sample Survey on Persons with Disabilities .
 

Further information can be found on the website of the Czech Statistical Office at:

– www.czso.cz/csu/czso/health_care_lide

or on the website of the Institute of Health Information and Statistics at:

– www.uzis.cz/en