I10 - Health: GeneralReturn

This paper analyses possible options how to improve the risk adjustment of the health insurance system in the Czech Republic. From the possible options it argues for including pharmaceutical cost groups (PCGs) as additional risk factors since it is an improvement that can be implemented almost instantaneously. On real data from an anonymous sickness fund it confirms that predictive performance of PCGs models is consistently better than the performance of the demographic model that is currently used. The study also describes and examines the Czech health insurance market and implications of proposed changes of policy makers. Based on experience from other countries we point to a problem of risk selection if the changes are not accompanied by a tighter regulation, specifically in the form of improved risk adjustment formula.

This paper presents an insight into problems of financing the greatest part of public services for the population - the health care. The situation in this field in two nearby countries - the Czech Republic and Austria is compared. The health status of the population and the health care bases in both countries are on a high level, and the Czech situation is approaching the somewhat better situation in Austria. The main problem in the both countries is the lack of financial resources for covering the increasing needs in health care services and medicaments. Therefore, the new ways how to balance the deficit of the system both on the revenue and expenditure sides are to be found. The reforms of the system should serve this goal. From the point of view of financial sources for health care a similar model is used in Austria and the Czech Republic, some modifications of it result from different historical development and from different economical level. These modifications and differences, together with the role of the state, insurance funds and direct payments of the population, are described in this paper. The causes of discrepancies between sources of finance and expenditures on the health care are discussed. Reforming the health care system is a long-term task. From this point of view the Austrian reform measures were prepared very well, with the needed advance before introducing them and it can serve as an example for preparation of the Czech reform. Nevertheless, many questions how to improve the financing of the health care for the benefit of patients remain still without answer and they are the matter of further research and discussions in many European countries.