Statistical Yearbook of the Czech Republic

      Act No. 48/1997 Coll., on General Health Insurance, as last amended, regulates public health insurance and the extent of and conditions for providing the health care.

       The health establishments are founded, administered, operated and abolished according to standard nation-wide principles set out by the Ministry of Health of the CR for establishing the network of health establishments. This network is based on the above-mentioned Act No. 20/1966 Coll., as last amended (Article 42 and Article 70(1)(c)) and Act No. 160/1992 Coll., on Health Care in Non-state Health Establishments, as last amended. This network of health establishments is updated by methodological measures of the Ministry of Health of the CR.

      From the founder’s point of view the health establishments are split into:

- state health establishments, founded by the Ministry of Health of the CR and other central and district authorities; and
- non-state health establishments, founded by regions, municipalities, including towns, churches, other legal persons, and natural persons.

      Due to the process of privatisation, the network of health establishments in the Czech Republic has been through significant changes since the end of 1991. The regional national health institutions ceased to exist, the district ones gradually disintegrated into smaller health establishments - independent legal persons - and new non-state health establishments came into being. This is why the figures relating to the past were adjusted to suit the new classification of health establishments. The year 2003 saw other changes concerning the division of health establishments into the state and non-state sectors. In accordance with the territorial state administration reform, the health establishments run by district offices were mostly moved under the jurisdiction of regions, which strengthened the state sector considerably. At the same time fourteen regional public health stations (administrative offices) and fourteen health institutions (health establishments in nature) were established in accordance with Act No. 258/2000 Coll., on Public Health Protection, as last amended.

      Data on the health state of the population and on the health establishments are contained in the National Health Information System. The fulfilment of the task of this system is ensured by the Institute of Health Information and Statistics of the CR – see the Act No. 20/1966 Coll., on Public Health Care, as last amended (Article 67(c)(d)).

      The Czech Statistical Office measures data on incapacity for work and selected indicators on the financial performance of health insurance companies. Data on expenditures from the state budget and local budgets (budgets of regional authorities and municipalities) are derived from financial statements on income and expenditure of government departments the CZSO receives from the Ministry of Finance of the CR. All other data concerning health service are taken over by the CZSO for its publications from the above-mentioned Institute. Some data released in this chapter are labelled as temporary due to updating the methodology and terminology used in this area.

      The data on the network and activities of health establishments and on the numbers of physicians in full-time equivalent terms published for 2000 and subsequent years are totals for the ministries of health, defence, the interior, justice and transport; the data on physicians and pharmacists in terms of actual persons are totals for the ministries of health, defence, the interior, justice, transport, and labour and social affairs. The data for 1995 are data for the ministry of health only.

      The health establishment does not include detached workplaces.

Notes on tables

Tables 23-1 and 23-2. Health establishments

      Beds in the health establishments refers to the approved bed stock, excluding makeshift beds.

      Places are given for health establishments, which are not run round the clock and for children's establishments such as institutions for infants, homes for children, etc.

      Physicians (f/t equivalent) – the sum of work loads of individual workers of the health establishments converted according to the full number of working hours per week laid down for a given establishment or workplace. According to relevant regulations, there are 40 working hours in normal operation, 38.75 and 37.5 working hours in shift operation, and 33.5/30.0 or 39.5 working hours at dangerous workplaces per week per physician.

      Specialized therapeutic institutions include therapeutic institutions for long-term patients, therapeutic institutions for TB and respiratory diseases for children and adults, mental hospitals for children and adults, physiotherapeutic institutions, balneological institutions for children and adults, convalescent homes, hospices and other in-patient institutions for children and adults.

      Independent out-patient care establishments include policlinics, joint out-patient health service establishments, health centres, independent surgeries, independent non-medical establishments (e.g. specialized in psychology, speech therapy, rehabilitation, home care health services, etc.), independent specialized laboratories, first-aid medical establishments, haemodialysis stations, and other out-patient care establishments.

      Special health establishments include institutions for infants, homes for children, day clinics for children, creches and other establishments for children, day clinics for adults, short-term rehabilitation centres for disorderly alcoholics, transport and medical emergency service establishments, and other special health establishments.

      Pharmaceutical service establishments include pharmacies and dispensaries of drugs and medical aids.

      Establishments of public health service include regional public health stations, health institutions, the State Health Institute, and a reference laboratory.

      Other health establishments include establishments for in-service training of medical personnel and other unspecified health establishments.

      Figures given under the indicators of the "Other health establishments" type are not comparable in individual years because their coverage was changing as the network of health establishments was established and updated.

Table 23-3. Bed care in health establishments

       The item “Other in-patient establishments” includes other specialized therapeutic institutions for adults and children (specialized in one branch) and hospices.

Table 23-4. Beds in hospitals: by department

      “Other departments” includes departments of cardiology, rheumatology, diabetology, gastroenterology, clinical pharmacology, allergology, independent neonatal units, speech therapy, nephrology, prosthetics, and intensive care.

Table 23-6. Physicians: by main branch of activity

      The data on the branches of activity of physicians, stomatologists and pharmacists are obtained from the updated Register of Physicians, Stomatologists and Pharmacists (RPSP). Physicians and pharmacists are recorded as actual (physical) persons by main activity branch. Where a physician (pharmacist) has more contracts, he/she is included in the branch corresponding to his/her longest contracted time or, in the case of equal contracts, in the branch corresponding to his/her highest qualification (specialist postgraduate study certificate). In the other cases he/she is included in the branch stated as the first. As a rule, the physician is classified registered in the department of his/her main branch of activity.

      The prerequisite for a physician or pharmacist to be included in the RPSP as at 31 December of a given year is to have an employment contract of limited or unlimited duration concluded with a state or non-state health establishment or to be a founder of a health establishment and where he/she provides health care.

      Pursuant to Act No. 258/2000 Coll., as last amended, and subsequent regulations, physicians working in the regional hygienic stations were excluded from the RPSP as of 31 December 2002, because they only carried out administrative activities (they did not provide health care), and were included in a different category (“health personnel with other university education”).

Table 23-7. Cases of treatment (examination) in out-patient care establishments: by department

      “Others” includes the following departments (branches): geriatrics, occupational diseases, neurosurgery, cardiosurgery, traumatology, X-ray oncology, physical training medicine, medical genetics, and first-aid medical service.

Table 23-13. Incapacity for work due to disease or injury

      Listed are selected results produced by processing the CZSO statistical questionnaire. The questionnaire had to be filled in by all businesses and/or their lower organizational components, which independently fulfil duties concerning health insurance. The processing also included total figures submitted by the District Administrations of Social Security for entities that do not settle health insurance claims themselves.

      Average number of sickness-insured persons - the methodological coverage of this indicator is identical to that in Table 24-1 in the chapter Social Security.

      Calendar days of incapacity for work - number of calendar days on which employees insured for sickness were on sick leave (based on the reported beginning and end of sick leave).

      Average percentage of incapacity for work per year is calculated from calendar days of incapacity for work due to disease or injury divided by the average number of the sickness insured, multiplied by the number of calendar days in a year.

      Since 1997, imputation for non-response has been made as a rule in processing the questionnaire. Imputation has been made for all questionnaires not submitted by reporting units with 25 employees and over (records on health insurance for organizations with 24 employees and under are kept by district social security administrations as dictated by the law), using relevant statistical methods.

Table 23-16. Expenditure on health service

      The table shows two main sources for funding the health service in the Czech Republic: (i) state plus local budgets and (ii) general health insurance premiums collected by health insurance companies (including the state budget contribution to health insurance companies to pay the premium for citizens for whom it is paid by the state).

      Data on expenditure of state and local budgets on health service fully respect the functional breakdown of expenditure and include data from the budgetary structure on health (Part 35) in greater detail given in the table.

      The table heading complies with the classification by kind of the budgetary structure in force.

      Expenditure of health insurance companies on health service refers to full or partial payments, for reported cases of treatment within the framework of health service, made by health insurance companies to health service establishments under contract. Data included in this table are taken from national accounts and cannot thus be confused with data on the expenditure of health insurance companies listed in Table 23-17.

      Direct private expenditure of population on health service includes expenditure of the population on medicines, medical goods and supplies and rendered health services (financial participation of patients, payments for medical procedures not covered at all or only partially covered by public health insurance, etc.).

Table 23-17. Expenditure of health insurance companies

       The table shows expenditure of health insurance companies by most significant health care function and by type of provider. The breakdown used complies with the OECD System of Health Accounts methodology modified to national conditions.

       The ancillary services to health care include clinical laboratory, diagnostic imaging and transfusion services.

Table 23-18. Financial indicators of health insurance companies

      The table shows selected financial performance indicators from the processing of annual statistical questionnaires of the CZSO completed by incorporated businesses with health insurance as their principal activity. The financial indicators for 2001 and subsequent years have been adjusted to comply with the methodology for accounting procedures of health insurance companies.

      Financial investments include long-term financial assets as well as short-term ones are traded in the market. The financial investments in 2000 includes land and non-service constructions while in the other years, land and constructions (of both service and non-service types) are excluded.

      Deposits in banks refer to term deposits and receivables from deposits. In 1999, they include means on current accounts and special bank accounts of the funds of health insurance companies. From the year 2000 on, the deposits in banks exclude means on current accounts and special bank accounts of the funds of health insurance companies as these are classified under financial assets.

      Tangible fixed assets – in 2000 only land and service constructions are referred to, while the other years include both land and constructions (of both service and non-service types).

      Intangible and tangible fixed assets and other components of assets are shown as net.

      There were ten active health insurance companies operating in the Czech Republic at the end of 1999. Starting from 2000, they have been nine in number.

      Data on incapacity for work due to disease or injury are released in the following publication brought out by the CZSO according to the CZSO Catalogue of Publications 2004 (group 3 - LABOUR, SOCIAL STATISTICS, subgroup 33 - Education, Culture, Health):

– “Incapacity for Work Due to Disease or Injury in the Czech Republic” – data for January-June 2004 are published in November 2004, data for the whole year in May 2005.

      More detailed data obtained via statistical surveys taken in health insurance companies can be found in the following CZSO publications brought out according to the CZSO Catalogue of Publications 2004 (group 9 - SERVICES, subgroup 95 - Non-market Services):

– “Economic Results of Health Insurance Companies” - quarterly, in June, September and December 2004 and in March 2005
– „Ekonomické výsledky zdravotních pojišťoven za rok 2003“ - December 2004.