DEFICIT AND HEALTH REFORM – TWO DIFFERENT PHENOMENA? pp. 171-194
Authors: (Z. Darmopilova, Z. Zigova, Masaryk University, Brno,Czeck Republic)
Abstract: Health sector in Czech Republic is now on the threshold of extensive and complex reform. The reasons of launching the reform are not only the trends challenging health systems in almost all developed countries, such as ageing of population or development of new diagnostic and treatment methods. The system itself contains a certain predisposition to deficits, or, in other words, it lacks the auto-regulatory mechanisms on both the demand and supply sides. Public health insurance (“p. h. i.”), which is the main source of financing the health sector in Czech Republic, is referred as being indebted for several years. Different sources quote different amount of this cumulative debt - the reason and, simultaneously, the consequence lies in an insufficient definition of this term. Furthermore, different causes of debt emergence are quoted as well. This paper analyzes eventual causal relationship among financial balance of p. h. i. system, necessity of health reform and success of reform enforcement. Authors identify possible factors influencing the p. h. i. debt cumulation against historical background of Czech health sector development and examine the relation between the debt and health reform initiation. The category of p. h. i. debt is subject to analyses of its definition, causes of emergence and the role of the debt in health reform. Health reform is introduced according to its goals together with its timing within the context of p. h. i. debt development. The main objective is to identify key player who, due to his strategy of supporting the reform, has an influence on successful enforcement and implementation of examined reform policy in the Czech Republic.