Mezi autonomií a státní regulací: pozice zdravotních pojišťoven v českém zdravotnictví
Between autonomy and state regulation: the position of health insurance companies in the Czech healthcare system

Summary/Abstract: The article addresses the position of health insurance companies in the Czech public health insurance system and provides an analysis of the apparent dilemma between the extent of their autonomy and regulation by the state. It is based on the thesis that the issue of the number of health insurance companies is overrated in the current public discourse, whereas the institutional conditions under which they operate, the range of their legal powers and responsibilities and their role in the financing of the healthcare system as a whole are of greater importance. The text first positions the emergence of the pluralist health insurance company system in the historical and international contexts and subsequently analyses the current level of state intervention in its management, especially in terms of the management of so-called reserve funds. Particular attention is devoted to the relationship between health insurance companies and healthcare providers especially with concern to the differing institutional and information conditions applied in the inpatient and outpatient sectors. The article further indicates that the key parameters that govern the remuneration of healthcare workers in the Czech healthcare system emerge primarily in crisis situations that are external to the contractual relations in place between insurance companies and providers, i.e. via political negotiations and extraordinary intervention measures driven by public opinion. The article concludes with a discussion on the future role of health insurance companies and the risks related to adhering to existing hybrid institutional arrangements that assign responsibilities without granting the corresponding legal powers. The article argues that the further weakening of the autonomy of health insurance companies has the potential to result in the destabilisation of the system without any improvements in terms of efficiency or fairness.

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