Health Care Reforms in the Slovak and Czech Republics 1989–2011: the Same or Different Tracks?

For 20 years the successor states of the former Czechoslovakia have tried to improve health outcomes in an efficient or at least effective manner. Slovakia and the Czech Republic chose partly different policies, different health delivery and finance systems, and different payment and incentive structures. And yet in both countries better health outcomes emerged, but at great cost, as efficiency proved elusive. The goal of the paper is to examine processes and results of health care reforms in the Czech Republic and Slovakia – are both countries after 20 years of changes still on the same track? The paper has four sections. Following the first section of background and introduction, we examine the principles and development of social policy in health care, how political instability neutered reform, yet politicised health issues, sometimes resulting in policy reversals. The third section explores the outcomes of the transition health care policies and how voters have perceived them. A summary of findings concludes, indicating that both systems are still very close, but some important differences emerged during the reforms process. Although there has been progress towards western European outcome standards, there is much to be done. While the costs of health care will continue to rise, it is unclear that the present political, policy-making and implementation systems can deliver either efficiency or a responsiveness to patients` views.