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21 October 2025 | Policy Analysis
Recent reforms in public health and prevention -
22 June 2025 | Country Update
Capitation payment for gynaecologists to improve access and preventive care -
25 February 2025 | Country Update
Aneurysm screening and Be Fit 24: Initiatives in the 2025–2035 National Cardiovascular Plan -
08 July 2024 | Country Update
Expanded prescribing roles for GPs -
28 November 2022 | Policy Analysis
Primary care reform – expanding GP competencies
5.3. Primary care
The goals of primary care are to provide preventive care (immunizations and screenings), diagnostic, therapeutic and assessment care and consultations, and coordination and continuity of health services with other providers. Primary care physicians also perform several tasks related to assessing and verifying health status, including dependency status and other social protection measures linked to health or disability status, along with fitness for employment. Section 5.1 lists preventive care services covered by SHI. Primary care physicians also collaborate with RPHAs in epidemiological surveillance by reporting cases of communicable diseases (see section 5.1) and can also provide visiting services to immobile patients or prescribe home care for nurses to provide. Nurses can provide injections, intravenous therapy, wound dressing and medical check-ups, and can also prescribe certain types of medical aids (such as compression stockings, bandages, incontinence aids) under certain conditions.
Primary outpatient care is provided to patients by registering providers. The Health Service Act (2011) defines registering providers as those in general practice medicine, general practice for children and adolescents, dentistry, and gynaecology and obstetrics, who have admitted patients to provide primary outpatient care. Note that there are no family physicians in Czechia. Younger patients switch from paediatricians to GPs between the ages of 14 and 19 years.
Most primary care physicians are self-employed in solo practices, typically employing a nurse who also has administrative duties (see section 3.7.1). In 2019, there were 4540 independent GP practices with 4787 physician FTEs, 1835 paediatric practices (1970 FTEs), 5624 dental practices (6793 FTEs) and 1274 gynaecological practices (1350 FTEs). The total number of health care facilities in Czechia (including inpatient) reached 32 240 in 2019, meaning independent primary care offices formed around 41% (ÚZIS, 2020a). A primary care physician may join others to work in private group practices, health centres or polyclinics. Primary outpatient care can also be provided in inpatient facilities.
Health centres and polyclinics tend to be well equipped. Most have electrocardiographs, ultrasound scanners and X-ray equipment. They also generally have diagnostic laboratory facilities on the premises and employ nurses and physiotherapists. Primary care physicians working in solo practices are less likely to have direct access to advanced diagnostic equipment. Moreover, the working conditions for primary care physicians depend to a considerable extent on local circumstances and whether they are situated in urban or rural settings.
Patients may register with a physician of their choice and can switch to a new one every three months without restrictions and a registering physician can reject patients, primarily if a tolerable workload has been exceeded. “Tolerable workload” is not defined, and no threshold exists in terms of the number of registered patients. Moreover, physicians can further reject patients if their residence is too far away to provide visiting services when needed.
The number of children and adolescents registered with a paediatrician steadily declined between 2007 and 2019, from 993 to 894 patients per 1000 population aged 0–18 years. In 2019, the average number of contacts with a paediatrician was 4.7. Out of these, 1.1 contacts were preventive visits. These data come from annual surveys among health care providers (including inpatient providers) conducted by ÚZIS (86.8% response rate in 2019). Even though Prague typically sees high numbers of commuters for both work and health services, the number of registered patients with a paediatrician located in Prague is 930. The highest densities of registered patients are in the Středočeský and Ústecký Regions (both 1031) and Pardubický Region (1000). The lowest average number of registered patients, 795, is in the Olomoucký Region (ÚZIS, 2020a; VZP, 2020) (it should be noted that the regional values were calculated by the authors under the assumption that all paediatricians have a contract with VZP). In 2017, 89.5% of adults were registered with a GP; adults made on average 4.1 visits (out of which 0.25 were preventive visits) (ÚZIS, 2018).
HIFs are responsible for contracting physicians to ensure their accessibility for their members, though measuring the accessibility of health care is not straightforward. Based on an evaluation by VZP, their network of physicians for primary care complies with Governmental Regulation no. 307/2012 Coll. and health care is reachable in all municipalities in Czechia within the agreed-upon time limits (VZP, 2022).
Personnel stabilization in health is another priority of Health 2030 and is especially important for primary care (see Box5.2). Primary care reform, as envisioned, pursues a gradual transformation and strengthening of primary care to provide the broadest possible range of services while maintaining quality. As part of ongoing reforms, primary care physicians gained new competences in 2019 to monitor oncological patients no longer in need of therapeutic treatment with specialized check-ups and examinations. Professional associations believe that GPs are easier to reach for most patients, yet monitoring patients at higher risks of disease relapse remains the oncologists’ responsibility (MZČR, 2018c). Although it focuses mainly on strengthening GPs, the focus in the long term is a gradual reconstruction of outpatient care entirely (MZČR, 2020a). See section 6.1 for further details.
Box5.2
Prevention and protection of public health are essential for reducing disease burdens, improving population health, and ensuring a resilient and sustainable health system. Below are several examples of recently discussed and accepted measures targeting areas of prevention and protection in Czechia.
Primary care
In September 2025, the Ministry of Health, together with general practitioner representatives, introduced a reform of preventive check-ups and additional measures to strengthen disease prevention and the role of GPs in primary care. The reform aims to enable earlier detection of serious diseases and enhance cooperation between the Ministry and GPs. It expands laboratory testing – covering liver function, blood glucose, kidney function, lipid profile and ECG – and strengthens the early detection of dementia, osteoporosis and chronic kidney disease. Preventive check-ups will be more individualized, with greater emphasis on vaccination, screening and patient history. GPs will also play a more active role in informing patients about the importance of preventive programmes and the risks of non-participation.
Moreover, from 2026, dispensary care for people with cognitive disorders will be added to the existing monitoring by GPs of degenerative diseases of the central and peripheral nervous systems (amendment to Decree No. 39/2012 Coll. on dispensary care). This extension emphasizes the key role of primary care in early detection, ongoing monitoring and coordination of care for these patients. Dispensary care refers to specialized medical follow-up aimed at the systematic, long-term monitoring and management of the health status of patients who are at risk of, or suffer from, a serious disease, with the goal of preventing complications.
Focus on children
Effective from 2026, the amendment to Decree No. 39/2012 Coll. on dispensary care will also introduce regular monitoring of overweight children. The inclusion of overweight and obesity to the conditions subject to dispensary care by paediatric GPs reflects the growing prevalence of childhood obesity in Czechia and the need for systematic preventive and follow-up care. The amendment emphasizes long-term lifestyle guidance, complication prevention and family education. The amendment also expands the list of conditions regularly monitored by child and adolescent psychiatrists. The new monitoring includes anxiety disorders, cases related to child abuse or neglect, adolescent diagnoses such as self-harm, and severe non-organic encopresis and secondary enuresis. The aim is earlier diagnosis, timely intervention and ongoing support for children, helping prevent deterioration and further complications.
From 2025, early detection of serious eye disorders in children under three has been organized as a national screening programme, building on initiatives started in 2022. The first three years of life, particularly the first 12 months, are crucial for proper visual development. The programme aims to prevent permanent vision problems by identifying refractive errors such as myopia, hyperopia, astigmatism and other eye conditions at an early stage, including children with and without family histories of eye disorders.
On 1 September 2025, an amendment to the decree on school meals came into effect, introducing the most significant changes in over 30 years. The reform aligns school catering with the latest nutritional recommendations, improves menu quality and variety, and reduces excessive salt, added sugars and highly processed foods. These updates were developed with input from doctors, nutritionists and public health experts. Meals are designed to be nutritious, appealing and feasible to prepare in school canteens. A transitional period until 1 September 2026 allows schools to gradually implement the new rules, supported by a detailed methodology.
Mental health care
In September 2025, the Ministry of Health, together with the National Mental Health Council, introduced a new Concept for Child and Adolescent Psychiatry as part of broader efforts to improve access and quality of mental health care. The reform expands acute inpatient capacity, community and outpatient services, and introduces modern treatment approaches, including telemedicine and digital cognitive behavioural therapy. It also develops new acute and community services, day-care centres, and specialized adolescent wards, supported by an online information portal (nzip.cz/dusevni-zdravi) for families. The ministry addresses workforce shortages through expanded residency programmes, simplified specialty training, and new accreditation schemes for psychologists and psychotherapists.
In October 2025, the ministry launched a call for applications to pilot Acute Psychiatric Outpatient Clinics under the Development of Acute Psychiatric Care project. The 14-month pilot, funded for up to ten facilities, will test operational models, gather data for sustainable financing, and provide temporary care for patients with acute mental health needs who lack a regular psychiatrist.
Oncology
From 2026, preventive colorectal cancer screening will be covered by statutory health insurance for people aged 45 and over, expanding eligibility from the previous threshold of 50 years. However, for the first time, the programme will institute an upper age limit of 74 years.
From 2026, a new complex oncology centre will open in the Karlovy Vary Region, which has so far had among the poorest access to cancer care. The facility will allow most examinations and treatments to be carried out locally, reducing the need for long-distance travel while maintaining access to specialized procedures at higher-level centres.
Also from 2026, every complex oncology centre in Czechia will have a dedicated patient coordinator. These coordinators will help patients navigate the often-complex healthcare system – from the first contact to the start of treatment – by ensuring continuity of examinations, supporting staff with administrative tasks and guiding patients between departments. Their role aims to reduce waiting times, prevent delays, and improve patient comfort and confidence.
Vaccination
From October 2025, a pilot project allows flu vaccinations to be administered in selected pharmacies in three big cities of Czechia (Prague, Brno and Ostrava). The Ministry of Health aims to boost vaccination rates and strengthen pharmacies’ role in prevention. However, general practitioners have criticized the plan, arguing that pharmacists lack the necessary expertise and that the measure will not benefit patients or the healthcare system.
Digital tools and technology
Recognizing its importance for public health, the Ministry of Health, together with ÚZIS and the National Institute of Public Health (SZÚ), launched on 1 July a pilot of automated infectious disease reporting from primary care. Data are transmitted directly to the Infectious Disease Information System (ISIN), providing fast, accurate information while reducing administrative burden for doctors and regional health authorities. This digital tool enables quicker responses to epidemic threats and strengthens population health protection.
In recent years, Czechia has also introduced a fully digitalized central vaccination registry that collects real-time data from all healthcare providers, significantly reducing administrative burden. The system provides immediate overviews of vaccine distribution, capacity and coverage, with data openly accessible to professionals and the public.
From 2026, the app EZKarta will expand its functionality. It will include a “health index”, a type of alert guiding users on preventive check-ups and other health activities. If eligible for a free screening, the app will send mobile notifications. EZKarta already provides an overview of vaccinations, completed preventive check-ups, screening tests and links to other Ministry of Health web services, with additional features to be added over time.
References
https://mzd.gov.cz/tiskove-centrum-mz/prevon-2025
https://mzd.gov.cz/tiskove-centrum-mz/koordinovat-je-slusnost
https://www.nzip.cz/clanek/2428-screening-zavaznych-ocnich-vad-u-deti
https://www.zdravotnickydenik.cz/2025/07/demence-i-obezita-praktici-detsti-psychiatri-dohlednou-na-vic-pacientu
https://www.zakonyprolidi.cz/cs/2025-341
https://www.zdravotnickydenik.cz/2025/10/elektronizace-ezkarta-ezadanky-foltyn
Authors
In February 2025, the Ministry of Health introduced a new National Cardiovascular Plan for 2025–2035 to strengthen prevention and reduce the proportion of Czech residents with heart and vascular diseases. This emphasis on prevention includes new screening options and the promotion of healthy lifestyles. As such, a new screening for abdominal aortic aneurysms and the “Be Fit 24” program have been launched, fully covered by the health insurance funds. The plan also includes new guidelines supporting the effectiveness of GPs’ preventive examinations.
The new screening program for abdominal aortic aneurysms started on 1 January 2025. It is intended for men aged 65–67 and can be joined via their GPs. Its goal is to detect aneurysms early and collect key data that will make health statistics more accurate.
Be Fit 24 is a program promoting healthy lifestyles in overweight children aged 6–11. The goal is to reduce their BMI by 5% within one year. Eligible children can enrol via their paediatrician. Each child participating in the program receives a free Garmin Vivosmart 5 fitness tracker and access to a mobile app similar with game-like features. This app allows children and their parents/guardians to track daily physical activity, energy intake and daily activity, and achievement of healthy eating and exercise goals. If a physician is not involved, a free fitness bracelet will not be provided, though the mobile app can still be downloaded. A new educative web also informs about nutrition, exercise and obesity prevention, where parents/guardians and children can get practical advice and tips on lifestyle changes (https://www.nzip.cz/bf24).
Authors
References
Authors
References
Decree of the Ministry of Health No. 376/2011 Coll., as amended
As part of the ongoing primary care reform, which is also one of the specific goals of Health 2030 (Zdraví 2030), GPs have gained new competencies over the past few years. Besides taking care of stabilised patients with diabetes mellitus type 2, GPs now monitor recovered oncological patients no longer needing therapeutic treatment and perform regular specialized check-ups and/or examinations. A GP monitoring these patients only assumes these responsibilities based on individual agreements they make with the responsible oncologist, and with explicit patient approval. Professional associations believe that GPs are easier for patients to reach, and most patients appreciate this change, while oncologists estimate that two thirds of patients can be transferred for monitoring and tertiary prevention to their GPs, thus freeing the oncology centres’ capacities and enabling clinicians to focus on acute patients. However, monitoring patients at higher risk of relapse, including children, will remain oncologists’ responsibility. GPs are compensated for this new role via FFS in addition to general capitation payments. Additionally, while Czechia has entered a period in which total numbers of GPs are likely to slightly decline over the next decade (at least in some regions), a strong renewed interest among medical students to become GPs is gaining traction. This trend, as of this writing, has not yet been seen in the case of paediatricians, however.
Additional new competencies for GPs (also compensated via new FFS payments) include management and analysis of colorectal screenings (since 2019); early dementia detection (since 2020); care for patients with prediabetes (since 2020); and detecting candidates for lung screening pilots among their registered patients (2022). Further development and strengthening of GPs competencies, as part of Health 2030, are aimed at boosting the competencies of primary care physicians in Czechia and uses incentives from HIFs to increase the availability of care and promote prevention. For example, various incentives for health care providers are defined in the Reimbursement Directives (for example, rewards in remote areas and for extended office hours). HIFs can award bonuses regarding quality and VZP launched the VZP PLUS programme in 2019 to reward good organisation and high quality of (mostly chronic) care. In VZP PLUS, paediatricians are rewarded for improved test results for patients previously diagnosed with obesity. The list of tests (monitoring BMI, blood pressure, serum lipids and patient compliance) was defined by VZP in cooperation with professional organisations and providers associations. VZP also incentives adult GPs, diabetologists and internists to examine glycated haemoglobin, LDL cholesterol, eyes, diabetic foot syndrome and renal functions in patients with diabetes mellitus; VZP rewards providers for improved results.
Authors
References
MZČR (2018) – Dohoda onkologů s praktickými lékaři a MZ ČR: Vyléčené onkologické pacienty budou dále sledovat jejich praktici [Agreement between oncologists and general practitioners and the Ministry of Health of the Czech Republic: Cured oncology patients will continue to be monitored by their practitioners]. Press release, 18 October 2018
MZČR (2020) – Vyhláška č. 428/2020 Sb. Vyhláška o stanovení hodnot bodu, výše úhrad hrazených služeb a regulačních omezení pro rok 2021, annually updated [Reimbursement directive]