All healthcare costs regarding testing (if recommended, see below), treatment, transport, etc. of COVID-19 patients are paid by the statutory health insurance (SHI). Universal coverage is based on citizenship and permanent residence, including prisoners, asylum seekers, etc., and is not a condition of paying SHI contributions.
Tests for COVID-19 are covered by SHI only if recommended by a physician (general practitioners, paediatricians, pneumologists or attending physicians in hospitals) or by the public health authority (for recommendation details, see Section 1.5: Testing and Section 1.3: Isolation and quarantine). The Compensation Reimbursement Directive introduced special reimbursements for hospitals and outpatient facilities for running sample collection points and taking the samples.
Private testing for other individuals has been allowed since the second week of March 2020; however, people must pay out-of-pocket. Private tests may be requested in some private laboratories and their prices differed (between 1 000 and 3 000 CZK; EUR 37–111). Since 15 May 2020, the maximum price for a PCR test had been regulated at CZK 1756, but starting on 1 January 2021, the maximum PCR test price (including the sample taking) was decreased to CZK 1309 for private testing and to CZK 1276 when covered by SHI funds (MoH directive No. 563/2020, Coll.). Since 16 December 2020, people can also get voluntarily tested (that is, without the necessity of getting a GP’s or public health officer’s referral) using antigen testing every five days (shortened to every three days as of 1 February 2021). The test is covered by SHI funds, and the price (including sample taking) is regulated at a maximum of CZK 352 [13].
Starting 1 June 2021, the population screening rules changed. Newly, people are allowed, within the population screening testing, to two PCR tests and four POC antigen tests per month (covered by the SHI; the employment antigen testing counts into this limit). This limit does not affect PCR testing for diagnostic and preventive purposes (that is, referred by a physician or a public health officer). At the same time, MoH lowered the maximum PCR test price to CZK 350 only (applicable to PCR tests for all purposes, that is, population screening, preventive and diagnostic purposes). As a consequence, many private laboratories stopped providing the PCR tests due to below-the-cost price, and the PCR tests became inaccessible within the first day of the maximum price lowering [14]. The MoH quickly reacted by increasing the PCR regulated price to CZK 614. The POC antigen final maximum price was set at CZK 201. However, laboratories complain no rules for sample pooling are set, which causes lack of clarity on whether it is or is not allowed, and costs savings are not exhausted; the MoH decided the HIFs shall define the sample pooling rules before the end of June 2021.
In spring 2020, the HIFs widened benefit entitlements and providers’ reimbursements to include telemedicine (phone calls) for most outpatient specialists, including the GPs, who were newly able to claim these procedures without further conditions. For example, even dentists could perform telemedicine consultations with their patients with add-on reimbursement 55 CZK (2 EUR) [7]. Most of these reimbursement measures were temporary and were withdrawn by 30 June 2020 [12]. In the beginning of September 2020, health insurers introduced new codes for GP phone consultations for greater clarity in spring phone consultation coding. The new code is activated by health insurers only in “crisis” times as temporary measure; it was activated on 1 September 2020.
In spring 2020, an Extraordinary Measure of the Ministry of Health ordered the hospitals to free up beds and make health workers available for COVID-19 treatment, as part of the effort to increase capacity. This changed the structure of beds, which was contracted by the HIFs. The HIFs officially accepted such changes as “contracted capacity”, otherwise providers would face a penalty clause [8]; this measure was called off by 3 June 2020 [12].
VZP, the largest HIF with a 60% market share, offered monthly advance payment of 50 000 CZK (1 850 EUR) to its contracted dentists who continued to provide services and operate at least 17 hours per week during the state of emergency in spring 2020. VZP also increased the reimbursement for dental care to COVID-19 positive patients by 3 000 CZK (111 EUR) per treatment [9]. This measure was called off by 30 June 2020 [12].
Since November 2020, regular antigen testing of clients and staff at LTC facilities and senior homes (including home care services) was ordered (see Section 1.4: Monitoring and surveillance). Financing of these tests was delegated to the health insurance funds. An amendment to the law was needed for health insurers to be able to directly reimburse the test distributor for costs.
The distribution and administration of vaccine doses are covered by SHI funds, while the state budget pays for the vaccines themselves based on an agreement with the Commission. Still, the final vaccine bill will be settled by the health insurance funds, who will reimburse the central state budget for all administered doses (not only for the administering itself as was originally intended).
Employers are reimbursed CZK 60 (EUR 2.3) per POC antigen self-test/per employee/per week by the SHI funds; tests administered by healthcare providers are covered directly by the SHI funds.