Public and Private in Transition: Debating Choices in Health Care Reforms in the Post-Communist Czech Republic

The paper examines a public discussion on health policy reforms in the Czech Republic between 2006 and 2008. After the fall of communism, the first period of transformation focused mostly on basic market oriented reforms such as setting a pluralistic insurance model, decentralizing through privatization and setting a public/private mix for the provision of health care. Although health care changed significantly in the two following decades, the biggest reform plan was proposed after the parliamentary elections in 2006 when the right-wing government prepared several new proposals aiming both at the privatisation of large hospitals and health insurance funds and the cost containment of health care provision.

The reform was presented both as a way to save public funds and as an important step toward a health care system based on diversity and choices. The plan corresponded with a general shift towards a neoliberal paradigm in healthcare focusing on consumer-oriented services accessed via the market and patients as self-responsible and rational actors in Central and Eastern Europe. While  similar processes have attracted some sociological attention in the context of Anglo-Saxon world and Western Europe, little has been said about the post-communist countries.

Using a discourse analysis of parliamentary speeches, TV debates, and media articles the paper examines how health consumers and boundaries between private and public in health care provision were constructed and negotiated. The paper describes the contradictory rhetorics of both enhancing choices and steering choices in the proposed policy program and how the Czech public perceived those rhetorics. Health care is strongly considered by the Czech public to be a public good, which should be covered by the state. According to public opinion surveys, the public does not sympathize with market liberalism in the area of health care, even though it has accepted these principles on housing and employment.