Assessment of health sector activities in the Czech Republic

The Czech Republic has achieved all the health reform goals it established after the fall of communism in 1991. Specifically, it has: conceived, forged political consensus on, and then passed progressive health legislation; dismantled old bureaucratic structures; rapidly and successfully implemented a sophisticated national health insurance system covering the entire population; privatized virtually all ambulatory care; and provided consumers with free choice in selecting among caregivers even as the quality of care has improved. USAID-supported training, teaching, and consultation activities in support of transformation of the Czech health care sector have been wide-ranging and remarkably inexpensive. Over the 6-year course of its assistance to the Czech Republic, USAID"s total direct health care sector investment has amounted to $7.5 million. Activities supported by USAID have been in the areas of hospital management and quality assurance assistance, health sector privatization, clinical and preventive care, and health insurance. With important but relatively minor exceptions, these activities have had positive and substantial impact and have largely accomplished the purposes for which they were undertaken. Many activities -- including some whose direct impact in the health care sector to date has been limited -- have had significant "spillover" effects elsewhere, sometimes even beyond the health arena. Overall, USAID"s assistance has been -- and is perceived to have been -- highly responsive to Czech needs and a major source of assistance in the Czech successes. USAID assistance was based on Czech requests, although the Agency did not hesitate to warn or counsel Czech decision makers of potential difficulties. While USAID"s investments in absolute terms have been a pittance, the return on that investment has already been enormous. The assessment team also observed a level of appreciation among the Czechs for USAID"s material and intellectual assistance that seemed disproportionate to USAID"s dollar investment. USAID"s activities, which were never patronizing, facilitated the forging of personal and professional connections between partners. Those connections will last and expand long after USAID"s formal departure. (Author abstract, modified)