LTC System in Czech Republic

The long-term care (LTC) system in the Czech Republic has evolved from its historical roots, undergoing significant transformation after the political changes of 1989. The system had to adapt to a new social and economic order, but the development of LTC has been fragmented, with responsibilities strictly divided between the health care sector and the social care sector. In addition to this horizontal split, there is also vertical fragmentation: competencies are shared among the state, regions, and municipalities. This division has affected not only funding but also service provision, often resulting in disparities in access and costs.

One of the main challenges stems from differences in the financing of care: while most social care costs are paid by clients, care provided in health facilities is covered by public health insurance. This discrepancy frequently leads to the hospitalisation of individuals whose needs are primarily social, not medical. Although long-term care reform has been discussed for over 15 years, no comprehensive integration of health and social care has yet been implemented.

The social services market in the Czech Republic is diverse, comprising public, religious, private, and non-profit organisations, as well as individual providers. In the public sector, services are delivered at the state, regional, and municipal levels. According to Act No. 108/2006 on Social Services, each region is responsible for ensuring the availability of social services within its territory, based on a Medium-term Plan for the Development of Social Services. Regions determine the network of services in cooperation with municipalities, which provide information on capacity needs and help create conditions to meet local demand.

In 2023, the Czech social services sector included 5,656 registered social services, with 522 nursing home providers and 657 providers of home care services. Residential social services offered a total of 96,239 beds, yet unmet demand remained high, affecting 132,799 individuals. There were 367,911 recipients of the Care Allowance, and total expenditure on social services reached approximately EUR 2.8 billion. Overall, every 11th Czech citizen is a client of social services.

The health care system, in which part of long-term care is embedded, is based on compulsory health insurance, with all residents contributing a portion of their income. The state covers insurance for certain groups, such as students, older adults, and the unemployed. Funding primarily comes from social health insurance, and citizens can choose from several health insurance companies. Health care is generally free at the point of service, with only minor co-payments in some cases. Known for its high quality and accessibility, the system offers a broad range of services, including preventive care, through a dense network of hospitals, clinics, and general practitioners.