In 1990 and 1991, even as wider reforms were taking place, the principle of free choice began to be introduced into the Czech health care system and the former regional and district health authorities were dismantled. New legislation in 1991 brought in a compulsory social insurance model, with several insurers financing health care providers on the basis of contracts.7 The Czech Republic had 8 different Ministers of Health between 1993 and 1989.
One hospice worker in the country wrote with the following comments: 'As for the Czech Republic, the hospice movement is still in process of developing and we have no legal background for our work (officially hospice or palliative care doesn't exist as an individual branch of medicine).'8
Whilst some politicians express an interest in palliative care, there is a sense that in the context of restructuring the whole health care system, palliative care is not a priority. However, public awareness of pain relief and end of life care issues is growing and 'patients have started to expect good symptom control for themselves and their relatives.'9
Health care expenditure (US$) per capita, Central and Eastern Europe
Source: WHO Regional Office for European Health for All database and HiTs
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