This paper investigates the financial sustainability of predominantly public healthcare systems in Europe, using Czechia as a case study. It combines a systematic review of 39 empirical studies on the integration of private financing mechanisms (such as complementary insurance, co-payments, and prevention incentives) with original microsimulation analysis based on the EUROMOD model. The literature review reveals that private contributions can play a constructive role in strengthening system resilience if they are introduced within a politically feasible scope. Building on this evidence, the study simulates six policy scenarios for increasing individual financial participation in Czech healthcare. These include various hypothetical adjustments to indirect taxes and social insurance contributions, used as methodological proxies for different forms of increased private co-financing (not as suggestion of further expansion of public healthcare). Each scenario is assessed in terms of its budgetary impact and distributional effects across income groups and household types. The results reveal significant trade-offs between fiscal outcomes and political sustainability. Comparative insights from France, Germany, and Norway (each applying distinct models of public-private funding mix) help contextualize the findings. The paper concludes with policy recommendations supporting gradual diversification of funding sources, complemented by efficiency gains and prevention policies, to ensure long-term sustainability while maintaining broad access. Market-based principles adopted to these policies may increase their efficiency significantly.
Key findings:
- Europe’s public healthcare systems face growing fiscal pressure as population ageing increases healthcare spending while shrinking the base of contributors.
- A systematic review of 39 European studies finds that carefully designed private financing mechanisms can improve the resilience of public healthcare systems, but only when accompanied by strong regulation and safeguards for vulnerable groups.
- Private financing is not a substitute for universal healthcare. The evidence suggests it works best as a complement to publicly financed systems rather than a replacement.
- EUROMOD microsimulations for Czechia show that expanding private contributions can generate meaningful additional revenues, but aggressive cost-sharing disproportionately burdens elderly and low-income households.
- Protecting essential medicines while broadening the financing base through a mix of targeted co-financing and modest insurance contributions produces the most balanced fiscal and distributional outcomes among the simulated reform options.
- No financing reform alone can solve the sustainability challenge. Long-term fiscal stability also requires greater emphasis on prevention, digitalisation, administrative efficiency, and organisational reform.
- Experiences from France, Germany, and Norway demonstrate that different mixes of public and private financing can preserve universal access when supported by appropriate institutional design and regulation.
