Socioeconomic barriers to healthcare cost-sharing in the Czech Republic: limited awareness and resistance.

Abstract

BACKGROUND: The Czech Republic provides near-universal healthcare through compulsory public health insurance yet rising costs have intensified debate on patient cost-sharing. This study examined (i) citizens’ experiences with out-of-pocket (OOP) payments, (ii) awareness of health insurance expenditures, and (iii) willingness to contribute financially beyond mandatory coverage. METHODS: A nationwide face-to-face survey was conducted in November–December 2024 in a quota-based sample of 1,809 individuals aged ≥ 15 years, with quotas set for age, gender, and region. A nationwide face-to-face survey was conducted in November–December 2024 on a representative sample of 1,809 individuals aged ≥ 15 years. A structured questionnaire assessed OOP payments, cost awareness, and attitudes toward additional financial contributions for consumed healthcare. Descriptive statistics, Chi-square tests, and logistic regression were used to evaluate associations with socioeconomic characteristics. RESULTS: Over 60% of respondents reported paying for non-reimbursed medications or supplements, and 43.7% for dental services; payments for above-standard services were uncommon. Cost awareness was low: 64.3% did not monitor their insurance expenditures. Only 24.3% were willing to contribute financially beyond mandatory payments, while almost half believed healthcare should be fully covered by public insurance. Willingness to contribute was significantly higher among younger respondents and those with higher education and income. CONCLUSIONS: Czech citizens demonstrate limited awareness of healthcare costs and low readiness for broader cost-sharing, shaped by socioeconomic factors. These findings suggest that any reform should balance solidarity and sustainability and be accompanied by transparent communication on healthcare financing and targeted efforts to improve health and financial literacy, supporting informed public debate and gradual acceptance of necessary changes.