(1) Background: Diagnosis-Related Groups (DRG), one possibility of a hospital payment system, are currently used in most European countries. Introduced to the Czech system in the 1990s, the DRGs are currently used mainly for care reporting and partly for reimbursement. According to most experts, the use of DRG remain controversial. The goal of this paper was to study the effects of the current Czech DRG system on hospitals financing and, on this basis, to propose possible changes to the reimbursement mechanism in the Czech Republic. (2) Methods: Qualitative research methods were used for evaluating DRG mechanisms of application in three selected healthcare establishments in the CR in the period of 2012–2018. (3) Results: Our study shows that the current implementation of the DRG system is set up in a way that is very similar to traditional flat rates and is unlikely to yield major positive effects of the DRG mechanism, such as predictability of payments for hospitalisation cases, care quality and efficiency and transparent financing. (4) Conclusions: Based on our results, deep systemic change of the reimbursement mechanism in the Czech Republic is necessary. We propose five partial measures leading to the cultivation of the Czech DRG.

Understanding the communication dynamics between vaccine-hesitant parents and healthcare professionals (HCPs) is vital for addressing parent concerns and promoting informed decision-making. This paper focuses on strategies used by HCPs to communicate with vaccine-hesitant parents. It draws on empirical evidence generated as part of the international project VAX-TRUST. More specifically, 60 hours of observations were carried out in three different pediatric practices during vaccination-related visits, and 19 physicians and nurses were interviewed. We focused on the specific context of the Czech Republic, which represents a country with a mandatory vaccination system and in which children's immunization is the responsibility of pediatric general practitioners. We demonstrate that the dynamics between parents and HCPs and their willingness to invest time in the vaccination discussion are influenced by how HCPs categorize and label parents. Furthermore, we outline some of the different strategies HCPs employ while addressing concerns regarding vaccination. We identified two different strategies HCPs use to manage the fears of vaccine-hesitant parents. The first strategy focused on the communication of risks associated with vaccination (and lack thereof). HCPs used a variety of discursive practices to familiarize the unfamiliar risks of vaccine-preventable diseases (by mobilizing representations that are part of collective memory, incorporating personal experiences to materialize the presence of risk and the confidence in the safety of vaccines and by situating risk as embedded in everyday processes and integral to the uncertainty of the global world). The second strategy involved the conscious employment of medical procedures that may contribute to reducing vaccination fears.

Health systems in most (if not all) countries perpetually struggle with financial problems and search for resources to cover health care needs. Increased efficiency of health procurement has the potential to save a lot of money and to reallocate them to treatments. The aim of our study is to analyze technical efficiency (efficiency/economy dimension) and allocation efficiency (effectiveness) of public procurement in health care facilities in the Czech Republic and Slovakia, countries whose health systems are governed by the principle of universal access to high quality health services. Concerning the technical efficiency, the results show a low rate of competitiveness whereby the potential of competition is not exploited. In terms of allocation efficiency, our research also sufficiently illustrates the criticality of the situation; however, compared to the element of technical efficiency the situation in the evaluated countries is different. In Slovakia, purchases are usually decided by doctors and procurement is prepared without the necessary ex-ante analysis. In the Czech Republic, the ex-ante evaluation of purchasing of medical equipment is regulated, however, the decision-making process is non-transparent and does not guarantee allocative efficiency. The study has critical policy implications – both countries should urgently adopt measures to improve their respective procurement processes.

Many countries aim to strengthen patient and public involvement (PPI) in healthcare decision-making. This article discusses the institutionalisation of PPI in the Czech Republic from 2014 to the present based on a review of available documents as well as interviews with policymakers and representatives of patients' organisations. Important steps that contributed to the institutionalisation of PPI were the establishment of the Ministry of Health's (MoH) Patients' Council and the MoH's Patients' Rights Support Department. The institutionalisation of PPI was facilitated through the bottom-up engagement of patients, top-down policy developments, transnational pressures, the support of statutory insurance funds and the pharmaceutical industry, and macro-societal developments. Compared to other post-socialist countries, the institutionalisation of patient involvement in policymaking is amongst the most developed. Although the pharmaceutical industry enhanced PPI, its involvement raised ethical concerns. Various stakeholders called for public funding of patients' organisations to provide them with a stable income and more independence. In summary, the role of patients has been strengthened through macro-institutional involvement. Further progress will demonstrate whether these changes at the macro level of policymaking will stimulate more profound transformations at the meso and micro levels and, therefore, contribute to more profound cultural changes in doctor-patient relationships.

Health and care workforces across Europe face overlapping crises that test their resilience and governance capacities. In the Czech Republic, the COVID-19 pandemic was swiftly followed by a major influx of Ukrainian refugees, creating new pressures on both frontline healthcare workers and intercultural care workers. To explore, from the perspectives of frontline healthcare workers and intercultural care workers, how governance capacities and gaps shaped workforce functioning, adaptation, and resilience during the refugee response in the CR, and what lessons this experience offers for strengthening workforce governance in times of multiple crises. Thirty semi-structured interviews with frontline healthcare workers and three focus groups with 20 intercultural care workers (September 2022-June 2023) were analysed thematically within a multi-level governance framework. Fragmented coordination, lack of intercultural training, and limited psychosocial and managerial support undermined resilience. Intercultural care workers played critical but unrecognised roles bridging linguistic and cultural gaps, while refugee health workers remained underused due to rigid qualification rules and limited pathways for integration. Despite strong moral commitment and informal collaboration, reliance on individual initiative rather than structured governance weakened equity and preparedness. Preparedness depends on governance that sustains the human and cultural dimensions of care. Strengthening coordination across levels, formally recognising intercultural roles within health organisations, and enabling refugee health worker integration through flexible qualification procedures are timely and achievable governance priorities for building resilient and inclusive health workforces across Europe.

The COVID-19 crisis has shed new light on a category of experts already well known in the Czech Republic, but long neglected and underfunded: epidemiologists. Faced with challenges that no one could have predicted, one name among epidemiologists stands out above all others: that of Professor Roman Prymula. At the outbreak of the pandemic, he was already part of the ministerial structure, in an important position (deputy minister), a position that had absolutely no link with his expertise as an epidemiologist. The pandemic and the uncertainty of the overwhelmed Czech authorities gave him new and an increasingly important role. When the first peak was over, Prymula left to let other epidemiologists take over. In reality, however, he never really disappeared, and his place - especially in the media - remained strong. Moreover, the prime minister offered him a new position - created ad hoc for him. Finally, during the second COVID wave, he was appointed Minister of Health. Thanks to a series of gradually opening windows of opportunity, Roman Prymula made his breakthrough. His meteoric rise, especially in the media, can certainly be attributed to his expertise and previous positions (soldier, director of a state hospital, links with the pharmaceutical industry), but also to his style (strict, even combative) and high ambition. The transformation of public health from a neglected sector to one of the most important and closely monitored in the health system is also not to be overlooked. Although Prymula was not the only epidemiologist in the Czech Republic, he was perceived as a leading, if not the only, expert. Another problem, less personal but no less important, is that in the Czech Republic we have seen the emergence of protests against the strict containment measures in the event of a pandemic. These protests are coming from other experts, particularly doctors and economists. This raises a new question(s): who can really be called an expert and on what basis, and who is an expert in what? More generally, the aim of the chapter is not only to highlight the meteoric rise of one expert, but also to explain the context, both political and medical-epidemiological, that made this rise possible.