If we are aware of these problems, why haven’t we solved them yet?

Healthcare is a highly complex system, and meaningful change takes time. However, we have long operated in an environment of uncertainty—take, for example, the lack of accessible data on care quality. While some information is likely gathered at the level of individual healthcare facilities, there is no systematic national analysis of care quality across different regions. Many people perceive healthcare as functioning well simply because hospitals are readily available. But the COVID-19 pandemic exposed critical weaknesses, particularly in crisis response. Suddenly, we faced fragmented and incomplete data—some of it revealing uncomfortable truths. International comparisons placed us among the worst-performing systems during the pandemic. We realized that while data was being collected, it was often used selectively or interpreted in ways that served particular interests. As our population continues to age, these shortcomings will only become more apparent.

Would we have realized these issues without COVID-19?

COVID-19 was a stress test for the healthcare system, revealing its fragility much earlier than expected. The challenges we saw would have surfaced eventually—just later. In 20 years, the number of older adults in Czechia will increase by one million. When today’s 50-year-olds, known as Husák’s children, begin retiring, we will face a profound demographic shift. The silver lining is that awareness has grown, discussions on solutions have begun, and institutions like the Czech Institute of Health Information and Statistics are now actively working to improve access to healthcare data to support necessary reforms.

Is that why you're developing a new study programme (AHE)? Because data is difficult to interpret?

Exactly. Healthcare data analysis requires more than just counting hospital beds. Understanding clinical principles is essential. For example, caring for an Alzheimer’s patient demands a completely different approach than treating someone with appendicitis. These differences have implications for staffing, funding, and resource allocation. Another critical gap is in modern public health, which remains largely underdeveloped in Czechia. Our program aims to fill these knowledge gaps.

What are the most urgent issues in healthcare today?

There are several. First, by international standards, we have enough doctors and nurses. Yet, they are overworked due to excessive bureaucracy, inefficient workflows, and the lack of digitalization. Many processes remain unnecessarily complex and time-consuming. As the population ages, these pressures will only grow.

Second, the structure of the hospital network is inefficient. Acute care accounts for nearly half of total healthcare costs, yet we have thousands of excess hospital beds. This results in many hospitals maintaining round-the-clock operations, straining healthcare workers and creating inconsistencies in care quality. Modern healthcare requires centralized specialist units and better access to preventive care—not an overabundance of underutilized facilities.

Third, data management and digitalization remain critical challenges. In Czechia, patients often have to repeat their medical history each time they see a new doctor, leading to inefficiencies and delays in diagnosis. A more integrated system would significantly improve care.

What does the future hold?

Ageing is a success story—it means people are living longer, healthier lives. However, as we age, healthcare needs change. The typical patient of the future will be over 65 years old, living with multiple chronic conditions, and relying more on family and social support systems. This shift will require smarter workforce and financial planning. We must carefully balance funding strategies, as massive increases in health and social insurance may not be sustainable. At the same time, while foreign healthcare professionals may help address labor shortages, full reliance on external staffing is unlikely. The key will be efficiency—delivering more effective care with fewer unnecessary doctor visits, without compromising quality.

What do we need to achieve these changes?

Healthcare is full of talented professionals, but we lack interdisciplinary expertise that connects clinical care, economics, and bioethics. Health economists who understand clinical workflows, manage data effectively, and extract meaningful insights are particularly in short supply. For example, data on care quality might reveal that certain hospitals deliver different outcomes—not necessarily due to poor care, but because they serve more complex patient populations. Understanding these nuances is essential for making evidence-based decisions that improve healthcare outcomes.

Your new programme Applied Health Economics integrates all of these aspects. What will it cover?

We expect students from varied backgrounds, so the first year will focus on building a strong foundational skill set. Everyone will gain expertise in data analysis, epidemiology, economic evaluation, legal frameworks, regulatory issues, and even social science and bioethics.

In the second year, students will informally specialize in one of three areas:

• Health Policy and Systems Management – ideal for those interested in running organizations and shaping healthcare reforms.
• Health Technology and Cost-Effectiveness Analysis – focused on evaluating new drugs and medical technologies.
• Health Data Analytics – for those who want to work with big data, uncovering insights to drive system improvements.

We will explore resource allocation at national and regional levels—training professionals for roles in government ministries, hospital management, health insurance companies, and regional authorities in our and other countries. Some specific topics will include designing preventive programs, structuring physician reimbursements, and pricing innovative medicines and technologies.

Are there healthcare challenges unique to Czechia?

While healthcare struggles are universal, Czechia often resists adopting proven international solutions. A clear example is hospital network optimization—many countries have already centralized specialized care and shifted hospital beds from acute to long-term and rehabilitative care. However, in Czechia, these discussions remain politically sensitive. Data shows that smaller hospitals often perform worse in quality comparisons, yet reforms in hospital organization remain off the table. Addressing these inefficiencies is essential before the system reaches a breaking point.

What lessons can we learn from other countries?

One of the biggest lessons is avoiding costly mistakes. Germany, for example, experimented with hospital privatization, only to realize that it was unsustainable—many facilities are now being brought back under public management due to accessibility and quality concerns. Meanwhile, Denmark successfully implemented digital health records 20 years ago, yet in Czechia, some doctors and associations still oppose digitalization. The delay is not just inefficient—it’s preventable.

What about the U.S.? You’ve worked in the American system for years—what could we learn from them?

The U.S. healthcare system achieves comparable results at much higher costs, so it’s not an ideal model to emulate. However, what I would adopt is the American mindset—a proactive, solutions-oriented approach. In Czechia, cynicism and passivity often stand in the way of change. The focus should not be on how much healthcare costs or how many doctors we have, but rather how to keep people as healthy as possible, ensure access to preventive care, and deliver swift, effective treatment when needed. Ultimately, our goal should be to create a healthcare system that gives people confidence—not one that makes them feel they would have been better off being born elsewhere.