The Constitutional Court found No 474 / 2025 Coll.
Findings of the Constitutional Court sp. zn.
Valid
The Constitutional Tribunal found
Text versions:
19.11.2025
474
FIND
The Constitutional Court
of 15 October 2025
sp. zn. Pl. ÚS 7 / 25 on the proposal for the repeal of Annexes 1 and 10 to Decree No 314 / 2024 Coll., establishing the value of the point, the amount of the remuneration for the services paid and the regulatory restrictions for 2025
On behalf of the Republic
On 15 October 2025, the Constitutional Court decided under sp. z. z. pl. ÚS 7 / 25 in plenary composed of the President of the Court of Josef Baxy and judges and judges of Lucie Dolanská Bányai, Josef Fiala (Judge Rapporteur), Milan Hulmák, Veronica Christian, Zdeněk Kühn, Tomáš Langáš, Jiří Bíbán, Catherine Ronovské, Dita Řepková, Jan Svatona, Pavel Šámal, Jan Winter and Daniela Zeman, represented by JUDr. Martin Slobodník, Ph.D., LL.M., Lawyer, based U Rybníček 553, Prachatice, on the annulment of Annex 1 and Annex 10 to Decree No 314 / 2024 Coll., on the determination of the Points, on the amounts of Reimburges for the Rated Services, and the Law 2025;
as follows:
Motion denied.
Reasons
Subject matter
1. The Constitutional Court received a proposal from a group of 31 Senators of the Senate of Parliament (hereinafter referred to as "the applicant ') pursuant to Article 87 (1) (b) of the Constitution of the Czech Republic (hereinafter referred to as" the Constitution') and Article 64 (2) (b) of Act No 182 / 1993 Coll., on the Constitutional Court, on the abolition of Annex 1 and Annex 10 to Decree No 314 / 2024 Coll., on the setting of the value of the item, the amount of the compensation for the services covered and the regulatory restrictions for the year 2025 (hereinafter referred to as "the Decision '). In the petition, however, the appellant refers to this decree as" Decree No 314 / 2023 Coll., "from the title page of the proposal, the signed documents and arguments attached, it is clear that it is an obvious typist error and that the appellant undoubtedly challenges the decree valid and effective for 2025.
2. The subject matter of the adjustment of the contested Annex No 1 to the Reimbursement Order is the determination of the value of the item, the amount of the payment of the paid services and the regulatory limitation provided for in Section 5 of the same Order, affecting the services provided by the bed care provider (§ 5 (1)), including (§ 5 (2)) of the follow-up bed care, long-term bed care, social and medical care or special bed care, as well as the special outpatient care provided for under Section 22 (c) of Act No 48 / 1997 Coll., on public health insurance and amending and supplementing certain related laws, as amended (hereinafter referred to as "the Act on Public Health Insurance '). This Annex establishes, in determining (i) the amount of remuneration to be paid on a flat-rate basis (point 4.2, KCCE, (i), (ii) the amount of remuneration to be paid on a case-by-case basis (point 5.2, KCBFG, (i) and (iii) the amount of remuneration to be paid on paid services to foreign insurers, as well as, where the provider provides, in the reference period or the evaluation period of paid services within 50 and less cases of hospitalisation of insured persons by the relevant health insurance undertaking (point 6, KCBCEFG, (i), inter alia, for certain groups of diagnoses in the selected parts of Annex 10, the so-called care centralisation coefficient. In particular, the appellant considers that this coefficient is unconstitutional.
3. Annex No 10 of the reimbursement order, divided into "A" to "H" sections, defines in the tables the individual CZK-DRG groups (Diagnosis Related Groups) representing - in a simplified manner - the classification of individual clinically and economically similar hospitalisation cases, their relative weight and, for some groups, the value of the so-called centralisation coefficient and the specification of the type of high-level care centre (and intermedia care in perinatology) to which this centralisation coefficient relates. This Annex does not, contrary to Annex No 1, apply to the payment of services provided by post-bed care providers, long-term bed care, social-bed care, special bed care or special outpatient care provided under Section 22 (c) of the Public Health Insurance Act (Section 5 (2) of the Payment Order and Contrario).
Arguments of the appellant
4. The appellant contends that the remuneration decree or Annex No 1 thereto and Annex No 10 thereto are contrary to the right to own property pursuant to Article 11 (1) of the Charter of Fundamental Rights and Freedoms (hereinafter referred to as the "Charter '), the right to exercise freedom of business pursuant to Article 26 (1) of the Charter, the right to a fair remuneration for work under Article 28 of the Charter, the right to health protection and the right of citizens to free health care under Article 31 of the Charter and Articles 1, 2 (2), 4 (4) of the Charter and Articles 1 (1), 2 (3), 8, 10, 79 (3) and 101 (4) of the Constitution. The appellant also refers to Article 12 of the International Covenant on Economic, Social and Cultural Rights and Article 11 of the European Social Charter, with which the remuneration decree is to be contrary.
5. The point of the appellant's argument is that the remuneration decree, as a result of establishing the so-called centralisation coefficient, introduces discriminatory differences in remuneration for the same services. The centralisation factor for providers with the status of [note. Constitutional Court: sc. status - see Act No. 290 / 2025 Coll., amending Act No. 372 / 2011 Coll., on health services and the conditions for their provision (Law on Health Services), as amended, and some related laws] of the High Specialised Care Centres increases remuneration by 5%, while other providers who do not have this status reduces remuneration for the same diagnosis in some cases up to 50%. The differences in the level of remuneration are not justified by the quality of care or real costs, without support in the Public Health Insurance Act. For this reason, according to the appellant, the Constitutional Court should proceed to the annulment of the contested annexes to the order for reimbursement, since they do not respect the conditions for the issue of a statutory law. The Ministry of Health (hereinafter referred to as "the Ministry ') is" attempting to implement the creation of a network of health service providers', which clearly does not belong to it. If the State wishes to centralise the network of providers, it must do so through legal regulation. The use of the Order for this purpose is contrary to Article 79 (3) of the Constitution. Furthermore, any interest in centralising health care cannot be justified by the refusal of payment to those providers who provide the same paid services as centres of highly specialised care.
6. The Ministry discriminates against smaller and regional health service providers by introducing different remuneration for the same performance on the basis of the provider's status. In particular, the introduction of the so-called centralisation coefficient and cost modifiers disproportionately favours large centres, while smaller hospitals receive remuneration that does not correspond to the real cost of care. The centralisation coefficient is increased by an index of 1.05 for those providers who have the status of a high-level care centre, while for other providers it is humiliated by an index of 0.9 or 0.75 or even 0.5. The appellant contends that, as a result of the existence of a centralisation coefficient, there are in some cases differences in remuneration of up to 149%, which cannot be justified by objective reasons. In this context, it refers to specific cases of diagnosis treatment such as heart failure or hypertension. The Reimbursement Order does not provide - especially for smaller providers - compensation to cover their necessary costs, which affects the right to free enterprise under Article 26 (1) of the Charter. In this context, the appellant refers to the justification for the reimbursement order, according to which the Ministry expects only 95% of the total costs of acute bed care to be covered by public health insurance. Health service providers are thus forced to provide care below the level of real costs and thus without the possibility of achieving their return, let alone a reasonable profit. The appellant therefore considers the method of implementing the recovery order to be a "system defect 'which knowingly deepens the differences between health service providers.
7. Two categories of insured persons arise as a result of establishing the centralisation coefficient according to the appellant. The first to receive full-paid care, if they take it in a hospital with a centre of highly specialised care, and the second to receive the same care in an establishment where payment is deliberately reduced. While there is no obligation to supplement the insured person, the underfunding of hospitals not having the status of a high-level care centre will lead to a reduction in the availability of care and a breach of the equality of insured persons. The public health insurance system is intended to ensure that all insured persons have equal access to adequate care. However, the contested scheme leads to the failure to pay the full amount of the necessary costs to regional providers, which ultimately limits the availability of care and damages the insured persons who contact these providers. The applicant is of the opinion that the right of the insured person to health services corresponding to Article 31 The Charter is provided only if the State actually and effectively guarantees reimbursement to health service providers within the scope of the care paid or its costs. Intervention into the right to health protection and the right of citizens to free health care on the basis of public insurance under Article 31 of the Charter shall be manifested in particular in the regional unavailability of providers who, by economic law, cease to provide such inadequately paid care.
8. According to the appellant, the contested parts of the recovery order also have effects on the performance of the Authority. Regional hospitals are generally established by counties or municipalities which have an obligation to provide available healthcare on their territory. Where these hospitals are systematically disadvantaged, this affects the possibility of regions and municipalities fulfilling their constitutionally protected right to self-administration, guaranteed by Articles 8 and 101 (4) of the Constitution. Insufficient remuneration is also reflected in employees' rights. According to Article 28 of the Charter, they are entitled to a fair remuneration for work, but if providers do not receive compensation corresponding to costs, they cannot fulfil that right in reality. The lower wage level in regional hospitals leads to the departure of qualified medical personnel to privileged facilities, which further threatens the availability of care.
9. The appellant points out that the remuneration order was issued arbitrarily and without objective evidence. The Ministry has at its disposal data from reference hospitals that would allow a fairer set of payments, but these data were not used. On the contrary, the remuneration decree knowingly envisages only 95% of the costs of acute bed-keeping in 2025 (see paragraph 6 above). According to the appellant, the remuneration decree leads to the destabilisation of the entire public health insurance system. It favours faculty hospitals and larger hospital centres that cover approximately one third of acute bed care, while regional and smaller hospitals providing two thirds of this care are systematically underfunded. As a result, regional hospitals cannot ensure an adequate level of care, there is a risk of reducing their activities and staff outflows. According to the author, this condition threatens not only the provider itself, but above all the availability of health care for insured persons throughout the Czech Republic.
Proceedings before the Constitutional Court
10. The Constitutional Court assessed the procedural assumptions of the proceedings and found that the application had been lodged by the authorised appellant [Paragraph 64 (2) (b) of the Constitutional Court Act]. The Constitutional Court found no reason for inadmissibility of the application under Article 66 of the same law and notes that it is competent under Article 87 (1) (b) of the Constitution to discuss a proposal which fulfils all the formal requirements laid down by law.
Proceedings before the Constitutional Court
11. The Constitutional Court, pursuant to Article 69 of the Law on the Constitutional Court, has sent a proposal to the Ministry, which, as a public authority which has issued another law, has the status of party to the proceedings and to the Ombudsman, who is entitled to intervene.
Statement by the Ministry
12. The Ministry considers that the application for annulment of Annexes 1 and 10 to the Order of Payment is unfounded. In its extensive observations, it calls into question the appellant's argument, stressing that the centralisation coefficients respond to scientifically substantiated findings that centralisation of care leads to better treatment outcomes for highly specialised interventions, in some cases in addition to reducing the resources spent on such treatment. It refers to several scientific studies and recommendations (p. 5 to 6 observations). The purpose of the centralisation coefficient is to move care to the workplace with the status of a highly specialised care centre in order to achieve higher quality and, in some cases, the efficiency of spending resources. In addition, it contradicts the appellant's assertion that the centres of highly specialised care, on the one hand, and for other providers, on the other hand, would be the provision of care under the same conditions. In order to obtain a status, a provider of highly specialised care must fulfil a number of conditions which the provider does not have to fulfil without such a status, which can also be verified in individual calls for the status of the Centre published in the Ministry of Health Bulletin. In addition to the minimum number of defined interventions over a specified period of time (operations where payments of the centralisation coefficients are affected), these are above-standard requirements for staff and for staff, material and technical security, beyond the legal minimum requirements for the provision of health services. Moreover, in some cases, the conditions for the availability of follow-up care are set, which providers do not need to perform without the status of a centre of highly specialised care.
13. Given the multi-source financing of health care, the appellant's erroneous assumption is that all the costs charged are to be financed by the public health insurance system. It cannot be concluded from the justification for the recovery order referred to by the appellant that the hospitals will be loss of 5% for emergency bed care. According to the Ministry, the essential part of the justification for the recovery order is that the total annual financial situation of hospitals should not deteriorate. It contests the claim that the level of remuneration provided for by the remuneration order does not cover the costs of (mainly smaller) hospitals for care. Data on the economic results of regional hospitals reported by hospitals at the Institute of Health Information and Statistics (hereinafter referred to as the "SAA ') show that the proportion of small hospitals in loss is relatively low and gradually decreasing; According to Germany, the total amount of public service compensation for the IRIS-H was EUR [...] million. In order for smaller hospitals to have a more detailed picture of their actual costs, they can be more closely involved in the CRG reference network, since the cost rate is calculated precisely from the dates of this reference network involving only about half of the hospitalisation cases of acute bed care.
14. The Ministry also stressed that on the data from the reference network of providers it has analysed the cost of hospitals according to their size. The ratio of the costs of reference hospitals of type 1 (faculty, large regional and specialised hospitals) to the costs of reference hospitals of type 2 (other hospitals) per unit of relative weight shows that the cost of first-type hospitals per unit of relative weight is 23.3% higher. This results in convincing evidence that the size of hospitals increases the cost per unit of relative weight of care provided and justifies differences in individual basic rates. In doing so, the centralisation coefficients constitute an incentive element for the legislation envisaged, transparent and long-term communication of the centralisation of selected care for the purpose of the professional literature evidenced by improving its quality and results for insured persons. Individual base rates are then a way to take into account the different costs of different care facilities included in the same CZ- DRG groups (but not for the same care). If the Ministry were to select the most obvious possible case in terms of a combination of different CZK-DRG groups and hospital types, the difference in the average cost of "heart failure 'is between hospital type 1 and hospital type 2 to 413%. For" hypertension', the calculated difference in average cost would be up to 241%. The different level of individual base rates is therefore, in the most general sense, justified by the fact that, in the fields of care in which it can be retrofitted or reimbursed under it, care included in the same CZK-DRG group between different providers is not sufficiently cost-effective, clinically and qualitatively homogeneous, thus not the same care provided under the same conditions. In fact, the smallest (regional) hospitals are on average less specialised and provide on average less complicated care than larger hospitals or units of highly specialised hospitals, such as the Institute of Clinical and Experimental Medicine. Although, in theory, remuneration for all hospitals can be brought together and believe that small and medium-sized hospitals will provide care at the same level of specialisation as large and specialised hospitals, given the overall financial possibilities of the system, the Ministry is convinced that this would in fact only result in overpaying small hospitals, while specialised hospitals would have to limit the most specific care, as there would be no adequate amount of funding for it or would have to be financed by operating subsidies.
15. The appellant's argument as to the breach of the right of insured persons to free healthcare under Article 31 of the Charter is considered irrelevant by the Ministry. The insured person may use his or her right with the provider of his or her choice without regional restrictions, because for many years now the liability of the insured person to health care facilities has not been valid. Even if the insured person cannot use his right with one provider, such as the nearest regional hospital, he may use it with any of the other providers, including those with the status of a highly specialised care centre. The fact that this may mean an increase in the distance between the hospital and the residence of the insured person is not in itself sufficient to allow for the breach of the right of the insured person to receive free health care, all the more so if the chosen provider would be in the range of the range under Government Decree 307 / 2012 Coll., on the local and time availability of health services. Moreover, when granting the status of a high-level care centre, the Ministry always tries to take account of the geographical distribution of these providers. Nor can the appellant's argument that the contested annexes to the recovery order interfere with the right of the local authorities to self-administration. The Reimbursement Order provides for remuneration for care on the basis of rational considerations based on objective facts and does not directly interfere with the property sphere of the local authorities. The Act does not provide for any participation by the authorities of the local authorities in the process of issuing a recovery order beyond the possibility of its influence by political means.
Replication of the appellant
16. The Constitutional Court sent its observations to the appellant by the Ministry and a possible reply. The appellant made use of this possibility and stated in a reply that the Ministry's observations were based on internally contradictory and purposeful claims which did not refute the substance of its proposal. The argument that the scheme envisages covering the costs of healthcare providers from sources other than public health insurance, in particular subsidies, is, according to the appellant, directly contrary to Article 31 of the Charter. The Ministry further ignores the fact that the payment granted of around 95% of the costs relates only to a smaller part of the care covered by the case flat rate. For others, historically underfunded, care segments are even lower in real cost compensation. If the Ministry states that the costs of hospitals of type 1 are 23.3% higher than those of smaller hospitals of type 2, it admits that it "preserves and rewards" the historically created and manifestly lower effectiveness of large hospitals by means of a remuneration decree. Such a system denies the sense of free competition and is contrary to the right to freely engage in business under Article 26 (1) of the Charter. The Ministry does not deal with the actual and legitimate costs of care provided, but only mechanically verifies historical injustices. The sub-financing of regional hospitals is further directly reflected in their competitiveness in the labour market and affects the very essence of the right to health protection under Article 31 of the Charter.
Communication from the Ombudsman
17. The Ombudsman informed the Constitutional Court that he would not exercise his rights under Paragraph 69 (3) of the Constitutional Court Act and would not intervene in the proceedings.
Oral proceedings
18. The Constitutional Court concluded that further clarification of the case could not be expected from oral proceedings and therefore, in accordance with Article 44 of the Constitutional Court Act, it decided without its regulation.
Substantial assessment of the proposal
Assessment of whether the Order was issued under the law and within its limits
19. The Reimbursement Order is a statutory law issued by the Ministry, representing the so-called other legislation under Article 87 (1) (b) of the Constitution and Article 64 (2) of the Law on the Constitutional Court. For the review of other legislation, the Constitutional Court follows [not including generally binding orders from municipalities and regions - see the finding of 22.3.2005 sp. zn. Pl. ÚS 63 / 04 (N 61 / 36 CollNU 663; 210 / 2005 Coll.)] according to a three-stage algorithm. The Constitutional Court first examines whether a statutory law was issued by a public authority which had jurisdiction to do so and whether it did so in a constitutionally consistent manner, and, consequently, the Constitutional Court will assess whether the law was issued within the limits of the legal authority (i.e. whether the public authority did not act on ultra vires), until it finally assesses the substance of the legal regulation itself [see for example the findings of 25.3.2014 sp. zn. Pl. ÚS 43 / 13 (N 39 / 72 SbNU 439; 77 / 2014 Coll.) or of 8.11.2023 sp. In order for the contested decree to be complied with, it must not, in either of these steps, show deficiencies which are found by their nature contrary to the constitutional order or the law. This threshold cannot be clearly objectified by the determination of a specific measure, but on the contrary it must always be sought in the light of all the relevant circumstances relating to the contested regulation [cf. the finding of 11.8.2015 sp. zn. ÚS 1 / 15 (N 136 / 78 SbNU 127; 231 / 2015 Sb.)].
20. The Constitution in Article 79 (3) empowers ministries and other administrative authorities to legislate, but the implementation of which may only take place on the basis and within the limits of the law if they are empowered by law. That provision should be interpreted strictly in the sense that the authorisation must be specific, unambiguous and clear [cf. the findings of 21.6.2000 sp. zn. ÚS 3 / 2000 (N 93 / 18 CollU 287; 231 / 2000 Coll.) and sp. zn. ÚS 43 / 13]. The remuneration decree, which includes both the contested annexes, was issued on the basis of the legal authorisation contained in Section 17 (5) of the Public Health Insurance Act. It follows that the determination of the value of the item, the amount of the payment of the services paid, the amount of the advances for payment of the services paid and the regulatory restrictions is to be primarily the result of an agreement between representatives of the General Health Insurance Company of the Czech Republic, other health insurance companies and the relevant professional associations of providers as representatives of the contracting providers. In the case of an agreement between these entities and provided that this agreement is compatible with the law and public interest, the Ministry shall issue the agreed regulations in the form of a decree. If the conciliation agreement is not reached, or if the agreement is contrary to law or public policy, the Ministry shall determine the value of the item, the amount of the payments and the regulatory limitation itself by decree.
21. The Constitutional Court assesses Article 17 (5) of the Public Health Insurance Act as a sufficiently specific and clear legal authorisation for the setting of the regulatory provisions laid down in Annex 1 and Annex 10 of the Order of Payment, including the setting of the amount of the so-called centralisation coefficient, which is reflected in the formula for calculating the amount of individual payments (see below). It is further submitted from the justification of the order for reimbursement that the conciliation procedure for payments for 2025 took place in the period from 29.1.2024 to 20.6.2024, with its participants reaching an agreement in only 3 segments out of 14 segments [the meaning of the conciliation procedure for the use of the authorisation and commitment of the possible agreement compared to the finding of 9.2.2010 sp. zl. ÚS 6 / 07 (N 20 / 56 SbNU 207; 66 / 2010 Coll.)]. The appellant does not question the data on the course of the conciliation procedure and there is no indication that the conciliation procedure is not being held or carried out in breach of Article 17 (5) of the Public Health Insurance Act. Reimbursement decree was issued by the Ministry and published in the Collection of Laws and International Treaties under No. 314 / 2024 Coll.
22. If an assessment is made as to whether a remuneration order has been issued within the limits of legal authorisation, the relevant authorisation provision does not specify exactly what is meant by the value of the item, the amount of the fees paid and the regulatory limit. However, as stated by the Constitutional Court in its judgment of 22 October 2013 in sp. zn. However, by considering them to be explicitly mentioned, the legislature made it clear, first of all, that it had an idea of how to calculate these payments, which, although to be based on the so-called point system, is to depend on the number of points per health performance, but with the possibility of their overall limitation, which would also take into account other relevant factors, particularly in terms of the stability of the health system. In view of the last sentence of Section 17 (5) of the Public Health Insurance Act, it is clear that this authorisation includes the possibility of determining the method of payment... '(recital 41). The Constitutional Court takes the view that the Ministry did not act on ultra vires (cf. paragraph 19 above), even when establishing the so-called centralisation coefficient in the contested annexes, as the appellant contends. The centralisation coefficient has undoubtedly been set within the limits of the substantive scope (authorisation) under Section 17 (5) of the Public Health Insurance Act, which is only one of the many parameters from which the level of remuneration depends. The Reimbursement Order does not create a distinction between providers with the status of a highly specialised care centre [see Section 112 et seq. of Act No. 372 / 2011 Coll., on health services and the conditions for their provision (Health Services Act), as amended]. The anchoring of the centralisation coefficient, which - and in this way can be agreed with the appellant - confers a financial advantage on the provider with the status of the highly specialised care centre in calculating the amount of the remuneration (i.e. in the area to be regulated by the Decree under the above-mentioned authorisation provision), cannot be identified even with the legislation which the Constitutional Court considered in the decision of 13 December 2016, sp. zl. ÚS 19 / 16 (N 237 / 83 SbNU 677; 8 / 2017 Coll.). In it, it annulled part of the reimbursement order on the ground that it also regulated the payment of health services provided by residential social services facilities, but for which the Ministry did not enlarge the Public Health Insurance Act.
23. The Constitutional Court therefore concludes that the remuneration order, which includes both the contested annexes, has been adopted and declared in accordance with the law or the law and within its limits provided for in Article 17 (5) of the Public Health Insurance Act.
Assessment of infringement of the right to free enterprise pursuant to Article 26 (1) of the Charter and of the Accesorial Equality referred to in Article 3 (1) of the Charter
24. The Reimbursement Order is one of the instruments by which the State ensures that the right to free health care under Article 31 of the Charter in conjunction with Article 12 (1) of the International Covenant on Economic, Social and Cultural Rights is fulfilled. The remuneration decree issued on the basis of Article 17 (5) of the Public Health Insurance Act is at the same time the nature of price regulation (finding sp. zn. In so doing, the appellant contends that there is an unconstitutional breach of the right to conduct business freely under Article 26 (1) of the Charter. The Constitutional Court, when assessing the constitutionality of legislation with the right to do business, which is systematically classified by the Charter in the title of the fourth (economic, social and cultural rights), follows a rationality test [cf. the findings of 5.10.2006 sp. zn. In so doing, if the Constitutional Court concludes, at the second step of this test, that the contested regulation interferes with the essential content of the free enterprise right under Article 26 (1) of the Charter, it will assess the admissibility of such intervention under the "stricter 'proportionality test as a test of three steps to assess the legitimacy and necessity of the objective pursued in a democratic society, to assess the rationality of the link between the objective and the means chosen to enforce it and, finally, to assess whether there are no alternative ways of achieving the objective, the use of which would make the fundamental law less intense, or to exclude [see, for example, the finding of 13 May 2014 sp.
25. On the essential content of the law referred to in Article 26 (1) of the Charter of the Constitutional Court already in the decision of 8.12.2015 sp. zn. Pl. ÚS 5 / 15 (N 204 / 79 SbNU 313; 15 / 2016 Coll.), which rejected the application for annulment of the 2015 reimbursement order, he defined that the substance and purpose of the basic right to do business under Article 26 (1) The Charter is the freedom to pursue a certain gainful activity on its own account and the responsibility for making a profit.
26. The contested annexes to the recovery order clearly do not affect the cores of the free enterprise right under Article 26 (1) of the Charter. Although the appellant argued that intervention in the very substance of that right did not imply that such intervention could take place, the Constitutional Court has therefore not carried out the evidence proposed since the claims which it should have demonstrated could not refute the conclusions further adopted. In particular, the appellant disputes the centralisation coefficient, which it considers will increase the economic losses of smaller hospitals in particular. In this context, however, it should be stressed that the centralisation coefficient is only set for selected DRG groups in sections "E 'to" G' of Annex 10 to the Remuneration Order, for which providers with a high-level care centre status are financially favoured, who must meet higher personnel and technical requirements than providers without this status (see paragraph 30 below). For DRG groups defined in sections "A 'to" D' and in section "H ', the centralisation coefficient shall not apply at all. Since the overwhelming majority of DRG groups are no longer subject to the centralisation coefficient, the appellant's argument that the contested annexes to the reimbursement order would make it virtually impossible for hospitals to be entitled without the status of a centre of highly specialised business care. Indeed, the level of potential economic profit or loss cannot be clearly assessed from the perspective of several selected diagnoses - such as heart failure and hypertension, for which the appellant contends that the level of remuneration will not cover even the costs of smaller hospitals for treatment - but in the context of all the DRG groups and the overall economic indicators of the relevant providers. The applicant has not qualified to deny that according to the data of the ÚZIS to which the Ministry referred in its observations (see paragraph 13 above), approximately" only one tenth of regional hospitals are lost, with the percentage of regional hospitals in the loss being reduced annually. In the present case, the full reference can be made to the conclusions reached by the Constitutional Court in the sp. zn. In this finding, it pointed out that "the established method of calculating the amount of remuneration does not preclude certain health service providers (possibly even for more than one year) from managing losses, but this does not in itself affect the substance and meaning of the right to do business. In particular, each provider must strive to make its activity as effective as possible and not incur unnecessary costs. Even if it were shown that some providers, given the specific conditions at their place of business, under the current setting of the level of remuneration, could in fact not achieve profit, the level of that right would be the result of their own decision on the way and place of business and the associated business risk'.
27. If the appellant contends that, in the statement of reasons for the recovery order, the Ministry envisages that "only 95% of the costs of emergency bed care will be covered by public health insurance, which will necessarily lead to the economic loss of providers (paragraph 6 above), the Constitutional Court considers that the interpretation of the relevant part of the statement of reasons is inaccurate. It states that" the ratio of the central base rate to the cost base rate (used for normalising the relative weights of CZK-DRG, which is CZK 85 027 for 2025) for 2025 will be 95.3%, which is an increase compared to 91.9% in 2024. It follows that already 95% of the total costs of emergency bed care will be covered by public health insurance in 2025 and the overall financial situation of hospitals should not deteriorate year-on-year '. In other words, if the ratio indicator increases from 91.9% in 2024 to the assumed 95.3% in 2025, it cannot be said to increase the loss rate of bed care providers. As stated by the Constitutional Court in Case 19 / 13 ÚS Pl, the above-mentioned ratio cannot be considered to be unconstitutional, since "the concrete setting of the amount of compensation for health services paid by public health insurance depends primarily on the political decision to which Parliament is responsible in its legislative capacity and, to the extent and within the limits of the statutory authorisation granted by it, also the Ministry of Health... In order to conclude that such reductions were affected by the nature and purpose of the right to do business, it would not be sufficient to simply establish that the conditions for profit for individual providers have become more difficult or that the number of providers has even decreased. There would have to be a real situation where, on the one hand, the State formally allows a business in a given area, but on the other hand, it lays down conditions for it which effectively exclude its meaning." However, according to the Constitutional Court, this was not the case by adopting a recovery order for 2025.
28. In the next step, the Constitutional Court has assessed whether the contested annexes to the remuneration order (in particular the appellant's contested centralisation coefficient) pursue a legitimate objective, or whether the Ministry does not arbitrarily and discriminate against a selected group of providers, as the appellant contends. The Constitutional Court testified by the Ministry's statement that the anchoring of the centralisation coefficient responds to scientific knowledge and empirical data on better treatment results (mostly) in highly specialised procedures. The Constitutional Court considers the attempt to improve the quality of the care provided through financial motivation to "centralise" the treatment of certain selected diagnoses as a legitimate objective, which is simple elements of arbitrariness. In fact, the appellant disputes the centralisation of selected healthcare by arguing. This is already the case with the introduction of highly specialised care centres in Sections 112 and 113 of the Health Services Act. The assessment of the constitutionality of these legal provisions was already the subject of proceedings before the Constitutional Court, which, by decision of 26.4.2022 sp. zn. Pl. ÚS 49 / 18 (N 51 / 111 SbNU 260; 171 / 2022 Coll.), rejected the application for annulment. In this finding, the Constitutional Court identified as a legitimate need to centralise certain performances, pointing out that it also needs a certain amount of performance in order to maintain its appropriate and highly specific competence in order to ensure that the health team has sufficient expertise. In some cases, the fact that the highly specialised care centres are financially favoured over other providers in a certain way (through the centralisation coefficient) does not contradict the legitimate objective of improving the quality of care precisely through legally foreseen centralisation.
29. In assessing the alleged discrimination of a part of the providers, the Constitutional Court came out of its constant caselaw on the principle of equality and conditions of unequal treatment of different groups or categories of persons. In its view, the equality of categories is relative to the breach of which it is necessary to treat different entities in the same or comparable situation in a different way without having objective and reasonable reasons for such an approach [finding of 15.3.2016 sp. zn. At this point, the Constitutional Court only briefly states that, in order to distinguish between Accesoric and Non-Accesoric Equality, it had already expressed its views in detail in the judgment of 28 March 2006, sp. zn. Pl. ÚS 42 / 03 (N 72 / 40 SbNU 703; 280 / 2006 Coll.), in which it defined Accesoric Equality as an equality in relation to another fundamental law or freedom, whereas non-accesoric equality as a universal equality before the law. For this reason, the Constitutional Court has focused on whether the contested annexes to the recovery order interfere with the Accesorial Equality of Providers without the status of a highly specialised care centre. In order to conclude on the direct discrimination of a part of the health care provider objected to by the applicant, the Constitutional Court is generally based on a test formulated in particular in the findings of 28.1.2014 sp. zn. Pl. ÚS 49 / 10 (N 10 / 72 SbNU 111; 44 / 2014 Sb.) and of 10.7.2014 sp. zn. Pl. ÚS 31 / 13 (N 138 / 74 SbNU 141; 162 / 2014 Sb.), which can be expressed in the form of the following questions: (1) Is this comparable individual or group? (2) Are they treated differently on the basis of one of the prohibited grounds? (3) Is the different treatment of the complainant liable (by imposing a burden or by denying good)? (4) Is this different treatment justified, or (a) is it pursuing a legitimate interest and (b) is it appropriate? The positive answer to the first three questions and the current negative answer to the fourth question then leads the Constitutional Court to its conclusion on discrimination (sp. zn.
30. The wording of Annex 10 to the Order shows that the criterion on the basis of which the level of the centralisation coefficient is applied in a particular case is only whether this provider has the status of a high-level care centre granted to him by the Ministry. The Constitutional Court refers above to recital 28 to the (possible) benefits of centralising part of healthcare in the form of an increase in its quality.
31. In view of the above, it is thus apparent that the case under examination is not two comparable groups, but different groups: providers without the status of a highly specialised care centre and providers with this status (although it is true that this status is granted mainly to faculty, large and medium-sized hospitals). There are different requirements for each of these groups of providers, and since the centres of highly specialised care provide on average more specialised and demanding care than other providers, such care is also characterised by higher costs (on the other hand, the appellant argues that these higher costs are due to higher inefficiency, but this does not prove anything). Therefore, although the different setting of the centralisation coefficient in some cases results in different treatment between different providers, it is not comparable. Moreover, the distinction between groups of providers according to whether or not they have the status of a highly specialised care centre is manifestly non-discriminatory and cannot be placed under any of the "prohibited 'categories or under the so-called" other status' referred to in Article 3 (1) in the fine Charter. It can therefore be concluded that the chosen criterion is not in any way and the priori suspicious [cf. the finding of 28.6.2016 sp. zn. The different treatment, according to the Constitutional Court, is also justified by the reasons set out above (different requirements, different spectrum of care provided and resulting from higher average costs).
32. In the final step of the rationality test, the Constitutional Court considered that the means used to achieve a legitimate objective (centralisation coefficient) is reasonable, although it is certainly possible to imagine other (and possibly more appropriate) means to finance high-level care centres and improve the quality of care. However, the Constitutional Court is not the creator of a health policy and does not have the right to assess the different options of that policy from the point of view of their effectiveness (see paragraph 27 above and the finding of the CRL 19 / 13, recital 65). The illegality of the contested annexes to the recovery order is clearly not given in respect of the other elements of the calculation laid down therein. Moreover, the appellant disputes only the above-mentioned centralisation coefficient and the fact that the Ministry is based, inter alia, on "historical 'data on the costs of individual DRG groups when drawing up the remuneration order. The appellant did not limit the petit of its proposal to the selected parts of the contested annexes to the remuneration order (in particular those which lay down the centralisation coefficients), but seeks their abolition en bloc, even if its argument does not reveal what their inconstitutionality or illegality should be. The appellant does not question the vast majority of the parameters and regulators enshrined in the contested annexes to the remuneration order. This applies to Annex 1 also to the index of the increase in remuneration for individual groups, the institute of bonification or, for example, regulatory restrictions on prescribed medicinal products, medical devices and requested care. Finally, it should be stressed that the legislator has considerable discretion in the area of health policy. Doing business in health care is not a normal type of business, and the legislator has a very wide scope for regulating it. Article 26 (1) of the Charter should be interpreted in the light of Article 31 of the Charter in conjunction with Articles 2 (1) and 12 of the International Covenant on Economic, Social and Cultural Rights.
Assessment of interference with other fundamental rights and freedoms
33. The appellant further contends that the contested annexes to the recovery order infringe the right to health protection and the right of citizens to free healthcare under Article 31 of the Charter. As in sp. zn. It does not regulate their relationship with providers or health insurance companies. Therefore, the possibility that there would be a restriction on that right can only be accepted in a factual level, that is, if the remuneration order would restrict the right of individual providers to do so so, that they would not be able to fulfil their obligations in the provision of health services which, as a result, could become inaccessible to patients. In this case, however, it would not be possible to view the cause of this situation in isolation "(recital 72). At the same time, the Constitutional Court pointed out in the same finding (recital 73) that, in the absence of direct interference with the law under Article 31 of the Charter, the conduct of a reasonable test (rationality) carried out by the Constitutional Court above in relation to the alleged infringement of the right to freely engage in business pursuant to Article 26 (1) of the Charter is not considered.
34. The Constitutional Court has already dealt with the possible limitation of the regional availability of health care for selected performances in the sp. zn. Pl. ÚS 49 / 18, which assesses the constitutionality of Sections 112 and 113 of the Health Services Act. It stated that "ensuring such highly demanding health care at an appropriate level requires a certain degree of centralisation of health care facilities, and their regional uneven is therefore a logical consequence. The primary concern of the patient is certainly not that the centre should be as close to its residence as possible, but that it should be given the best possible professional care, for which there must be adequate conditions, such as instrumentation, as well as adequate medical experience with a particular type of specific procedure - cf. § 112 (1) of the Health Services Act '(recital 144). Nor can it be overlooked that" the exercise of the right under Article 31 of the Charter depends on the amount of funds spent on health care through public health insurance. This volume must also reflect the potential increase in costs incurred in the context of its provision, as otherwise it would, sooner or later, lead to a burden on patients' access to or even a threat to health care '(the finding of the CRL 19 / 13, recital 67). The above-mentioned Constitutional Court does not exclude the possible obligation for health insurance companies to provide available health care - for example by negotiating another method of financing in an individual contract - in a situation where, in certain areas of the Czech Republic, it will not be possible to achieve long-term profits in certain areas of the provision of health services (cf. KRATOCHVÍL, J. In KÜHN, Z., KRATOCHVÍL, J., KMEC, J., KOSAøR, D. and kol. Charter of Fundamental Rights and Freedoms. Big comment. Praha: Leges, 2022, p. 1128). The State's obligation to provide a model of health policy, which the appellant considers most appropriate (in particular without a centralisation coefficient), cannot be inferred from Article 12 of the International Covenant on Economic, Social and Cultural Rights, which the appellant refers to. The determination of health policy is a matter of the political decision of the state; it is crucial to ensure the best possible professional care in the necessary quality and within a reasonable time.
35. Nor has the Constitutional Court found that the contested annexes to the order for reimbursement directly affect other fundamental rights and freedoms. Although the appellant contests infringement of a number of them, including the right to own property pursuant to Article 11 (1) of the Charter, the right to local authorities pursuant to Article 8 The Constitution or even the right to a fair remuneration for the work referred to in Article 28 of the Charter, for most of which it itself admits that it can only indirectly intervene in those rights, as a result of (in its view non-constitutional) an infringement of the right to freely engage in business pursuant to Article 26 (1) of the Charter. The appellant's argument in this regard is found by the Constitutional Court to be unfounded and manifestly insufficiently constitutional. The finding of 9.7.2003 sp. zn. In the present case, unlike the one invoked by the appellant, there is no transfer of the State's assets (in particular the hospitals in debt) to the regions without their consent or any direct interference with the property or other rights of the local authorities. Moreover, there is nothing to prevent hospitals established by local authorities (or hospitals in which the local authorities have a holding) from seeking the status of a centre of highly specialised care, which will bear the centralisation coefficient of 1,05.
Conclusion
36. For the above reasons, the Constitutional Court did not find the grounds for the annulment of Annex 1 and Annex 10 to the Decree of Payment for 2025 and therefore rejected the application under Paragraph 70 (2) of the Constitutional Court Act.
President of the Constitutional Court:
JUDr.
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Regulation Information
| Citation | The Constitutional Court found No 474 / 2025 Coll., sp. zn. |
|---|---|
| Regulation Type | The Constitutional Tribunal found |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 19.11.2025 |
|---|---|
| Effective from | - |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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