Limity v přístupu ke zdravotní péči a zdravotnímu pojištění pro migranty a uprchlíky v USA a České republice

Both in the US and the Czech Republic, there was a group of people who were uninsured or underinsured due to insufficient residency status, high insurance rates, business practices and exemptions, and insufficient legislative tools to address this situation and offer affordable insurance to the widest possible population. The aim of the article was to specify these causes in the Czech Republic and the US, compare health insurance systems and forms in the Czech Republic and the US, define people at risk due to its absence or limitation, and describe the changes that have been made to provide affordable insurance and healthcare to the widest possible population. In the US, this problem is long-standing and more widespread, as it also affected citizens and permanent residents who could not afford standard commercial insurance due to low income or serious diagnosis. In the Czech Republic, permanent residents and employees of employers based in the Czech Republic are entitled to public health insurance, so the problem mainly affected foreigners outside these groups. In the Czech Republic, this problem has increased with the arrival of war refugees from Ukraine. In order to define vulnerable persons and determine their access to healthcare, a questionnaire survey was conducted in the US, which examined the residence status of persons, access to health insurance, diagnoses, and average healthcare expenditures. Furthermore, changes in the Czech Republic were monitored, carried out with the aim of including previously excluded groups of the population in public health insurance. In both countries, legislative changes led to a reduction in the number of uninsured and underinsured persons, but the problem persisted, especially in the US. In addition to people who remained uninsured because they did not meet the conditions for obtaining insurance, there may also have been people who were insufficiently aware of their health insurance entitlements. They would have welcomed advice, but if they did not find it, their insurance problems could have persisted. In both countries, insurance debt was a problem for vulnerable individuals, but in the US, it is more devastating, given the high level of patient co-payments.