Ombudsperson Calls for Continued State Support When Patients Require Alternative Medical Treatment

Ombudsperson Karina Palkova has called on the Cabinet of Ministers to revise the regulations governing the individual reimbursement of state-funded medicines, ensuring that patients with severe and progressive illnesses do not lose access to public support when their treatment needs change.

According to the Ombudsperson, patients should continue to receive reimbursement when their existing therapy becomes ineffective and medical specialists determine that alternative medication is necessary.

Under the current regulatory framework, individual circumstances and medical needs cannot always be adequately assessed. As a result, some patients may be denied reimbursement for medicines that represent their only remaining treatment option.

The Ombudsperson stresses that such situations raise concerns regarding the right to health and equal access to healthcare, as patients should not be placed at a disadvantage simply because their condition requires a different course of treatment.

“A patient’s right to healthcare should not depend solely on the stage of their illness. If the state has established an individual reimbursement mechanism for exceptional cases, it must be accessible to all patients on the basis of equal and objective criteria, including when a disease progresses and treating physicians determine that a different therapy is medically necessary,” emphasizes Ombudsperson Karina Palkova.

The Ombudsperson acknowledges that healthcare resources are finite and that governments must make difficult decisions regarding their allocation. However, any regulatory framework governing access to publicly funded healthcare must be fair, consistent, and based on objective criteria. Patients in comparable situations should not be treated differently without a reasonable and evidence-based justification. The Ombudsperson also notes that the existing individual reimbursement system already contains safeguards that enable authorities to assess medical necessity, treatment effectiveness, and potential implications for public expenditures.

Particular concern arises from the fact that patients for whom medicines included in the standard reimbursement scheme are unsuitable from the outset may be eligible for an individual assessment, while patients whose condition progresses and requires a change in treatment during the course of their illness can lose access to that possibility. According to the Ombudsperson, such differential treatment raises questions about compliance with the principles of equality and non-discrimination and therefore requires a clear, objective, and proportionate justification.

The Ombudsperson also highlights the importance of maintaining a clear division of responsibilities between healthcare professionals and public authorities. Decisions regarding the most appropriate medical treatment should be based on the professional judgment of healthcare specialists, while state institutions should determine the conditions under which public funding is provided.

The Ombudsperson calls on the Cabinet of Ministers to amend the current regulatory framework to ensure equal treatment of patients regardless of how their illness progresses or at what stage of treatment they are. The revised framework should establish a clear procedure for the individual assessment of exceptionally justified cases, along with transparent and understandable criteria for decision-making.

The Cabinet of Ministers has been requested to inform the Ombudsperson by 1 December 2026 of the measures it intends to take. The Ombudsperson has not ruled out the possibility of bringing the matter before the Constitutional Court should the identified shortcomings remain unaddressed.

Human dignity, equality, and the right to accessible healthcare are fundamental values of a democratic and socially responsible state. Every patient should therefore have the opportunity to receive an individual and fair assessment of their situation, particularly when decisions may affect the preservation of life, the stabilization of health conditions, or the improvement of quality of life.