Category making in discourses of health policy reforms: the case study of the Czech Republic

Justification in public discourse is an inevitable part of the process when states attempt to regulate accelerating markets. In this process, policymakers define problems to be solved and attribute values to good policy. Those qualities are constantly negotiated, and to analyse them is essential for understanding the processes and ways different actors take control of political debates. This article examines a public discussion on health reform in the Czech Republic between 2006 and 2008. At that time, the government tried to promote a comprehensive reform for cost containment. The reform corresponded with a shift from a social democratic state paradigm to a neoliberal paradigm in health-care provision which can be observed also in other post-communist countries. In this case, controlling health-care costs gained a top priority in a discourse driven by the combination of factors including scarcity, the ageing of the population and patient responsibility. The authors of the reform used a “funnel strategy” where an original broader set of issues was narrowed to predominantly the economic aspects of reform. The wasting of money in health care was associated primarily with personal patient responsibility. While the distribution of care provided by hospital professionals was considered reasonable, the way in which patients consumed health care was questioned. This categorization replicated dominant media representations of professional medicine as a way to treat sickness competently and successfully by doctors in hospitals using the latest technology and fast-acting drugs.