The End of Tenders for Outpatient Healthcare Providers
From 1 October 2026, the obligation to hold a tender before concluding a contract with an outpatient healthcare provider will be abolished. This is changed by an amendment to Act No. 48/1997 Coll., as implemented by Act No. 289/2025 Coll. Access to the health insurance companies' network will now depend on direct negotiation. In this article, the lawyers at the Prague-based ARROWS law firm explain the impacts and next steps.
Key takeaways
What is changing and from when
Until 30 September 2026, a tender procedure – a public competition – is generally always held before a contract for the provision and reimbursement of covered services is concluded. This is announced by the regional authority (in Prague, the Prague City Hall) under Sections 46 and 47 of Act No. 48/1997 Sb., on Public Health Insurance. The tender procedure can be proposed by a health insurance company, a bidder, or the region, and the announcement must include the scope of covered services, the defined territory, the deadline for submitting bids (at least 30 days), and the deadline from which the provider must ensure the service.
Amendment No. 289/2025 Sb. amends Section 46(2) with effect from 1 October 2026, so that a tender procedure will only be held before a contract is concluded for one-day or inpatient care. For outpatient providers and providers of care in the patient's home environment, the requirement for a public competition for a place in the network is abolished completely. The announcer is also changing: the remaining tender procedures will now be announced centrally by the Ministry of Health, not by individual regional authorities.
The transition between the two regimes is accompanied by specific deadlines. Regional authorities only processed proposals for tender announcements received by 30 June 2026, specifying the deadline from which the provision of covered health services must be ensured from 1 October 2026 – after that, the regional authority will no longer announce new tender procedures for outpatient and home care. This is why many regions (for example, the Central Bohemian Region) actively informed bidders during 2026 not to miss the last opportunity to use the old procedure.
Legislative background and opposition from professional chambers
The Ministry of Health had already pushed for the abolition of tender procedures for outpatient and home care during the inter-ministerial consultation process for the entire amendment. The Czech Medical Chamber and the Czech Dental Chamber disagreed with the move and proposed to keep the existing system, arguing that the proposed change does not solve the real problems of care accessibility. The Ministry did not back down from its intention, but in exchange, it added a transparency requirement to the law: health insurance companies must publish an annual report on their network of contracted providers by the end of November each year.
What this means for outpatient providers in practice
Until now, a new or existing outpatient provider could rely with a greater degree of probability on obtaining a place in the health insurance company's network of contracted providers through a formalised public competition with fixed rules, deadlines, and the opportunity to apply. After 1 October 2026, this certainty disappears – the conclusion of a contract for the provision and reimbursement of covered services will depend exclusively on direct business negotiations between the provider and the specific health insurance company.
In practice, this strengthens the bargaining position of insurance companies and places higher demands on providers: without the support of a tender procedure, the wording of the contract (scope of covered services, duration, grounds for termination and notice periods, volumes of care) will be more important, as will whether the provider holds a valid authorisation to provide health services in the required field, form, and place. Smaller or newly entering providers, who have so far relied on the level playing field of public competition, will have to rely more on a well-prepared offer and contract negotiations.
Potential problems | How ARROWS can help (consultation@arws.cz) |
|---|---|
Uncertainty as to whether the exemption applies to a specific type of care provided (outpatient, home care, one-day care) | We will assess the classification of a specific service under the new version of Section 46 of Act No. 48/1997 Sb. and recommend the next steps. |
Weaker negotiating position with the health insurance company without the support of a public tender procedure | We will prepare and negotiate contractual terms with the health insurance company to protect the provider's interests. |
Refusal to conclude a contract without clear justification from the insurance company | We will review the insurance company's procedure in the context of the published report on the network of contracted providers and assess defence options. |
Discrepancy between the valid authorisation to provide health services and the scope required by the insurance company | We will check the compliance of the authorisation under the Health Services Act with the offered scope of covered services. |
Unclear impact of the transitional provisions on a proposal for a tender announcement that has already been submitted | We will verify how the transitional provisions affect a specific submitted proposal and set out the next steps. |
Final summary
From 1 October 2026, a tender procedure will no longer be a condition for outpatient and home care providers to enter the health insurance companies' network – it will only remain for one-day and inpatient care and will be newly announced centrally by the Ministry of Health. For providers, this means that the contract with the insurance company will be decided primarily by the quality of negotiations and contractual preparation, not by a formalised public competition. Anyone who does not want to risk losing their place in the network due to an incorrectly set contract, insufficient authorisation, or an overlooked transitional provision should discuss the situation with experts. The lawyers at ARROWS law firm have long-term experience in medical law and are insured for professional liability up to CZK 400,000,000. Contact us at consultation@arws.cz.